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published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

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Thesis (Ph. D.)--University of Hawaii at Manoa, 1996. / Includes bibliographical references (leaves 136-146). / Microfiche. / xiv, 146 leaves, bound ill., maps 29 cm

This thesis presents a discursive analysis of accounts of breast cancer screening, risk and prevention. Breast cancer is currently the largest form of cancer death for women in Australia ( and many other Western nations ), but the causes are unknown. Consequently, health promotion has tended to focus on the early detection of the disease. Despite this focus, the currently available techniques for early detection of breast cancer continue to be subject to research and debate. For women at high risk of the disease due to a family history and, in some cases, a genetic predisposition, there is also discussion regarding the best course of preventative action. One option, prophylactic surgery ( or the removal of healthy breasts ), continues to be the topic of both medical and psychological research. In addition to the ongoing medical research and debate around the topics of breast cancer screening, risk and prevention, there has been extensive sociological theorising around the increased societal emphasis on risk more generally. This emphasis on risk has been argued to be one feature of governance in modern liberal democratic societies. Particularly with respect to health - care in such societies, there has been argued to be a shift towards increasing individual responsibility for health and the management of potential illness. A focus on individual responsibility is not necessarily a key feature of contemporary public health approaches. Nevertheless, it has been suggested that the emphasis on risk management, in combination with the prevalence of ' lifestyle ' diseases, has widened the gaze of public health, such that all aspects of individuals ' lives are open to scrutiny and regulation. An inevitable consequence of such shifts is the placing of increased responsibility for health on to individuals. The analysis in this thesis draws on a synthetic discursive approach to examine talk and text around the issues of breast cancer screening, risk and prevention, in light of these shifts in conceptualisations of health and health - care, and the medical debate surrounding detection and prevention techniques. In particular, three analytic chapters are concerned with three sets of data : media accounts of prophylactic mastectomy ; pamphlets promoting breast cancer screening ; and women ' s focus group talk. The analysis focuses on the discursive themes, ideological dilemmas, and subject positions deployed in the data. The following analytic findings are discussed : - the repeated positioning of individuals as ' patients without symptoms ', who are required to engage in risk management in order to prevent their ( inevitable ) future illness ; - the positioning of women in terms of traditional notions of femininity and mothering ; - the construction of a dilemmatic relationship between individuals and medical experts, whereby individuals are positioned as responsible for their own health and illness prevention, while simultaneously being reliant on medical experts who are sometimes wrong ; - the negotiation and flexible management of notions of responsibility, emotion and health behaviours in women ' s talk. The final chapter in the thesis considers implications of the analysis for public health and health promotion, and for a critical ( public ) health psychology. / Thesis (Ph.D.)--School of Psychology, 2006.

[Truncated abstract] Mastitis during lactation is a severe illness and approximately one in five breastfeeding women in Australia suffer at least one episode in the first 3-6 months post partum. Despite this, there is little understanding of the physiological and pathological processes occurring before, during and following mastitis. In this study 26 women who, on the basis of my previous research, were assessed to be at risk for developing mastitis, were recruited during the first week post partum and followed prospectively throughout the course of their lactation. Breastmilk, and 24 hour urine samples were collected at Days 5, 14, 30, 60 and 90 post partum and blood was collected at Days 5 and 14 post partum. If participants experienced inflammation of the breast at any time, either during the 90 day reference sampling period or later in their lactation, samples were then collected daily for the duration of symptoms and then, as a follow up, again one week following resolution of symptoms. Breastmilk samples were analysed for a range of biochemical components that reflect immunological (sIgA, lactoferrin) and acute phase (C-reactive protein) response, synthetic activity (lactose, glucose), and permeability of the paracellular pathway (sodium, chloride, lactose and serum albumin) within the breast. Blood and 24 hour urine samples were analysed for lactose, and blood was also analysed for C-reactive protein (CRP). Bacteriological examination of milk samples was undertaken where clinical mastitis was present. Results from these analyses were compared to the severity of breast and systemic symptoms experienced. Twenty-two episodes of mastitis and 13 episodes of blocked duct(s) were identified during the study period. When adjusted for co-existing breast pathology milk composition in the breast affected by blocked duct(s) was generally not different from that of healthy breasts. One mother, who was IgA deficient, experienced six of the 13 episodes of blocked duct(s). It is possible that the absence of sIgA in the milk of this mother increased her susceptibility to inflammation of the breast. During mastitis there was a significant increase in sodium, chloride, and serum albumin to a median concentration of 23 mmol⁄l; (p<0.001); 30 mmol⁄l; (p<0.001) and 0.8g⁄l; (p<0.001) respectively, and a decrease in the median concentration of lactose in milk to 152mmol⁄l; (p<0.016) from the mastitis breast when compared to the contralateral asymptomatic breast. Increased permeability of the paracellular pathway was confirmed by a significant increase in the median daily excretion of lactose in urine to 7.5 mmol⁄24hour (p<0.001). The rate of excretion of lactose in urine over a 24 hour period proved to be, not only a reliable means of assessing breast permeability, but also allowed the researcher to discern whether milk sampled from the breast affected was representative of milk at the site of the inflammation. The changes in lactose in urine were generally consistent with the changes in sodium, chloride and lactose in milk confirming milk expressed for sample analysis was representative of milk from the site of the inflammation

Thesis (Ph.D.)--Tufts University, 2004. / Adviser: Sergio Fantini. Submitted to the Dept. of Electrical Engineering. Includes bibliographical references (leaves 201-202). Access restricted to members of the Tufts University community. Also available via the World Wide Web;

Thesis (Ph. D.)--University of Virginia, 2007. / Includes bibliographical references. Also available online through Digital Dissertations.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.