Medicine and Health Sciences Commons^™

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 …

Markov Decision Process Approach To Strategize National Breast Cancer Screening Policy In Data-Limited Settings, Vijeta Deshpande

Masters Theses

Early diagnosis is a promising strategy to reduce premature mortalities and for optimal use of resources. But the absence of mathematical models specific to the data settings in LMIC’s impedes the construction of economic analysis necessary for decision-makers in the development of cancer control programs. This thesis presents a new methodology for parameterizing the natural history model of breast cancer based on data availabilities in low and middle income countries, and formulation of a control optimization problem to find the optimal screening schedule for mammography screening, solved using dynamic programming. As harms and benefits are known to increase with the …

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. …

A Computational Simulation Model For Predicting Infectious Disease Spread Using The Evolving Contact Network Algorithm, Buyannemekh Munkhbat

Masters Theses

Commonly used simulation models for predicting outbreaks of re-emerging infectious diseases (EIDs) take an individual-level or a population-level approach to modeling contact dynamics. These approaches are a trade-off between the ability to incorporate individual-level dynamics and computational efficiency. Agent-based network models (ABNM) use an individual-level approach by simulating the entire population and its contact structure, which increases the ability of adding detailed individual-level characteristics. However, as this method is computationally expensive, ABNMs use scaled-down versions of the full population, which are unsuitable for low prevalence diseases as the number of infected cases would become negligible during scaling-down. Compartmental models use …

Development And Cross-Validation Of A Cadence-Based Metabolic Equation For Walking, Christopher C. Moore

Masters Theses

The ACSM Metabolic Equation is a widely recognized equation for predicting metabolic intensity from walking speed. However, an equation that uses an observable metric (i.e., cadence [steps/min]), accounts for individual characteristics, and is validated across walking conditions may enable more accessible and accurate predictions of walking intensity. PURPOSE: To develop metabolic equations that predict metabolic intensity (oxygen consumption; mL/kg/min) from cadence using a large treadmill walking dataset (Study One) and cross-validate these equations during overground unconstrained and cadence-constrained walking conditions (Study Two). METHODS: In Study One, 193 adults (21-81 years) completed treadmill walking bouts while oxygen consumption was measured with …

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 …

Antipsychotic Drug Use And Postmenopausal Breast Cancer Risk In The Women’S Health Initiative (Whi): A Prospective Cohort Study, Anna George

Masters Theses

Breast cancer is the most prevalent form of cancer and the second leading cause of mortality, affecting 1 in 9 women in the United States. Recent studies have shown that antipsychotic drug use is associated with increased prolactin levels, which, in turn, is associated with increased risk of breast cancer. However, studies of the association between antipsychotic drug use and the risk of breast cancer are sparse and have largely been conducted in homogenous populations. Therefore, we evaluated this relationship in postmenopausal women (N = 119 524) in a diverse population of the Women’s Health Initiative (WHI) cohort. Antipsychotic drug …

Young Adult Early Childhood Home Visitors’ Perceptions Of Fan (Facilitating Attuned Interactions) And Its Potential Protection To Burnout, Lee Mackinnon

Doctoral Dissertations

ABSTRACT YOUNG ADULT EARLY CHILDHOOD HOME VISITORS’ PERCEPTIONS OF FAN (FACILITATING ATTUNED INTERACTIONS) AND ITS POTENTIAL PROTECTION TO BURNOUT FEBRUARY 2019 LEE MACKINNON, B.A., WILLIAMS COLLEGE Ed.M., HARVARD UNIVERSITY Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Claire E. Hamilton This qualitative study investigated the experience of young adult early childhood home visitors in the training and implementation of a family engagement tool, Facilitating Attuned Interactions (FAN) (Gilkerson, 2015). Using Interpretative Phenomenological Analysis, the case study explored how 5 home visitors, who were under 30 years of age, viewed their training and use of FAN in three components of their …

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 …

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 …

Quality Improvement: Intimate Partner Violence Screen In Nurse Home Visit Program, Masayo Nishiyama

Doctor of Nursing Practice (DNP) Projects

Purpose: Women are disproportionately impacted from intimate partner violence (IPV). Their children also experience long-term adverse consequences. Effective IPV prevention and intervention efforts are vital. This quality improvement project addressed the lack of an evidence-based IPV training and protocol in a nurse home visit program.

Methods: Stakeholder engagement and an evidence-based practice intervention were implemented. Training effectiveness was examined by the pre-post-training assessments; completed by 17 nurses. To measure the IPV practice change, 196 pre- and 107 post-intervention charts were reviewed.

Results: The training significantly increased nurse knowledge and comfort (t=5.9, p< .001). Only 22% of those referred due to recent IPV history were screened before the intervention; 65% after the intervention. Multivariate analysis of screening rates was performed; predictors included county, mental health status, education, subprogram, and IPV referral reason. Due to low power, a one-tail test was employed. One county was 14 times less likely to screen than the other county (p= .023). 93% of those referred due to IPV history were enrolled in the crisis response subprogram, only offered by the other county. Those referred due to IPV history were three times more likely to be screened (p=.042) than those referred for other reasons. There was no significant change observed on IPV disclosure and intervention practice.

Conclusions: The adoption of an evidence-based IPV training …

Program Evaluation Of An Easy Access Clinic For Effective Contraception For U.S. Active Duty Women In Okinawa, Japan, Cynthia Kuehner

Doctor of Nursing Practice (DNP) Projects

Background: Unintended pregnancy in the United States (U.S.) is a significant health problem that takes on additional magnitude in the context of military service. Young, active duty women have higher unintended pregnancy rates compared to the general population, secondary to non-use of contraception or selection and use of the least effective methods (condoms and oral contraceptive pills). The literature validates the problem, identifies access barriers to highest-efficacy contraception options in primary care settings, and offers evidence-based, best practice opportunities to impact this public health challenge.

Purpose: The purpose of this project was to evaluate access, utilization, effectiveness, and patient satisfaction …

Incidence Of Pediatric Cannabis Exposure Among Children And Teenagers Aged 0 To 19 Years Before And After Medical Marijuana Legalization In Massachusetts, Jennifer M. Whitehill, Calla Harrington, Cheryl J. Lang, Michael Chary, Waqaas A. Bhutta, Michael D. Burns

Health Promotion and Policy Faculty Publication Series

Importance Pediatric health care contacts due to cannabis exposure increased in Colorado and Washington State after cannabis (marijuana) policies became more liberal, but evidence from other US states is limited.

Objective To document the incidence of pediatric cannabis exposure cases reported to the Regional Center for Poison Control and Prevention (RPC) before and after medical marijuana legalization (MML) in Massachusetts.

Design, Setting, and Participants Cross-sectional comparison of pediatric cannabis exposure cases 4 years before and after MML in Massachusetts. The exposure cases included those of 218 children and teenagers aged between 0 and 19 years, as reported to the RPC …