No contexto da assistência ao parto em Londrina-PR, a passividade das parturientes, diante da atitude desrespeitosa de muitos profissionais que não atendem a suas necessidades, e o uso excessivo e rotineiro de intervenções geraram alguns questionamentos que nortearam o presente estudo: as mulheres desejam participar das decisões relacionadas ao seu parto? Elas desejam planejar seu parto? As mulheres participam do parto? O acesso às informações favorece a participação ativa das mulheres no parto? Como as mulheres desejam ser atendidas durante o parto? Quais são as suas necessidades durante esta experiência? Com quem elas desejam compartilhar esta experiência? Diante de tais questionamentos, estabeleceram-se os seguintes objetivos: Conhecer e compreender as necessidades de cuidado e de participação nas decisões sobre o parto de um grupo de gestantes de Londrina-PR. Apreender o típico da ação de um grupo de gestantes de Londrina-PR diante do parto. Para tanto, realizou-se uma pesquisa qualitativa, fundamentada na Sociologia Fenomenológica de Alfred Schütz, com base nas questões norteadoras: Qual a sua expectativa em relação ao seu parto? Como você gostaria de ser cuidada durante o seu parto? Você deseja tomar alguma decisão em relação ao seu parto? Qual decisão? Dos depoimentos de quatorze gestantes, obtidos por meio de entrevista fenomenológica, emergiram categorias concretas do vivido, com base no agrupamento dos aspectos significativos das ações das mulheres perante o parto, os quais permitiram a compreensão do tipo vivido deste grupo social que, neste contexto, manifesta preferência pelo tipo de parto e apresenta justificativas para o parto normal com base na experiência própria e também de outras mulheres e em seus acervos de conhecimentos disponíveis; sente-se insegura e vivencia múltiplos medos, entre eles o das condições de assistência, de ficar sozinha, da dor do parto, de não identificar o trabalho de parto, das condições de vitalidade do recém-nascido, dos imprevistos do trabalho de parto, da falta de atenção relacionada à assistência e da falta de respeito à sua privacidade. Verbaliza necessidades de cuidado no parto, com destaque para a companhia dos familiares como forma de receber ajuda, atenção e segurança. Deseja ter acesso às informações sobre a gestação, os procedimentos e evolução do trabalho de parto e do parto, atribuindo aos profissionais de saúde esta responsabilidade; quer atenção obstétrica com profissionais competentes e que ofereçam segurança e um ambiente silencioso e privativo no momento do trabalho de parto e parto. Apesar de querer ser bem assistida, de participar do seu parto e verbalizar suas necessidades e desejos, não realiza ações para concretizar suas necessidades de cuidado, de participação e de decisão sobre suas escolhas e preferências. O reconhecimento à individualidade da mulher e a percepção de suas necessidades fazem parte da ação humanizada e gera relações menos desiguais e menos autoritárias. Com uma prática ética fundamentada em evidências, a gestante poderá ser vista como condutora do processo, e sua gestação e parto, como fenômenos fisiológicos, os quais ela poderá planejar livremente. / Within the context of delivery assistance in Londrina-PR, the passivity of pregnant women when facing the lack of respect of many professionals that care for their needs as well as the excessive number of routine interventions, have raised many questions that led to the present study: Do women want to participate in the decisions related to their deliveries? Do they want to plan their deliveries? Do women participate in their deliveries? Does access to information promote a more active participation of these women? How do women want to be assisted during delivery? What are their needs during the experience? Who do they want to share this experience with? Based on these questions, the following objectives were established for this work: to know and understand the need for special care and participation in the delivery decisions of a group of pregnant women from Londrina-PR, and to learn about the typical behavior of a group of pregnant women from Londrina-PR during delivery. Therefore, a qualitative research based on Alfred Schützs sociological phenomenology was carried out, including the following questions: What are your expectations towards your delivery? How would like to be treated during your delivery? Do you want to make any decision regarding your delivery? Which one? From the statements of 14 pregnant women, collected during the phenomenological interview, concrete categories arose based on the grouping of significant aspects of the behavior of these women during delivery. These categories helped understand the behavior of this social group, which, within this context, expressed its preference for the normal delivery, based on their own experiences, those of other women and on the information available. According to them, they feel insecure and experience many fears regarding assistance conditions, loneliness, delivery pains, inability to identify labor pain and the newborn life conditions, unforeseeable labor problems, lack of assistance and lack of respect towards their privacy. They also expressed their needs during delivery, emphasizing the importance of the company of family members as a way to get help, attention and security. They also want to have access to information on pregnancy, procedures, and labor and delivery developments, which should be provided by health professionals. In addition, they look for obstetric attention from competent professionals that can offer them security and a quiet and private environment during labor and delivery. Although they want to be well assisted, make delivery decisions and express their needs and desires, they do not carry out actions that meet their care, participation and decision-making needs, choices and preferences. The recognition of these womens individuality and the perception of their needs are part of a humanized action thus creating less unequal and authoritarian relationships. With an ethical practice based on evidences, pregnant women can be seen as leaders of the whole process, and their pregnancy and delivery as physiological phenomena, which they can plan freely.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2017-02-22T19:39:50Z No. of bitstreams: 1 Maria M¿nica Paulino do Nascimento.pdf: 1616200 bytes, checksum: 24df1c4dc5ed8f29f91052acd0d438e0 (MD5) / Made available in DSpace on 2017-02-22T19:39:50Z (GMT). No. of bitstreams: 1 Maria M¿nica Paulino do Nascimento.pdf: 1616200 bytes, checksum: 24df1c4dc5ed8f29f91052acd0d438e0 (MD5) Previous issue date: 2016-12-15 / The use of post-exposure prophylaxis after sexual intercourse for women is one of the challenges for the HIV prevention policies, because sociocultural aspects and gender inequalities hamper the appropriation of preventive measures for this population segment. Thus, this study aimed to describe the use of this type of post-exposure prophylaxis for HIV in consensual sexual intercourse between women assisted by public health services in Brazil. This is a cross cutout of a larger study that was conducted from the data of 365 women assisted by four health services from May 2012 to May 2016. Were described characterization variables of women, of the partner in sexual exposure that caused the use of prophylaxis, of the sexual exposure, of the use and the clinical follow-up, being the use categorized as complete or partial. The average age of women was 30.7 years (SD = 9, 5), 32.6% attended complete high school, 28.3% were sex workers, 16.1% owned serodiscordance partnership and 61.4% had not held test anti-HIV before. Sexual exposure occurred for vaginal sexual intercourse with casual partner (68.3%), with serological status unknown (60.1%) and rupture of condom (51.7%). A total of 49.0% of women held only one return query and 72.1% presented adverse effects. Specifically, among those who returned to the service in the period of 29 to 60 days, only 22.2% attended one or two return visits, 15.7% underwent anti-HIV testing and 81.8% underwent complete antiretroviral use. We can affirm that women use post-exposure prophylaxis after sexual exposure completely, but the health services can not retain these women during the period of clinical and serological follow-up, damaging the evaluation of the effectiveness of prophylaxis, pointing out the need for the organization of services and expansion of strategies that may provide greater autonomy for women to use preventive measures. / O uso da profilaxia pós-exposição sexual por mulheres é um dos desafios para as políticas de prevenção da infecção pelo HIV, pois aspectos socioculturais e as desigualdades de gênero dificultam a apropriação de medidas preventivas por este segmento populacional. Assim, este estudo objetivou descrever o uso da profilaxia pós-exposição sexual ao HIV em relações sexuais consentidas entre mulheres atendidas em serviços públicos de saúde no Brasil. Trata-se de um recorte transversal de um estudo maior que foi realizado a partir dos dados de 365 mulheres atendidas em quatro serviços de saúde no período de maio de 2012 a maio de 2016. Foram descritas variáveis de caracterização das mulheres, do parceiro na exposição sexual que ocasionou o uso da profilaxia, da exposição sexual, do uso e do seguimento clínico, sendo o uso categorizado em completo e parcial. A idade média das mulheres foi 30,7 anos (DP=9,5), 32,6 cursaram ensino médio completo, 28,3% eram profissionais do sexo, 16,1% possuíam parceria sorodiscordante e 61,4% não haviam realizado teste anti-HIV anterior. A exposição sexual se deu por relação sexual vaginal com parceiro ocasional (68,3%), com status sorológico desconhecido (60,1%) e rompimento de preservativo (51,7%). Um total de 49,0% das mulheres realizaram apenas uma consulta de retorno e 72,1% apresentaram efeitos adversos. Especificamente entre as que retornaram ao serviço no período de 29 a 60 dias, somente 22,2% compareceram a uma ou duas consultas de retorno, 15,7% realizaram teste anti-HIV e 81,8% realizaram uso completo dos antirretrovirais. Podemos afirmar que mulheres usam de forma completa a profilaxia pós-exposição sexual, porém os serviços de saúde não conseguem reter essas mulheres durante o período de seguimento clínico e sorológico, prejudicando a avaliação da efetividade da profilaxia, apontando a necessidade de organização dos serviços e de ampliação de estratégias que possam proporcionar maior autonomia das mulheres para o uso de medidas preventivas.

Thesis (M.CUR.) -- University of Limpopo, 2014 / Indigenous practices (IPs) are experiences generated by people who are living in a specific region context and a specific cultured group. IPs are shaped by cultural traits that are passed from one generation to the next. The practices are rooted and embedded in such a society and, therefore, the practices become part of the people’s lifestyle. It is difficult to try and change these practices, since people have adhered to them throughout their entire lives. The believe system plays a major role in health care seeking behaviour of individuals because they are informed by the IPs that are observed in their environment (Shaik & Hatcher, 2005). IPs are stored in people’s memories and are expressed in songs, dances, beliefs, rituals, cultural values, myths, and healing of diseases by using herbs. During pregnancy, IPs are still applied worldwide. Ayaz and Efe (2008) indicate that it occurs mostly in Turkey and Africa where women’s reassurance is depending on the local context and meaning of pregnancy. THE PURPOSE OF THE STUDY To determine indigenous practices of pregnant women at the Dilokong Hospital in the Greater Tubatse Municipality of the Limpopo Province.This was achieved by the exploring and describing the indigenous practices of pregnant women in the antenatal (ANC) clinic of the maternity ward at the Dilokong Hospital.. DESIGN AND METHOD A qualitative, descriptive, explorative and contextual research design was used for the participants to describe the indigenous practices by pregnant women. Data was collected by means of unstructured one-on-one interviews in maternity unit of the ANC clinic at the Dilokong Hospital of the Greater Tubatse Municipality. Ethical considerations as described by Denosa (2000) were adhered to in order to ensure the v quality of the study. The criteria for trustworthiness were observed as stipulated in Babbie and Mouton (2009).Fifteen pregnant women were interviewed. FINDINGS AND RECOMMENDATIONS Four themes with sub-themes emerged from the data analysis by using Tech’ṡ open coding approach (Creswell 2006, Botma, Greef, Mulaudzi & Wright, 2010). Four themes were emerged namely; indigenous practices based on ancestral knowledge; indigenous practices based on spiritual diviners versus church principles; restricted practices versus instructions followed during pregnancy and labour and indigenous practices during labour and delivery. It is recommended that a national IP strategy needs to be developed to provide a framework and platform to support and promote grass roots IPs into mainstream development in the health care system in relation to midwifery practice. CONCLUSION The study findings indicated that IPs were regarded as an honourable health intervention by THPs, families, and pregnant women. They showed trust in methods used to preserve pregnancy, labour, and delivery, although, the indigenous practices by pregnant women still continue. Indigenous practices such as cords around their waists, are still observed during physical examinations. However, there is a reduction of prescribed potions mixed with cool drinks for use to accelerate labour and to prevent negative consequences because the potential toxicity has been explained during the provision of health education. These findings call for health care professionals to emphasise training and workshops for the THPs church diviners that are the fundamental principle of effective implementation of IPs to enhance improvement in the prevention of complications during pregnancy, labour and delivery. KEYWORDS Pregnant women Indigenous practice Indigenous knowledge Antenatal care

Postmenopausat women on hormone replacement therapy (HRT) have been reported to be stronger when compared to women who are not using HRT. The first goal of this study was to investigate whether muscle morphology was altered in women who use HRT when compared to women who do not use HAT. In addition, this study examined the combined effects of a 6-month moderate-intensity strength training (ST) routine and HRT on the neuromuscular system of early postmenopausal women. Because not all the women completed the ST, this study was separated into two separate analyses, baseline (n=17; 7 HRT, 10 non-HRT) and training (n=14; 6 HRT, 8 non-HRT). ST consisted of two exercises (squat and dead lift), two days a week, for 6-months. Vastus lateralis muscle biopsies were taken at baseline and 6-months after exercise training. Biopsy samples were sectioned and analyzed histochemically for muscle fiber type and fiber cross-sectional area (CSA). In addition, voluntary knee extension strength was assessed at 30��/sec using an isokinetic dynamometer at these two time points. At baseline there were no significant differences in knee extensor strength between groups (HRT: 443 �� 121 N, non-HRT: 490 �� 106 N). Regardless of hormone status, Type I fibers were significantly larger (p=.005) in GSA (Type I=3705 �� 877��m��; Type II=2790 �� 756��m��). However, there were significantly more Type II fibers (p<.0001) (61.5 �� 7.9% of total) and consequently, Type II fibers occupied significantly more total fiber area p=.00l2) (Type I=45.3 �� 7.4%; Type II=54.7 �� 7.4%). No significant differences were found in the fiber type distributions of the HAT (37.9 �� 2.5% Type I, 62.1 �� 2.5% Type II) and non-HRT (38.9 �� 2.9% Type I, 61.1 �� 2.9% Type II) groups. There were no significant differences in fiber CSA of Type I fibers (HRT: 3615 �� 886 ��m��, non-HRT: 3769 �� 912 ��m��) or Type II fibers (HRT: 2770 �� 722 ��m��, non-HRT: 2849 �� 804 ��m��) obtained from the two groups. Six months of ST had no effect on the strength, fiber CSA, and fiber type distribution for HRT and non-HRT subjects. These results suggest that HRT does not alter muscle strength, fiber type distribution, and fiber CSA in early postmenopausal women. / Graduation date: 2003

Osteoporosis is a skeletal disease affecting 44 million Americans. A primary strategy to prevent osteoporosis is to develop a high peak bone mass in youth. Oral Contraceptives (OCs) alter hormones in women and could affect bone mass development. The interaction between OCs and skeletal mineralization is poorly understood. PURPOSE: Our aims were to 1) compare bone mineral density (BMD) of young women who had a history of OC use with regularly menstruating controls, 2) compare changes in BMD in controls, women who initiate OC use, and those who have a history of use, and 3) to evaluate predictive capabilities of physical activity and years of oral contraceptives use on changes in BMD. METHODS: We recruited women, 18 to 25 years of age, with a history of OC use and controls. BMD at the hip, whole-body, and spine (AP, g/cm�� and width-adjusted lateral, g/cm��) was measured by dual-energy x-ray absorptiometry. Physical activity (METs) was measured via questionnaire and grip strength was evaluated using an isometric dynamometer. RESULTS: Groups were similar in body mass index (BMI), fat mass, grip strength, calcium intake and physical activity but controls were slightly older than OC users. In analysis of covariance (ANCOVA), controlling for age and BMI, controls had significantly greater BMD than OC users at baseline at the AP and lateral spine, hip, and whole-body (p<0.05). By ANCOVA (covariates = age at baseline, change in weight), oral contraceptive users had greater bone loss at L��� in the lateral view than controls whereas, controls had greater increases in L��� volumetric BMD, BMD of the total hip, and whole body than OC users (p<0.05). Stepwise regression results did not reveal years of oral contraceptive use, grip strength, or METs to be a significant predictor of changes in BMD at any site. CONCLUSIONS: We conclude that, in the cross-sectional analysis, oral contraceptive use by young women may compromise bone health during a time when mineral is still accruing. In the prospective analysis, regularly menstruating controls had greater BMD accrual or less bone loss over a 12-month time period than women with a history of oral contraceptive use. / Graduation date: 2005

In order to develop effective interventions designed to encourage more middle-aged individuals to engage in regular exercise, there is a need to further understand the mechanisms involved in the decision to exercise. One appropriate conceptual framework involves future-oriented self-conceptions, or possible selves (Markus & Nurius, 1986). Possible selves, both hoped-for and feared, have been shown to vary over the lifespan in content and number (Cross & Markus, 1991), and to be predictive of future health behaviors (Hooker & Kaus, 1992,1994). The role of possible selves in the exercise context can be explored using the Stage of Change Model (Prochaska & DiClemente, 1983), which identifies participation as a process consisting of five identifiable stages. The purpose of this study was to examine the number and content of possible selves generated by individuals across stages of exercise behavior, in order to determine whether possible selves can differentiate those stages and be predictive of exercise-related behavior. Participants were 204 middle-aged women employed at a university in the U.S. Pacific Northwest. Results indicated that differences in the number and content of open-ended possible selves across stage of exercise were relatively few, although differences that did exist held potential for future interventions. Of particular interest was the significant finding of possible selves related to body image, which differed by stage for both hoped-for and feared selves. Responses to focused possible selves directly related to exercise behavior showed a number of differences between stage of exercise, providing support for previous literature as well as for the methodology employed in the present study. Individuals whose self-efficacy and outcome expectancy associated with a particular possible self related to exercise was high, were most likely to engage in exercise behavior. Finally, when the strongest predictor of exercise behavior was combined with exercise self-efficacy, the variance accounted for by the possible self was negligible. Findings support the conclusion that possible selves are worthy of future research in the exercise domain, including the role of possible selves as an antecedent to exercise self-efficacy. Results are discussed in terms of past research, practical applications, and future research directions. / Graduation date: 1998

<p>The study findings were thematically grouped into three themes including the coordination and partnerships, culture and implementation challenges. Poor coordination and failure of systems in place appeared to characterise the many challenges. Gender inequalities and masculine dominated cultural practices like polygamy and widow inheritance are associated with consequences of ill health among women / including high HIV/AIDS prevalence, early marriage, high teenage pregnancies and high maternal mortality. Although these practices are in favor of men, they hardly protect them from the wrath of poor RH like STDS, HIV/AIDS, stressful big families and vast poverty. Hence, Tanzanian men are also victims of their own behavior.</p>

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Buddhist Studies / Doctoral / Doctor of Philosophy

Background: Advanced breast cancer (ABC) is affecting substantial number of Chinese women in Hong Kong. Understanding their unmet supportive care needs (SCNs) is important for health care system to precisely allocate resources to areas demanded for help the most and for patients to achieve better quality of life. Objectives: (1) To validate Chinese version of Supportive Care Needs Survey Questionnaire (SCNS-SF34), (2) to address the prevalence of unmet SCNs at baseline (newly diagnosis of ABC) and explore relevant factors associating with baseline unmet SCNs, (3) to identify the trajectories of unmet SCNs from baseline, 6-week, 12-week, 18-week to one-year post-diagnosis of ABC among Hong Kong Chinese women and identify the predictors related to individual resources. Methods: The study consisted of two phases. In Phase I, breast cancer (BC) patients were recruited from six public hospitals and the SCNS-SF34 (which covers five domains of needs) was administered concurrently with measures of psychological distress CHQ-12 (Chinese Health Questionnaire-12), HADS (Hospital Anxiety and Depression Scale), symptom distress (MSAS-SF), and patient satisfaction (ChPSQ-9) to explore factor structure by using Exploratory Factor Analysis (EFA) and to examine internal consistency, and convergent, divergent and discriminant validities of the identified factor structure. In phase II, women newly diagnosed with ABC were recruited and followed up to assess their unmet SCN trajectories one year after diagnosis. Prevalence of initial baseline SCNs and associated demographic, medical and psychological factors were identified. Linear Mixed Modeling (LMM) was performed to assess trajectories for each SCNs domain. Hypothesized variables reflecting personal and social resources (optimism, trait hope, social support, psychological distress and patient satisfaction) were examined for association with the changes of unmet SCNs after adjusting for demographic and medical characteristics. Results: Instead of five-factor structure identified in the original SCNS-SF34, a four-factor structure with 33 items was identified, comprising: 1) Health system, information and patient support needs (HSIPS), 2) Psychological needs (PSYC), 3) Physical and daily living needs (PDL) and 4) Sexuality needs (SEX). The SCNS-SF33-C demonstrated moderate-to-good internal consistency (Cronbach’s alphas=0.75-0.92) across all domains. Acceptable convergent and divergent validity were demonstrated. Discriminant validity was demonstrated in the SCNS-SF33-C’s ability to differentiate between clinically distinct patient groups (ABC vs. localized BC and active treatment vs. no active treatment). Of the top 15 unmet SCNs, all belonged to the HSIPS domain. There were significant linear declines in unmet HSIPS and PSYC needs over the year after diagnosis, but not in PDL and SEX. After adjusting for demographic and medical factors, LMM identified symptom distress, patient satisfaction and patient satisfaction x time are predictors of HSIP. Total symptom distress, optimism, anxiety and anxiety x time predicted PSYC. Total symptom distress was predictor of PDL. Anxiety was predictor of SEX. Conclusions: The SCNS-SF33-C has a suitable factor structure and psychometric properties for the use in assessing unmet psychosocial SCN among Chinese women with BC. Generally, unmet HSIP and PSYC tended to decline, while levels of unmet PDL and SEX tended to persist over time. Specific individual resources predicted the future change of unmet SCNs. / published_or_final_version / Community Medicine / Master / Master of Philosophy