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The Social Process Of Dying In The Hospital: A Grounded Theory Study, Alyson Prokop

Doctoral Dissertations

The majority of deaths in the United States occur in the hospital (Xu, Kochanek, Murphy, & Tejada-Vera, 2010). Because there is little understanding of the meaning behind this delicate social process for the patient, the purpose of this study was to develop a theory that describes the social processes one undergoes during the in-hospital end-of-life phase. Grounded theory methodology was chosen to understand this phenomenon and then explain it theoretically (Charmaz, 1990). The data used to develop the theoretical model was previously collected by StoryCorps and therefore components of secondary analysis were taken into consideration. Stories that are housed at …

Cross-Cutting Narratives Of Opioid Use Disorder Among Pregnant Women And Mothers: Implications For Humanistic Care, Alice Fiddian-Green

Doctoral Dissertations

Opioid-related fatalities in the U.S. have increased drastically. Pregnant women and mothers with opioid use disorders (OUD) are a rapidly growing and vulnerable population. Using a critical narrative approach, this dissertation examines how the syndemic of trauma, substance use, and mental health conditions influences opioid use and treatment trajectories among pregnant women and mothers across the lifecourse. The goal of this dissertation was to examine three discursive resources that shape the social construction of perinatal and maternal opioid use across all strata of social life: macro-level (news media), meso-level (scientific), and micro-level (individual) narratives. Informed by 18-months of ethnographic observation, …

Improving Chinese Mothers’ Health Literacy: A Wechat Intervention, Qiong Chen

Doctoral Dissertations

The health literacy and eHealth literacy of women during the reproductive age is crucial, as it can affect their health and the health of their children. Promoting health literacy is essential to achieve mothers’ empowerment by improving access to and capacity of using health information effectively. However, functional, interactive, and critical health literacy and eHealth literacy have never been assessed among Chinese women. The first study during this dissertation assessed functional, interactive, and critical health literacy and eHealth literacy among 421 of Chinese mothers with children under 3 years old. The results revealed overall less than optimal level of health …

Multi-Level Barriers To Art Adherence Among Hiv-Infected Women In Rural Eswatini: A Mixed Methods Approach, Nozipho Becker

Doctoral Dissertations

Eswatini has the highest global prevalence of HIV despite universal access to free treatment. Lack of compliance continues to be a significant challenge for HIV care and management programs throughout the country. Studies investigating barriers to antiretroviral therapy (ART) adherence, particularly in women, who are the most vulnerable to HIV infections, are limited. The disproportionate impact of HIV on women can be attributed to multiple risk factors at the individual, household, and community/structural levels. Women living in rural settings are particularly at risk as a result of socio-cultural and environmental vulnerabilities such as oppressive traditional practices, intimate partner violence, and …

Estimating Age-Specific Contraceptive Use For Spacing Of Childbirth For All Countries In Sub-Saharan Africa From 1985 To 2030 Using A Bayesian Hierarchical Time Series Model, Gregory Guranich

Masters Theses

Contraceptive usage for spacing of childbirth is an important indicator for understanding family planning practices as well as fertility transitions. Fertility transition are especially important in sub-Saharan Africa where fertility remains high in many countries. However, estimates and short-term projections are generally not available for countries in this region. We developed a Bayesian hierarchical time series model to estimate and project usage of contraceptives for spacing by 5-year age groups for all countries in sub-Saharan Africa for the years 1985-2030. Estimating country-age-year specific usage is challenging due to limited data availability. We use Bayesian hierarchical models to share information across …

Gestational Weight Gain, Offspring Asthma And Wheeze Phenotypes In Project Viva, Kathryn Wagner

Masters Theses

In the US, 8.4% of children are diagnosed with asthma by age 18, making asthma one of the most common chronic conditions among children. Additionally, 25% of children experience persistent wheezing by age 6, an indicator of childhood asthma. Both childhood asthma and persistent wheezing may be linked to inflammatory and immune mechanisms, which are associated with inadequate and excessive gestational weight gain. Studies investigating the relationship between gestational weight gain and offspring asthma and wheeze phenotypes are limited by self-reported gestational weight gain, early age at asthma and wheeze assessments, limited adjustment for potential confounders and no trimester-specific evaluations. …

Assessing The Association Between Physical Activity And Prediabetes Using The National Health And Nutrition Examination Survey 2007-2014, Mabeline Velez

Masters Theses

Prediabetes, a condition in which glucose levels are higher than normal but not high enough to be diagnosed as type 2 diabetes, affects approximately 37% of adults in the United States and is a major public health concern. Extensive research has evaluated the association between physical activity (PA) and type 2 diabetes; however, few studies have examined the association between PA and prediabetes. Therefore, we evaluated the association between PA (including leisure time, occupational and total) and prediabetes status among adults, stratified by gender, using multinomial logistic regression models fit to serial cross-sectional 2007-2014 National Health and Nutrition Examination Survey …

Making The Invisible Visible: Adolescent Caregiver Experiences In Multiple Sclerosis, Renee Crizer

Doctoral Dissertations

Multiple Sclerosis, a chronic, debilitating neurological disease is typically diagnosed during the child bearing and child rearing ages of 20-50. Therefore, many people diagnosed with Multiple Sclerosis have children and adolescents living at home. With approximately 400,000 people in the United States currently diagnosed with multiple sclerosis and 10,000 new cases each year, a group of caregivers have emerged that are often unrecognized and potentially at risk: a group of young caregivers. The aim of this study was to explore the lived experience of individuals who provided care for a family member with Multiple Sclerosis during their adolescence. This qualitative, …

Associations Between Adverse Childhood Experiences And Attitudes Towards Abuse Against Women And Children Among Adolescents And Young Adults In Malawi, Nellipher Lewis Mchenga

Doctoral Dissertations

The purpose of this study was to examine attitudes towards abuse against women and children between adolescents, aged 13 to 17, who had adverse childhood experiences (ACEs) and those who did not, and young adults, aged 18 to 24, who had ACEs and those who did not. The study also evaluated whether the region of residence moderates the relationship between participants’ adverse childhood experiences and attitudes towards abuse against women and children. Secondary data collected from adolescents and young adults aged 13 to 24 between September and October of 2013 in the Violence Against Children and Young People Malawi Survey …

Impact Of Footwear On Mechanisms Of Knee Osteoarthritis Progression, Ethan Steiner

Masters Theses

Knee osteoarthritis (OA) is a debilitating disease affecting the entire knee joint by inducing pathological changes to the cartilage and menisci. Currently, the etiology of OA is not completely understood. However, altered gait mechanics, specifically increased joint loading, of OA patients have a clear association with both symptomatic and structural OA progression. Non-surgical intervention tools, such as variable stiffness shoes (VSS), have been developed as a way to decrease loading within the knee joint. However, with external moments being surrogate measures for knee loading, it is unclear if changes in knee moments with the footwear are sufficient to result in …

Patient Sex And Physician Adherence To Treatment Guidelines For Non-Purulent Cellulitis, Rebecca Goldberg

Masters Theses

In 2015, participating US Emergency Departments (EDs) reported approximately 2.8 million visits related to skin and soft tissue infections (SSTIs). Studies indicate that there may be disparities by patient sex in physician treatment guideline adherence rates as a result of a gender bias during physician-patient interactions; however, only two epidemiologic studies have investigated the role of patient sex in guideline adherence rates for SSTIs. These prior studies were limited in size and covariate assessment. Thus, the magnitude and direction of the effect of patient sex is uncertain, warranting further research. Therefore, we conducted a large prospective study to elucidate the …

Cultural And Family Challenges In Type Two Diabetes Self-Care For Puerto Rican Identified Hispanic Adults, Jalil Johnson

Doctoral Dissertations

ABSTRACT CULTURAL CHALLENGES IN TYPE TWO DIABETES SELF-CARE FOR PUERTO RICAN IDENTIFIED HISPANIC ADULTS FEBRUARY 2019 JALIL A. JOHNSON, B.S.N., MIDDLE TENNESSEE STATE UNIVERSITY M.S., UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL, WORCESTER Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Dean Stephen Cavanagh Background: Puerto Rican identified Hispanics are disproportionately affected by type 2 diabetes and co-morbid conditions compared to their white counterparts. Culturally tailored interventions improve self-care for Hispanic populations. Interventions should be tailored to the targeted Hispanic subgroup. The intersection of Familism in Puerto Rican culture as it influences type 2 diabetes self-care is not well understood. Research Aims: The …

The Impact Of Ptsd And History Of Involvement In The Criminal Justice System On Medication Treatment Success In Opioid Use Disorder, Kirk Sanger

Doctoral Dissertations

This analysis examined the impact of post-traumatic stress disorder (PTSD), history of trauma, and a history of involvement in the criminal justice system (CJS) on treatment outcomes related to medication treatment for opioid use disorder. This study employed a secondary analysis of data derived from a multi-state, multi-site treatment center focused on substance abuse and more specifically opioid use disorder treatment. The total sample size was 19,970 patients. The majority of the sample received treatment in Massachusetts, was white, and non-Hispanic. Those with PTSD accounted for 9.5% of the sample, while 12% had a history of trauma. Just under 1/4 …

Social Factors That Exacerbate Features Of Borderline Personality Disorder In Young Adult Women Between 25 And 35 Years Of Age Living In The Commonwealth Of Puerto Rico, Erika M. Carrasquillo

Doctoral Dissertations

The high prevalence of BPD hospitalizations, unsuccessful treatments, poor social awareness, suicide attempts and complete suicides were motivating forces for this research study. The aim was to uncover pertinent social factors that exacerbate BPD in the lives of individuals with this affliction and therefore find ways to combat this disease. Since most of the individuals affected by this disease are female, the present research was focused on uncovering factors that increased the likelihood of BPD factors in women between the ages of 25-35 years. Borderline personality disorder is often viewed as difficult to treat. However, recent research shows that BPD …

Aging-In-Community: The Influence Of Social Capital On Accessory-Dwelling Unit Access And Utilization Among Older Americans, Travis M. Gagen

Doctoral Dissertations

Accessory-Dwelling Units (ADUs) are one form of the built-environment in which the field of public health law can intervene to improve population aging. Modifying the built-environment to incorporate ADUs allows older adults to utilize a higher level of smart home technologies (SHT) to age-in-community. Under Massachusetts law MGL c. 40A, the state gives authority to cities and towns to adopt ordinances and bylaws to regulate the use of land, buildings and structures. A mixed-methods research design was used to examine the access and utilization of ADU and SHT among older adults. Of the 351 Massachusetts town and cities, 66.5% were …

The Core Of Social Network Modeling: Industrial Engineering., Shannon C. Roberts, Chaitra Gopalappa, Nazanin Nazanin

Science and Engineering Saturday Seminars

Networks are abound in our everyday lives, from disaster response networks to cellular networks to social networks. In this workshop, we will introduce the different types of networks and how Industrial Engineering is used to model these networks. Next, we will describe current social network modeling research done at UMass. Finally, we will delve into hands-on activities that include social network analysis, such as the clustering of people into groups, and modeling of the spread of ideas in a social network, such as how tweets spread on Twitter.

Roadside Exposure And Inflammation Biomarkers Among A Cohort Of Traffic Police In Kathmandu, Nepal, Kabindra M. Shakya, Richard E. Peltier, Yimin Zhang, Basu D. Pandey

Environmental Health Sciences Faculty Publication Series

Air pollution is a major environmental problem in the Kathmandu Valley. Specifically, roadside and traffic-related air pollution exposure levels were found at very high levels exceeding Nepal air quality standards for daily PM_2.5. In an exposure study involving traffic police officers, we collected 78 blood samples in a highly polluted spring season (16 February 2014–4 April 2014) and 63 blood samples in the less polluted summer season (20 July 2014–22 August 2014). Fourteen biomarkers, i.e., C-reactive protein (CRP), serum amyloid A (SAA), intracellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1), interferon gamma (IFN-γ), interleukins (IL1-β, IL-2, IL-4, …

Associations Between Indoor Air Pollution And Acute Respiratory Infections Among Under-Five Children In Afghanistan: Do Ses And Sex Matter?, Juwel Rana, Jalal Uddin, Richard Peltier, Youssef Oulhote

Environmental Health Sciences Faculty Publication Series

Background: Low-income families often depend on fuels such as wood, coal, and animal dung for cooking. Such solid fuels are highly polluting and are a primary source of indoor air pollutants (IAP). We examined the association between solid fuel use (SFU) and acute respiratory infection (ARI) among under-five children in Afghanistan and the extent to which this association varies by socioeconomic status (SES) and gender. Materials and Methods: This is a cross-sectional study based on de-identified data from Afghanistan’s first standard Demographic and Health Survey (DHS) conducted in 2015. The sample consists of ever-married mothers with under-five children in the …

Associations Between Indoor Air Pollution And Acute Respiratory Infections Among Under-Five Children In Afghanistan: Do Ses And Sex Matter?, Juwel Rana, Jalal Uddin, Richard E. Peltier, Youssef Oulhote

Environmental Health Sciences Faculty Publication Series

Background: Low-income families often depend on fuels such as wood, coal, and animal dung for cooking. Such solid fuels are highly polluting and are a primary source of indoor air pollutants (IAP). We examined the association between solid fuel use (SFU) and acute respiratory infection (ARI) among under-five children in Afghanistan and the extent to which this association varies by socioeconomic status (SES) and gender. Materials and Methods: This is a cross-sectional study based on de-identified data from Afghanistan’s first standard Demographic and Health Survey (DHS) conducted in 2015. The sample consists of ever-married mothers with under-five children in the …

Curcumin, Hormesis And The Nervous System, Maria Concetta Scuto, Cesare Mancuso, Barbara Tomasello, Maria Laura Ontario, Andrea Cavallaro, Francesco Frasca, Luigi Maiolino, Angela Trovato Salinaro, Edward J. Calabrese, Vittorio Calabrese

Environmental Health Sciences Faculty Publication Series

Curcumin is a polyphenol compound extracted from the rhizome of Curcuma longa Linn (family Zingiberaceae) commonly used as a spice to color and flavor food. Several preclinical studies have suggested beneficial roles for curcumin as an adjuvant therapy in free radical-based diseases, mainly neurodegenerative disorders. Indeed, curcumin belongs to the family of hormetins and the enhancement of the cell stress response, mainly the heme oxygenase-1 system, is actually considered the common denominator for this dual response. However, evidence-based medicine has clearly demonstrated the lack of any therapeutic effect of curcumin to contrast the onset or progression of neurodegeneration and related …

Suicide Education To Support Caregivers In Their Abilities To Care For Suicidal Individuals, Cassandra Lipa

Doctor of Nursing Practice (DNP) Projects

Purpose: Suicide is a preventable act of lethality yet still remains a public health concern. Suicide can affect individuals from a variety of backgrounds and does not discriminate against age, gender, ethnicity, income, or occupation. Efforts to prevent suicide often focus on supporting the suicidal individual however there is a lack of available resources that focus on supporting those closest such as caregivers. Caregivers can play a pivotal role in their loved one’s trajectory towards recovery. The purpose of this project was to provide caregivers with a suicide toolkit that encompasses basic education, approaches to supporting a loved one who …

Human Trafficking Recognition And Response Training For Sexual Assault Nurse Examiners In New Hampshire Emergency Departments, Carolyn L. Noyes

Doctor of Nursing Practice (DNP) Projects

Human trafficking is a pervasive yet under-recognized public health epidemic. Traffickers use various forms of manipulation to control their victims for the benefit of the trafficker with little regard for the victims’ well-being. This leads to victims of human trafficking suffering short- and long-term health problems. Trafficking victims may subsequently access healthcare during their time in captivity as a result of a direct harm caused to them due to their victimization from neglect, injury or disease. Unfortunately, victims often do not see themselves as victims or are too afraid to let their healthcare provider know that they need help. Warning …

The Implementation Of A Faith-Based Heart Healthy Education Program For Latinos In Miami, Florida, Cassandra Zacke

Doctor of Nursing Practice (DNP) Projects

Background: Cardiovascular disease (CVD) has been identified as a leading cause of mortality in the Latino population in the United States. Studies conducted in faith-based settings demonstrate effectiveness in improving the promotion of lifestyle changes.

Methods: This project was a four-week faith-based educational intervention for Latinos meeting weekly at a faith-based organization in Miami-Dade Florida. Classes focused on cardiovascular disease prevention and risk reduction and included PowerPoint presentations, fotonovellas, and interactive activities offered in English and Spanish. Participants were asked to complete cardiovascular disease knowledge questionnaire before and after the educational classes based on the National Institute of Health’s …

Incorporating Complementary Alternative Methods In The Management Of Chronic Pain Into A Primary Care Practice In New York, Vladimir Sher

Doctor of Nursing Practice (DNP) Projects

Background: Pain is a physical, emotional, and psychological symptom that causes discomfort and leads to physiological consequences that can damage tissue, alter neurological pathways, and cause severe psychological distress. The combined use of complementary and alternative medicine (CAM) therapies can reduce pain and lead to an improvement in patient health. Purpose: The purpose of this quality improvement project/evidence-based practice intervention was to review concepts related to pain and analyze the current use of music and massage CAM therapies in a primary care setting.

Methods: The Gate Control Theory was used in this project describing pain as "a category of …

Improving Mental Healthcare For Older Adults: Community Based Screening For Social And Emotional Loneliness And Major Depressive Disorder, Eunice Kowalczyk

Doctor of Nursing Practice (DNP) Projects

Abstract

Purpose: Major depressive disorder (MDD) is a devastating mental health disorder affecting older adults that is often misdiagnosed or untreated due to a lack of screening and the stigma that MDD symptoms are a normal and expected part of aging. The goal of this quality improvement (QI) project was to implement a community-based screening intervention to identify community-dwelling older adults at risk for or suffering from MDD, and facilitate further evaluation and care.

Methods: Participants were community dwelling older adults, age 56 and older, in Massachusetts. Two screening tools were administered in two sites that screened for social and …

Simulation-Based Mental Health Nursing Education, Deanna Dubay

Doctor of Nursing Practice (DNP) Projects

• DNP Project Goal: Provide a simulation-based mental health nursing education experience to pre-licensure nursing students prior to participating in a mental health clinical rotation to reduce anxiety and increase confidence in therapeutic communication and care of the patient with mental health needs.
• Background and Review of Literature: Research suggests nursing students feel anxious about participating in mental health clinical rotation and have decreased confidence in treatment and communication with patients.
• Methods: A quality improvement project was conducted utilizing seven nursing students from a BSN program. The participants engaged in a simulation-based mental health nursing education experience, which …

Mitigating Prescription Opioid Risk: Prescription Drug Monitoring Programs, Brenda Vigue

Doctor of Nursing Practice (DNP) Projects

Background: Opioid-related morbidity and mortality is a serious public health issue in the United States. Prescription Drug Monitoring Program (PDMP) review prior to prescribing opioids has consistently been recommended as best practices for risk mitigation, however, access/utilization of this monitoring program remains low.

Methods: This quality improvement (QI) project for improved PDMP utilization employed a pre-post survey design in a random sample of Advanced Practice Registered Nurses in Arizona. Quantitative measures included online surveys with close-ended responses to salient items from the review of literature and best practices. A follow-up survey was requested of the participants who provided their …

A Public Health Initiative To Support The Development Of A Trauma Informed Care Culture In A Community Organization That Provides Services To Individuals With Developmental And Intellectual Disabilities, Lisa Coenen

Doctor of Nursing Practice (DNP) Projects

Background: Trauma informed care (TIC) is a socio-ecological theoretical approach for universal practice focus to improve HRQOL and wellbeing outcomes. There is a gap in TIC system implementation for vulnerable populations, including the ID/DD population.

Purpose: The purpose of this project was to transfer knowledge to a newly created TIC work group on the use of an existing TIC system implementation tool to plan, develop, and measure the level of TIC systems culture in their community organization.

Methods: Knowledge transference through the utilization of a TIC systems implementation process map, TIC education, and the facilitation of a …

Using Mobile Health To Improve Mild Depression Outcomes In Adult Primary Care, Michele Marek

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Mild depression is a common patient complaint in primary care, potentially impairing role function in multiple dimensions, with risk for escalation to severe Major Depressive Disorder (MDD), a chronic, recurring illness with multiple comorbidities at high emotional and economic cost to individuals, families, and society. Barriers to care include lack of access to Mental Health Specialists, financial constraints and stigma, all of which can cause escalation of symptoms to the point of disability and are magnified in underserved populations.

Purpose: The primary goal of this quality improvement (QI) project was to improve depression symptoms using the evidence-based mobile …

Promoting Sleep Health Through Identification And Management Of Obstructive Sleep Apnea, Melissa Vuolo

Doctor of Nursing Practice (DNP) Projects

Background: There is a high prevalence of obstructive sleep apnea in the United States, which left untreated can lead to increased cardiovascular risk. The current practice standard is to use a questionnaire to evaluate a patients’ sleep health, but this is not done regularly in every clinical setting. This DNP project aimed to bridge the gap in practice by implementing regular screening of obstructive sleep apnea in an urgent care center in Massachusetts.

Methods: This DNP project was conducted by having adult patients complete the Epworth Sleepiness Scale to determine the presence of a sleep health issue. The patients …