As scientific discovery and human presence push further into space, it is necessary to investigate the effects of spaceflight on physiological systems. Research into the effects of the space flight environment on the human body is still in its relative infancy. Although initial studies have indicated harmful effects of spaceflight environments on certain body systems, this phenomenon still needs illumination with regards to the female reproductive system. Better understanding of these consequences can change the way society views space travel and colonization of other planets. The spaceflight environment consists of at least two major factors that could confer negative effects on physiology, namely radiation and microgravity. In this experiment, uterine smooth muscle, or the myometrium, was analyzed in 6-month old female C57BL/6 mice that were exposed to 21 days of low dose/low dose rate whole-body radiation with γ-radiation using 57Co plates (0.04 Gy at 0.01 cGy/h) and/or simulated microgravity (via hind limb unloading). Tissue samples were harvested 4 months after the 21-day simulated spaceflight period. Following embedding, sectioning, and hematoxylin and eosin staining (H&E), the tissues were examined, and the average thicknesses of the myometrial layers were measured. Three types of measurements were made 1 – outer longitudinal layer, 2 – inner circular layer, and 3 –total muscle layer thickness (outer and inner combined). Two-way ANOVA statistical tests were used to compare the thicknesses of the myometrial muscle layers between the various treatment groups. A statistical difference was found between the thicknesses in the outer longitudinal layer of smooth muscle between the control animals and the unloaded animals (P: 0.051).

INTRODUCTION) Modern contraception is a safe and effective clinical service for reducing unintended pregnancy and improving birth spacing for women. Provider counseling is an important factor that may influence women’s decision making, satisfaction, and self-efficacy with contraception use. This study measures women’s perceptions of recent provider interactions and examines the extent to which these perceptions are associated with method satisfaction and confidence in use. We hypothesize that women who perceive more positive interactions are ultimately more satisfied and confident with their contraceptive method choice. METHODS) A cross-sectional survey of adult reproductive-aged women in two southern states (aged 18 to 44 years old) was used for the analysis. The Statewide Survey of Women was conducted in 2017 by NORC at the University of Chicago. Women were asked to rate providers across a series of statements reflecting aspects of patient-centered contraceptive counseling using a 5-point Likert scale. Responses were dichotomized to reflect those with very good/excellent experiences compared to those with less favorable experiences (Poor, Fair, Good). Women were subsequently asked about their level of satisfaction with current contraceptive methods and confidence in use, also using a 5-point Likert scale. These measures were also dichotomized. A chi-squared test for independence and unadjusted logistic regression models were used to examine associations between patient-provider interactions, satisfaction and confidence in contraceptive use. FINDINGS) The survey included 4,281 respondents. The majority of women reported being satisfied with their current contraceptive method (92.6%) and confident in its use (94.9%). Approximately 93% of women who felt respected as a person by their provider also reported being satisfied with their current birth control method, compared to 73% among women who did not feel respected as a person (p<0.001). Among women who felt their provider allowed them to say what mattered to them about their birth control method, 93.5% were satisfied with their current method, compared to 75% among those who did not feel allowed to say what mattered (p<0.001). Women who felt like their provider took their preferences for birth control into consideration were also more satisfied with their current birth control method compared to those who did not feel the same way (93.7% versus 73.5%; p<0.001). Women who felt their provider allowed them to say what mattered and those who felt their provider took their preferences into consideration were also associated with higher rates of confidence in correct use. Women reporting that their provider gave them enough information to make the best decision about their birth control method was also associated with greater confidence in correct use (95.6% versus 87.5%; p=0.007). CONCLUSION) Findings suggest that positive patient-provider interactions are associated with increased satisfaction in current contraceptive method use. Interestingly, women reporting that providers did not give them enough information to make the best decision about birth control methods also reported being less confident in using their current method. Collectively, these findings support existing evidence suggesting that patient-provider interactions are important for patient-centered care and can be used to inform future clinical practice guidelines around contraceptive counseling.

Phytoestrogens are chemicals produced by plants that act like estrogens and have the ability to bind to the mammalian estrogen receptor system. The purpose of this study is to evaluate a new phytoestrogen analog called 4-acetoxy Resveratrol. Resveratrol is a phytoestrogen that has been found in the skin of grapes. Resveratrol has been shown to be able to bind to the estrogen receptors and has a similar molecular structure as estradiol. Resveratrol has been shown to have many positive health benefits such as improving cardiovascular health, serving as a neuroprotective agent, acting as an anti-inflammatory agent, working as an anti-cancer agent, increasing sperm output, acting as an anti-aging agent, and reducing incidence of prostatic adenocarcinoma. The challenge with using Resveratrol as an oral therapy is that it is quickly metabolized by the liver so for this study we used injections. The injections were 5mg/ Kg, 20 mg/Kg, and 90 mg/Kg of 4-acetoxy Resveratrol. We used intact 160 day old male Long-Evans rats and intact 90 day old female Long-Evans rats. The rats were given injections once a day for 21 days based on their treatment group. The animals were weighed daily and then tested in the Porsolt swim test at day 160 and 90 respectively. At the end of 21 days the rats were sacrificed and white adipose tissue, blood, brains, testis, and prostates were collected. Administration of 4-acetoxy Resveratrol decreased weight gain but not white adipose tissue in the male rats but has no effect in the females. In the male rat administration of 4-acetoxy resveratrol the high group also decreased testosterone, 5α-DHT , and prostate 5α-reductase activity. The high dose of 4-acetoxy Resveratrol also caused a change in prostate histology and decreased prostate weight. 4-acetoxy Resveratrol had no effect on testis weight and only showed a slight increase in depressive-like behaviors. In the females, 4-acetoxy resveratrol had no effect on white adipose tissue deposition, estrous cycle, hypothalamus aromatase activity, or depressive-like behaviors.

Introduction: Over 420,000 women aged 13-44 in Tennessee depend on publicly funded contraceptive services, yet only 42.9% receive them. Lack of access to contraception leads to unintended pregnancies, which are associated with higher rates of maternal and neonatal morbidity and mortality. This study explores perceived barriers to contraception and patient awareness of preexisting resources to mitigate such barriers in a rural region. Methods: Women with a confirmed pregnancy establishing obstetric care at East Tennessee State University’s resident clinic were offered a 20-question survey assessing demographic variables and perspectives to contraceptive care. Results: 141 survey respondents met inclusion criteria. 95.7% denied using contraception prior to conception. Of these, 24.8% reported their pregnancy was unintended. Only 59.6% reported knowing where they could access free long-acting, reversible contraception (LARC) in the community. 50.4% agreed it would be helpful to have a free community clinic providing reproductive health care. Specifically, 73.7% of participants reported they would benefit from free LARCs; 61.0% expressed need for evening hours and 67.4% for weekend hours. Conclusions: One in four women experienced an unintended pregnancy. The known risks of unintended pregnancies to the mother and fetus will likely increase secondary to recent changes in abortion policies. Two in five women reported no awareness of resources for free LARCs in our community, suggesting that knowledge about and access to contraception is lacking at a time which women need autonomy over reproductive choices the most. Initiatives which aim to educate women regarding contraceptive care and to eliminate barriers which hinder access are warranted.

Young men are at the greatest risk of contracting sexually transmitted infections (STIs) within the U.S. male populations, yet are the least likely to make a sexual and reproductive health (SRH) care visit. Clinical approaches in these areas that include the outreach to and the involvement of male partners of female patients can prove particularly useful in expanding SRH care to men and can also improve health outcomes for women who have sex with men. In this study I examined UCF's healthcare provider's approaches to educate and involve men (between the ages of 18 and 30) and male partners of female patients in their SRH needs. I conducted qualitative semi-structured interviews with 18 health care providers at the Student Health Center; including physicians, physician assistants, and registered nurses. This study found that there were significant differences in perception of men's SRH risk behaviors among the providers. In addition, this study revealed issues that might deter male students from accessing care, specifically how patients are required to state to the operator (who is also an undergraduate student) their name, PID and exactly why they are scheduling a visit to the clinic, thus many men say they have cold symptoms instead of issues with SRH. This study is significant because it can contribute to improvements in the delivery of SRH care to male students on campus.

Since 2015 Canada has welcomed 44,620 Syrian refugees. The research on Syrian refugees in Canada has mainly focused on their immediate health needs, communicable diseases, and chronic illnesses. Aside from maternal health, the sexual and reproductive health (SRH) needs of Syrian refugee women is undocumented in Canada. To address this gap in the literature we conducted a qualitative study in Ottawa, Ontario that involved in-depth interviews with Syrian refugee women and individuals who provide health services to them. When accessing SRH services Syrian women identified a preference for women providers, faced difficulty adjusting to societal norms during the perinatal period, felt that contraception counselling was not culturally informed, and struggled with their maternal mental health. Key informants mainly echoed these findings and expressed a need for more cultural competency/humility training, interpretation services, and trauma-informed counselling. The path to improving SRH services for Syrian women is complex, but highly warranted.

Individuals with chronic medical conditions are at an increased risk for adverse reproductive and perinatal outcomes. However, there is limited condition-specific information on the reproductive and perinatal implications of chronic conditions and their associated treatments. In this dissertation, we focus on thyroid disorders and migraines, two relatively common chronic conditions among females of reproductive age, and three distinct reproductive outcomes, spanning from preconception to delivery. In study one, we analyzed the association between thyroid disorders and fecundability, the per-cycle probability of conception among non-contracepting couples, using data from Pregnancy Study Online (PRESTO), a preconception cohort study of pregnancy planners in the United States and Canada. We did not find an association between a diagnosis of hypothyroid, hyperthyroid, thyroid autoimmunity, or thyroid nodules/thyroid cancer and fecundability. We also found no association between thyroid medication use or non-use among individuals with a thyroid disorder and fecundability. In the second study, we focused on migraines and spontaneous abortion (SAB), which is pregnancy loss before twenty weeks gestation, also using PRESTO data. We found that a history of migraines is not independently associated with SAB risk in females, but that routine use of medication for migraines during the preconception period may be associated with an increased risk of SAB. In the third study, we focused on the association between migraines and hypertensive disorders of pregnancy (HDOP), which include gestational hypertension and preeclampsia. We used data from the Clinical Practice Research Datalink Gold, a longitudinal database of de-identified patient records from hundreds of primary care practices in the United Kingdom. We found that while migraines overall are associated with a small increase in risk of HDOP, this increase is most substantial among those with pre-pregnancy migraines that persist in the first trimester of pregnancy. Overall, we observed that while a history of diagnosed thyroid disorder or migraines ascertained via self-report during the preconception period may not be associated with the reproductive and perinatal outcomes we studied, certain subgroups of individuals with migraines may be at increased risk of SAB or HDOP. Migraine severity and persistence in the first trimester are likely important factors in determining the magnitude of this increased risk. Nuanced research into chronic conditions with a disproportionate disease burden among females of reproductive age will guide and improve reproductive health care for individuals with chronic conditions. This dissertation aims to address these gaps in the literature by exploring the relationship between two chronic conditions and three reproductive and perinatal outcomes: thyroid disorders and fecundability, migraines and spontaneous abortion, and migraines and hypertensive disorders of pregnancy. / 2023-04-20T00:00:00Z

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Infertility impacts numerous individuals during their reproductive journey. Yet, there is little research and information available that examines if having a history of infertility goes on to have further implications after an individual conceives and gives birth. Thus, the current study aimed to examine if infertility impacts the postpartum period, and if there were any particular risk or resiliency factors that contributed to this relationship. In this study, women aged 18 to 50, who had given birth within the last 12 months, participated in an online survey that assessed a variety of physical and mental health constructs. Overall, results largely exemplified that infertility does not go on to impact postpartum adjustment within in this particular sample of women who identified as having higher levels of education, perceived SES, and income. However, many of the covariates, such as SES, did correlate with postpartum outcomes. Findings highlight the resilience of this sample of women, despite previously experiencing stressful events.

Introduction: Improving the quality of contraceptive care that youth receive improves the patient-provider relationship, satisfaction with care, and contraceptive method use and continuation. In recent years, high-quality contraceptive care for youth has shifted away from tiered effectiveness counseling and toward youth-friendly, person-centered contraceptive counseling (YFPCCC). Rooted in the reproductive justice movement, YFPCCC requires that counseling encourages youth to say what matters to them in their contraceptive method, respects youth’s preferences in their contraceptive method, provides youth with the information necessary to make the best choice for them, and is respectful of youth’s choices. YFPCCC is especially important for minor youth and youth of color who have historically received biased care and for youth in the United States South where restrictive policies may prevent youth from receiving care. This study examined youths’ perspectives of YFPCCC at safety-net clinics in two states in the U.S. South. Methods: Between 2018 and 2022, a survey measuring patient perspectives of their contraceptive counseling was collected from youth (ages 16 to 24) who received care at federally qualified health centers (FQHCs) and health departments (HDs) in Alabama (AL) and South Carolina (SC). A total of 1,052 youth were included in the study (AL n=513 and SC n=539). Four survey items measuring the four components of person-centered counseling and two survey items measuring youth-friendliness (knowledgeable and trustworthy providers) were dichotomized into Yes/No responses and combined to create two new variables measuring PCCC and providers’ youth-friendliness. PCCC and youth friendliness were compared across clinic type, state, age, race/ethnicity, and insurance coverage using logistic regression. P-values less than 0.05 were considered significant. Results: Overall, 56% of youth in the study reported that they received all four components of PCCC and 71% reported that their providers were youth-friendly. Minor youth (ages 16 and 17) were 34% less likely than older youth (ages 20-24) to report receipt of PCCC (aOR 0.66, 95% confidence interval (CI) [0.45, 0.98]). Minor youth were also 39% less likely than older youth to report that their provider was youth-friendly (aOR 0.61, 95% CI [0.40, 0.93]). Non-Hispanic Black youth were 45% less likely than non-Hispanic White youth to report PCCC (aOR 0.55 95% CI [0.40, 0.70]). Similarly, non-Hispanic Black youth were 44% less likely than non-Hispanic White youth to report that their provider was youth-friendly (aOR 0.56 CI [0.41, 0.77]). Discussion: Providing contraceptive care that is both person-centered and youth-friendly is essential in improving the quality of care that youth receive. In this study, minors and non-Hispanic Black youth were the least likely to report that their care was both person-centered and youth-friendly. This gap in the quality of care that non-Hispanic Black youth receive may contribute to lower satisfaction with care which may contribute to lower contraceptive use rates and higher unintended teen birth rates for this group. Clinics can improve their ability to provide YFPCCC by ensuring providers are trained in youth-friendly and person-centered contraceptive care.