eScholarship@UMassChan
eScholarship@UMassChan is a digital archive for UMass Chan Medical School's research and scholarship, including journal articles, theses, datasets and more. We welcome submissions from our faculty, staff, and students. eScholarship@UMassChan is a service of the Lamar Soutter Library, Worcester, MA, USA. See also our open access journal publishing services.
Questions? See the Help menu or contact escholarship@umassmed.edu.
Communities in eScholarship@UMassChan
Select a community to browse its collections.
Recent Publications
Publication Longitudinal Associations Between Peritraumatic Oestradiol and Fear Responding in Women and Men(2025-04)PTSD is more prevalent in women than men and associated with autonomic dysfunction. Higher oestradiol levels have been associated with decreased PTSD severity, however, the impact of oestradiol on autonomic function is not well characterised. We examined associations among peritraumatic oestradiol levels and autonomic function in the multi-site AURORA study. Participants (n = 283, 69.6% female) were recruited from the emergency department (ED) following trauma exposure. Skin conductance (SC) was measured during trauma recall at the ED. Oestradiol was assayed from blood collected at ED, 2-week and 6-month. Fear conditioning, including fear potentiated startle (FPS), was completed at 2-week and 6-month. In women, ED oestradiol was significantly positively associated with ED SC and FPS at 6-month. In men, significant negative correlations between ED oestradiol and SC were found. Among women in the study, peritraumatic oestradiol was positively associated with fear responding 6-month. Findings suggest that the protective effects of oestradiol on PTSD may depend on other factors, such as time since trauma. Additional research is needed to elucidate how peritraumatic oestradiol and autonomic function may interact to confer risk for PTSD.Publication Multicenter study of association between socioeconomic status and treatment of ruptured cerebral aneurysms compared to unruptured cerebral aneurysms: insights from 4,517 patients using the area deprivation index(2025-03-29)Background: Socioeconomic status influences health outcomes, including cerebrovascular diseases. Patients from socioeconomically deprived areas may present with more severe conditions due to delayed access to care. This study evaluates the association between neighborhood-level deprivation, measured by the Area Deprivation Index (ADI), and the treatment of ruptured intracranial aneurysms (RIAs) compared with unruptured intracranial aneurysms (UIAs) across multiple centers. Methods: This retrospective cohort study analyzed data from 4517 patients treated for cerebral aneurysms at 10 US comprehensive stroke centers between 2018 and 2024. Patients were stratified by national ADI decile based on their residential addresses. Multivariable logistic regression was used to examine the relationship between ADI and aneurysm rupture (reference being unruptured aneurysms) and controlled for age, sex, smoking history, family history, and race. Results: Of 4517 total patients, 1260 (27.9%) underwent treatment of RIAs. Multivariable analysis confirmed ADI as an independent predictor of presentation for treatment of RIA (odds ratio (OR)=1.100, 95% confidence interval (CI)=1.068-1.133, P<0.0001) after adjusting for age, sex, smoking history, and race. This corresponds to a 10% increase in likelihood of presenting for treatment of a ruptured vs unruptured intracranial aneurysm with each ADI decile. Conclusion: Socioeconomic deprivation independently predicts treatment of RIAs compared with the treatment of UIAs. These findings highlight disparities in aneurysm detection and management, emphasizing the need for targeted preventive care and accessible screening programs to mitigate the impact of socioeconomic disadvantage on cerebral aneurysm outcomes.Publication Comparative Safety of Short-Acting Opioid Dose Escalation and Long-Acting Opioid Initiation in Nursing Home Residents(2025-03-28)Background: For patients with continued pain while receiving an initial course of a short-acting opioid (SAO), clinicians may intensify the opioid regimen by escalating the SAO dose or initiating a long-acting opioid (LAO). The objective of this study was to assess the comparative safety of opioid intensification regimens in nursing home residents with nonmalignant pain. Methods: We conducted a retrospective cohort analysis of US long-stay nursing home residents identified from the national Minimum Data Set (MDS) 3.0 and linked Medicare data, 2011-2016. Opioid regimen changes were assessed using Part D claims to identify dose escalation of SAO, adding LAO to SAO, or a switch from SAO to LAO. The outcomes of interest were hospitalized falls/fractures and delirium identified in the MDS or hospitalization. Resident attributes were described by opioid regimen. Hazard ratios of study outcomes were quantified using as-treated (primary analysis) and intent-to-treat (secondary analysis) doubly robust inverse probability of treatment (IPT) weighted Fine & Gray regression models with a competing risk of death. Results: In the as-treated analysis, relative to residents in the SAO escalation cohort, the hazard of delirium was elevated in the LAO cohorts (aHR [LAO switch]: 2.05, 95% CI: 1.57-2.67; aHR [LAO add-on]: 1.55, 95% CI: 1.23-1.96). Results for falls and fractures were inconclusive. We did not observe evidence of an association with falls and fractures in the primary as-treated analysis; however, the intent-to-treat analysis observed increased hazards in the LAO switch cohort relative to the SAO escalation cohort (aHR 2.86, 95% CI:1.64-4.99). Conclusions: There is limited evidence to inform the clinical judgment between escalating the SAO dose or incorporating a LAO. Our study suggests increased risks of delirium in nursing home residents with nonmalignant pain when switching or adding an LAO to the opioid regimen relative to increasing the dose of SAOs.Publication Medical Care for Patients With Mental Health and/or Substance-Use Disorders: A Qualitative Investigation of Emergency Department Patient Experiences and Recommendations(2025-03-26)Objectives: (1) To investigate the healthcare experiences of individuals with mental health and/or substance use disorders (SUDs) who seek medical care in the emergency department (ED) for physical health concerns (e.g., abdominal pain), and (2) to explore recommendations for improving these patients' care experiences. Although this population suffers from a high disease burden and disproportionately seeks care in the ED, surprisingly little research has examined their experiences. Study setting and design: Qualitative study employing grounded theory and semi-structured interviews with patients with mental health and/or SUD(s) (identified via health records) seeking care for a physical health concern during an ED visit to an academic medical center in the Northeastern USA. Longer follow-up interviews were conducted via telephone. Interviews occurred between February 2018 and January 2019. Data sources and analytical sample: We transcribed and coded digital recordings of interviews with 50 patients at two time periods. We used constant comparative analysis throughout interviewing, coding, and analysis. Principal findings: Most participants were White (80%), non-Hispanic (84%), and female (72%). Three key themes emerged, revealing a broad range of negative and positive patient care experiences that are influenced by provider, treatment, and healthcare system factors. Findings demonstrate that stigma and perceived biases due to mental health and/or SUDs extend to medical care experiences not directly related to these conditions (e.g., dismissive, rushed, unprofessional care, medical errors). Participants also identified positive care experiences (e.g., attentive, communicative, efficient, quality care), which informed recommendations for improving care. Conclusions: Understanding care experiences of vulnerable patient populations is critically important for informing interventions to improve their healthcare quality and safety. Findings underscore the need for additional education and training for providers, integrated behavioral healthcare, and widespread changes to the healthcare system. Localized interventions that target stigma and mismatches between patients' care expectations and ED capabilities are also needed.Publication Hope for the Future: Key Informants' Perspectives on HIV Prevention in Dominican Republic Batey Communities: A Qualitative Description Study(2025-03-26)The purpose of our study was to understand the interlocking spheres of cultural identity and health behaviors related to HIV prevention within Haitian migrant batey communities in La Romana, Dominican Republic. A qualitative description design was employed using the PEN-3 model by Airhihenbuwa (1990) as a theoretical framework. Data were collected through semi-structured interviews with 12 key informants. Participants, primarily adults of Hispanic (10) and African descent (2), ranged from 33 to 53 years old, with a majority having high school or higher education. A central theme, "Hope for the Future," emerged, highlighting five subthemes: stigma/discrimination, religious beliefs, voodoo tenets, community nurturers, and HIV education. Findings emphasized the need for a multifaceted approach using community health workers and incorporating local cultural contexts, including religious beliefs and stigma, to enhance HIV prevention efforts. Cultural identity of Haitian migrant batey communities included religious beliefs, stigma, and cultural practices as considerations in HIV prevention interventions.