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Musculoskeletal trauma including fractures, represents a significant burden of disease for Low- and Middle-Income Countries (LMICs). Within LMICs, women possess reduced agency to make health care decisions and represent a vulnerable population. In this thesis, I aimed to characterize priority fractures among women within LMICs, and investigated whether women were delayed in hospital admission following an orthopaedic trauma. In Chapter 1, I introduce and review the existing literature on injury burden, health care deficiencies, and gender inequities within LMICs. In Chapter 2, we analyzed regional distributions of fracture burdens across 9,934 female orthopaedic trauma patients across 17 LMICs. Half of our study patients were ≥ 60 years old. We determined that the major burden of orthopaedic trauma among women within LMICs were fractures among the elderly. Fracture burden in Africa was notably different. A majority of patients were between the ages 18-59, and common fractures included tibia/fibula and femur fractures. In Chapter 3, we analyzed 26,910 orthopaedic trauma patients across 17 LMICs to determine whether women were delayed in hospital admission by >24 hours. After controlling for confounds, sex was not a significant predictor of delay. We found that instead, the severity and type of fracture influenced the delay of patient’s hospital admission. Closed fractures, falling-related injuries, pelvic, spine and hip fractures were associated with increasing delay. Irrespective of sex and region, inter-hospital referrals accounted for nearly half of the reasons patients were delayed. These two chapters highlight regional trends in orthopaedic burden sustained by women, pointing to the high frequency of fragility fractures. In addition, this thesis identifies critical gaps within LMICs’ health care systems infrastructure, demonstrating the need for improved hospital referral systems and ambulatory services. This analysis will enable policymakers, and future researchers to target interventions to address the rising global burden of injuries especially among women. / Thesis / Master of Science (MSc) / Fractures represent life-threatening injuries within Low- and Middle-Income Countries (LMICs), and globally are a top-ten leading cause of death and disability. Within LMICs, due to gender inequalities, women may be restricted from receiving hospital care following an injury. We investigated the most common types of fractures in women within LMICs and determined that women most frequently experienced fractures due to old age. We further examined whether women were delayed in reaching a hospital after sustaining a fracture, and found that sex did not significantly play a role in determining delay. Instead, injury associated factors, such as the type and severity of the fracture influenced whether a patient was delayed. In addition, transferring patients between hospitals was the most common reason for delay. As a result, policymakers in LMICs should explore strategies to treat the high burden of fractures in the elderly and improve communication between hospitals to reduce delays.

Background Postpartum depression (PPD) is a major public health challenge and associated with poor maternal and infant health outcomes. Quality prenatal care decreases adverse outcomes in pregnancy and may reduce PPD risk factors. This study critically reviews the evidence about the role of prenatal care practices in reducing PPD prevalence across population groups and examines the association between prenatal care timing and counseling content with PPD prevalence. Methods A scoping review was completed across eight databases to synthesize evidence about prenatal care and PPD across different contextual settings. National data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was used to examine the research questions. The key outcome was PPD symptoms as self-reported by postpartum women. Key independent variables were timing and content of prenatal care. Bivariate analyses used chi-square and t-tests, as appropriate, and a logistic regression analysis examined associations at the multivariable level while accounting sociodemographic characteristics, history of depression, and interaction effects. An issue brief was developed, triangulating findings from the scoping review and quantitative analysis. Results Forty-five studies were analyzed as a part of the scoping review and identified a strong association between robust prenatal care that included education about depression and increased awareness of PPD prevention among pregnant women. In the PRAMS analysis, women with a history of depression (aOR: 2.87; 95% CI: 2.74, 2.99) and those who initiated prenatal care in the third trimester or had no prenatal care (aOR: 1.54; 95% CI: 1.21, 1.85) had higher odds of PPD. Women who were not asked about depression during prenatal care had higher odds of PPD (aOR: 1.26; 95% CI: 1.21, 1.32). Women who were Asian, Black, and asked less than five questions on health-related topics during prenatal care were more likely to report PPD symptoms. Conclusion Blending education and counseling into routine prenatal care for pregnant women will increase awareness of depression, thereby preventing PPD. Prenatal care should, therefore, be accompanied by evidence-based systems for counseling, education, diagnosing, treatment, and referral of perinatal depression. To optimize the health of women, prenatal care should provide services and support tailored to each woman's needs.

Intimate partner violence (IPV), substance use, and HIV are syndemic and have compounding risks that contribute to the collective physical and mental health burden among women in the United States. These syndemic factors may contribute to the significant gender-related disparities in substance use disorder (SUD) treatment. IPV is a source of stress and trauma for women, with known interactions with SUD; however, SUD services generally lack trauma-informed treatment modalities to address IPV-related health impacts. The goal of this dissertation was to improve the understanding of the associations between IPV, substance use behaviors, and SUD treatment utilization, and to inform the response to women’s needs related to IPV experiences and substance use within healthcare settings. We employed a mixed-methods approach to understand the interplay of IPV with subsequent substance use behaviors and utilization of SUD services, along with identifying differences by HIV status. We used quantitative methods to evaluate the association of specific forms of IPV (psychological, physical, and sexual) with subsequent substance use (Chapter 2) and SUD service utilization (Chapter 3), and qualitative methods to explore women’s perspectives on how IPV experiences influenced their substance use behaviors and SUD treatment and recovery (Chapter 4). The study in Chapter 2 found that incident IPV experiences were associated with increased risk of subsequent substance use, with physical IPV being more consistently associated than other IPV forms. The study in Chapter 3 found recent IPV experiences to be associated with increased SUD service utilization, whereas lifetime IPV experiences were associated with decreased utilization. Both quantitative studies highlight the complex relationship between IPV and substance use and SUD service utilization. This relationship varies by IPV form, with the syndemic interaction of IPV and HIV exacerbating adverse outcomes. In Chapter 4, qualitative findings explained mechanisms of IPV’s contribution to substance use behaviors and impediment of SUD service engagement and recovery. The interviews also highlighted the value of mental health and IPV supportive services, along with SUD treatment, for a successful SUD recovery. Overall, the findings of this dissertation emphasize the importance of using a trauma-informed approach to address IPV to facilitate women’s SUD recovery. / 2026-05-16T00:00:00Z

The Catholic Church is one of the largest providers of medical care in the US, with 1 in 6 acute-care beds residing in a Catholic hospital. One third of these hospitals are in rural or underserved areas in the US, and advocacy for the vulnerable is a central platform of the Catholic Healthcare Association. Despite this, the Church has been under attack for allegedly putting women at risk of injury or death due to the care restrictions concerning reproductive health stipulated in the Ethical and Religious Directives (ERDs). Additionally, scholars are questioning the distinctiveness of the Catholic healthcare mission in practice, pointing to the increased homogenization of Catholic and non-Catholic hospitals. For these reasons, it is necessary to assess if and how women are being harmed in Catholic hospitals and, if there is harm being done, if there is a way to prevent these harms while preserving the Catholic Social Tradition in medicine. In carrying out this assessment, I read the current literature closely to explore both the origins and the practical consequences of these ethical conflicts. Subsequently, I use Chris Durante's "pragmatic perspectivism" to formulate a proposal that considers both Catholic medical ethics and secular medical ethics on the same plane. The proposal suggests the adoption of an alternative and complementary lens for Catholic health care. Using this framework would allow the Church to pursue its health care mission in a fuller sense, unencumbered by the inertia of the medical industry towards homogenization due to legal and economic pressures. It also provides the potential for Catholics to more easily receive Catholic care in all hospitals, not just those under Catholic sponsorship. Importantly, it would also prevent any American woman from being practically forced to receive Catholic care, circumventing many of the ethical conflicts present in the current system.

This research presents a framework for enhancing and analyzing time-sequenced mammographic images for detection of cancerous tissue, specifically designed to assist radiologists and physicians with the detection of breast cancer. By using computer aided diagnosis (CAD) systems as a tool to help in the detection of breast cancer in computed tomography (CT) mammography images, previous CT mammography images will enhance the interpretation of the next series of images. The first stage of this dissertation applies image subtraction to images from the same patient over time. Image types are defined as temporal subtraction, dual-energy subtraction, and Digital Database for Screening Mammography (DDSM). Image enhancement begins by applying image registration and subtraction using Matlab 2012a registration for temporal images and dual-energy subtraction for dual-energy images. DDSM images require no registration or subtraction as they are used for baseline analysis. The image data are from three different sources and all images had been annotated by radiologists for each image type using an image mask to identify malignant and benign. The second stage involved the examination of four different thresholding techniques. The amplitude thresholding method manipulates objects and backgrounds in such a way that object and background pixels have grey levels grouped into two dominant and different modes. In these cases, it was possible to extract the objects from the background using a threshold that separates the modes. The local thresholding introduced posed no restrictions on region shape or size, because it maximized edge features by thresholding local regions separately. The overall histogram analysis showed minima and maxima of the image and provided four feature types--mean, variance, skewness, and kurtosis. K-means clustering provided sequential splitting, initially performing dynamic splits. These dynamic splits were then further split into smaller, more variant regions until the regions of interest were isolated. Regional-growing methods used recursive splitting to partition the image top-down by using the average brightness of a region. Each thresholding method was applied to each of the three image types. In the final stage, the training set and test set were derived by applying the four thresholding methods on each of the three image types. This was accomplished by running Matlab 2012a grey-level, co-occurrence matrix (GLCM) and utilizing 21 target feature types, which were obtained from the Matlab function texture features. An additional four feature types were obtained from the state of the histogram-based features types. These 25 feature types were applied to each of the two classifications malignant and benign. WEKA 3.6.10 was used along with classifier J48 and cross-validation 10 fold to find the precision, recall, and f-measure values. Best results were obtained from these two combinations: temporal subtraction with amplitude thresholding, and temporal subtraction with regional-growing thresholding. To summarize, the researcher's contribution was to assess the effectiveness of various thresholding methods in the context of a three-stage approach, to help radiologists find cancerous tissue lesions in CT and MRI mammography images.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work