Excessive screen time among children and adolescents has been associated with physical inactivity, obesity, bullying, sleep disorders and risky sexual behaviors. However, the relation between screen time and different types of high-risk sexual behaviors has not been well explored. The aim of this study was to determine the impact of screen time, (defined as watching television 3 or more hours per day, or playing video or computer games or using a computer 3 or more hours per day) on high-risk sexual behaviors:- early onset of sexual intercourse before the age of 13 years, having sexual intercourse with four or more sexual partners within the last 3 months, alcohol consumption or drug abuse before the last sexual intercourse, or unprotected intercourse without male or female condom use. Methods: Data from the 2015 Youth Risk Behavior Surveillance System (YRBSS), a national survey representative of 9th through 12th grade students in public and private schools in the United States was used. Logistic regression analysis was conducted to determine the association between the predictor variables and the different high-risk sexual behaviors. The model was adjusted for age, sex, and race. Out of 15,624 respondents, about a third (5,770) reported having had “high-risk” sexual intercourse. Results: Analysis showed that students (9th -12thgrade) who watched television 3 or more hours per day were 49% more likely to have been sexually active before the age of 13 years (aOR: 1.49, 95% CI: 1.23-1.80, p Conclusion: The study findings suggest that watching television 3 or more hours per day is more significantly associated with high-risk sexual behaviors than playing video or computer games or using a computer 3 or more hours per day. More research might need to be conducted to determine the ‘protective effect’ of screen time with video or computer games and computer use. In addition, parents, caregivers and all stakeholders should ensure screen time be limited toyouths.

Pregnancy induces maternal metabolic adaptations including mild glucose intolerance and weight gain in order to support fetal development and lactation. Adipose tissue (AT) function in gestation is featured by reduced insulin sensitivity and fat mass accrual which partly accounts for the weight gain in pregnant women and adaptation of glucose metabolism. A common metabolic pregnancy complication is gestational diabetes mellitus (GDM), a disease characterized by impaired glucose tolerance with onset in gestation. However, the relationship between AT expandability and glucose metabolism in gestation is not well understood. The goal of this thesis was to investigate the adaptations of human AT expansion induced by pregnancy, how these changes are reflected in pregnancies complicated with GDM and characterize a mouse model to study the mechanisms underlying this disease. This dissertation illustrates that pregnancy promotes AT expandability by a signaling mechanism between placental pregnancy-associated plasma protein-A (PAPP-A) and AT- insulin-like growth factor binding protein-5 (IGFBP5). In addition, gravidas with GDM showed impaired AT expansion. Studies investigating the relationship between PAPP-A and glycemic state demonstrated that low levels of PAPP-A in the 1sttrimester are highly associated with the development of GDM. Moreover, PAPP-A knockout mice exhibit reduced insulin sensitivity and impaired AT growth exclusively in gestation. These results expand the knowledge of AT biology in gestation and have the potential to improve maternal care by proposing PAPP-A as an early biomarker and possible therapeutic for GDM. It also introduces a new mouse model to study the etiology of gestational diabetes.

Background: Symptomatic knee osteoarthritis (OA) is an incurable condition that affects nearly 50% of adults, and women are twice as likely as men to develop OA. Throughout pregnancy, women experience large changes in morphology and gait mechanics, as well as changes in joint loading. It is possible these adaptations could cause lasting changes postpartum, which may potentially contribute to initiation of OA, thereby increasing the overall risk of OA for women. Purpose: This exploratory study looked to identify differences between lower limb gait mechanics of healthy nulliparous women and healthy parous women. Methods: 28 healthy female participants (14 parous, 14 nulliparous) were recruited for the study. Nulliparous participants had never given birth to a child, and were self-reported not pregnant. Parous participants had given birth to at least one full term infant (37 – 42 weeks) without complications between one to five years before data collection. Kinematic and kinetic data was collected for the lower body, using motion capture and in-ground force plates. Participants completed one quiet standing trial, and walked over-ground through the motion capture space at their preferred, fast, and set walking speeds (1.4 m/s). An ANOVA was performed to test if there were significant differences in between groups. Results: Q angle did not differ between groups. There was a significant main effect of group indicating a larger knee flexion angle at toe off (p = 0.060), smaller knee extension moment at heel strike (p = 0.0006), smaller first peak knee flexion moment (p = 0.040), and smaller peak hip adduction moment for the parous group compared to the nulliparous group (p = 0.003). Conclusions: Our data revealed a decrease in the moments experienced, which could possibly lead to degradation of cartilage due to under loading of the joint. We think this may be an indication that pregnancy could increase risk of OA, and therefore more research into this possibility is warranted.

Congenital Adrenal Hyperplasia (CAH) encompasses several disorders related to disruptions in the adrenal steroid production pathway. These disruptions may cause virilization of the external female sex organs, incorrect gender assignment, precocious puberty, and in the most severe form, may cause life-threatening salt wasting and adrenal crisis if not detected and treated early in the newborn period. 17α-Hydroxyprogesterone (17-OHP) is the primary target for immunofluorescence detection of CAH from dried blood spots in newborn screening (NBS). Unfortunately, current immunoassay techniques for the detection of CAH suffer from high false positive rates. The primary factors contributing to false positive determinations can include the natural increase of 17-OHP due to stress stimuli as well as cross-reactivity of the immunoassay antibody with other hormones and endogenous compounds in blood. Analysis of the adrenal steroid profile and corresponding analyte ratios using high performance liquid chromatography (HPLC)or ultra-high pressure liquid chromatography (UHPLC)combined with tandem mass spectrometry (MS/MS) has been shown to be a sensitive and selective technique for the significant reduction of the false positive reporting rate for CAH in newborn screening. In working toward optimization, validation, and implementation of an HPLC-MS/MS steroid profile for use by Virginia’s Newborn Screening laboratory as a 2nd tier analysis for CAH screening, a commercially-available core-shell HPLC column with a biphenyl stationary phase was determined to offer adequate retention and selectivity to achieve baseline resolution of isobaric target analytes under rapid reversed phase gradient conditions. Method linearity, precision, and accuracy were assessed using enriched dried blood spot materials. Double-blinded analyses of over 300 newborn dried blood spot specimens were used to determine clinical sensitivity and specificity of the assay, which is projected to substantially reduce the false positive reporting rate for CAH screening while meeting target sample turnaround times.

Background Buprenorphine is a semi-synthetic opioid used for the treatment of opioid dependence. Opioid use, including buprenorphine, has been increasing in recent years, in the general population and in pregnant women. Consequently, there has been a rise in frequency of neonatal abstinence syndrome (NAS), associated with buprenorphine use during pregnancy. The purpose of this study was to investigate correlations between buprenorphine and buprenorphine-metabolite concentrations in cord blood and onset of NAS in buprenorphine exposed newborns. Methods Nineteen (19) newborns who met inclusion criteria were followed after birth until discharge in a double-blind non-intervention study, after maternal consent. Cord blood and tissue samples were collected and analyzed by liquid chromatography–mass spectrometry (LC–MS) for buprenorphine and metabolites. Simple and multiple logistic regressions were used to examine relationships between buprenorphine and buprenorphine metabolite concentrations in cord blood and onset of NAS, need for morphine therapy, and length of stay. Results Each increase in 5 ng/ml level of norbuprenorphine in cord blood increases odds of requiring treatment by morphine 2.5 times. Each increase in 5 ng/ml of buprenorphine-glucuronide decreases odds of receiving morphine by 57.7 %. Along with concentration of buprenorphine metabolites, birth weight and gestational age also play important roles, but not maternal buprenorphine dose. Conclusions LC–MS analysis of cord blood concentrations of buprenorphine and metabolites is an effective way to examine drug and metabolite levels in the infant at birth. Cord blood concentrations of the active norbuprenorphine metabolite and the inactive buprenorphine-glucuronide metabolite show promise in predicting necessity of treatment of NAS. These finding have implications in improving patient care and reducing healthcare costs if confirmed in a larger sample.

Opioid Use Disorder is defined by the NIH as “the chronic use of opioids that causes clinically significant distress or impairment.”1 Due to a number of factors, the overuse of opioids has become an epidemic in the United States. In recent years there have been a number of lawsuits against pharmaceutical companies and other parties who have benefitted from the proliferation of this issue. In most cases, it is up to the states or local governments who receive these funds to determine their best use. The purpose of this Thesis is to analyze the resources recommended by Ballad Health’s Community Health Needs Assessments, and five additional panels of experts in this field, and to compare these recommendations with available resources, along with making recommendations for the distribution and use of funds coming from a number of lawsuits and settlements.

Background: Mothers’ diets impact their health and the health of their children, but diet quality is suboptimal among women with young children. Evening snacking among women with young children, especially consumption of high-calorie, high-carbohydrate snacks, may impact overall diet quality and glucose metabolism. Short sleep duration and poor sleep quality may be potential risk factors. We examined whether sleep duration and poor sleep quality were associated with diet quality and evening snacking among women with young children. Methods: Data were from the National Health and Nutrition Examination Survey (NHANES) 2005-2012, nationally representative cross-sectional surveys of noninstitutionalized U.S. population. Eligible participants were non-pregnant women aged 20-44 years within 5 years of childbirth who completed two 24-hour dietary recalls and completed questions on sleep duration and quality. Results: Among US women with young children, sleep duration was not associated with diet quality. However, overall sleep quality was associated with poorer diet quality. Short sleep duration was not associated with the consumption of neither evening snacks, nor energy intake from or nutrient consumption of evening snacks. Conclusion: The findings of this dissertation provide information useful for informing the direction of future research of dietary quality and eating behaviors of U.S. women with young children. Studies are needed to explore whether improvement in sleep quality may improve diet quality among women with young children, which has the potential to improve both maternal and children’s health. Research may be better focused on identifying other psychosocial and behavioral risk factors for unhealthy dietary behaviors among US women with young children.

Depression is the leading cause of disability among women of reproductive age worldwide. Upwards of 1 in 5 women suffer from perinatal depression. This condition has deleterious effects on several birth outcomes, infant attachment, and children’s behavior/development. Maternal suicide causes 20% of postpartum deaths in depressed women. Although the vast majority of perinatal women are amenable to being screened for depression, screening alone does not improve treatment rates or patient outcomes. Obstetrics/Gynecology (Ob/Gyn) clinics need supports in place to adequately address depression in their patient populations. The primary goal of this thesis is to develop, refine, and pilot test a new low-cost and sustainable stepped care program for Ob/Gyn clinics that will improve perinatal women’s depression treatment rates and outcomes. We developed and beta tested the Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID) Program, to create a comprehensive intervention that is proactive, multifaceted, and practical. RAPPID aims to improve perinatal depression treatment and treatment response rates through: (1) access to immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers; (2) clinic-specific implementation of depression care, including training support and toolkits; and (3) proactive depression screening, assessment, and treatment in OB/Gyn clinics. RAPPID builds on a low-cost and widely disseminated population-based model for delivering psychiatric care in primary care settings. Formative data and feedback from key stakeholders also informed the development of RAPPID. Our formative and pilot work in real-world settings suggests RAPPID is feasible and has the potential to improve depression detection and treatment in Ob/Gyn settings. The next step will be to compare two active interventions, RAPPID vs. enhanced usual care (access to resource provision/referrals and psychiatric telephone consultation) in a cluster-randomized trial in which we will randomize 12 Ob/Gyn clinics to either RAPPID or enhanced usual care.

This study aimed to assess and compare the visual perceptual, visual motor integration and motor abilities of infants weighing less than 1250 grams at birth and a matched group of normal full birth weight controls at the age of five to six years. The group of infants with birth weights below 1250 grams were born during the period July 1988 to June 1989 at Groote Schuur Hospital (GSH), Cape Town or in midwife obstetric units in the Peninsula Maternal and Neonatal Service (PMNS) and referred to the neonatal intensive care unit at GSH. The very low birth weight (VLBW) infants were assessed at 1 and 2 years of age in 1989 & 1990. The present study was part of a broader study that included the examination of developmental outcome of these infants, using the Griffith's Mental Development Scale (Griffith's). The study recognised the complex interaction of biological and environmental factors and their influence on development and attempted to describe the confounds that may have influenced outcomes. The VLBW children were shorter in stature than their full birth weight counterparts. They were also significantly lighter and had smaller head circumferences. Psychometric evaluation with the Griffith's showed the VLBW children to fall predominantly in the normal range, though their performances were significantly inferior to that of the full-term children. The greatest differences between the groups were in scores for the subscales performance and practical reasoning of the Griffith's. Visual perception, visual motor integration, fine motor skill and gross motor function were all significantly poorer in the VLBW children. There was no correlation within the VLBW group between the test results and birth weight, gestational age, growth status, neonatal hospital stay or social status.

This dissertation reports on an evaluation of the home visiting programme of the SACLA Rehabilitation Worker project against the background of the socio-economic context of the community and the history of the project. The evaluation had two aims. Firstly, it aimed to highlight the programme's strengths and weaknesses so that the work could become both more efficient and more effective. Secondly, it aimed to establish whether the SACLA rehabilitation project is an effective model of a community based rehabilitation project on which other local projects could be based. Quantitative data was collected by interviewing the caregivers of disabled children who were involved in the project. In-depth interviews with the rehabilitation workers provided qualitative data which was used to confirm the validity of some of the quantitative data. The foremost findings were that the mothers were very positive about the support received from the RWs. The majority of the caregivers remembered the activities that they had been taught by the RWs and performed them well. Poor communication with the caregivers and a lack of skills on the part of the RWs gave rise to a number of problems. A number of changes highlighted by the evaluation were suggested. In conclusion, the project was found to be an effective model of local community based rehabilitation on which other projects could be based.