Introdução: A metade da população brasileira feminina é constituída por negras. Muitas mulheres pertencentes a este grupo racial jamais fizeram a mamografia, e a taxa de mortalidade materna é maior entre as negras. Muitas desigualdades ainda persistem em diversos setores da sociedade, inclusive no âmbito da saúde, mesmo após a implementação do Sistema Único de Saúde, que disponibiliza assistência gratuita a todas as pessoas. Objetivos: Explorar as crenças, valores e práticas das mulheres negras relativas ao cuidado com a saúde no domicílio, no contexto da própria comunidade e a sua interface com a busca por assistência nas instituições de saúde. Metodologia: A pesquisa foi desenvolvida mediante abordagem qualitativa, utilizando-se do método etnográfico. O estudo foi desenvolvido na Cidade de São Paulo, no bairro Cidade Ipava (CI), uma região do Jardim Ângela constituída por uma grande proporção de negros, apresentando altos índices de vulnerabilidade à pobreza. Os dados foram coletados mediante o processo de observação participante e entrevistas etnográficas com 17 informantes gerais e três informantes chave. Resultados: Três descritores e um tema cultural expressam as crenças, valores e práticas das mulheres negras relativas ao cuidado com a saúde: 1) Faço o máximo para não ir ao médico - cuido da saúde do jeito que posso para evitar ficar doente: 2) A experiência com a assistência à saúde que recebo nas instituições não é boa: 3) Sofro racismo velado por ser negra. O tema cultural foi: Sem outra saída somos obrigadas a enfrentar obstáculos e buscar assistência médica porque os remédios caseiros não deram certo e o problema de saúde é grave. Conclusões: As mulheres se deparam com muralhas (in)visíveis ao acessar as instituições de saúde. Os resultados desta pesquisa reiteraram a premissa de que os determinantes sociais que marcam as desigualdades em saúde, tais como, as relações de gênero, classe social, idade, território, religião, raça/cor, entre outros aspectos, não se manifestam de forma isolada nas relações sociais. No tempo atual pós-moderno, as desigualdades sociais persistem, sobretudo entre as mulheres negras moradoras das regiões periféricas de grandes metrópoles. Estas requerem suporte para o empoderamento, essencial para reivindicar, acessar e usufruir de uma assistência à saúde de qualidade. / Introduction: Half of the female Brazilian population is black. Many women in this racial group never did mammography, and the maternal mortality rates are higher among them. Many inequalities still persist in many society sectors, including health, even after the implementation of the National Health System, which provides free health care for all people. Objectives: To explore the beliefs, values and practices of black women regarding health care at home, in the community context, and it is the interface with the process of seeking for health care facilities. Methodology: The research was conducted through qualitative approach and the ethnographic method was done. It was carried out in the city of São Paulo, at a neighborhood district called Cidade Ipava, located in Jardim Angela, where is there a large proportion of blacks, which suffer high levels of vulnerability to poverty. Data were collected through the participant observation process and ethnographic interviews were done with 17 general informants and three key informants. Results: Three descriptors and a cultural theme express the beliefs, values and practices of black women regarding health care: 1) I do my best to not have to go to the doctor I take care of the health as I can to avoid getting sick: 2) The experience with the health care that I have received in health care facilities is not good: 3) I suffer hidden prejudice for being black. The cultural theme was: Do not having another way - we are forced to face obstacles and must seek for medical care because the home medicines did not showed effects and the health problem is serious. Conclusions: Women are faced with (in)visible obstacles when they to access the health care facilities. These results reiterated that the social determinants which characterize the health inequalities, such as gender relations, social class, age, territory, religion, race, among others, do not manifest themselves alone in the social relations. At the current post-modern environment, the social inequalities persist, especially among black women residents of outlying areas of large cities. These require support for empowerment, essential to claim, to access and to enjoy a high quality health care.

A incontinência urinária (IU) é definida como toda perda involuntária de urina, sendo um problema social e de higiene. No Brasil, é incipiente a produção bibliográfica sobre incontinência urinária no pós-parto. Trata-se de uma morbidade pouco explorada pelo profissional de saúde, o que dificulta a identificação da mulher que apresenta a intercorrência. O objetivo deste estudo foi verificar a prevalência de incontinência urinária autorreferida no pós-parto e relacionar os fatores associados. Trata-se de um estudo epidemiológico, transversal sobre os fatores relacionados à incontinência urinária autorreferida no pós-parto, realizado no Centro de Saúde Escola Samuel Barnsley Pessoa, localizado na região oeste do município de São Paulo. A população foi constituída por 288 mulheres com 30 dias a seis meses de pós-parto, entrevistadas no período de janeiro a agosto de 2009. Os resultados indicaram prevalência de 24,6% de perda involuntária de urina autorreferida no pós-parto. A idade das mulheres variou de 18 a 45 anos. Quanto às características sociodemográficas, apenas a cor da pele apresentou diferença estatística significante (p-valor=0,0043), com maior representatividade em mulheres brancas. Dentre as 71 entrevistadas que referiram IU no pós-parto, a maioria era primípara e se submeteu a parto normal. Não houve diferença estatística significante entre a paridade e o tipo de parto e a ocorrência de IU. O ganho de peso e a ocorrência de infecção urinária durante a gestação, o uso e o tipo de anestesia, o uso de ocitocina, o tempo de trabalho de parto, a situação do períneo e o peso do recém-nascido ao nascer não apresentaram diferença estatística significante com a ocorrência de IU no pós-parto. Quanto às características das perdas, 44 mulheres (62%) referiram incontinência aos esforços, 14 (19,7%) citaram IU de urgência e 13 (18,3%) apontaram IU mista; em 53 mulheres (74,7%) a severidade foi classificada como incontinência moderada. Verificou-se que para 20 mulheres (28,2%) a morbidade interferia nas atividades diárias; enquanto que 10 (14,1%) comunicaram a intercorrência ao profissional de saúde; e 96,2% (277 em 288) não receberam qualquer orientação sobre o preparo do períneo, fator apontado pelas entrevistadas como uma das causas desencadeantes da IU. Os achados deste estudo nos permitem concluir que a ocorrência de incontinência urinária autorreferida no pós-parto associa-se à cor da pele; com predominância de incontinência urinária em primíparas em comparação às não-primíparas. Identificar os fatores associados à incontinência urinária em mulheres no pós-parto e sua prevalência contribui no planejamento de atenção de enfermagem obstétrica à mulher que vivencia o período reprodutivo. / Urinary incontinence (UI) is defined as any involuntary loss of urine, being a social and hygiene problem. In Brazil, the literature about the urinary incontinence after childbirth is incipient. UI is a morbid little explored by health professionals, making it difficult to identify the woman who has a complication. The aim of this study was to assess the prevalence of urinary incontinence self-reported in the postpartum period and to relate the associated factors. This is an epidemiologic and cross-sectional study about the factors related to urinary incontinence self-reported in the postpartum period, held at the Health Center School Samuel Barnsley Pessoa located in the western region of São Paulo. The population consisted of 288 women with 30 days to six months in the postpartum period. They were interviewed from January to August 2009. The results showed that 24,6% was the prevalence of involuntary loss of urine self-reported in the postpartum period. The women ranged from 18 to 45 years old. The sociodemographic characteristics showed that only the color of the skin was statistically significant (p-value = 0.0043); women with white skin had greater representation. Among the 71 women who reported UI in the postpartum period, the primiparous were majority and underwent vaginal delivery. There was no statistically significant difference between parity and kind of the delivery and the occurrence of UI. The weight gain and urinary tract infection during pregnancy, the use and the type of anesthesia, the use of oxytocin, the duration of the labor, the episiotomy or the integrity of the perineum and the weight of the newborn at birth showed no statistically significant difference in the occurrence of UI in the postpartum period. Regarding the characteristics of losses, 44 women (62%) had incontinence when exercising, 14 (19.7%) reported urgency UI and 13 (18.3%) had mixed incontinence; to 53 (74.7%) women, the severity of the incontinence was classified as moderate. It was found that to 20 women (28.2%) the morbidity interfered on their daily activities, while 10 (14.1%) reported the complications to the health professional; and 96.2% (277 of 288) of women did not receive any guidance on the preparation of the perineum, reason given by them as one of the contributory causes of UI. Our findings allow us to conclude that the occurrence of urinary incontinence self-reported in the postpartum period is associated with skin color and that there is a prevalence of urinary incontinence in primiparous compared to multiparous. Identify factors associated with urinary incontinence in women after childbirth and its prevalence contribute to the planning of obstetric nursing care to women on the reproductive period.

Introduction: There is a large literature across disciplines aimed at understanding the causes of the depression gap, defined as an excess of depression among women compared with men. Based on the totality of evidence to date, social stress appears to be an important explanation for the depression gap. Social stress theory highlights women’s disadvantaged social position relative to men, positioning gender differences in socio-economic opportunities as social stressors, while also acknowledging how gender socialization teaches women to respond to stressors in depressogenic ways from an early age. This dissertation applied social stress theory to better understand the social causes of the depression gap with three related aims. Aim 1 summarized the evidence for variation or stability in the depression gap in recent decades, through a systematic review and meta-regression of depression gap studies over time and by age. Aim 2 examined the evidence for a changing depression gap across birth cohorts, and tested the extent to which any changes over time were mediated by changing gender differences in education, employment, and housework rates, three indicators of broader trends in gendered social position through the 21st Century. Aim 3 examined whether women in the workforce with competing domestic labor roles were at increased risk of depression, and whether pro-family workplace benefits buffered the effects of competing roles. Methods: In aim 1, depression gap estimates were extracted through a systematic review of published literature (from 1982-present). Analytic datasets were comprised of 76 diagnostic-based estimates and 68 symptom-based estimates. For each dataset, meta-regression models estimated time and age variation in the depression gap, as well as the interaction between time and age group, to estimate the variation in the gap over time by age. Data from the National Longitudinal Surveys were utilized for aims 2 and 3. Depression was measured with the Center for Epidemiologic Studies Depression Scale (CESD), and the depression gap was defined as differences in mean CESD scores for women vs. men. The aim 2 sample included 13,666 respondents interviewed from 1992-2014. Hierarchical mixed models estimated the magnitude of the gender depression gap over time, and its relationship with 10-year birth cohort (range: 1957-1994) and whether any variation was mediated by gender differences in: those with a college degree or more, those who were employed full-time, and the average number of hours spent doing housework per week. The sample in aim 3 was limited to employed women ages 17-57 (n=3993). Generalized estimating equations estimated the relationship between competing roles and depression, and the interaction between competing roles and pro-family employee benefits on depression. Interaction results were compared to models estimating the effect of non-family-related benefits on the relationship between competing roles and depression. Results: In aim 1, there was no evidence of change in the depression gap over time. Compared with the reference group (i.e., respondents ages 60+), the age effect was appreciable among the youngest age group (age 10-19) (RR=1.44; 95% CI=1.19, 1.74), but did not differ for any other age groups. The age by time interaction was elevated for youngest age group (RR=1.27; 95% CI=1.0, 1.61), suggesting that, compared to the oldest age group, the diagnostic depression gap had increased among the youngest ages from 1982 to 2017. There was no evidence of time changes among any other age group. Results were similar for symptom-based studies. In aim 2, there was a linear decrease in the depression gap by 0.18 points across birth cohort (95% CI= -0.26, -0.10). The results of the mediation analysis estimated that an increasing ratio of college degree attainment mediated 39% of the gender depression gap across cohorts (95% CI= 0.18, 0.78). There was no evidence of mediation due to changing employment or housework ratios. In aim 3, there was evidence that women in competing roles reported a 0.56-point higher CESD score (95% CI= 0.15, 0.97), compared with women not in competing roles. The interaction between pro-family benefits and competing roles was associated with CESD scores (B=-0.44, p=0.023). More specifically, among women without access to pro-family benefits, those in competing roles reported a 6.1 point higher CESD score (95% CI=1.14, 11.1), compared with those not in competing roles, however, among women with access to these benefits, there was no association between competing roles and CESD scores (difference=0.44; 95% CI=-0.2, 1.0). Results were similar for non-family-related benefits. Women in competing roles without non-family-related benefits reported a 3.59 point higher CESD score than those not in competing roles (95% CI=1.24, 5.95) while among women with access to these benefits, there was no association between competing roles and CESD symptoms. Conclusion: This dissertation provided evidence to partially support the hypothesis that the depression gap is changing over time and is meaningfully related to the social environment, through which gender roles, responsibilities, and opportunities available to women and men are defined and reinforced. The results of these studies suggest that the depression gap may be expanding and contracting over time for different age groups. Understanding the social causes of the depression gap is important to reduce the present and future burden of the depression gap, and to understand the fundamental processes through which depression disparities may be perpetuate or attenuated in adolescence and beyond.

This formative research examines the effects of health promotion on girls' and young women's health behaviours. Health promotion campaigns targeting women have previously had variable success. Some have been criticised for containing unhelpful values and messages, for example, those that were seen to cause harm to women outside the target population or use of stereotypical symbolism to support the message. Within this study these are called 'unintended consequences'. The Young Women and Health Promotion (YW&HP) study examines the potential for unintended consequences (both negative and positive) of health promotion in general. The focus is then narrowed to examine in more detail whether the use of specific methodologies (such as social marketing), contribute to unintended consequences when promoting physical activity, nutrition and non- smoking messages to girls' and young women. These health behaviours were specifically targeted as they are known to be the major modifiable risk factors for women in the prevention of many chronic illnesses. / This formative research involved the collection and analysis of qualitative and quantitative data from 132 girls and young women across three age categories. These were Year 7 girls (Children - 11-12 years), Year 10 girls (Adolescents - 14-15 years) and young adults (18-25 years). Eighteen focus groups and 15 in-depth interviews were conducted to elicit responses to examine the effects of health promotion on girls' and young women's health behaviours, with particular focus on unintended effects. Current and past health promotion materials, plus a selection of commercial campaigns were utilized to prompt discussion within the groups. The discussion allowed the exploration of girls' and young women's motivators (enabling and reinforcing factors) for personal health behaviours, attitudes and responses to health promotion materials, and the longer-term impacts of health promotion campaigns. A self-administered questionnaire was distributed at the commencement of each focus group, which provided additional information and was later triangulated with the qualitative data. Limitations due to the cross-sectional nature and sampling process of the study mean the results cannot be generalized beyond the study population. However the findings demonstrated that young women are motivated by a complex set of factors. The most common factors influencing the study groups were body image, self-esteem, media and role models. / In addition young women of all age groups had a high awareness of the available messages in the areas studied. All groups discussed the increasing volume of health information available that is targeted at women. Participants noted much of the information originated from commercial sources. This in addition to public health initiatives resulted in increased 'health noise' to which they 'switched off. Furthermore the YW&HP study revealed the importance of written media for women. The young women in this study appreciated the need for mass media advertising, however, preferred to have take-home advice to process at their own time. Discussion of how women process information revealed these young women to be a critical and analytical audience that are often skeptical of health information. Prior to making a decision, therefore, most of the women underwent a process of internal and external validation which included cross referencing information with peers, friends, family and health professionals to establish its accuracy, credibility and validity. Hence the findings of this study would support the need for further exploration of media such as women's magazines to promote health to young women which may in turn prompt discussion with peers and therefore expedite the validation process. / Due to study limitations, results from this formative research need to be interpreted with caution. The results, however, would indicate the area of health promotion and how it communicates health information to young women would benefit from further investigation. The findings suggest many types of media currently being used to communicate health information to young women were useful and appropriate, specifically the use of social marketing media, which, was seen as a worthwhile and necessary strategy for this target group. Methods routinely used by commercial companies were also viewed as effective especially the use of women's magazines. As part of a comprehensive health promotion approach, this is a strategy, which may be an equally useful vehicle for public health messages. In conclusion, discussion with participants revealed a number of negative and positive unintended consequences. This would, therefore, support the need for further research in this area. Furthermore, the research has highlighted the importance of a comprehensive approach to the delivery of health information to young women. Best practice suggests this approach should adhere to ethical communication principles, which would enhance the intended outcomes of the communications whilst also assisting to maximize positive unintended consequences and minimize negative unintended consequences.

This ethnographic study explored the social and cultural context of Maldivian women???s emotional, social and psychological well-being and the subjective meanings they assign to their distress. The central question for the study was: How is suffering and distress in Maldivian women explained, experienced, expressed and dealt with? In this study participant observation was enhanced by lengthy encounters with women and with both biomedical and traditional healers. The findings showed that the suffering and distress of women is embedded in the social and economic circumstances in which they live, the nature of gender relations and how culture shapes these relations, the cultural notions related to being a good woman; and how culture defines and structures women???s place within the family and society. Explanations for distress included mystical, magical and animistic causes as well as social, psychological and biological causes. Women???s experiences of distress were mainly expressed through body metaphors and somatization. The pathway to dealing with their distress was explained by women???s tendency to normalize their distress and what they perceived to be the causes of their distress. This study provides an empirical understanding of Maldivian women???s mental well-being. Based on the findings of this study, a multi dimensional model entitled the Mandala for Suffering and Distress is proposed. The data contributes a proposed foundation upon which mental health policy and mental health interventions, and curricula for training of health care providers in the Maldives may be built. The data also adds to the existing global body of evidence on social determinants of mental health and enhances current knowledge and developments in the area of cultural competency for health care. The model and the lessons learnt from this study have major implications for informing clinicians on culturally congruent ways of diagnosing and managing mental health problems and developing patient-centred mental health services.

Aim: As a priority for Aboriginal women, in the context of worsening Aboriginal health and lack of clarity about successful strategies to address healthcare needs, this research explored successful strategies in remote Aboriginal women’s health that may be transferable to another community with similar health needs. Methodology: Against a background of cultural and historical events, the study sought to identify existing strategies and frameworks for Aboriginal women’s health. It uses Naturalistic Inquiry situated within the Interpretive paradigm and conceptualised within the philosophical approach of feminist and critical social theory It has examined Aboriginal health providers’ and women’s priorities, practices, perceptions and expectations within the context of primary health care and community development principles by Participatory Action Research (PAR). The successful elements of an established and effective Aboriginal Well Women’s Health (AWWH) program from Central Australia (CA) were identified, transferred and adapted to meet the needs of a willing recipient remote community in South Australia (SA). Working together with healthcare providers from CA and SA, the adapted Well Women’s Health program was implemented in an Aboriginal Community Controlled Health Service collaboratively with local mainstream Community Women’s health services and evaluated. Results: Over a two year period, the research was evaluated through Critical Social Theory examining both the process of implementation and the impact on the Aboriginal community, analysing both qualitative and quantitative data. The AWWH program model and its principles were successfully transferred, adapted and implemented in this community. The AWWH program which included comprehensive health screening, health information and lifestyle sessions have become core business of the Aboriginal health service and an Aboriginal Men’s Well Health program has also been established using the same model. The women have found the AWWH program culturally acceptable and their attendance has steadily increased and the program has reached those women in the community who previously had never experienced a well health check. It has also identified an extremely high incidence and comorbidity of acute illness and chronic disease in diabetes, renal and dental disease, mental and social health problems that require address. Conclusion: Health programs that are well established and effective can be successfully replicated, transferred and adapted to other communities if the elements that made them successful are acknowledged and those principles are then transferred with the program to a willing community with similar needs. This program transfer has potential to save much time and developmental costs that will help to address poor Aboriginal health.

Self-reported mental health problems have increased dramatically among young female high school (Swedish: gymnasium) and university students in Sweden since the 1990’s. The reasons for this increase are mostly unknown but self-esteem and body image might be important factors behind this problem. The aim of this study was to test whether self-esteem and body dissatisfaction predict health. All correlation directions were in accordance with previous studies on the subject. There was no age group difference in levels of self-esteem, body dissatisfaction or health among the women. Multiple regression analysis revealed that global self-esteem was the strongest single predictor of health. These results give support for the importance of global self-esteem for subjective health. This should be considered in future studies and in the battle against the development of depression, anxiety and eating disorders among women.

Thesis (M.A.)--Memorial University of Newfoundland, 2001. / Bibliography: leaves 158-169.

The mental well-being of individuals has been studied for centuries. Yet a full understanding of the causal mechanism of mental distress has not been achieved. The prevalence of depression in women has spurred much of the research in this area. The goal of this dissertation is to contribute to the understanding of the determinants of women's mental and physical functioning. The means to this end is to incorporate a concept from each of the following disciplines, sociology and psychology. The sociological discipline lends the stress model to this research, while psychology contributes the concept of worry. To date, sociologists have not studied the effects of worries on women's mental health, while psychologists have not included socio-demographic indicators and stress variables in their studies of worry. The purposes of this dissertation are to add worry to the Traditional Stress Model, explore the determinants of worry, and observe the consequences of worry on mental distress and physical functioning. / A community sample of 170 mothers is employed to test the hypothesis that adding worry to the Traditional Stress Model, while controlling for socio-demographic indicators, stress, social support, and coping measures, will significantly increase the explanatory power when predicting the Total Mood Disturbance Score (TMDS) and the Total Physical Health Score (TPHS). Results from a series of multiple regressions indicate that worry measures do significantly contribute to the understanding of the TMDS and TPHS. / Other conclusions are also reached regarding several determinants of women's mental and physical functioning included throughout the analyses. In the case of married women, a measure of their marital status is a better indicator of their TMDS and TPHS than a measure of their social support from friends and family. In the case of employed women, the most significant indicator for both the TMDS and TPHS is their level of employment stress. / Research and policy implications emerge from these results. For example, general practitioners should be trained to detect employment or marital stress, and poor mood states which are likely to affect their patients' perceptions of their mental and physical health.

This cross-cultural study examines eating disorders, Anorexia nervosa, Bulimia, and compulsive overeating in Japanese and Canadian women. Through qualitative interviews with nine Japanese and nine Canadian women with eating disorders, it was found that factors contributing to the onset of eating disorders were similar in the two groups. Similarities included the value placed upon thinness by society which is widely perpetuated by the media, being told they were fat and made to feel they needed to lose weight, wanting attention for their eating disorder, and a history of sexual abuse. The Canadian women interviewed, revealed that their mothers also had eating disorders. On the other hand, the Japanese women reported stress from the education system, which led to abnormal eating behavior. Japanese women also reported gender-role conflicts as a cause. / A questionnaire regarding attitudes towards food and weight was given to 100 Japanese and 55 Canadian female university students. It was found that the women's desire to lose weight was strong in both samples. Sixty-six percent of the Japanese women and 38.1 percent of the Canadian women reported that they are "always," "usually," or "often" terrified that their weight will increase. This study postulates that the women with eating disorders want to empower themselves by controlling their food intake and their body weight. The implication is that any factor that creates a sense of ineffectiveness in the woman may trigger an eating disorder if the woman believes the only thing she can control is her food intake. Evidence to support this argument will be shown through discussions of actual experiences of women with eating disorders.