Numerous cross-sectional studies have reported an inverse relationship between VO2,,,ax and age. However, few longitudinal investigations have compared the rate of decline in VO2,,.x between women who did or did not report exercise habits consistent with the 1990 ACSM position stand for quantity and quality of exercise. The purpose of this study was to determine if changes in exercise habits and body composition affected age-related changes in VO2.x. Subjects were 91 women (age 40.9 ± 8.8 years at baseline) tested twice between 1973 and 1996 (range of 3.1 - 21.9 years, mean interval of 9.3 ± 4.2 years). The subjects were divided into four physical activity groups based on their reported exercise habits at baseline and follow-up as: non-exercise - exercise (NE-EX; n = 21), NE-NE (n=36), EX-EX (n=19), and EX-NE (n=15). Baseline VOz,,,ax (ml-kg-1-min-1) was significantly higher for the EX vs. NE ( 38.4 ± 8.4 vs.28.8 ± 5.7; f42.2; P<.0001). ANOVA revealed significant differences between the physical activity change groups and mean percent changes in VO2. (% A ml•kg'.min'-yr') (F =10.887; P<.0001) which are listed in the following:NE-NENE-EXEX-EXEX-NE-1.081.58*-1.25-2.21* NE-EX vs. EX-NE; NE-EX vs. EX-EX; and NE-EX vs. NE-NE (P<0.05)There were differences between the following groups: NE-EX vs. EX-NE; NE-EX vs. EX-EX; and NE-EX vs. NE-NE for percent change in VO2max (nl•kg'-min 1•yr 1) with the EX-NE group having the largest decline in VO2max during the follow-up period.Using a multiple regression model after adjusting for the exercise habit groups, the exercise group scheme accounted for 27.3 percent of the variance in percent change in VO2max at step 1 of the analysis (f = 1.09; P < 0.001). Change in percent body fat and change in maximal ventilation accounted for an additional 7.2 percent and 6.5 percent of the variance at steps 2 and 3, respectively. The change in maximal heart rate accounted for an additional 2.5 percent of the variance at step 4, although the statistical significance of the contribution was low (P = 0.057). Increases in body fat and decreases in pulmonary ventilation were found associated with declines in aerobic power while a decline in maximal heart rate between the tests was associated with a decline in percent change in aerobic power.In conclusion, these data demonstrate that: 1) adoption or maintenance of a regular exercise program is associated with less decline in VO2,,. during long-term follow-up compared to women who did not exercisers, and 2) changes in exercise habits, body composition, maximal ventilation, and maximal heart rate accounted for nearly half (43 %) percent of the percent decline per year. / School of Physical Education

The present study explored whether African American women's level of dietary fat intake could be predicted by the variables of food preferences and preparation methods, support for healthy eating from family and friends, attitudes toward health, and acculturation. The present study also explored whether African American women's level of dietary fat intake could be predicted by the variables of food preferences and preparation methods, support for healthy eating from family and friends, and attitudes toward health, as moderated by acculturation.Information was obtained from five hundred and nintey nine African American females between the ages of eighteen and forty four. The women were recruited from a Midwestern univeristy, an undergraduate and graduate chapter of an African American sorority, two African American professional organizations, and through the snowball method. Particpants completed a Demographic Questionnaire, The Eating Behavior Patterns Questionnaire, The African American Acculturation Scale Short Form, The Health Attitudes Scale, The Social Support Scale, and The Eating Patterns Subscale on the Eating Habits Questionnaire. The data was collected via hardcopy and InQsit, an online survey program.Numerous preliminary tests were run to screen the data for outliers, linearity, and multicollinearity. Then, two forced entry multiple regressions were performed. In the first analysis, the overall model was a significant predictor of dietary fat intake. African American women's preferred foods, positive and negative support from friends, overallconcern for health, and intentions to adopt positive health practices are significant predictors of their level of dietary fat intake. In fact, these variables acccounted for almost half of the amount of variance in dietary fat intake. The second model was not significant and acculturation was not a significant predictor or moderator of dietary fat intake. Although acculturation was proven to be influential to dietary behaviors in African Americans in previous literature, the findings were not confirmed in this study.Multiple possibilies may explain the lack of significant findings between level of acculturation and dietary fat intake. The women in the current study were of a higher educational and income status than women in previous studies indicating significant findings. This difference in education and income, among other factors, may account for the difference in significant findings. The information gained in this study can be used to develop pschoeducational and treatment programs aimed at helping African American women prevent or treat health problems associated with poor eating habits. Several research implications are also noted. / Department of Counseling Psychology and Guidance Services

Graduation date: 2000

The way gender relations influence access to care and treatment particularly access to antiretroviral medicines is a challenge to HIV/AIDS programmes and to the individuals and families with HIV. Gender norms that push women and men to adhere to dominant ideals of femininity and masculinity may restrict women's access to economic resources, health care and fuel the spread of HIV. The aim of this study was to determine the role of gender relations in influencing decision-making for access to antiretroviral medicines between partners and in the family.

Orientadores: Ellen E. Hardy / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T02:14:44Z (GMT). No. of bitstreams: 1 Ribeiro_CarmenSilviaPorto_M.pdf: 1183394 bytes, checksum: 1a0df05a8b11b768ce3f9cac76583a9b (MD5) Previous issue date: 2006 / Resumo: Objetivo: Avaliar a associação entre a experiência menstrual de mulheres e as mudanças preferidas na menstruação. Métodos: Estudo de corte transversal, no qual 420 mulheres foram entrevistadas, alocadas em três grupos de idade (18 ¿ 20; 25 ¿ 34 e 45 - 49 anos), e de escolaridade (= 8 anos e = 12 anos) e que tinham menstruado nos três meses que antecederam a entrevista. As mulheres foram selecionadas na cidade de Campinas, SP, em nove serviços de saúde privados e sete serviços públicos. Nestes locais foram abordadas mulheres que estavam esperando atendimento e aquelas que cumpriam com os critérios de inclusão (Lista de Verificação) e aceitavam participar do estudo eram entrevistadas. Para a coleta de dados foi utilizado um questionário construído com base nos resultados de um estudo-piloto prévio, que foi realizado com grupos focais. Foi constituído um banco de dados com as informações registradas nos questionários e os dados foram analisados através do software SAS versão 8.2. Para análise estatística utilizou-se o teste qui-quadrado de Pearson e o teste exato de Fisher para avaliar a associação entre as variáveis estudadas (p < 0,05). Resultados: A maioria das mulheres menstruava regularmente, durante cinco dias ao mês, com intervalos de 24 a 32 dias. A maioria tinha dor ou desconforto durante a menstruação e metade das que tinham dor considerava-a forte. Houve associação entre o intervalo preferido entre menstruações (maior que uma vez por mês) e os intervalos característicos da menstruação das mulheres (p = 0,0248), bem como com o grau de interferência da menstruação nas atividades diárias (p=0,048). Entretanto, não houve associação entre o intervalo preferido pelas mulheres e as características da dor: duração, intensidade e uso de medicação. Conclusão: Os resultados sugerem que as mulheres gostariam de menstruar em intervalos maiores do que um mês ou até gostariam de nunca menstruar / Abstract: Objective: To evaluate the association between women¿s menstrual experience and preferred changes in their menstrual cycles. Methods: A cross sectional study design was used, a total of the 420 women were interviewed, three groups age (18 to 20, 25 to 34 and 45 to 49 years); schooling (=8 years, =12 years); having menstruated during the three months previous to the study. Subjects were selected in the city of Campinas, São Paulo state, in nine private and seven public health services. Women who were waiting to be attended were approached by the interviewers. Those who complied with the inclusion criteria (Check List) and accepted to participate in the study were interviewed. A questionnaire was prepared on the basis of the results of a previous pilot study that consisted of focus groups. This questionnaire was used for data collection. A data bank was prepared with the data registered in the questionnaires and the data was analyzed with SAS v. 8.2. For the statistical analysis Pearson¿s Qui-square test and Fisher¿s exact test were used to evaluate the association between the variables studied (p<0.05). Results: Most of the women menstruated regularly, during five days per month and intervals varied from 24 to 32 days. Most of them experienced pain or discomfort during menstruation. The preferred interval between menstruation (less than once a month) was associated to the typical intervals experienced by women (p = 0.0248) as well as to the degree of interference of menstruation in daily activities (p=0.048). However, there were no association between preferred interval by the women and the characteristics pain: duration, intensity and use of medication. Conclusion: The results suggest that women would like intervals longer than one month or never / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia

Orientador: Lea Maria Leme Strini Velho / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Geociências / Made available in DSpace on 2018-08-21T15:39:30Z (GMT). No. of bitstreams: 1 Feltrin_RebecaBuzzo_D.pdf: 3826949 bytes, checksum: 8247f03c98cadd789b10af4245a2069b (MD5) Previous issue date: 2012 / Resumo: O presente trabalho acompanha o processo de construção do conhecimento científico sobre o corpo da mulher na menopausa dentro de um hospital-escola brasileiro. As controvérsias em torno do tema e a maneira diferenciada em tratar ou sentir a menopausa entre culturas distintas sinalizam que o conceito de menopausa não é universal. Ao contrário, todo conhecimento produzido é localizado e traz as marcas de seu lugar de produção. Por esse motivo, acompanha-se um lugar de produção de conhecimento - o Centro de Atenção Integral à Saúde da Mulher (CAISM) - amplamente reconhecido e responsável por direcionar políticas públicas na área de saúde da mulher no Brasil. Acompanham-se ainda os discursos que circulam no lugar, a divulgação do conhecimento produzido, a organização do espaço e objetos de maneira a dar suporte a esse discurso, bem como, o alistamento de diferentes atores para que o lugar e os conhecimentos ali produzidos alcancem credibilidade e "viajem" para além dos limites do hospital-escola, tornando-se universais. A padronização do lugar, espaços, protocolos e corpos garantem que a verdade produzida naquele ambiente particular possa ser verdade em qualquer lugar, em qualquer corpo. Nesse sentido, o Ambulatório de Menopausa do CAISM revela-se, ao mesmo tempo, como um vasto campo de pesquisa e como um laboratório no sentido Latouriano, na medida em que o atendimento às mulheres se tornava um espaço de ensino, pesquisa e interação entre os atores. A análise concentra-se na cena médica, local de encontro entre dois dos mais importantes atores envolvidos na construção desse conhecimento - o médico e a paciente. Não um simples médico, mas um médico aprendiz dentro do hospital-escola, que tenta ao mesmo tempo "ver" com os olhos de seu professor, conhecer a natureza, decifrá-la e traduzir esse discurso recém-descoberto. Essa tradução feita dentro do consultório tem a finalidade de alistar as mulheres para que aceitem o discurso como verdadeiro e permitam que o conhecimento finalmente se efetive através de seu corpo. Do outro lado, a paciente cumpre o papel que lhe cabe, disponibilizando seu corpo como objeto em favor das pesquisas, para que em troca continue sendo atendida em um centro de referência em saúde da mulher / Abstract: This paper accompanies the construction of scientific knowledge about the body of menopausal women in a Brazilian teaching hospital. The controversy surrounding the subject and the different ways in which menopause is treated or thought of in various cultures, indicate that the concept of menopause is not universal. On the contrary, all produced knowledge is local and bears the marks of their place of production. For this reason, a knowledge producing location was accompanied: the Centro de Atenção Integral à Saúde da Mulher (CAISM, or the Comprehensive Healthcare for Women Centre), which is widely recognized and responsible for directing public policy in the area of women's health in Brazil. In addition, the discourse was accompanied that circulates in the location as well as the dissemination of produced knowledge, the organization of spaces and objects in order to support this discourse, and the recruitment of different actors who instill credibility to the location and the knowledge produced there and who make this discourse "travel" beyond the limits of the teaching hospital, making it universal. The standardization of the location, the spaces, protocols, and bodies ensures that the truth produced in that particular environment can become true anywhere, for anybody. In this sense, the Menopause Outpatient Facility at the CAISM proves to be a vast field of research and, at the same time, a laboratory in the Latourian sense, insofar as the care of women has become a space for teaching, research and interaction between actors. The analysis focuses on the medical scene, the meeting place between two of the most important actors involved in the building of knowledge - the doctor and patient. Not just a doctor, but a doctor-student in the teaching hospital, who tries to "see" through the eyes of his teacher, understand the nature, decipher it and translate this newly discovered discourse. This translation performed within the office aims to enlist women patients, so that they accept the discourse as true and allow that this knowledge finally takes effect through their body. On the other hand, the patient fulfills her assigned role, providing her body as an object for the benefit of research, so that in turn she will continue to be treated at a center that is a reference in women's health / Doutorado / Politica Cientifica e Tecnologica / Doutora em Política Científica e Tecnológica

No description available.

Context: The Women’s Health Initiative (WHI) study, published in July 2002, had a significant impact on the prescribing of hormone replacement therapy (HRT). The controversy surrounding the findings, however, has led to much uncertainty regarding the prescription of HRT. Aims and Objectives: The aim of this study is to determine both the initial and the continued impact of the WHI study on the prescribing of HRT in a defined South African population and to determine whether HRT was appropriately individualised based on recommendations published subsequent to the WHI study. Setting: Claims data from a Managed Healthcare Organisation (MHO) that administers for a number of medical aid schemes in South Africa. Method: A retrospective drug utilisation review (DUR) was conducted to identify HRT-related prescribing patterns in the defined populations. The time-frame of the dataset included January 2002, to assess prescribing patterns prior to the publication of the WHI study, January 2003 to determine the initial impact of the WHI study, and January 2005 to assess the continued impact. An extensive, additional dataset of all the HRT users in the defined populations was utilised to conduct a sub-group analysis and determine whether HRT had been appropriately individualised. Key Findings: The percentage of patients in the dataset using HRT decreased from 30.05 percent in January 2002 to 28.30 percent in January 2003 and to 23.24 percent in January 2005, with the latter decrease reaching statistical significance. Although sex hormones and modulators (G03) of the genital system were the most frequently prescribed drug class in all three years of the study period, the prescribing frequency decreased significantly from 10.40 percent in January 2002 to 9.32 percent in January 2003 and 7.44 percent in January 2005. The most noteworthy change in the prescribing of HRT was a 3.95 percent decrease in the prescribing of conjugated equine estrogen (CEE), with a corresponding 2.53 percent increase in the prescribing of estradiol between January 2002 and January 2003. However, less pronounced changes were observed in the prescribing frequencies of other types of HRT, including medroxyprogesterone and estrogen (the HRT type investigated in the estrogen plus progestin phase of the WHI study). Patients initiating HRT post-WHI publication were generally found to be in the younger menopausal age categories (40 to 49 years). These patients were more likely to have been initiated on HRT types other than those investigated in the WHI study and were at a higher risk for disease states for which HRT use is beneficial, such as osteoporosis. Patients discontinuing HRT post-WHI publication were generally found to be in the older menopausal age categories (60 to 69 years), were more likely to have been combined HRT users (although not necessarily the type investigated in the WHI study) and were at a higher risk for disease states for which HRT use is considered harmful or has an uncertain effect, such as diseases affecting the cardiovascular system. Conclusion: It can be concluded that the WHI study did have an impact on the prescribing of HRT in the defined South African population of this study, but that the impact was considerably less than the impact reported in global studies. It was also determined that HRT was appropriately individualised according to recommendations made subsequent to publication of the WHI study.

Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics.

The association between physical inactivity, adverse health and hypokinetic diseases has been widely researched. There is an increased risk of being overweight, and of developing certain chronic diseases and suffering premature death associated with physical inactivity (Young, Miller, Wilder, Yanek & Becker, 1998). Recent surveys and studies have revealed that the majority of the South African population has moved extensively along the epidemiological transition towards a disease profile related to Western lifestyle, where deaths due to chronic diseases of lifestyle is a great cause for concern (Steyn, 2006). Black women, in particular, have been identified as a high risk group with the highest levels of inactivity and the highest levels of overweight and obesity in the country (SADHS, 1998; WHO, 2005). Although there is a growing body of knowledge and research on physical activity in general, there is still a lack of data on the determinants and barriers to participation in physical activity (Lambert & Kolbe-Alexander, 2006). Cultural patterns and economic, political and ideological orders affect the participation of women in sport (Hargreaves, 1994:5). Black women in South Africa have been disadvantaged by the past government’s policy of apartheid, and have also been marginalized and oppressed in their own patriarchal societies. The first democratically elected government in 1994, however, committed itself to gender equality and women’s emancipation, with constitutional guarantees on equality and an affirmative action policy to address gender inequalities. In order to evaluate the extent of the beneficial impact of these political changes in women’s lives, this study proposed to investigate physical activity patterns in the lives of two generations of black professional women (teachers, nurses, social workers and public managers) from the Nelson Mandela Metropolitan Municipality. The objectives that guided the research were: • To describe and compare the physical activity patterns and health status of two generations of black women through questionnaires, physical activity records and mechanical devices. • To explore and describe the psychosocial context and socio-cultural influences on physical activity in the lives of the participants. xi • To explore and describe the participants’ perceptions and attitudes, motivations and constraints relating to physical activity. • To use the research findings to compile guidelines to promote physical activity participation among black women. A mixed method approach using both quantitative and qualitative methods was selected to achieve an holistic understanding of physical activity in the lives of black South African women. The older generation (OG) of professional women was comprised of community teachers, nurses, social workers and public managers (n=111, aged 35 to 45 years, mean age = 39.87 years). These women, through their occupations, were in constant contact with the community and could be regarded as role models who influence community lifestyle, attitudes and behaviour. The younger generation (YG) (n=69, aged 18 to 21 years, mean age = 20.12 years) was comprised of teaching, nursing, social work and public management students in the Nelson Mandela Metropolitan Municipality. The objective of the quantitative section of the study was to provide baseline information on the physical activity patterns and health status of these two generations of black professional women. Physical activity and health questionnaires were administered and the ActiGraph GT1 accelerometer was used to provide an objective measure of energy expenditure. The objective of the qualitative data collection was to explore and describe the psychosocial context and socio-cultural influences on physical activity in the lives of the participants, and to investigate their attitudes to and perceptions of physical activity, and their motivations and constraints related to it. In-depth qualitative interviews were held with the participants who wore the ActiGraph, and a group of 47 were interviewed (sample size determined by data saturation from the interviews). An explorative-descriptive research design was used in the study. The sampling method was purposive and criterion-based. The younger generation of students were mostly selected from the various campuses of the Nelson Mandela Metropolitan University, while additional student nurses were recruited from the Lilitha Nursing College in the Nelson Mandela Metropolitan Municipality. The older generation of professionals were recruited from schools and clinics in the areas of New Brighton, Kwa-Zakhele, Zwide, Motherwell and Kwa-Nobuhle (all historically black areas), the Eastern Cape Department of Social Development, non-government organizations and the Nelson Mandela Metropolitan Municipality. xii The quantitative data were analysed by means of descriptive and inferential statistics. The qualitative data was analysed according to the steps described in Creswell (2003). The results of the quantitative data indicated that prevalence of overweight and obesity among both the YG and OG was high. The mean BMI for the YG and OG were 24.71 kg/m2 and 31.27 kg/m2, respectively, with 41% of the YG and 86% of the OG falling into the overweight/obesity category. BMI was significantly greater (p<.05) for the OG than for the YG. In addition, both the OG and YG had satisfactory scores for the health-related behaviour measures (the Belloc and Breslow Lifestyle Index and the HPLP). All the physical activity measurements (the FIT Index of Kasari, the GPAQ and the ActiGraph data) confirmed that both the YG and OG were not sufficiently physically active. They did not meet the Centre of Disease Control (CDC) and American College of Sports Medicine (ACSM) recommendation of engaging in at least 30 minutes of moderate-intensity physical activity on most, or preferably all, days of the week. The YG were significantly more active than the OG in all the physical activity measuring instruments. They were still, however, not reaching the health enhancing physical activity (HEPA) level (≥7 days of any combination of moderate and vigorous activity, ≥ 3000 METmins/week). Pearson Product Moment correlations were calculated to determine the relationship among the various measurements of physical activity o the one hand and the relationship between the measurements of physical activity and the health-related behaviour measurements on the other hand. The correlational analyses highlighted a good cross-validation of the various measures of physical activity. There was a significant correlation between the measures of leisure time physical activity, that is the FIT Index, and the leisure domain of the GPAQ. There was also a significant relationship in the area of walking or steps taken, that is the ActiGraph steps and the GPAQ transport domain. There was also a significant relationship between the overall measures of physical activity, that is the GPAQ total score, and the ActiGraph calories. The correlations between the various physical activity and health related behaviour measures revealed that only the leisure related physical activity measurements, that is, the FIT index and the GPAQ leisure domain, had a significant correlation with the two health related behaviour measures, namely the Belloc and Breslow Lifestyle Index and the HPLP, respectively. xiii The results from the qualitative data revealed that both the OG and YG had positive attitudes towards physical activity participation (displayed by their awareness of the many benefits, their expressed intention to start exercising, the encouragement given to their children in relation to physical activity participation), even though the majority of them were not active on a regular basis. Participants recognized the educational, recreational and developmental importance of being physically active, a shift in attitude from their own upbringing and lifestyles. Regardless of how firmly people may believe that physical activity is beneficial to their health, there are many barriers, whether real or perceived, that represent significant potential obstructions to the adoption, maintenance, or resumption of participation in physical activity (Booth et al., 1997). Three sub-themes were identified in relation to the barriers to physical activity participation, namely personal factors, environmental factors and socio-cultural factors. The personal factors included time constraints, stress and tiredness, lack of motivation, negative school experiences, negative associations with exercise and financial constraints. The environmental factors included residential areas, availability of recreation and sports facilities, and safety. The socio-cultural factors were lack of social support, exercise “not being a part of African culture”, traditional roles of males and females, dress code, exercise associated with the young, exercise associated with undesirable weight loss and negative comments by the community. On the basis of research findings, guidelines were drawn up for the promotion of physical activity participation among black women.