Though an industrialized nation characterized by increasing secularization and liberalization, the Republic of Ireland has a long history of religious and morally-driven politics. Much of Ireland's economic success of the last ten years has been noted as a significant motivator for social change. However, a shift in the Irish moral sphere has been underway for at least thirty years. Despite a flourishing self confidence in National identity, already marginalized women---including drug-users, asylum-seekers from sub-Saharan Africa, and those in economically deprived communities of Greater Dublin---have felt increased social polarization. The cultural and epidemiological boundaries created between the 'healthy' Irish self and the 'dangerous' others have contributed to a unique climate regarding HIV/AIDS and cultural constructions of 'risk'. This anthropological analysis utilizes both political-economic and social constructionist frameworks so that both structural and discursive contributions to the spread of HIV/AIDS are examined. Particularly important are the ways competing discourses shape both practices and conceptions of HIV and the 'other'.

No description available.

Behavioral and physiological reactivity, and its relationship to cardiovascular disease has been studied in men for a number of years, and the expression of anger has been identified as a possible contributing factor. Few studies, however, have focused specifically on the reactivity of women, and those which have suggest that women are less reactive to laboratory tasks than men. For the present study, 45 undergraduate women, ages 19-21 were selected from a larger sample of 135 women to represent three discrete groups: (1) low anger/low denial, (2) high anger/low denial, and (3) low anger/high denial, based on their scores on the State-Trait Anger Expression Inventory, P and the Marlowe-Crowne Social Desirability Scale. It was hypothesized that the three groups would show reliable differences in heart rate and blood pressure during presentation of a stressful laboratory stimulus, the Stroop Color and Word Test. Each subject received three counterbalanced conditions: (1) no feedback, (2) error feedback without observer present, (3) error feedback with observer present. As hypothesized, women who reported a high level of denial and a low level of anger exhibited reliably greater systolic blood pressure to the no-feedback condition than subjects who reported low levels of denial and anger. The hypothesis that all groups would display greater A reactivity in a condition which provided error feedback with observation was not supported. / Master of Science

Secular trends in breast cancer incidence in younger women suggest environmental factors, like exposure to environmental chemicals, may play a role in rising incidence. One of the strongest risk factors for developing breast cancer, next to family history, is high mammographic breast density, which is defined as the proportion of fibroglandular breast tissue relative to fat as seen on a mammogram. Phthalates, a ubiquitous endocrine disrupting chemical, have the potential to interfere with endogenous hormones like estrogen and androgens. There is growing evidence from animal and epidemiologic studies indicating distinct periods of heightened susceptibility to endocrine disrupting chemicals throughout the life course, particularly during critical windows of breast development. Exposure to hormonally active environmental chemicals like phthalates may be a modifiable risk factor for breast cancer, therefore reducing or eliminating exposure could have substantial public health benefits. The overarching goal of this dissertation was to assess the relationship between exposure to phthalates during two critical windows of susceptibility, the prenatal and pregnancy periods, and its effect on breast tissue composition in adolescence and adulthood. First, a comprehensive review of epidemiologic studies summarized the body of evidence for the association between phthalate exposure and intermediate markers known to be in the causal pathway of breast cancer risk (age at breast development, menarche, and breast tissue composition). This systematic review of the literature aimed to identify potential patterns of evidence by outcome and timing of exposure. Evidence from this review suggested that phthalate exposure during the prenatal and childhood periods may play a role in altering menarche. Findings for phthalate exposure and age at breast development were inconclusive. There was a considerable lack of epidemiologic data on phthalate exposure and breast tissue composition throughout the life course. Based on one study, there is a potential association between phthalate exposure during pre-puberty and altered breast tissue density in adolescent girls. No study assessed the relationship between phthalate exposure during the prenatal or pregnancy period and subsequent breast tissue composition. Second, an examination for the association between prenatal phthalate exposure and breast tissue composition measured in adolescence (Chapter 3) and the association between phthalate exposure during pregnancy and breast tissue composition measured during or after the postpartum transient period (Chapter 4) aimed to address this major gap identified from the comprehensive review. The empirical chapters of this dissertation used data from an ongoing longitudinal birth cohort study of mothers and their children conducted by the New York City Columbia Center for Children's Environmental Health and the Breast Cancer and the Environment Research Project (CCCEH-BCERP). The CCCEH-BCERP study cohort has prospective data on nine phthalate metabolite concentrations measured during the third trimester of pregnancy and breast tissue composition measured in a subsample of mother-daughter dyads. Notably, we used novel non-invasive methods (optical breast spectroscopy) in this younger cohort of mothers and daughters to objectively measure specific components of the bulk breast composition before mammography screening age. There was significant evidence of altered breast tissue composition in both mothers and daughters. For daughters (n=127, mean age 15.2 ± 1.9 years), prenatal exposures to select low molecular weight (LMW) and high molecular weight (HMW) phthalate metabolites altered overall breast density in opposing directions, which appears to be driven by significant altered percent breast water. There was a significant association between higher prenatal levels of a LMW phthalate metabolite (monobutyl phthalate) and lower levels of overall breast density (adjusted β = -0.32; 95% CI: -0.51, -0.13) and significant association between sum of di(2-ethylhexyl) phthalate (∑DEHP), a HMW phthalate metabolite, and higher levels of overall breast density in girls (adjusted β = 0.20; 95% CI: 0.05, 0.34). For mothers (n=133, mean age 41 ± 5.3 years at follow-up), there was a significant association between two LMW phthalate metabolites and lower levels of percent breast collagen. Additionally, there was a significant inverse relationship between levels of mono-(3-carboxypropyl), a HMW phthalate metabolite, and percent total hemoglobin of the breast (adjusted β =-0.03; 95% CI: -0.06, 0.00, p=0.05). Overall, this dissertation increased our understanding of the impact that exposure to phthalates during critical windows of susceptibility may have on specific components of the breast. Reducing exposure to both HMW and LMW phthalates may have an impact in reducing breast cancer risk, particularly for girls prenatally exposed, as there was stronger evidence of higher overall breast density and percent water from exposure to select HMW phthalates. Future prospective studies should confirm these results as findings might provide an opportunity for modifying potential breast cancer risk.

Environmental exposure levels are often sufficiently disparate between populations such that there is little or no overlap, complicating our ability to ascertain the full dose-response curve and as such create informed regulatory policy.I reviewed the literature on methods available to address non- and partially-overlapping exposure distributions, drawing from both epidemiology as well as other relevant disciplines to describe the universe of proposed solutions. I also used the case study of maternal PCB-153 exposure and birthweight, utilizing real-world and simulated data to explore our ability to ascertain “true” dose-response curves from observational data given the limited cohort-specific exposure ranges. I investigated the importance of controlled and uncontrolled confounding as well as the impact of sample size on our ability to ascertain a “true” underlying dose-response curve. Pooling and meta-analysis were useful to increase the heterogeneity of exposure distributions despite imperfect confounding control and heterogenous confounding structures across cohorts. The analyses also serve as continued evidence of the challenges of making population-wide inferences from study samples with restricted exposure ranges as well as the danger of pooling multisite data without sufficiently accounting for heterogeneity in both exposure level and distribution of confounders. These results highlight the limitations of using both individual studies and systematic reviews of environmental chemicals, and emphasize the need for pooling and meta-analysis to widen exposure distributions that in turn permit us to accurately capture the negative effects of these environmental chemicals.

The relationship between the PQ-segment slope on ST-segment depression during vigorous exercise was examined in 26 apparently healthy females between 18 and 26 years of age. Each subject performed 2 submaximal cycle ergometer exercise tolerance tests (trial A and trial B) on nonconsecutive days wherein the following variables, as delta scores, were measured; P-wave amplitude (microvolts), PQ-segment slope (uV!sec), and J-point at 0 and 60 msec (uV). Each variable was measured by both visual and computer averaging. The degree of reproducibility within and between trials differed for the visual and computer averaged measures. Generally higher reproducibility was found with computer averaging particularly within trial B (r =0.63-0.89, p<O.OI). Trial b served as a basis for assessment of PQ-segment slope effect on ST segment response. Computer analysis of frequency distribution for responses revealed a greater frequency of downsloping PQ-segment with clinically significant ST-segment depression (>50 uV) at both 0 and 60 msec after the J-point in lead II. However, there was a greater percentage (91%) of flat PQ-segment slopes with clinically significant ST-segment depression at J-point 0 msec in lead V5. These findings suggest possible influence of lead selection on the measurements of the PQ-segment slope and ST-segment. Implication of clinical application would be to use lead VS for diagnosing CHD and by measuring ST-segment depression at J-point 60 msec. However when screening exercise ECG tests in apparently healthy women use J-point at 0 msec. / Master of Science

Breast cancer poses a serious public health concern. This case-control study describes the relationship of night-shift working on the development of breast cancer in 57 women diagnosed with breast cancer compared to 49 women with other types of cancer in the Vaal Triangle area (selected through non-probability purposive sampling from CANSA). The study revealed that women who work night-shift developed breast cancer 1.24 times more often than women who do not work nightshift (OR=1.24 [95% CI 0.52 to 2.89]). The odds ratio was further increased in women who worked rotating-shift (OR=1.44 [95% CI 0.58 to 3.59]). Night-shift work exposure was not statistically related to the development of breast cancer. It is recommended that the relationship between night-shift exposure and breast cancer risk be further explored through cross-sectional and cohort studies, and other breast cancer pathways. / Health Studies / M.A. (Public Health)

Breast cancer poses a serious public health concern. This case-control study describes the relationship of night-shift working on the development of breast cancer in 57 women diagnosed with breast cancer compared to 49 women with other types of cancer in the Vaal Triangle area (selected through non-probability purposive sampling from CANSA). The study revealed that women who work night-shift developed breast cancer 1.24 times more often than women who do not work nightshift (OR=1.24 [95% CI 0.52 to 2.89]). The odds ratio was further increased in women who worked rotating-shift (OR=1.44 [95% CI 0.58 to 3.59]). Night-shift work exposure was not statistically related to the development of breast cancer. It is recommended that the relationship between night-shift exposure and breast cancer risk be further explored through cross-sectional and cohort studies, and other breast cancer pathways. / Health Studies / M. A. (Public Health)

Indiana University-Purdue University Indianapolis (IUPUI) / Rates of chronic disease and physical inactivity are disproportionately high among African American women. Despite the known benefits of physical activity and an increasing number of programs designed to increase activity, attendance rates to many exercise programs remain low. There is much to learn about program types, such as healthy lifestyle programs (HLP); individual factors, such as self-efficacy; and mediating variables that may influence exercise program attendance. An observational study design was used to compare exercise self-efficacy and attendance in a community-based exercise program in African American women who were enrolled in a HLP (N = 53) to women who were not (N = 27). Exercise program attendance was gathered across six months; demographics, self-efficacy and physical activity behaviors were assessed through surveys; and physiological variables (resting heart rate and blood pressure, height, and weight) and physical fitness (muscular strength and endurance and cardiovascular endurance) were measured at baseline. Descriptive statistics were used to describe participants and groups were compared using T-tests, chi-square and non-parametric statistics. Finally, mediation analyses were conducted using multiple regression models to assess self-efficacy as a potential mediator to exercise program attendance. Women who enrolled in this study were of low income (61% having an annual income less than $20,000), obese with a mean (standard deviation) body mass index (BMI) of 37.7 (7.6), pre-hypertensive with a mean (standard deviation) systolic blood pressure of 125.9 (14.4), and scored poorly and marginally on two fitness tests. On average, women reported being Moderately Confident in their ability to exercise regularly, yet had low attendance in the exercise program with a median number .5 days over six months and there were no significant differences in exercise self-efficacy (p = .23) or attendance in the exercise program between groups (p = .79). Additionally, exercise self-efficacy was not a mediating variable to program attendance. Women in this study had little discretionary income and several chronic disease risk factors, yet exercise program attendance was low even in those enrolled in a HLP. Identifying factors that increase exercise self-efficacy and factors that influence attendance beyond self-efficacy may help future program design and attendance.

Unwanted and unintended pregnancies pose major reproductive health challenges to women throughout the world. Despite the availability of modern contraceptives, many women and men fail to use contraceptives effectively. This research focussed on reasons for not using contraceptives effectively in the Northern Tshwane area of the Gauteng Province of the Republic of South Africa (RSA). Structured interviews were conducted with 83 women and 71 men about their contraceptive practices. Age, religion, educational level and residential areas influenced clients' contraceptive practices. These results were categorised for adult males and females as well as for adolescent males and females. Adolescents encountered problems in accessing contraceptive services. Adult females knew most about traditional contraceptives, although men knew about some of these methods, and adolescents used some of them. All respondents could gain additional knowledge about modern contraceptives. The respondents' knowledge about · emergency contraceptives was extremely limited. Although most respondents knew about legalised choice on.termination of pregnancy (CTOP) services in the RSA, they did not know when nor how to access these services. Nurses working in contraceptive health services, revealed during a focus group discussion that a lack of resources (including shortages of malcondoms, contraceptive injections and oral contraceptives) hampered the quality of services that could be rendered. Of particular concern was the nonavailability of Norplant implants and female condoms. Nurses expressed a need for pecific national policy guidelines about supplying contraception to adolescents. Although most nurses knew about emergency contraceptives, they did not promote its use because they assumed that clients would misuse emergency contraceptives.instead of using contraceptives regularly. The nurses indicated that very few facilities offered CTOP services. The nurses regarded women who obtained repeated CTOPs to be misusing these services and suggested that limitations should be placed on the number-of times any woman could obtain such services. The negative attitudes of community members and of colleagues towards persons working in CTOP services caused hardships for them. Recommendations address ways in which contraceptive services could be improved. / Health Studies / D. Litt. et Phil. (Advanced Nursing Sciences)