A growing body of literature suggests that healthy and well-nourished women can safely participate in most forms of physical activity during pregnancy. In addition, participation in physical activity during pregnancy may have potential health benefits, such as reducing the risk of gestational diabetes mellitus. These potential benefits are reflected in a recent opinion issued by the American College of Obstetricians and Gynecologists (ACOG), in which women without medical or obstetric complications are recommended to accumulate 30 minutes or more of moderate intensity physical activity on most, if not all, days of the week. Despite these recommendations, little is known concerning current patterns of physical activity among pregnant women. The first study of this dissertation addressed this limitation by providing estimates of the frequency, intensity, and duration of commonly performed activities during pregnancy among a racially and economically diverse sample of women receiving prenatal care. Comprehensive 24-hour recalls were used to measure physical activity in all activity domains and the factors associated with activity were identified. The second study in this dissertation evaluated the reliability and validity of the Kaiser Physical Activity Survey (KPAS) when used to assess pregnancy physical activity. The KPAS assesses all domains of physical activity and is more practical than 24-hour recalls to measure activity in large epidemiologic studies. These results suggest that the KPAS is a reliable and reasonably accurate instrument for estimating physical activity among pregnant women. These findings should help to address the need for valid instruments to assess pregnancy physical activity in etiologic research, as most prior studies have focused on leisure time activity using questionnaires not validated for use among pregnant women. The final study in this dissertation used the KPAS to examine the association between physical activity during pregnancy and gestational weight gain among Hispanic women. This study was unique in its use of a measure of total activity energy expenditure, rather than a measure of leisure exercise, as the exposure of interest. Consistent with prior literature, moderate levels of physical activity was not efficacious in preventing excess weight gain during pregnancy.

This research generated theory related to women's self-treatment of vaginal symptoms utilizing the grounded theory method. Data collection guided by theoretical sampling consisted of interviews with women and pharmacists, consumer literature related to vaginal conditions, and advertisements for non-prescription vaginal antifungal products. Data analysis identified that the basic problem experienced by the women was relief of symptoms. Because of many competing demands on their personal time, the women needed to resolve their problem in a way that was uncomplicated and involved minimal use of time and resources. In order to accomplish this, women used the process of Bypassing the Middleman. The use of this process enabled women to resolve the problem in a convenient and timely manner, and provided the least disruption to their current lifestyles and beliefs. Bypassing the middleman consisted of four stages: Noticing Vaginal Symptoms, Making Sense of Symptoms, Choosing a Treatment Path, and Bypassing the Middleman. The pace and progression through the stages is influenced by each women's unique attributes and circumstances. Several conditions that facilitated this process were low degree of uncertainty about cause of symptoms and low need to know specific cause, judgment that the symptoms were low-risk and minor, feeling capable of solving the problem, perception that the time and effort to access the middleman (health care provider) were beyond her resources, a high priority for convenience, the belief that self-treatment (non-drug) was safer than medical treatment, and low congruence of beliefs between woman and health care provider. Analysis of advertisements and consumer literature provided the context for understanding environmental influences on women's knowledge and decision-making about self-treatment. Four principal factors emerged as the primary reasons for variance in participants' behavior during bypassing the middleman: symptom characteristics, available resources, knowledge and experience, and beliefs about symptom management. This theory contributes to nursing knowledge about women's self-care because it is grounded in data, and provides nurses with the ability to explain and predict which women will choose to use this process. In addition, this theory identifies controllable conditions for designing nursing interventions to enhance women's self-care skills.

This study explored whether prenatal attachment differed in women who conceived through IVF with their own eggs versus those who conceived with donor eggs and whether source of eggs, number of treatment cycles, anxiety and social support in pregnancy were predictive of prenatal attachment in this population of women. Three study designs were used: (1) a comparative descriptive design to compare prenatal attachment in women who used their own eggs and those who used donor eggs, (2) a predictive correlational design to identify significant predictors of prenatal attachment, and (3) a descriptive correlational design to examine the relationships between selected demographic variables and prenatal attachment. The admission sample consisted of 113 women who conceived through in vitro fertilization and completed an on-line survey. Of these women, 102 conceived with their own eggs and 11 with donor eggs. Their mean age was 34 years, and they were predominantly Caucasian, married, and well educated. Participation in the study was announced through a posting on the bulletin boards of two web sites related to pregnancy after infertility. An on-line survey was used to collect data on sociodemographic information, source of eggs, number of treatment cycles, anxiety (State-Trait Anxiety Inventory), social support in pregnancy (Social Support Apgar), and prenatal attachment (Maternal-Fetal Attachment Scale). No significant differences were found in prenatal attachment between women who conceived with their own eggs and women who conceived with donor eggs. Source of eggs, number of treatment cycles, anxiety and social support in pregnancy were not significant predictors of prenatal attachment for the study sample. Women who conceived with their own eggs had significantly less trait anxiety and higher social support. Prenatal attachment was positively and significantly correlated with fetal movement, known sex of baby, and anxiety. Influences on prenatal attachment in women conceiving through IVF are multifaceted and much is still unknown. Uncovering influencing variables and better understanding the process of developing prenatal attachment in women conceiving through IVF will provide nurses the evidence base they need to practice and support these women through pregnancy and beyond. Implications of this study and directions for further research are discussed.

Includes bibliographical references. / Background External Cephalic Version (ECV) is the manipulation of the baby, through the mother’s abdomen to a cephalic presentation. ECV is typically performed antenatally, in women with a breech presentation who are not in labour, at or near term, to improve their chances of having a normal vaginal delivery. ECV is one of the few obstetric interventions for which there is evidence that its use leads to a fall in caesarean section rates. ECV is an intervention that gives women another option, prior to considering caesarean section. Objective: To evaluate whether there were missed opportunities for performing ECV in women that had caesarean sections for breech presentation at term, and to determine the reasons why ECV was not offered or attempted for women with breech presentation, who had a caesarean section for that reason.

Includes bibliographical references. / Background: The Lesbian, Gay, Bisexual and Transgender (LGBT) community has historically been marginalised. Increased international awareness of the LGBT profile has led to the recognition that the medical profession has overlooked the health needs of lesbian women, with a resultant paucity of data regarding lesbian women’s health risks. International literature has shown that lesbians remain at risk of sexually transmitted infections and HIV; are at significant risk of mental health disorders; exhibit a high-risk profile for cardiovascular disease, diabetes, as well as cancer, and underutilise health care services due to experiences of homophobia. South African data is almost non-existent. Objective: To explore Cape Town wsw’s (women who have sex with women) experiences with, and trends of utilisation of Reproductive Healthcare Services. Study Design: Cross Sectional Survey. Methods: A sample of self-identified wsw was recruited using a snowball sampling method to complete an anonymous, self-administered online questionnaire during February 2013. Outcome Measures: Predominantly descriptive, with an aim to validate the study questionnaire for the South African context. Results: A total of 116 responses were analysed. The mean age of the population was 37 years of age, with the majority identifying as lesbian. The population comprised predominantly of Caucasian, middle class suburban residents, with most having medical aid, and accessing private health care. A significant proportion of respondents reported previous intercourse with a male sexual partner. Barrier contraception was not always used during intercourse with men and almost never during sex with women. There were a significant number of sexually transmitted infections in women with no previous male sexual partners. Most respondents considered themselves to be at low risk of contracting HIV, and at intermediate risk of cervical and breast cancer, and showed higher than average utilization of cervical screening practices for 4 this population, despite a general perception that screening is unnecessary in lesbian women. A general trend towards disclosure of sexual orientation was noted; however users of private healthcare were significantly more likely to have disclosed their orientation to their physician than users of public and NGO services. Respondents held a preference for practitioners that were themselves gay/lesbian.The study tool was validated for use in the South African context; however redundancy could not be formally excluded from the questionnaire. Conclusions: Wsw from Cape Town experience internationally comparable exposures and risks of gynaecological problems. Further research is required to fully understand the healthcare needs of lesbian women living in lower socio-economic conditions.

Purpose: The purpose of this study was two-fold: (1) identify predictors that influence diet quality in low SES pregnant women; and (2) explore relationships between perceived nutrition compliance of participants, healthy pregnancy weight gain, and diet quality. Hypothesized predictors to diet quality include: High Pre-pregnancy BMI, high educational level, high income level (above or below poverty line), medical/insurance coverage, presence of a previous/current medical condition, cost and ability to purchase healthy food, presence of social support, and source of nutrition information. Also it is hypothesized that healthy pregnancy weight gain will positively influence diet quality. Methods: This quantitative/correlational study included 37 women in their second and third trimesters of pregnancy. Participants were recruited from a low-income clinic and a private healthcare facility. Participants were asked to complete a pregnancy nutrition survey on their demographics and activity level and eating habits. Three 24 hour dietary recalls (1 weekend day and 2 nonconsecutive weekdays) were used to assess their diet quality using the ESHA Food Processor software. Comparative, correlational, and linear regression analyses were conducted. The Diet Quality Index for Pregnancy (DQI-P) was used to assess overall diet quality. The DQI-P includes eight components: % recommended servings of grains, vegetables, and fruits, % recommendations for iron, calcium, and folate, % energy from fat, and meal pattern. Scores can range from 0 to 80, with ≥70 indicating adequate diet quality. Each component contributed 10 points. Results: The mean score for the population was 27.1 (standard deviation 17.1). Women with the highest diet quality score are married, have a bachelor's degree, an average family income between $45,000 and $60,000, and private medical insurance. Two of the eight hypothesized predictors of diet quality were found to be significant. High pre-pregnancy body mass index (BMI) is associated with low DQI-P scores (p=.050). Source of nutrition information from family is associated with high DQI-P scores (p=.013). There was a significant negative correlation between diet quality and pre-pregnancy BMI (r= -.344; p=0.05). Conclusion: Low SES women are at-risk for low diet quality during pregnancy. Based on the results of this small convenience sample, there is a need for effective nutrition interventions to improve the diet quality of low SES pregnant women. Additional research is needed to better predict and utilize situations that motivate low SES pregnant women to achieve high diet quality scores by translating these motivational situations to other low SES pregnant women. / A Thesis submitted to the Department of Nutrition, Food and Exercise Sciences in partial fulfillment of the Master of Science. / Spring Semester, 2015. / March 20, 2015. / nutrition, diet quality, pregnancy / Includes bibliographical references. / Jenice Rankins, Professor Directing Thesis; Maria Spicer, Committee Member; William Weissert, Committee Member.

ABSTRACT Endometriosis, defined by ectopic growths of uterine tissue, is considered an enigma because it is unknown how or even if these abnormal growths contribute to the painful conditions including dysmenorrhea, dyspareunia, and chronic pelvic pain that often accompany the disease. Many clinicians and biomedical scientists assume that the amount of ectopic growth (cysts) predicts the presence or severity of pain symptoms, even though considerable evidence suggests that this assumption is unwarranted. Studies from our laboratory using a rat model of surgically-induced endometriosis (ENDO) demonstrated for the first time that the cysts develop a sensory and sympathetic nerve supply. This discovery gave rise to the hypothesis that this newly-sprouted innervation of the cysts is a significant contributor to the development (i.e., generation) and maintenance of painful symptoms. One of these common symptoms, studied here, is vaginal hyperalgesia (often called dyspareunia in women). The purpose of this dissertation was to use a combination of immunohistochemical, physiological, and behavioral methods to test various aspects of this hypothesis. In the first study, the developmental time course of cyst innervation (sensory and sympathetic) and ENDO-induced vaginal hyperalgesia was examined over a 10 week period post-ENDO. It was found that rudimentary innervation appears within the cysts at 2 weeks post-ENDO, and becomes active at 3 weeks post-ENDO. Between 4 and 5 weeks post-ENDO, vaginal hyperalgesia becomes significant, but is highly variable as the innervation increases and approaches maturity. By 8 to 10 weeks post-ENDO the cyst innervation and hyperalgesia have both matured completely, plateaued and stabilized. Based on these findings, the developmental timeline was divided into three phases: INITIAL (1-2 weeks post-ENDO), TRANSITIONAL (4-6 weeks post-ENDO), and ESTABLISHED (8-10 weeks post-ENDO). In each phase, characteristics of the cyst innervation and vaginal hyperalgesia were found to be as follows: INITIAL, no innervation and no vaginal hyperalgesia; TRANSITIONAL, immature but active innervation and significant but highly variable hyperalgesia; ESTABLISHED, mature innervation and stabilized hyperalgesia both of which varied with the estrous cycle. Then, in each of the three phases, the contribution of the cysts (and their innervation) to ENDO-induced vaginal hyperalgesia was tested, by removing the cysts and assessing the effect on the development and maintenance of the vaginal hyperalgesia. In the TRANSITIONAL phase, the relationship between the severity of ENDO-induced vaginal hyperalgesia and the innervation of the cysts, eutopic uterus, and vaginal canal was also assessed. The effect of cyst removal on ENDO-induced vaginal hyperalgesia in the INITIAL phase prevented the development of vaginal hyperalgesia. In the TRANSITIONAL phase, cyst removal did not significantly alleviate the vaginal hyperalgesia developed prior to cyst-removal, but, prevented its future development. In the ESTABLISHED phase, cyst removal completely alleviated the vaginal hyperalgesia. Further, in the TRANSITIONAL phase, innervation of the cysts (sensory and sympathetic) and innervation of the vaginal canal (sympathetic only) significantly correlated with severity of ENDO-induced vaginal hyperalgesia. Overall, results from these studies strongly support the general hypothesis that the innervation of the cysts contributes to ENDO-induced vaginal hyperalgesia. Specifically, the cyst innervation likely contributes to the development, severity, and maintenance of ENDO-vaginal hyperalgesia. Importantly however, the varying effects of cyst removal suggest that mechanisms by which the innervation operates to contribute to the vaginal hyperalgesia change during its progression through the three phases from peripheral sensitization to peripherally-independent then peripherally-dependent, hormonally-modulated central sensitization. Thus changes, which emerge most clearly in the TRANSITIONAL phase, could help explain the poorly-understood, clinically-challenging issue on how pain transitions from an acute to a chronic problem, not only in endometriosis but also in other chronic pain conditions. / A Dissertation submitted to the Department of Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2014. / October 21, 2014. / cyst, endometriosis, hyperalgesia, innervation, pain, sprouting / Includes bibliographical references. / Richard Hyson, Professor Directing Dissertation; David Kirby, University Representative; Karen Berkley, Committee Member; Mary Gerend, Committee Member; Frank Johnson, Committee Member; Mohamed Kabbaj, Committee Member.

In this thesis the use of real-time ultrasound in the assessment and management of preterm labour has been studied, with particular reference to the observation of fetal breathing movements, gross fetal body movements and the state of the uterine cervix. In addition, a longitudinal analysis of the trends in preterm labour in the John Radcliffe Hospital in Oxford between 1973 and 1981 has been performed. Finally, an attempt has been made to clarify the relationship between prostaglandin E2 and fetal breathing movements. The analysis of the trends in preterm labour in Oxford has shown that the incidence of preterm delivery remains unaltered. Of these patients, however, those eligible for tocolytic therapy (unexplained spontaneous preterm labour) form a small proportion. The incidence of extreme prematurity in this group is very low and the neonatal outcome is good. The presence or absence of Fetal Breathing Movements (FBM) by defined criteria is shown to be a highly sensitive index of whether the preterm labour is going to progress to delivery or not in singleton pregnancies with intact membranes. Its significance is lost when the membranes are ruptured and in multiple pregnancies. In pregnancies complicated by antepartum haemorrhage the presence or absence of Fetal Breathing Movements does not predict further haemorrhage leading to delivery. Fetal Breathing Movement status on admission bears no relationship to neonatal outcome and gives no indication of the presence of intrauterine infection. Silent chorioamnionitis has been highlighted as an important cause of "unexplained" preterm labour. Gross Fetal Body Movements (FM) are shown to give no early indication of impending preterm delivery. Evidence is presented to suggest that significant diminution in Fetal Movements is related to poor neonatal outcome. Ultrasonic measurement of the uterine cervix has been found to be technically feasible but of no benefit in the diagnosis of ongoing preterm labour. The relationship between prostaglandin E2 (PGE2) and the cessation of fetal breathing movement has been approached by elucidating the maternal absorption of PGE2 from a vaginal pessary. This then enabled me to sample fetal blood at the time of maximal maternal concentrations (the time we expect the fetal concentration to be greatest). This was performed by fetoscopy and demonstrated that a significant rise in fetal bicycleprostaglandin-E-metabolite (bicyclo-PGEM) occurs following maternal vaginal administration of PGE2. Using this information FBM has been assessed two and a half hours following the vaginal administration of PGE2. Although inconclusive, no reduction in FBM was demonstrated. as the bicyclo-PGE metabolite is used to assess PGE levels, this evidence decreases the probability that PGE mediates the reduction in FBM with the onset of labour.

No description available.

Sepsis is a frequent complication in critical illness. The mechanisms that are involved in initiation and propagation of the disease are not well understood. Scavenger receptor A (SRA) is a membrane receptor that binds multiple polyanions such as oxidized LDL and endotoxin. Recent studies suggest that SRA acts as a pattern recognition receptor in the innate immune response. The goal of the present study was to determine the role of SRA in polymicrobial sepsis. SRA deficient (SRA-/-) and C57BL/6JB/6J (WT) male mice were subjected to cecal ligation and puncture (CLP) to induce polymicrobial sepsis. NFκB activity, myeloperoxidase activity, and co-association of SRA with toll like receptor (TLR) 4 and TLR2 was analyzed in the lungs. Spleens were analyzed for apoptosis. Serum cytokines and chemokines were assayed. Blood and peritoneal fluid were cultured for aerobic and anaerobic bacterial burdens. Long term survival was significantly increased in SRA-/- septic mice (53.6% vs. 3.6%, p<0.05) when compared to WT mice. NFκB activity was 45.5% lower in the lungs of SRA-/- septic mice versus WT septic mice (p<0.05). Serum levels of interleukin (IL)-5, IL-6, IL-10 and monocyte chemoattractant protein -1 were significantly lower in septic SRA-/- mice when compared to septic WT mice (p<0.05). We found that SRA immuno-precipitated with TLR4, but not TLR2, in the lungs of WT septic mice. We also found that septic SRA-/- mice had lower bacterial burdens than WT septic mice. SRA deficiency had no effect on pulmonary neutrophil infiltration or splenocyte apoptosis during sepsis. We conclude that SRA plays a pivotal, and previously unknown, role in mediating the pathophysiology of sepsis/septic shock in a murine model of polymicrobial sepsis. Mechanistically, SRA interacts with TLR4 to enhance the development of the pro-inflammatory phenotype and mediate the morbidity and mortality of sepsis/septic shock.