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 Descriptive Characteristics of Psychiatric Medication Discontinuation Among Perinatal Women With Depressive Symptoms(2025-06-20)Introduction: This study examined the prevalence of psychiatric medication discontinuation amongst perinatal women with depressive symptoms and describes characteristics of those who discontinued compared to those who continued medications in pregnancy. Methods: We conducted a cross-sectional analysis using baseline data from the PRogram In Support of Moms study. Amongst 98 women prescribed psychiatric medication, we descriptively assessed sociodemographic characteristics of participants who discontinued versus continued medications. A logistic regression model evaluated the association between depressive symptoms and medication discontinuation. Results: Approximately 65% reported medication discontinuation in pregnancy (95% CI: 55%-74%). Those who discontinued had a median Edinburgh Postnatal Depression Scale (EPDS) score that was 1 point higher than those who continued (p = 0.12). Of those who discontinued medications, 27% were never married, 52% reported annual incomes < $60 000, and 56% were Medicaid-insured. Conclusion: Most participants prescribed psychiatric medications before pregnancy discontinued them in pregnancy. Adequately powered studies are needed to validate findings and to explore mediating factors. Trial registration: NCT02760004.Publication "What Program Directors Think" VI: Results of the 2024 Survey of the APDR Part 2(2025-06-19)Rationale and objectives: The Association of Program Directors in Radiology (APDR) surveys its members for data gathering on impediments to resident education, variations in resource allocation and recent changes to the American Board of Radiology (ABR) certifying examination. Materials and methods: This was an observational, cross-sectional study using a Web-based survey. Members of the 2022-2023 Annual Survey Committee developed survey questions resulting in 40 items, including demographic data. The survey was distributed by email to all active members of the APDR in January and February of 2024. In this paper, challenges and potential solutions to residency education, current state of resource allocation, PD's opinion on return of the ABR's oral examination, and procedural skills necessary for graduating trainees are presented. Results: The total survey response rate was 31% (84/247). The top five challenges to education were high clinical volumes (88%), insufficient protected time for teaching (64%), remote reaching on clinical rotations (58%) and high focus on relative value units (RVU) (50%). Proposed solutions included dedicated teaching faculty on the rotation schedule, RVU balancing to better value teaching, incentivize on-site faculty, universal, validated teaching resources and increasing the number of residency slots. The results of this survey were presented at the annual Association of Academic Radiology meeting in Boston, MA (April 2024). Conclusion: Survey results find that a quarter of radiology PDs do not receive the full administrative time allocation mandated by the ACGME. The majority of the respondents favor the transition to the ABR oral examination and approve of the 10 procedures created by the APDR Procedures Taskforce. The greatest challenges facing Radiology residency education are a shortage of the radiology workforce, high clinical volumes impeding the balance between education and clinical work, and a lack of engagement and desire for remote work on the part of teaching faculty. Potential solutions to the challenges in Radiology residency education that are likely to decrease burnout and promote faculty interest in education include standardizing work RVUs to account for teaching, developing a cadre of dedicated in-person teaching faculty granted clinical RVU reductions, and facilitating asynchronous teaching.Publication Assessing Rural Veterans' Experiences with a Tele-Nephrology Program in the Veterans Health Administration (VHA)(2025-06-17)Introduction: Rural living Veterans with chronic kidney disease (CKD) and refractory hypertension (rHTN) have a higher mortality rate and are hospitalized more frequently than Veterans living in urban or suburban areas. They also face particularly unique challenges in accessing nephrology specialty care. Previous studies suggest virtual nephrology care can be used to increase access to care for Veterans. The purpose of this study was to examine Veteran's perceptions and experiences with a VA virtual nephrology program. Methods: We conducted semi-structured interviews with forty-four Veterans at five rural VA medical centers who were receiving virtual nephrology care ("tele-nephrology"). Results: Four major themes arose that represent the Veterans' perceptions and experiences with VA virtual nephrology care: 1) Tele-nephrology provides timely access to care for Veterans living in rural areas; 2) Clinical partnerships between primary care and tele-nephrology are key to Veterans' health; 3) Veterans' technology fears were assuaged with virtual nephrology care; 4) Improvements to care include more direct access to virtual nephrologists. Conclusion: This evaluation represents an important step forward in how the VA can enhance virtual nephrology care to better meet the needs of rural Veterans receiving care at facilities without VA specialty providers. Prior to the Choice and MISSION Acts, Veterans were often required to drive long distances to the closest VA specialty provider. However, since the COVID-19 pandemic, the VA has been shifting care from community to VA via virtual care. Further research should examine Veterans' experiences with both different modalities of nephrology care as well as experiences from demographically and geographically diverse Veterans.Publication High-density Lipoprotein Over Midlife and Future Cognition in Women: The SWAN HDL Ancillary Study(2025-06-17)Context: Limited data provides evidence-based insights on the association between the comprehensive metrics of high-density lipoproteins (HDL) and cognitive performance, especially in midlife women for whom the benefit might be the greatest. Objective: To assess the associations of serum HDL metrics including HDL lipid content [HDL cholesterol, phospholipid (HDL-PL), triglyceride], proteins/subclasses [apolipoprotein A-1 (apoA-1); small, medium, large, total HDL particle (HDL-P); and HDL size], and cholesterol efflux capacity with cognitive performance in midlife women. Methods: This prospective cohort study was conducted among 503 midlife women (1234 observations) from the Study of Women's Health Across the Nation HDL ancillary study. Joint models were applied to examine associations of HDL metrics assessed at midlife (50.2 ± 2.9 years, baseline of the current study) and their changes over midlife (6.1 ± 3.9 years of duration) with subsequent cognitive performance [working memory (Digit Span Backward Test), processing speed (Symbol Digit Modalities Test), and episodic memory immediate and delayed recall (East Boston Memory Test)] assessed repeatedly (maximum 5 times) 1.5 ± 1 years later over 7.72 ± 4.10 years of follow-up. Results: Higher total HDL-P and smaller HDL size at midlife were associated with a better subsequent immediate recall, delayed recall, and/or processing speed. Greater increase in HDL-PL, apoA-1, medium HDL-P, and total HDL-P and less increase in HDL size over midlife were associated with a better subsequent immediate and/or delayed recall. Conclusion: Enhancing specific serum HDL metrics during midlife could be promising in cognitive restoration, particularly memory, the initial and predominant symptom of Alzheimer's disease.Publication Stories of life during the COVID-19 pandemic: Personal growth among individuals living in the Italian speaking part of Switzerland(2025-06-16)Multiple influences such as climate change, environmental, and social factors, have been increasing the incidence of infectious disease outbreaks. Therefore, it is imperative to understand how people make sense of such events. Our study focuses on 100 Swiss-Italian participants during the initial COVID-19 pandemic wave, investigating how they navigated this period. We collected "Stories of Life," personal narratives about their experience and analyzed them with Thematic Analysis. Results show that over a third of the participants made sense of the pandemic by framing it as a time for personal growth. Our themes illustrated the importance of relationships, resilience, and appreciation of time. These findings align with existing literature on personal growth domains and underscore the significance of relational health in adversity. We discuss personal growth during a pandemic, emphasizing the need to consider socio-demographic characteristics and supportive social contexts, which can create inequalities in circumstances promoting growth.