The aim of this study was to determine Accident and Emergency (A&E) nurses’ perceptions of a structured debriefing programme based on the model of SP Hattingh. Objectives of the research were to train A&E nurses as peer debriefers to be able to implement a structured debriefing programme, to then implement it and finally to determine the debriefed A&E nurses and debriefers’ perceptions of the structured debriefing programme. A contextual, explorative, descriptive research design, using qualitative methodology, was adopted. The population for this study was all registered nurses working in an A&E unit in a private hospital in Gauteng. Three main themes were identified, namely: positive aspects, negative aspects and recommendations for implementation. Recommendations were made to optimise the use of this programme in the future. / Dissertation (MCur (Clinical))--University of Pretoria, 2007. / Nursing Science / MCur / unrestricted

This study examined women's health messages found on ten endometriosis websites. Qualitative research methods were used to investigate messages available via Internet media about causes and treatments of endometriosis, particularly as they relate to the suggestion that hysterectomy and pregnancy are effective treatments. Messages about infertility, physician-patient communication, and accessibility were also examined. Findings indicate that the websites provided similar messages regarding the symptoms, causes, and treatments of endometriosis; results pertaining to infertility were mixed. Little information was available on methods of improving physician-patient communication. Most websites provided additional low-cost information while requiring minimal technological competency or additional software of site patrons. The results of this study have implications for future research in medical science and communication and reflect the importance of research on women's health communication. A detailed discussion of findings and suggestions for further research are offered. The author's own experiences with endometriosis are incorporated into the analysis.

<p>There has been much controversy in the cardiovascular literature regarding sex/gender differences in the presentation of coronary artery disease and downstream implications. The aim of this thesis is not to resolve this controversy, but rather to assess and critique potential sex/gender similarities and differences from a variety of perspectives, explored through various methodologies.</p> <p>This thesis contains four main studies, each employing different quantitative and qualitative methods. An overarching framework was developed to contextualise each study presented in this thesis. The first main study entitled, the “<em>RACE CAR”</em> trial assessed physician opinion <em>prospectively</em> observing that women are perceived to benefit less from cardiac catheterization compared to men, while controlling for age, TIMI risk and preference for cardiac catheterization. The <em>“Identifying women with severe angiographic coronary disease</em>” study observed physician referral patterns <em>retrospectively</em> and determined that although women are less likely to have severe angiographic disease compared to men, the traditional risk factors and CCS Class IV angina are significant predictors of severe angiographic disease. This is an important finding to help physicians better identify women at risk.</p> <p>The findings from these two studies identified the need for the cardiovascular research community to better define angina, particularly among women. Using qualitative methodology, a new theory of angina emerged, illustrating symptoms along a <em>gender continuum</em>. Based on the findings from the qualitative study, the final study of this thesis developed an assessment tool to test the symptom parameters along the <em>gender continuum</em>. The findings confirm that the symptoms of women and men represent more <em>shared experiences</em> rather than differences, particularly among patients with obstructive coronary artery disease.</p> <p>These studies collectively address knowledge gaps and add new information to various stages of patient cardiac care within the sex/gender programme of cardiovascular research.</p> / Doctor of Philosophy (PhD)

Background Mass screening for celiac disease (CD) as a public health intervention is controversial. Before implementation, a suitable screening strategy should be outlined, and the acceptability of the screening scrutinized. Also, the benefits of early detection and possible negative consequences should be explored and compared. The overall aim of this thesis was to evaluate different strategies for finding 12-year-olds with undiagnosed CD in the general population, and to explore the experiences of those receiving the diagnosis in a mass screening. Methods A school-based CD screening of 12-year-olds was conducted in five study sites across Sweden. Out of 10041 children who were invited, 7208 had a blood sample analyzed for CD-marker tissue transglutaminase of isotype IgA (tTG-IgA) and 7161 for total serum IgA (s-IgA). If the s-IgA value was low, tTG-IgG was also measured. Additional analysis of endomysial antibodies (EMA) was performed if borderline values of tTG were found. In total, 192 had elevated CD-markers, 184 underwent a small intestinal biopsy and 153 eventually had CD diagnosed. Before receiving knowledge about their CD status, children and their parents filled in questionnaires regarding symptoms and CD-associated conditions. Questionnaires were returned by 7054 children (98%) and 6294 parents (88%). Later, all adolescents who had been diagnosed with CD more than one year ago (n=145), and their parents, were invited to a mixed-method follow-up study in which they shared their experiences in questionnaires, written narratives and focus group discussions. In total, we have information on 117 (81%) of these adolescents, either from the adolescents themselves (n=101) and/or from their parent/s (n=125). Data were analyzed using a combination of descriptive and analytical quantitative and qualitative methodologies. Results We found that information on symptoms and CD-associated conditions were poor predictors for finding undiagnosed CD in the study population. Questionnaire-based case-finding by asking for CD-associated symptoms and conditions would have identified 52 cases (38% of all cases) at a cost of blood-sampling 2282 children (37% of the study population). The tTG-IgA test had an excellent diagnostic accuracy with the area under the receiver operating characteristic curve of 0.988. If using the recommended cut-off for tTG-IgA (&gt;5 U/mL) 151 had fulfilled biopsy criteria and 134 CD cases had been identified. The strategy of lowering the cut-off to tTG-IgA&gt;4 U/mL, and adding the EMA analysis in those with tTG-IgA between 2-4 U/mL, identified another 17 cases (a 12% increase) at the cost of performing 32 additional biopsies. Measuring total s-IgA in 7161 children discovered only two additional cases at the cost of performing 5 additional biopsies. The positive predictive value of our screening strategy was 80%.  Results from the follow-up study of the screening-detected CD cases illustrated that 54% reported health improvement after initiated treatment, but also that these health benefits had to be balanced against social sacrifices. We also found that although the screening-detected diagnosis was met with surprise and anxiety, the adolescents and their parents were grateful for being made aware of the diagnosis. A majority of parents (92%) welcomed a future screening, but both adolescents and parents suggested that it should be conducted earlier in life. Conclusion Obtaining information on symptoms and CD-associated conditions was not a useful step in finding undiagnosed CD cases in a general population. The serological marker tTG-IgA, however, had excellent diagnostic accuracy also when lowering the cut-off. The diagnosis had varying impact on adolescents’ quality of life, and their perceived change in health had to be balanced against the social sacrifices resulting from the diagnosis. Overall, CD mass screening seemed acceptable to most of those who were diagnosed and their parents.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Cette thèse a pour objet de comprendre la question du mariage forcé vécu par des femmes immigrantes vivant au Québec et, les réponses politiques, législatives et sociales qu’on y apporte. De façon plus spécifique, il s’agit de mettre à jour la diversité des situations et des significations que recouvre la notion de mariage forcé pour tenter d’en dégager des éléments de définition et de compréhension. La thèse vise également à identifier les conséquences spécifiques qui découlent d’un mariage forcé pour les femmes immigrantes vivant au Québec, et enfin, d’analyser les réponses politiques, législatives et sociales visant le mariage forcé au Canada et au Québec afin de prévenir, dépister et d’en protéger ses victimes en contexte interculturel. S’appuyant sur un corpus de dix entrevues avec des femmes immigrantes vivant, ayant vécu ou menacées d’un mariage forcé et de dix-huit informateurs clés intervenant auprès d’elles et provenant de différents milieux de pratique (police, justice, santé services sociaux et communautaires), une analyse intersectionnelle a permis de révéler toute la complexité des mariages forcés due notamment aux interrelations entre des systèmes d’oppression et des vulnérabilités multiples. La recension des écrits et nos résultats indiquent que certains éléments caractérisent les mariages forcés. Premièrement, la préservation de l’honneur patriarcal qui problématise et contrôle le comportement des femmes en ce qui à trait notamment à leur vie sexuelle, mais aussi sociale. Deuxièmement, le fait que le mariage forcé soit un moyen de poursuivre des intérêts plus souvent collectifs qu’individuels. Dimension collective qui devra nécessairement être prise en considération lors des solutions à apporter à cette problématique. Troisièmement, le rôle des femmes (mères, belles-mères et autres femmes de la communauté culturelle d’appartenance) dans l’arrangement des mariages, mais également dans la surveillance et le contrôle de tous les faits et gestes des autres femmes. i Quatrièmement, le potentiel d’agresseurs multiples, y compris la communauté elle-même, dans les actes de violence commis avant, pendant et, le cas échéant, après le mariage. Une autre dimension qui devra elle aussi être prise en compte lors de l’inter- vention. Cinquièmement, le potentiel d’exploitation sexuelle (viol conjugal, grossesses forcées), physique (mauvais traitements, blessures), psychologique (pressions, manipulations) ou encore économique (travail forcé, privation d’autonomie financière). L’ensemble de ces résultats a permis de cerner certains besoins liés à l’intervention, en terme de prévention, de dépistage et de protection des victimes de mariage forcé. / This thesis aims to understand the issue of forced marriage experienced by immigrant women living in Quebec and the political, legislative and social responses. More specifically, it is to demonstrate the diversity of situations and meanings covered by the concept of forced marriage in an attempt to identify elements of definition and understanding. The thesis also aims to identify the specific consequences of forced marriage for immigrant women living in Quebec, and to analyze the political, legislative and social responses to forced marriage in Canada and Quebec in order to prevent, detect and to protect victims in an intercultural context. Based on ten interviews with immigrant women living, having lived or under the threat of forced marriage and eighteen key informants involved with them and coming from various practice settings (Police, Justice, Health and Social services, Community organizations), an intersectional analysis has revealed the complexity of forced marriages due to the interrelations between various systems of oppression and multiple vulnerabilities. The literature and our results indicate that certain elements characterize forced marriages. Firstly, the preservation of the patriarchal honor that problematizes and controls women’s behaviour, relating in particular to their sexual life as well as their social life. Secondly, the fact that forced marriage is more often a way to pursue collective interests instead of individual ones. This collective dimension will necessarily be taken into account in solutions to this problem. Thirdly, the role played by women (mothers, stepmothers and other women from the same ethnic community) in the marriage arrangements, but also in the surveillance and control of all the comings and goings of other women. Fourthly, the potential of multiple perpetrators, including the community itself, involved in violent acts before, during and sometimes after the wedding is another dimension which must also be taken into account during the intervention. iii Fifthly, the potential for sexual exploitation (marital rape, forced pregnancies), physical violence (bodily harm), psychological violence (pressures, manipulation) or economic violence (forced labor, deprivation of financial autonomy). All these results helped to identify some needs in terms of prevention, screening and protection of forced marriage victims.

The main objective of the present thesis is an effort to understand better how Czech women construct their views on feminism and what factors of Czech distance from feminism are, which is clearly visible in the post-1989 era. The thesis starts with the description of feminism, its development and inner differentiation. Then the author focuses on development and current situation in the Czech Republic, which is specific for its historically contingent connotation. The following section presents the analytical results of the qualitative research. By applying the technique of semi-structured interviews, the author brings up the questions of how Czech women perceive and understand feminism and how do they interpret the current situation of women. One of the main objectives of the empirical part was also to find out whether it is possible to apply Aronson's typology of feminism of the situation in the Czech Republic. Due to the specificity of the Czech environment, the author comes to the conclusion that there can be identified four different approaches to feminism. Within this framework, the analysis of interviews led to identification of several important factors that affect the construction of feminist consciousness among Czech women.

La thèse s’intéresse aux enjeux méthodologiques présents en situation d’enquête de terrain. Les enquêtes qualitatives réalisées dans le cadre de cette recherche visaient à explorer un trouble de santé. L’enquête portant sur le trouble du ballonnement met notamment en avant le jeu interactionnel entre enquêtée et enquêtrice, et fait apparaître les concepts de stigmate et de secret. L’analyse des interactions sociales entre ces deux acteurs invite à percevoir l’enquête comme un processus au sein duquel différentes phases se déclinent et interagissent ensemble. A partir du recrutement jusqu’à la clôture du terrain, les effets de l’enquête sont observés et analysés à travers le double regard de l’enquêtrice et de l’enquêtée. Nous qualifions cette démarche méthodologique d’ « observation interactive », puisant ses fondements au sein de la méthode d’observation participante et de la tradition de l’interactionnisme symbolique. Une réflexion est également menée sur les effets de réciprocité entre l’élaboration de stratégies d’enquête et le déroulement de l’enquête soumise à l’imprévisibilité du terrain. / This thesis concerns methodological matters existing in the situation of fieldwork. Here the qualitative survey realized in the frame of this research was to explore minor health issues. The survey conducted on bloating issue does notably shed light on the ‘interactional game’ between a female interviewee and a female interviewer revealing the key concepts of stigma and secrecy. Indeed, the analysis of social interactions between both actors incites to perceive the notion of fieldwork as a process where different phases decline and interact altogether. From the recruitment procedure to the closure of the survey, the effects of the investigation are observed and analyzed through a dual “eye”, the interviewee and interviewer. We qualify this methodological approach as “interactive observation”. This “interactive observation” feeds its very principle within the methodology relative to the ideas of participative-observation and the tradition of symbolic interactionism. A reflection is lead on the effects of reciprocity between the elaboration of the fieldwork’s strategies and the unfolding of the study submitted to the unpredictability of the fieldwork.

Magister Artium - MA (Psychology) / Psychological distress during pregnancy has been a fairly neglected phenomenon and has only recently started emerging as an area of research interest. The existing body of scholarship on distress during pregnancy has largely been conducted from a positivist paradigm, emphasising the identification, incidences and risks. There is thus a dearth of qualitative inquiry into pregnant women's experiences and accounts of distress. In an attempt to address these gaps within the literature, my study explored psychological distress among a group of pregnant women from socio-economically disadvantaged contexts. The specific objectives of my study was to explore how pregnant women conceptualised psychological distress within the context of pregnancy; the feelings or symptoms of psychological distress; what pregnant women perceived as its causes; and the psychosocial needs of pregnant women in relation to antenatal distress. This study was guided by a feminist approach and a feminist standpoint epistemology in particular. This lent itself to exploring the phenomenon while departing from a clinical, decontextualised position which translated into an investigation with pregnant women who subjectively perceived themselves to be distressed.

Magister Artium - MA (Psychology) / Psychological distress during pregnancy has been a fairly neglected phenomenon and has only recently started emerging as an area of research interest. The existing body of scholarship on distress during pregnancy has largely been conducted from a positivist paradigm, emphasising the identification, incidences and risks. There is thus a dearth of qualitative inquiry into pregnant women's experiences and accounts of distress. In an attempt to address these gaps within the literature, my study explored psychological distress among a group of pregnant women from socio-economically disadvantaged contexts. The specific objectives of my study was to explore how pregnant women conceptualised psychological distress within the context of pregnancy; the feelings or symptoms of psychological distress; what pregnant women perceived as its causes; and the psychosocial needs of pregnant women in relation to antenatal distress. This study was guided by a feminist approach and a feminist standpoint epistemology in particular. This lent itself to exploring the phenomenon while departing from a clinical, decontextualised position which translated into an investigation with pregnant women who subjectively perceived themselves to be distressed.