Breast cancer, according to research, is diagnosed in approximately one in every twenty-nine women in South Africa. Differences in gender, race and class produce disparities in health care, subjecting lower class women to lengthy waiting periods between diagnosis and treatment. Present research studies on breast cancer predominantly use quantitative methods. To understand women's lived experiences of the breast cancer trajectory this study explores experiences encountered during the waiting period, as well as the impacts of breast cancer and its treatment on feminine identity. For this a qualitative method was applied. Semistructured, in-depth interviews were conducted with five black and coloured breast cancer patients residing at two of CANSA's care homes. Participants varied in age and phases of treatment, were all married or widowed, had minor dependants, and had all travelled from distant and outlying areas. Based on a thematic analysis, six themes emerged from the data collected. These included: First experiences of cancer in the body; breast cancer and waiting periods from the patient's perspective; sources of support; meanings and perceptions of being a woman; conceptualising disease, and patients' needs. The analysis illustrates the importance of researching women's lived experiences and highlights that these need to be understood within a framework of socially constructed notions of gender, race and class in order to improve breast cancer treatment and psycho-social care.

Introduction: Transgender is an identity term used to describe people with diverse gender identities and expressions that differ from their sex assigned at birth. People who identify as transgender have worse health outcomes than the cisgender or non-transgender populations. Limited healthcare access and chronic stress from discrimination all contribute to worsening health outcomes for this population. However, research regarding this population is limited, particularly in the rural southern United States. The purpose of this study was to assess physicians’, nurse practitioners’, and physician assistants’ experience with, attitude towards, and knowledge of transgender healthcare in the Northeast Tennessee region. Methods: Medical providers, including NPs, PAs, DOs and MDs from Family Medicine, Emergency Medicine, Internal Medicine, Pediatrics, and Obstetrics and Gynecology in both academic and community settings were surveyed regarding their attitudes toward, knowledge of, and experiences with gender, sexual orientation, and sexuality as they relate to healthcare. All potential participants were informed that participation was voluntary. Limited demographics were gathered and surveys were collected in a confidential manner. Data were analyzed for statistical significance. Results: Initial analyses showed the majority of providers had not received training in transgender healthcare and perceived they had few to no trans-identified patients. Over half of all respondents felt competent in providing healthcare to trans people and the majority felt comfortable treating this population. Providers indicated it is important to know their patients’ sexual practices, gender identity and sexual orientation; however, the majority of providers do not ask patients their gender identity, sexuality, or desired pronouns. Respondents were unsure whether gender confirmation surgery is covered by insurance and widely accessible. In assessing clinical knowledge of providers, there were a wide variety of responses suggesting varying level of competence amongst providers. Responses were split regarding whether access to healthcare is the same for the transgender population as it is for the general population. Pediatric providers were asked about comfort in prescribing hormones, knowledge of mental health support in the area, referrals and discussing gender identity with patients. These responses fell along a normal distribution, indicating a variety of training, experiences, and opinion regarding trans healthcare for the adolescent population. Conclusions: Overall results from the preliminary data demonstrate a contradiction between ideology and practice. With most participants responding they felt comfortable and competent providing care to the transgender population, yet their responses indicated a lack of training and absence of inclusivity in their health care practices. This suggests that education is needed within the healthcare community on transgender healthcare.

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Purpose: To determine the difference of Body Mass Index (BMI), the prevalence of overweight and obesity, and their predictors among residents of different urbanization levels in China. Methods: A stratified, multistage, random cluster sampling method was used to select a representative sample aged 18-60 years in metropolitan, prefecture, and rural areas in 4 provinces and Beijing City in China. A total of 6,159 residents were interviewed. Multiple logistic regression was used to evaluate the association between urbanization levels and the prevalence of overweight/obesity adjusted for sociodemographic characteristics and lifestyle factors. Findings: The prevalence of overweight and obesity was 21.0% and 2.5%, respectively. Compared to metropolitan residents (BMI = 22.76 ± 3.20 kg/m2), rural and prefecture residents had a higher BMI, 23.17 ± 3.49 kg/m2 (P <001) and 23.06 ± 3.31 kg/m2 (P =.004), respectively. Multiple logistic regression showed that, compared to the rural residents, those in prefecture and metropolitan areas were less likely to be overweight and obese (OR = 0.80 [95% CI: 0.68-0.94] and OR = 0.68 [95% CI: 0.57-0.80], respectively). The prevalence of overweight/obesity was higher in males (OR = 1.68 [95% CI: 1.43-1.97]) and patients with noncommunicable chronic diseases (NCD; OR = 2.50 [95% CI: 2.16-2.89]). Less frequency of physical activity was associated with a higher prevalence of overweight/obesity (OR: 0.85, [95% CI: 0.74, 0.97]). Conclusions: The rural population had an increased prevalence of overweight/obesity compared to both the prefecture and metropolitan populations. Male gender, older age, and NCD were positively associated with the prevalence of overweight/obesity. Policies are urgently needed to combat the overweight and obesity challenge in rural China.

Purpose: The purposes of this study were to translate current knowledge regarding cardiovascular risk factors, screening, and prevention to a disparate population of women and to ascertain the cardiovascular health status and risk factors in a sample of minority and underserved Appalachian women.Data sources: Demographic data were collected from a voluntary sample of women from a disparate population living in Appalachian Tennessee. A coronary risk profile recorded family health history, personal health history, and lifestyle habits affecting risk for cardiovascular disease. Physiologic measurements included body mass index, blood pressure, fasting glucose, cholesterol levels, ankle brachial index, and carotid artery stenosis.Conclusions: Women in Appalachia Tennessee from a disparate population have high risks for heart disease and stroke. This is a critical time to address any modifiable risk factors and aggressively treat underlying cardiovascular diseases such as hypertension and hypercholesterolemia.Implications for practice: Nurse practitioners (NPs) often provide primary care to women who may not be aware of their cardiovascular risks or actual disease. NPs can ensure that their practice incorporates primary and secondary cardiovascular prevention through screening, individual health education, and aggressive evidence-based treatment plans for women.

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Distributive justice is a bioethical principle concerned with the fair distribution of resources and benefits in society. In the context of orthopaedic surgery management, distributive justice is an important consideration in ensuring that all patients have equal access to the resources and care in the treatment of their injuries. The literature well documents demographic and socioeconomic factors in the allocation of elective orthopaedic surgeries, but unfortunately a similar analysis is lacking when it comes to orthopaedic trauma surgeries. This study examines fundamental philosophical perspectives that underly healthcare delivery specifically pertaining to orthopaedic trauma. In doing so, the influence of race, socioeconomic status, insurance status and other factors on access to care and allocation of resources are described. Findings for various orthopaedic trauma surgery cases suggest decreased allotment to those of black race, lower socioeconomic, educational, and non-insurance status. Although the reason is multifactorial and complex, I suggest a shift in focus to the equity and fair distribution of surgical resources by considering the role of population health, understanding multidisciplinary interactions, improving research methodology, and community partnership. / Urban Bioethics

Whereas disability is a significant risk factor and contributor to various chronic conditions that lead to decline in the quality of life and to early death among older US Armed Forces veterans (> 64 years), little research exists focused on more granular levels of analysis to determine community level risk factors (such as rurality) associated with disability prevalence. A quantitative and cross-sectional design used 2010 – 2014 and 2015 – 2019 data sets from the United States Census Bureau American Community Survey. Results obtained have shown that disability is most prevalent among the older (>64) veteran population, overtime, rates are getting worse, rural areas are most affected, and primary care physicians are needed in areas where rates of disability is high. The findings help to improve our understanding of disability prevalence among older veterans and non-veterans and provide a foundation for the development and implementation of appropriate geographically targeted policy and program interventions to support the development and enhancement of services made at the federal, state, and local/community levels. Through effective interventions, the risk of having increased rates of poor health status, poor quality of life, and risk of death can be reduced substantially, particularly among older veterans in rural areas of the United States.

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<p>Education provides people with material, social, and cognitive resources which can bolster well-being, and a growing body of literature documents a positive association between adult children’s education and older parents’ health. Although researchers have begun to explore mechanisms which underlie and shape this association, few studies have considered the role of family context. Guided by the social foreground perspective, the central aims of this dissertation are to investigate: (1) whether adult children’s problems account for the relationship between adult children’s education and mothers’ depression and (2) whether the size of the association between adult children’s education and mothers’ depression varies between married and widowed mothers. To answer these questions, I utilize mediation and moderation techniques and data collected as part of the Within-Family Differences Study. Consistent with past work, I found that mothers with children who completed more education reported fewer depressive symptoms. In the first substantive chapter, mediation analyses suggested that this relationship was mediated by the proportion of adult children who have experienced physical and emotional problems in the last five years. Consistent with the life course perspective and cumulative inequality theory, these results highlight the ways in which (dis)advantages that impact health accumulate both across age and across generations. In the second substantive chapter, moderation analyses revealed that the association between adult children’s education and mothers’ psychological well-being was weaker among widowed mothers. I innovatively argue that these results are consistent with principles of socioemotional selectivity theory. Taken together, the results from these two chapters illuminate the importance of considering family context when studying the intergenerational implications of education for health. In addition, by augmenting our understanding of how and under what conditions adult children’s education matters for mothers’ psychological well-being, my results offer important insights for stakeholders invested in improving the psychological well-being of older adults.</p>