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.
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Recent Publications
Publication Assessment of Family Involvement as A Determinant of Rehabilitative Therapy Administration, Change in Depression Severity, and Risk of Pressure Injuries Development in U.S. Nursing Home Residents(UMass Chan Medical School, 2025-05-06)ABSTRACT Background: As older adults transition to nursing homes from the community, their health and quality of life in nursing homes are significantly influenced by various factors, including family involvement in care planning. Family involvement is associated with better health outcomes in older adults, yet its impact on specific conditions like therapy administration, depression, and pressure injuries among nursing home residents remains understudied. This dissertation addresses these gaps by examining the role of family involvement in these key areas. Methods: Using national data from the Minimum Data Set (MDS) 3.0, this dissertation explores the influence of family involvement on nursing home care and health outcomes from 2014 to 2019. The study includes three aims: 1) assessing the association between family involvement and rehabilitative therapy administration among newly admitted residents transferred from acute care in 2019; 2) examining the relationship between perceived family involvement and changes in depression severity in long-stay residents from 2014 to 2019, and 3) evaluating the impact of family involvement on the risk of developing stage 2 or higher pressure injuries in long-term care residents from 2014 to 2019. Statistical methods included linear regression, Poisson regression, and generalized estimating equations (GEEs). Results: The first study included 2,112,330 residents aged 50 years and older. In Aim 1, residents who reported family involvement as "Very Important" received an average of 247 minutes of individual physical therapy and 236 minutes of individual occupational therapy, compared to 222 minutes of individual physical therapy and 215 minutes of individual occupational therapy among those who found it "Important, but no choice." Adjusted analyses showed that residents who rated family involvement as "Not Important at All" received 21 fewer therapy minutes (95% CI: -27, -15) compared to those who valued it as "Very Important." In Aim 2, among 2,043,308 long-stay nursing home residents, those with none-to-low baseline depression who perceived family involvement as "Not Important at All" had a 10% higher risk of significant worsening of depression symptoms (RR: 1.10, 95% CI: 1.06, 1.14) after adjusting for confounders, compared to those who considered it "Very Important." Conversely, among residents with moderate to moderately severe baseline depression, those who perceived family involvement as "Not Important at All" had a 33% higher risk of significant worsening (RR: 1.33, 95% CI: 1.10, 1.61) compared to the "Very Important" group, after adjusting for covariates. In Aim 3, among 579,958 residents, the relative risk of developing stage 2 or higher-pressure injuries was 0.97 (95% CI: 0.78, 1.22) for those who rated family involvement as "Not Important at All," compared to those who viewed it as "Very Important." Subgroup analysis revealed a higher risk for residents with severe physical impairments (RR: 1.34, 95% CI: 0.94, 1.93) and those with no urine output/ostomy (RR: 1.59, 95% CI: 0.88, 2.86). Conclusions: This dissertation underscores the significant role of family involvement in enhancing the care and health outcomes of nursing home residents. Higher family engagement is associated with increased rehabilitative therapy use, reduced risk of worsening depression, and nuanced effects on pressure injury development, particularly among vulnerable subgroups. These findings highlight the need for nursing homes to foster family involvement in care planning as a strategy to improve residents' overall health and well-being. Implementing policies that encourage family engagement could lead to more personalized and effective care, ultimately enhancing the quality of life for older adults in nursing homes.Publication Sequential decreases in basolateral amygdala response to threat predict failure to recover from PTSD(2025-05-03)Amygdala hyperreactivity early-post trauma has been a demonstrable neurobiological correlate of future posttraumautic stress disorder (PTSD). The basolateral amygdala (BLA) particularly is vital for fear memory and threat processing, but BLA functional dynamics following a traumatic event are unexplored. BLA reactivity to threat may be a trait that can predict PTSD and persist over time. Alternatively, BLA responsivity to threat cues may change over time and be related to PTSD severity. As part of a larger, multisite study, AURORA, participants 18-75 years old were enrolled in an emergency department (ED) within 72 h of a traumatic event (N = 304, 199 female). At 2-weeks and 6-months post-trauma, PTSD symptoms, BLA responses to threat (fearful>neutral faces), and functional connectivity (FC) during fMRI were assessed. Generalizability of findings was assessed in an external replication sample of ED patients (n = 33). Two weeks post-trauma right BLA reactivity positively predicted later PTSD severity. However, left BLA reactivity to threat at 6 months post-trauma was negatively associated with PTSD severity at that timepoint (ΔPseudo-R = 0.04, IRR = 0.38, p < 0.001). In addition, a decrease in BLA reactivity from 2-weeks to 6-months predicted greater PTSD severity at 6 months (ΔPseudo-R = 0.03, IRR = 0.58, p < 0.001). This replicated in the external sample. A reduction in left BLA FC with the dorsal attention network predicted increased PTSD severity over time. These findings support a shift in BLA function within the first 6 months post-trauma that predicts PTSD pathology and stand in contrast to prior conceptualizations of amygdala hyperreactivity as a trait-like PTSD risk factor.Publication Effects of Hematoma Block During Ketamine Sedation for Pediatric Forearm Fracture Reductions(UMass Chan Medical School, 2025-05-01)Background Distal forearm fractures are common in children and require proper analgesia to be reduced appropriately in the pediatric emergency department (PED). While hematoma blocks have become a common form of analgesia for adult patients, few studies have examined the effect of hematoma block for pediatric patients undergoing distal forearm fracture reduction. Methods This retrospective cohort study included children between the ages of 3 and 17 years old who were treated in a tertiary care PED between October 2017 and August 2024 with distal forearm fractures who underwent intravenous ketamine sedation for closed reduction. Data were collected from patient’s electronic medical record including pre- and post-procedural pain scores, ketamine dosing, and occurrence of any adverse events. Results The mean age of the study population was nine years old, 34% were girls, 84% broke both bones in their forearm, and 38% received pain medication prior to arrival. Patients who received a hematoma block (n=53) had a 53% lower odds (95%CI 0.18-1.26) of having any pain post-procedurally compared with those who did not receive a hematoma block (n=168), and a 68% lower odds (95% CI 0.07-1.52) of reporting severe pain. The total ketamine dose for patients who received a hematoma block was 1.39 milligram per kilogram (mg/kg) compared to 1.5 mg/kg for the patients who did not receive a hematoma block. Conclusion For pediatric patients undergoing ketamine sedation for distal forearm fracture reductions, hematoma blocks can provide additional analgesia.Publication Oral, Vaginal, and Gut Microbiome in Birthing Parents With and Without Preeclampsia(UMass Chan Medical School, 2025-05-01)Pregnancy is a time of significant change to the microbiome, which can be influenced by medical intervention and parental disease states. Unhealthy parental microbiomes have been associated with adverse pregnancy outcomes including preterm birth and pregnancy loss. Recent data have shown differences in the gut microbiomes of birthing parents with and without preeclampsia (PE), but there are limited data on the birthing parent vaginal and oral microbiomes. Our objective was to comprehensively characterize and compare the oral, vaginal, and gut microbiome of birthing parents with and without PE during the third trimester of their pregnancy. Subjects planning for a vaginal birth were recruited in the third trimester of pregnancy at the time of admission for delivery. 16S rRNA gene sequencing and whole-genome sequencing (WGS) were performed on oral, vaginal, and gut samples. Within (alpha) and between (beta) subject diversity metrics were performed followed by discriminate taxa analysis. The vaginal microbiome samples were additionally classified into standard Community State Types (CSTs). A total of 100 birthing parents were enrolled, 49 with PE and 51 without PE (controls). The oral microbiome diversity was significantly lower in birthing parents with, as compared to those without, PE (p=0.040). On the taxa level, individuals with PE showed enrichment of Rothia and depletion of Neisseria compared with controls, both of which are nitrate-reducing genera. Beta diversity was significantly different with greater inter-individual variability in the PE group (Bray-Curtis, p=0.020). Vaginal microbiome beta diversity was significantly greater in birthing parents with PE (p=0.014), and Lachnospiraceae, a taxon linked to vaginal dysbiosis, appeared exclusively in PE individuals. No significant differences between the PE and control groups were found in birthing parents' gut samples. We found that PE was associated with significant alterations in the oral and vaginal microbiome, but not in the gut microbiome, of birthing parents in the third trimester of pregnancy. Although future research is necessary to confirm and quantify the role of the microbiome in the development of PE, these initial findings suggest that the birthing parent microbiome may be a suitable target for identifying individuals as risk for PE and the development of microbiome-based therapies to prevent and treat hypertensive disorders of pregnancy (HDP).Publication "Sleep is Not Getting the Attention It Deserves": A Qualitative Study of Patient and Provider Views on Sleep Management in the Veterans Health Administration(2025-04-30)Background: Unique characteristics and service exposures of the post-9/11 cohort of U.S. Veterans can influence their sleep health and associated comorbidities. The objectives of this study were to learn about men and women post-9/11 Veterans' and "front line" VA providers' knowledge about sleep and experiences with Veterans Health Administration (VA) sleep management. Research design: One sample included post-9/11 Veterans who received VA care (n=23; 60% women; Mage: 45 y). To complement those views, primary care and mental health providers were recruited from VA medical centers (n=27). Semistructured qualitative interviews were conducted using Microsoft Teams. Questions pertained to sleep knowledge, care practices, and perceived barriers to sleep-related VA care. Interview data were synthesized with content analysis and inductive coding to characterize major themes. Results: Four main themes emerged: (1) Sleep is viewed as foundational but Veterans and providers often have limited related knowledge and more routine education is needed. (2) Men and women have distinct sleep management needs. Relative to men, women are more likely to advocate for sleep assessment and for behavioral versus pharmacological treatment. (3) Sleep management practices vary considerably between clinics and providers. (4) Veterans and their providers each experience unique barriers to sleep management. Conclusions: Post-9/11 Veterans and providers view sleep as critical. Yet, VA sleep management needs to be more uniform. Providers are motivated to assess sleep but require standardized education and low-burden opportunities to incorporate sleep into their practice, perhaps with mental health screening. Ultimately, more specialized care is required to meet the responsibility of Veterans' sleep health.