O transplante cardíaco representa a última alternativa de tratamento e única possibilidade de sobrevivência do paciente com insuficiência cardíaca (IC) terminal. É indicado quando todos os procedimentos foram considerados ou excluídos no tratamento da cardiopatia grave. Atualmente, os resultados obtidos com a cirurgia de enxerto indicam possibilidade de aumento de sobrevida do transplantado que, de outro modo, iria a óbito. Em aproximadamente 80% dos transplantes de coração hoje realizados, os pacientes estão vivos dois anos após a cirurgia. Devido à escassez de trabalhos encontrados na literatura, a presente pesquisa foi realizada com mulheres cardiopatas indicadas à cirurgia de enxerto. Questiona-se a interferência de relações objetais estabelecidas pelas pacientes na decisão de submissão à cirurgia e adesão aos cuidados do pós-operatório. O objetivo principal foi verificar a dinâmica emocional de mulheres candidatas ao transplante cardíaco. Foram utilizados como instrumentos o Teste de Relações Objetais de Phillipson (TRO), interpretado através de investigações sobre o Sistema Tensional Inconsciente Dominante (STID), e a entrevista clínica classificada a partir da Escala Diagnóstica Adaptativa Operacionalizada (EDAO), aplicados em sete pacientes encaminhadas à avaliação psicológica pelo Setor de Transplante Cardíaco do Instituto Dante Pazzanese de Cardiologia (IDPC), em São Paulo. A análise dos achados se deu à luz da teoria psicanalítica das Relações Objetais de Melanie Klein. Constatou-se que as mulheres indicadas ao transplante de coração, participantes da presente pesquisa, estabelecem relações objetais persecutórias correspondentes às fases mais arcaicas do desenvolvimento esquizoparanóide e viscocárica. Agindo como fator tensional, a doença cardíaca terminal pode ser vivida como perigo interno, induzindo a excessiva pressão das forças de morte e agravando tendências à negação e abandono do tratamento. / The cardiac transplantation represents the last alternative of treatment and an unique possibility of surviving for the patient with terminal cardiac insufficiency (CI). It is indicated when all other procedures were considerate or excluded for the treatment of serious cardiomyopathy. Currently, the results archieved with the graft surgery indicate the possibility of growth in overlife of patients that submitted for a transplant which, otherwise, would die. In approximately 80% of the cases of heart transplantations today, the patients are still alive two years after the procedure. Due to the lack of studies found in literature, the current research was made with cardiomyopathy women that submitted for a graft surgery. It is questioned the interference of object relations established by the patients in the decision to submit for the surgery and in the adhesion to the pos-operatory cares. The main objective was to verify the emotional dynamic of women applying for a cardiac transplantation. Where used as instruments the Object Relations Test (ORT), by Herbert Phillipson, interpreted by investigations over Unconscious Tensional System, and clinical interviews using the Adaptive and Operationalized Diagnostic Scale (AODS), applied in seven patients sent to psychological analysis at the cardiac transplantation sector of Dante Pazzanese Institute (IDPC), in São Paulo. The analyses of the results were made using Melanie Klein´s psychoanalytical theory. The women investigated who applied to the transplantation established persecutory object relations corresponding to the more archaic phases of the development. Acting as a tensional factor, the terminal cardiac disease can be lived as an intern danger, inducting to excessive pressure of forces of death and aggravating tendencies to treatment denial and abandonment.

This study explores and describes the perceived needs of women living with HIV/AIDS in Saskatchewan. A purposive sample was used to recruit women to participate in three focus groups. A total of eleven women from urban and rural areas of Saskatchewan participated. Based on seroprevalence estimates this number may represent one third to one half of all expected cases of women with HIV/AIDS in Saskatchewan. Recursive analysis was used to validate the themes identified in the first two focus groups with participants in a third focus group. Content analysis of the data identified four themes from the women's experiences: 1) medical needs, 2) economic needs, 3) mental health needs, and 4) service needs. The results support previous studies which indicate that women with HIV have a number of unmet heeds. Women from rural areas were found to have more unmet needs and limited access to appropriate services and supports than urban women. Three types of coping strategies were found to be used by the women in getting their needs met: avoidance, maintenance, and mastery. Those who utilized a mastery coping strategy were more successful in having their needs met than those who did not. A number of individual, organizational, systemic, and policy interventions are identified to assist women in moving towards mastery coping strategies. Social workers can work at the clinical, family group, and policy levels to improve the situation for women living with HIV/AIDS in Saskatchewan. / Arts, Faculty of / Social Work, School of / Graduate

One of the greatest social injustices is that people who are marginalized experience more illnesses, disability, and shorter lives than those who are more affluent (Benzeval, Judge, and Whitehead, 1995). In this dissertation I critique the notion that health is affected by poverty through primarily material factors. In fact, poor women are systematically excluded from resources and opportunities to pursue their health. This feminist action research project addressed how poverty and exclusion influenced poor women's health, examined how a group of women negotiated their experiences of poverty and health, and developed action strategies to address their shared concerns. For 1 V2 years I worked with a group of 30 poor women and gathered qualitative data from 15 meetings, 32 interviews, and 30 sets of fieldnotes. The women lived in material deprivation and could not afford the most basic living necessities. They felt stereotyped, excluded, and invisible in their every day lives. The stereotype of the "welfare recipient" fueled institutional stigmatization and surveillance. Welfare, health care, and community recreation workers were threatening, withheld important information, and limited the women's access to services through chscriminatory practices and policies. The women had limited access to health-promoting resources, and their interactions with authorities were shaming which negatively influenced their psychosocial health through stress, depression, low self-esteem, and anger. Services that were meant to help them labelled them as poor and hurniliated them. The women's shame, material scarcity, and limited access to resources engendered feelings of lack of control and hopelessness and influenced their health. The women's varied discourses of poverty and health reflected attempts at finding legitimacy in a society that systematically excluded and de-legitimized them. Through their conversations and our feminist action research work together, they uncovered legitimate identities within experiences of poverty and ill-health and advocated action and social change. They cited a "livable" income, accessible health-promoting resources, and redressing stigmatizing practices and policies as changes required to improve their health. These findings confirmed that the social determinants of health must be reframed to better understand the effects of exclusion on poor women's health and that inclusion, respect, and dignity are fundamental conditions for promoting health. / Graduate and Postdoctoral Studies / Graduate

This is a step-by-step cosmetology handbook with instructions and techniques employed by professional makeup artists to transform a woman from average to gorgeous.

MPH / Department of Public Health / See the attached abstract below

According to the National Vital Statistics Report (1998), Black women age 45-64 are ten times more likely than white women of the same age to die from diseases of the heart. They are five times more likely to die from diabetes. The goal of this study was to examine how articles published in leading medical journals between 1989 and 1998 accounted for such differences in health outcomes among Black and white women. The explanatory content of the articles was analyzed and coded according to four types of attributions: genetic/biological, cultural/behavioral, structural/socioeconomic and alternative. Each type of explanation derives from different assumptions and operates with different models for understanding why health outcomes vary among groups. Alternative explanations are those that focus on the direct effect of race/gender oppression on Black women's health. Genetic/biological attributions occurred less frequently than structural/socioeconomic and cultural behavioral but were more likely to occur than alternative attributions, which were the least often employed. While alternative attributions are considered in some of the articles about Black women's health and mortality, they are overall rarely employed. The finding that explanations that most directly explore the impact of racism and sexism on Black women's health occur least often has important implications. Articles published in these three journals inform medical practitioners and affect the ability of such practitioners to adequately address the needs of Black women in their care.

Impaired intrauterine growth, inability of the fetus to achieve the required growth potential, contributes to a higher burden of neonatal morbidity and mortality. Intrauterine growth is an inferred process and small for gestational age is considered a rough estimate of impaired intrauterine growth that requires reliable gestational age data. Due to sparse data and measurement errors in gestational age, researchers rely on markers such as birth weight, birth length, and birth head circumference to infer fetal growth. While the etiology of impaired fetal growth is multifactorial, maternal anemia and undernutrition contribute substantially to impaired fetal growth and are prioritized in 2030 global nutrition goals by the World Health Assembly. Nutrition supplements such as lipid-based nutrient supplements, multiple micronutrients, and iron or folic acid during pregnancy are presumed to improve maternal anemia. But the effect of the supplements during pregnancy on fetal growth appears to be small to negligible, which has shifted the researcher’s focus to the pre-conception period. However, prior reviews on the preconception period have either synthesized the evidence from observational studies, or have explored outcomes such as congenital anomalies (e.g., neural tube defects), neurodevelopment disorders, or only birth weight. Hence the evidence from existing randomized controlled trials (RCTs) evaluating the effect of preconception nutrition supplements on maternal anemia and all markers of fetal growth including birth weight, birth length, and birth head circumference has not been systematically summarized and synthesized. We bridged this knowledge gap in the current dissertation (Aim 1). The Women First (WF) Preconception Nutrition Trial found that lipid-based nutrient supplementation started preconception or during pregnancy conferred greater benefits for birth weight and birth length among mothers who were anemic (Hemoglobin (Hb) < 12 g/dL) than among mothers who were non-anemic (Hb ≥ 12 g/dL) pre-pregnancy. However, by dichotomizing women into anemic and non-anemic women, we may miss high-risk women with specific Hb levels who may obtain greater benefits for intrauterine growth associated with the supplements. Assessing the effect of preconception nutrient supplements across a range of pre-pregnancy Hb levels will help us identify women with specific Hb cut-offs who may have the greatest potential to respond to the supplements (Aim 2). Additionally, there are major gaps in understanding the mechanisms of how nutrient supplements, consumed either before or during pregnancy, improve intrauterine growth. A better understanding of the underlying mechanisms would allow for fine-tuning of nutrition interventions for greater efficacy. Here, we examined whether Hb during pregnancy could be a potential mechanism through which nutrition supplements improve intrauterine growth (Aim 3). For Aim 1, we undertook a systematic review and meta-analysis of the RCTs evaluating the effect of preconception nutrition supplements on maternal hemoglobin and markers of intrauterine growth including birth weight, birth length, birth head circumference, and small for gestational age. Additionally, we examined preterm birth as an important perinatal outcome. We searched electronic databases including PubMed, Web of Science, Embase, CINAHL, and Cochrane Central. We computed pooled mean differences and risk ratios (RR) with 95% confidence intervals (CIs) using random-effect models. We employed I2 and Cochran’s Q test statistics to assess heterogeneity. We used the GRADE (grading of recommendations, assessment, development, and evaluations) tool to assess the quality of evidence. For Aim 2 and Aim 3, we leveraged the existing data from a large multi-country Women First (WF) Preconception Nutrition Trial conducted in Pakistan, India, Guatemala, and the Democratic Republic of Congo. Women in the WF trial were randomized to consume a lipid-based nutrient supplement (LNS) at least three months before and during pregnancy (Arm 1- preconception), only during pregnancy (Arm 2- during), or not at all (Arm 3 - control). The outcome was weight, length, and head circumference within 48 hours of birth expressed as Z-scores. For Aim 2, we analyzed the WF trial data on 2443 women-newborn dyads. For each site, we computed adjusted mean differences in these Z-scores between the randomized arms across six pre-pregnancy Hb categories (8-8.9, 9-9.9, 10-10.9, 11-11.9, 12-12.9, and ≥13g/dL) based on Hb distributions. We pooled site-specific effect measures using meta-analysis. For Aim 3, hemoglobin measured at 12 (n=2075) and 32 weeks of gestation (n=2157) was a mediator. We employed causal mediation analysis under a counterfactual approach to estimate direct and indirect effects. For Aim 1, we identified 20 eligible RCTs (n=27,659 women). Preconception nutrition supplements (iron and folic acid, multiple micronutrients, and a lipid-based nutrient supplement) increased maternal hemoglobin by 0.30g/dL ((0.03, 0.57); I2=79%). However, we did not find a significant effect of the supplements on birth weight (12.47gm ((-33.14, 58.08); I2=58%)), birth length (0.15cm (-0.26, 0.56); I2=68%; n=5), birth head circumference (-0.23cm (-0.88, 0.43); I2=84%), small for gestational age (RR: 0.91 (0.80,1.04); I2=31%), or preterm birth (RR: 0.93 (0.69,1.25); I2=57%). Overall, the quality of evidence was assessed as moderate and very low for maternal hemoglobin and three markers of intrauterine growth including birth weight, birth length, and birth head circumference, respectively. In Aim 2, we found that the effect of LNS on birth weight, length, and head circumference varied by pre-pregnancy Hb categories. Pooled mean differences in the Z-scores for birth length (0.60 (0.03, 1.23)), birth weight (0.50, (0.11, 0.89)), and birth head circumference ((0.26, (0.02, 0.51)) were greatest for Arm 1-preconception vs. Arm 3-control women with Hb 9-9.9g/dL. Women with Hb 10-10.9g/dL also benefited from preconception LNS. However, compared to controls, the effects of preconception LNS on birth weight, birth length, and birth head circumference attenuated for women with Hb 10-10.9g/dL. Compared to Arm 3-control, LNS during pregnancy (Arm 2) improved birth length, birth weight, and birth head circumference for women with Hb 8-10.9g/dL. Preconception LNS (Arm1) vs. LNS during pregnancy (Arm 2) improved the three markers of intrauterine growth only for women with Hb 9-9.9g/dL. Women with nearly normal (11-11.9 g/dL) and normal Hb (≥12g/dL) did not appreciably benefit from LNS, offered before and or during pregnancy. For Aim 3, Hb at 12 or 32 weeks of gestation did not mediate the relationship between the LNS and intrauterine growth. Indirect effects of preconception LNS (Arm 1) vs. Arm 3, mediated by Hb at 12 weeks, were 0.02 (-0.02, 0.01), 0.01 (-0.01, 0.02), and 0.01 (-0.01, 0.02) for length, weight, and head circumference Z-scores, respectively. The corresponding direct effects, not mediated by Hb, were 0.18 (0.09, 0.33), 0.12 (0.03, 0.23), and 0.06 (-0.03, 0.20), respectively. Site-specific and gestational age-adjusted data analyses both at 12 and 32 weeks of gestation confirmed the findings of negligible mediation by Hb during pregnancy. All types of preconception nutrition supplements studied to date appear to reduce maternal anemia. However, it is uncertain whether there are beneficial effects of preconception nutrition supplements on markers of intrauterine growth. Low quality of evidence from the RCTs examining the markers of intrauterine growth warrants future well-designed RCTs to produce solid scientific data, particularly on the benefits of a more comprehensive package of preconception nutrition supplements that include both macro- and micronutrients. The findings from the WF trial suggest that the benefits of preconception LNS on fetal growth are mainly confined to women with pre-pregnancy Hb 9-9.9g/dL. Compared to controls, women with Hb 10-10.9g/dL also benefited from preconception LNS, albeit the magnitude of effect on three markers of intrauterine growth was modest for women with Hb 10-10.9g/dL. However, LNS, started during pregnancy, appeared to improve markers of intrauterine growth for women with a wider range of Hb 8-10.9g/dL. Women with Hb ≥ 11g/dL did not benefit from LNS started either pre-conception or during pregnancy. These findings suggest that prioritizing women with specific pre-pregnancy Hb categories for targeted nutrition interventions may be advisable. This would target limited resources most efficiently in LMICs. Lastly, negligible mediation by Hb during pregnancy suggests that alternative pathways that potentially mediate the relationship between LNS and intrauterine growth need to be investigated.

The Institute of Medicine (IOM) and National Research Council (NRC) established guidelines for weight gain during pregnancy to maximize positive health outcomes for mothers and their offspring. However, in the US, about half of all pregnant women exceed these recommendations. Excessive weight gain during pregnancy is associated with various negative outcome for mothers and their children. Research in recent years has begun to explore the relationship between both diet quality and ultra-processed food (UPF) intake during pregnancy with gestational weight gain (GWG). However, research is scarce, especially pertaining to UPF intake and GWG. Additionally, there is no research which explores these relationships among Latina women living within the US. The purpose of this study is to explore the relationships between prenatal diet quality, measured with the Healthy Eating Index-2020 (HEI), and intake of UPF, based on the Nova classification system, with the adequacy of GWG among a predominantly Latina sample of adult pregnant women living within the US. Additionally, the association between social determinants of health with diet quality and with UPF intake were also explored. The study is a secondary-data analysis of data from a longitudinal study. The sample analyzed includes 118 pregnant women between the ages of 18-45 years old (mean = 29.9, SD = 6.1). Mean pre-pregnancy body mass index (pBMI) for the total sample was 25.8 kg/m2 (overweight). 67% of the sample identified as Hispanic/Latina. Overall, 22% of the sample were classified with inadequate GWG; 17% with adequate GWG; and 61% with excessive GWG. The mean total HEI score for the sample was 54.1 out of 100, where higher scores reflect higher diet quality and adherence to the Dietary Guidelines for Americans. There was a statistically significant difference across GWG groups (inadequate/adequate/excessive) in mean total HEI scores (p < .05). The adequate GWG group had the highest total HEI scores and the excessive GWG group had the lowest total HEI scores. Variables that were found to be univariately associated with excessive gestational weight gain included: average total HEI score, pBMI, ethnicity; education; and income (p < .05). A 1-point increase in mean total HEI scores was associated with a 5% lower chance of excessive GWG (p = .02). However, after adjustment for covariates (maternal age; pBMI; income; education; race and ethnicity), the association between average total HEI score and excessive gestational weight gain was attenuated and no longer statistically significant. There was a statistically significant difference across GWG groups (inadequate, adequate, or excessive) in their scores of two HEI components: Greens and Beans (p < .01); and Seafood and Plant Proteins (p < .01). The adequate GWG group had the highest scores and the excessive GWG group had the lowest scores in these HEI components. In simple logistic regressions of excessive GWG versus adequate GWG on HEI components, the Greens and Beans scores and the Seafood and Plant Protein scores were significantly associated with excessive GWG. After adjustment, the Greens and Beans scores and Seafood and Plant Proteins scores indicated strong estimated negative associations with excessive GWG, OR = 0.61, 〖 χ〗_1^2= 8.07, p < 0.01 and OR = 0.60, 〖 χ〗_1^2= 7.84, p < 0.01, respectively. A higher score on these components was associated with a lower risk of excessive GWG. The mean percentage of energy intake from ultra-processed foods (PEI-UPF) was 51.2%. There was no statistically significant difference in the PEI-UPF across GWG groups (inadequate, adequate, or excessive) and the PEI-UPF was not associated with odds of excessive GWG. However, the adequate GWG group had the lowest intake of PEI-UPF (49.2%) and the excessive GWG group had the highest intake of PEI-UPF (52.1%). Social determinants of health were not associated with the mean PEI-UPF, but results suggested a positive relationship between social support and total HEI scores (p = .08). Deeper analysis of the social support measure revealed a statistically significant relationship between the appraisal subscale of social support and HEI scores, Β = 0.13, F(1, 102) = 7.11 (p = 0.009). Overall, dietary intake during pregnancy may influence the adequacy of gestational weight gain. Achieving recommended intake of greens and beans, as well as seafood and plant proteins, may play a particularly important role in reducing the risk for excessive gestational weight gain. In addition, greater levels of social support, particularly access to another person who can offer advice and guidance with personal problems, may enhance diet quality during pregnancy.

National health care reform proposals advocate Primary Health Care (PHC) and preventive medicine as an efficacious way to control health care costs in the United States. This study examined a community in rural, southwest Virginia and evaluated the potential for PHC success. The study used focus groups to determine how Women Users, as consumers of health care, view their health and health care problems and potential solutions. Views of Community Leaders and Service Providers, as controllers of services, were obtained using semi-structured interviews. The results were compared using the PRECEDE framework of predisposing, enabling, and reinforcing factors influencing health behavior. This study was a component of a larger project - The Dickenson County Women's Health Project. The premise of that project was that women in Dickenson County would respond to a health education intervention program and the goal was to develop such a program. This study shows that Women Users fully comprehend the health behaviors and available services that would make themselves more healthy, but feel constrained by enabling and reinforcing factors that prevent healthy lifestyles. By contrast, Service Providers and Community Leaders focus on predisposing factors and remain convinced that women in Dickenson County need more education about healthy lifestyles and available health services. The study concludes that the women of Dickenson County are valuable resources for health program development. The success of PHC in Dickenson County is wholly dependent upon developing a mechanism whereby women are given a greater voice in program development and implementation. / Master of Urban Affairs

This thesis explores the potential of video as a research tool for anthropologists in the recording of a single ritual. The study examines interactions between ethnographers, informants and viewers. The thesis reveals the capacity of video to make possible close, detailed readings of performance in terms not originally anticipated by the researcher. Archival storage of the video recording allows for critique and assessment of the research. The case study chosen in which to test the potential of \ dcso as a research tool was a woman's 'initiation' r^L'ial (called inton jane) in Shixini in the Eastern Gape (in what was, until recently, the independent homeland of Transkei). Historically, the ritual was supposedly held at the time of a girl's first menstruation, this being the physical symbol of her transformation into adulthood. Ritual seclusion served to effect an accompanying social transformation in preparation for marriage. Paradoxically, in the late 1980's, it was older women and mothers, already married and well past the age of first menstruation, who were undergoing the ritual seclusion and symbolic marriage. The study explores this paradox with the goal of understanding the purpose of the ritual in contemporary times. By recording large segments of the ritual on video, and subjecting the footage to a close analysis of verbal and non-verbal aspects of performance, both the ritual and the merits of video as a research tool could be examined. Video was utilised, in an interactive research process, as an information elicitation tool. The analysis of the recorded text of the ritual brings to the fore elements which make what is apparently a paradox understandable. The elements which explicate the paradox were not anticipated when the research commenced, and in all likelihood would have eluded a researcher who did not have the benefit of the incidental capture on video. The thesis reveals the enormous Contribution video can make to research and suggests that video has an important contribution to make to the discipline of anthropology.