The purpose of this study was to explore the relationship between urinary incontinence and self-esteem and also social participation. A convenience sample of 25 women 60 years of age and older participated. Forty-eight percent of the women had urinary incontinence at the time of the study. No significant differences were found in the level of self-esteem between those women with urinary incontinence and those women without urinary incontinence. Two subjects with urinary incontinence reported refusing social participation due to urinary incontinence. However, no difference in the overall level of social participation was found when comparing those with to those without urinary incontinence. A nonsignificant correlation was found between self-esteem and the overall level of social participation. In addition, the relationship between self-esteem and the level of social participation for women with urinary incontinence was nonsignificant. Only two of the 12 subjects with urinary incontinence reported receiving treatment.

The incidence of bulimia seems to be increasing dramatically as actors, models, dancers, and college populations are seeking help for this eating disorder. In this study, the Adjective Checklist was administered to 21 bulimic women and 17 normal women to compare personality characteristics on the following scales: abasement, affiliation, autonomy, achievement, aggression, personal adjustment, succorance, and self-control. Results showed bulimic women scored higher on abasement and succorance. A multiple regression was performed which elucidated the scales responsible for the greatest amount of variance. These were aggression, autonomy, and self-control. Further studies of personality measures may aid in describing this population more fully.

Low physical activity levels and high serum C-reactive protein (CRP) levels are risk factors for coronary artery disease (CAD) in both men and women. However, postmenopausal women who take hormone replacement therapy (HRT) may have increased risk of CAD because of HRT-related increases in serum CRP. There are two manuscripts in this dissertation. The purpose of the first manuscript was to determine whether higher physical activity energy expenditure was associated with lower serum CRP, independent of oral HRT status and body fatness, in 133 postmenopausal women. Higher physical activity energy expenditures were significantly associated with lower serum CRP levels (r=-0.21, p=0.0l9), independent of oral HRT use, age, smoking behavior, alcohol consumption, aspirin use, and statin use. However, in the complete multivariate model, which included body fat, the association between higher physical activity and lower serum CRP levels was abolished. The purpose of the second study was to quantify the biological variability of insulin resistant CAD risk factors in a sample of 8 postmenopausal women. Risk factor outcomes, including serum total cholesterol, serum triglycerides (TG), serum high-density lipoprotein cholesterol (HDL-C), serum glucose, plasma insulin, serum CRP, waist and hip circumferences, abdominal sagittal diameter, body fat, systolic (SBP) and diastolic blood pressure, and self-reported physical activity energy expenditure, were measured on two occasions, 7-12 days apart. High absolute biological variability values (by standard error of measurement) were observed for serum TG (32.0 mg/dl), serum CRP (5.6 mg/l), SBP (4.0 mmHg), and physical activity (9.4 kcal/kg/week). High relative biological variability (by within-subjects coefficient of variation ���27.3%) was also observed for serum TG, serum CRP, and physical activity. Bland-Altman plots identified individual outliers for serum TG, serum CRP, plasma insulin, and SBP. Together, the results suggest that the correlations between lower levels of serum CRP and higher levels of physical activity, though significant, may have been attenuated by the high biological variability of both serum CRP and physical activity. Thus, the importance of higher levels of physical activity, in decreasing serum CRP and the concomitant risk of heart disease, may be underestimated in the absence of serial measurement of serum CRP and physical activity. / Graduation date: 2002

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / History / Doctoral / Doctor of Philosophy

Findings released from recent pivotal clinical trials on hormone therapy (HT) benefits and risks have stimulated a growing trend towards lower doses and earlier discontinuation of HT for menopausal women. Yet, there is little knowledge regarding women's personal experiences with the resultant earlier and possibly abrupt withdrawal of HT. The purpose of this study was to explore postmenopausal women's vasomotor symptom experiences after discontinuing HT. The data for this study was collected from menopausal women who discontinued HT. The study questionnaire was created through an extensive review of the literature as well as an expert panel review. The questionnaire was also piloted with a small group of women prior to its use in this study. Data analysis consisted of descriptive analysis with means and standard deviations and/or frequency distributions with percentages for demographic data, health behaviors, factors influencing HT decisions, use of CAM and perceived efficacy. Chi-square analysis, Spearman Rho correlation, and logistic regression analysis were conducted for contextual factors and vasomotor symptom experiences. A McNemar test was performed to assess within group differences for vasomotor symptoms experiences pre and post HT. Questionnaires were received from 563 menopausal women throughout the United States. This study revealed that 80% of participants experienced vasomotor symptoms after discontinuing HT. The most common predictors which accounted for only 13% of variance in the occurrence of vasomotor symptoms were younger age, type of menopause and the occurrence of vasomotor symptoms prior to initiation of HT. Of the 563 women participating in the study, less than half reported the use of CAM to treat reemerging vasomotor symptoms. For the most part, less than half of the women felt their treatment choices were helpful in relieving their reemerging vasomotor symptoms Because a woman's experience of menopause can be highly individualized, an adaptation of Bronfenbrenner's ecological theory was used guide this exploratory study. The study findings supported the usefulness of the adaptation of Bronfenbrenner's ecological theory as a model through which to view the vasomotor experiences of menopausal women who have discontinued HT. / text

This thesis examines the evolution of HIV/ AIDS education for women in metro- Vancouver. The research focuses on two questions, "What AIDS education programs for women currently exist in Vancouver?" and "How effective has AIDS prevention education for women been?" Since the reported incidence of HIV/ AIDS continues to rise, the latter question leads to a further issue, "Why have some women been excluded from the HIV/ AIDS discourse? I chose to investigate these issues from a socialist feminist perspective. This perspective, which focuses on women's position within the economy, society, and family, guided my analysis of information I gathered from a variety of sources. These included both primary and secondary sources, namely: brochures; magazines; newspapers; television reports; journals; books; presentations; and interviews. The findings of the research reveal that, at the onset, preventative educational strategies did not exist for metro-Vancouver women because the gendering of the AIDS epidemic rendered women invisible. Since subsequent AIDS education focussed on "risk groups" rather than risk behaviors, many women who do not belong to a "risk group" still believe that they are not at risk. Consequently, gender appropriate strategies for AIDS prevention education need to be further developed. As well, these strategies are only one part of the solution. Belief systems, social scripting, and perceptions of one's self and others are the more challenging and difficult pieces to change, as are the underlying root causes of drug addiction and promiscuity.

Steady increases in breast cancer burden have recently been observed in Ghana. Despite the low incidence of the disease compared with other African countries, breast cancer deaths are high in this West African country. However, the uptake of breast cancer screening programs remains extremely low among Ghanaian women. Using a mixed methods approach comprising quantitative surveys and focus groups interviews, this study examined the influences of individual and contextual level factors on Ghanaian women’s intention to perform breast self-examination or undergo clinical breast examination and mammography screening. The results suggest that health beliefs, knowledge, and sociodemographic, cultural and health system factors individually and collectively influence intentions towards breast cancer screening. These findings highlight the need for health education interventions to promote breast cancer screening programs, while addressing systemic, psychosocial, and cultural barriers to screening. / viii, 187 leaves ; 29 cm

[Truncated thesis] Background & Aims- The determinants of atherosclerosis in elderly postmenopausal women are poorly understood. We do not know if the traditional coronary heart disease (CHD) risk factors remain important in this group. Despite the growing body of data relating to exogenous estrogen, we know very little about the relationship of endogenous estrogen with inflammation, CHD risk factors and subclinical atherosclerosis in elderly women. Genes that may play a role in post-menopausal cardiovascular disease (CVD)(ER-α and Apo E gene polymorphisms) have not been examined in this population for their effect on sub-clinical atherosclerosis and whether this effect is modified by the level of endogenous estrogen. We have examined the effect of established cardiovascular risk factors, endogenous estrogen and Apo E genotype on carotid artery atherosclerosis in a large group of women over the age of 70 years. In smaller sub-groups, we have examined the relationship between ER-α gene polymorphisms and atherosclerosis and the relationship between endogenous estrogen and CRP. Methods- We studied 1149 ambulatory elderly women who were recruited from the electoral role in Perth, Western Australia in 1998 and subsequently underwent carotid ultrasound assessment in 2001 according to a standardised protocol (for detection of focal plaque and measurement of intimal-medial thickness). The subjects had a mean age of 75 years (range 70 to 82 years) at baseline. We assessed the following variables in almost all subjects at baseline; time from menopause, FEI (molar ratio of plasma estradiol to sex hormone binding globulin (SHBG) x 1000), systolic and diastolic blood pressure, total cholesterol, LDL and HDL cholesterol, triglycerides, body mass index, glycated haemoglobin, homocysteine, apolipoprotein E (ApoE) genotype, history of smoking, diabetes, cardiovascular disease and medication use. Four hundred and thirty three women were analysed for estrogen receptor alpha (ERα) genotype and 100 underwent measurement of high sensitivity C-reactive protein.

[Truncated abstract] The cost of managing osteoporotic fractures places a significant financial burden on the health-care system. To reduce the fracture burden, early identification of fracture risk is essential to allow early intervention. The limitations associated with dual-energy X-ray absorptiometry (DXA), such as limited sensitivity and specificity, cost, ionising radiation and accessibility, have resulted in the emergence of other technologies for assessing bone fragility. An example is the portable and non-ionising quantitative ultrasound (QUS) technology. The discriminatory power of quantitative ultrasonometry in fracture risk identification, either independently or in combination with other established risk factors, currently remains contentious. It is recommended that fracture risk assessment should not only focus on bone status, but also on the risk of falls. Additionally, it has been noted that disability arising from osteoporotic fractures, even when these fractures are not identified clinically, can translate into psychosocial symptoms and a poorer perception of health-related quality of life (HRQoL). The primary aim of the present study was to investigate if a composite model comprising: calcaneal QUS, falls risk and HRQoL assessments, can identify a group of elderly women at high risk of osteoporotic fracture from those at lower risk. One hundred and four community-dwelling women (mean age 71.3 ±5.8 years) were recruited for this study. These women underwent a series of tests that included: DXA bone mineral density (BMD) evaluation of the proximal femur and lumbar spine (L1 L4); calcaneal QUS measurement; spinal radiography; rasterstereographic back surface curvature (BSC) examination; and performance-based assessment of strength, mobility and balance. The women were classified into a `High Risk’group or a `Low Risk’ group using three separate classification criteria: i) low BMD, based on the World Health Organisation (WHO) recommended T-score of < -2.5, and⁄or a history of fragility fracture (Osteoporotic [OP] group versus Non-Osteoporotic [NOP] group); ii) presence of at least one radiographically identified prevalent vertebral fracture (Vertebral Fracture [VF] group versus Non-Vertebral Fracture [NVF] group); or iii) a history of either forearm or wrist fracture (Forearm/Wrist Fracture [WF] group versus Non-Forearm/Wrist Fracture [NWF] group)