Person:

Lee, Mihan

Infertility is a common problem in the US, affecting approximately 1 in 8 couples of childbearing age, or over 7 million women nationwide. But while infertility affects women from across the socio-economic spectrum, it is by no means egalitarian in its distribution, nor uniform in its lived experience. Rather, evidence shows significant disparities by race, income, and educational status, in terms of overall prevalence of infertility, drivers and underlying causes of infertility, access to infertility services, and success rates after receiving infertility treatments.

This dissertation seeks to examine some of the specific mechanisms and pathways by which these disparities arise and persist. First, I report findings from a document review of online reproductive health materials, concluding that information about the risks of infertility is differently available and targeted to different sectors of the population. This can lead to disadvantaged women having less information about strategies to prevent infertility, as well as being less likely to have symptoms of an infertility-causing condition diagnosed and treated in a timely way. The second paper builds upon and extends these hypotheses, investigating through key informant interviews how such targeted provision of infertility information comes to affect lived patient experiences of infertility. Finally, the third paper examines disparities in the way patients find and receive social support during an infertility journey. It undertakes a “cyber-ethnography” of an online infertility patient forum, examining how the forum’s discourse produces dominant and counter narratives of infertility, and enforces categories of belonging that impact how support is offered to users of the site.

Pediatric radiologists play a key role in the detection of child abuse, through the identification of characteristic fracture and injury patterns. Emergency radiologists have the potential to play an equally important role in the detection of elder physical abuse; however, existing literature shows that they currently play little to no part in this effort. We sought to examine the role of radiologists in the detection of physical elder abuse, and potential strategies to expand and optimize this role, by interviewing experienced health care providers who confront abuse at both ends of the age spectrum. Interviews were conducted with attending faculty from the fields of Emergency Radiology, Pediatric Radiology, Emergency Medicine, Geriatrics, and Pediatrics. Interviews explored subjects’ clinical experience with child/elder abuse; training received on abuse detection; common mechanisms of injury and imaging findings; and communications between radiologists and frontline, referring clinicians. Interviews were transcribed and coded using qualitative content analysis. Of 51 physicians contacted, 25 agreed to be interviewed, for a response rate of 49%. Interviewees included 7 emergency radiologists, 5 pediatric radiologists, 4 EM physicians, 5 geriatricians, and 4 pediatricians. 4 main themes, 3 sub-themes, and 2 minor themes emerged from data analysis. First, most radiologists reported never having read a case of suspected elder abuse, nor having received any specific training on the subject. This stood in stark contrast to the rigor with which child abuse is taught in radiology curricula. Physicians across disciplines agreed that the high prevalence of falls in the elder population, as well as common co-morbidities like osteoporosis and demineralization, posed significant obstacles to characterizing specific imaging correlates for elder abuse. One key child abuse detection strategy, the recognition of fractures inconsistent with reported mechanism, was noted to be applicable to elder abuse. For this reason, patient history and clinical context, including full information about injury mechanism and functional status, were deemed critical to radiographic interpretation of elder trauma. Importantly, communication of this information to radiologists was identified as a significant gap in current practice. Improvement in communication between clinical teams has the potential to lead to a more rigorous and effective abuse detection framework.