UMD Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/3
New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a given thesis/dissertation in DRUM.
More information is available at Theses and Dissertations at University of Maryland Libraries.
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Item Clinical Practice in Prenatal Care: Perspectives of Latina Mothers, Healthcare Providers, and Scientists on Male Circumcision(2015) Colon-Cabrera, David; Freidenberg, Judith N; Anthropology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study examines how the interplay between biomedical and ethnomedical perspectives impacts on reproductive health services and consumer decision to circumcise among Latinos in Prince Georges County, Maryland. International research influenced circumcision decision-making during prenatal care: little is known about how neonatal male circumcision (MC) is understood at local clinics; about what patients and providers know regarding circumcision benefits; and the reasoning behind the choices made regarding MC among Latinos. What are the beliefs, practices, and policies regarding MC at community clinics and the international research that influences these policies? Ethnographic research was conducted in three clinics in the state of Maryland including participant observation in the clinics, and interviews with healthcare providers, Latina women who sought services, and scientists and policy makers currently active in MC research. The study explored the interplay between biomedical and ethnomedical knowledge of prenatal care services. Interviews were also conducted with six scientists and policy makers currently active in MC research. The study found that as a reproductive health procedure MC illustrated a complex interplay between biomedical and consumer knowledge. Specifically, healthcare providers did not talk about MC to patients mainly because: 1) They thought that the majority of the Latina women seeking services did not want the procedure; 2) The clinics are constrained for resources and circumcision is not a priority when compared to other prenatal care topics deemed more important in the short prenatal visits. In addition, the policy makers and scientists made assumptions referring to the discussion of circumcision by reproductive and sexual health services clinics when providing prenatal care to clients. Their knowledge relied exclusively on the results of clinical trial data, and how this data could inform policy and clinical guidelines. This dissertation contributes to understanding how services impact MC decision-making and increase the pool of data in regards to the feasibility of overarching MC policies aimed at infants. In addition, this research recommends to critically examine MC as a biomedical practice that is now being rationalized as an HIV prevention strategy.Item The Association Between Inadequate Gestational Weight Gain and Infant Death Among U.S. Infants Born 2004-2008(2012) Davis, Regina R.; Hofferth, Sandra L.; Shenassa, Edmond; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Infant mortality is of great public health importance and its prevalence is often used as a summary indicator of a population's reproductive health status. Programmatic and policy focus on prematurity and birth weight stems largely from their known relationship to infant mortality and morbidity. A large body of literature exists linking poor gestational weight gain to prematurity and low birth weight, but its association with infant mortality is less well understood. Few nationally representative studies have examined infant death as an important pregnancy outcome of inadequate gestational weight gain and even fewer have explored its psychosocial and demographic correlates.
As a measure of healthy gestational weight gain, the Institute of Medicine (IOM) published guidelines which provide a recommended weight gain for each category of pre-pregnancy Body Mass Index (BMI). Informed by the Biomedical and Biopsychosocial models, this study examined the association between the IOM measure of inadequate gestational weight gain and risk of infant mortality by conducting secondary analyses of the 2005 Birth Cohort Linked Birth-Infant Death Data File (Cohort Linked File) and Phase 5 of the Pregnancy Risk Assessment Monitoring System (PRAMS). An analysis of 160,011 women who participated in PRAMS between 2004 and 2008 was used to replicate the IOM guidelines and examine the link between gestational weight gain and risks of infant mortality within four months of birth. The PRAMS dataset was also used to analyze the association between maternal pre-pregnancy BMI, weight gain, and infant death, as well as the influence of maternal stress on gestational weight gain. A separate analysis of 2,046,725 infants in the 2005 cohort linked file was conducted to quantify the risk of infant death associated with inadequate gestational weight gain as well as cause-specific mortality. Results from logistic and proportional hazards regression analyses suggest there is a substantial and significant association between inadequate gestational weight gain and infant death; however weight gain beyond the recommended amount may be protective. Inadequate gestational weight gain was associated with infant death from disorders relating to short gestation, fetal malnutrition, respiratory conditions, and birth defects. Receipt of adequate prenatal care was protective against inadequate gestational weight gain, but a positive association was not found between inadequate gestational weight gain and maternal stress. Implications for public health programs, policy, and future research are presented.