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Since 2015 Canada has welcomed 44,620 Syrian refugees. The research on Syrian refugees in Canada has mainly focused on their immediate health needs, communicable diseases, and chronic illnesses. Aside from maternal health, the sexual and reproductive health (SRH) needs of Syrian refugee women is undocumented in Canada. To address this gap in the literature we conducted a qualitative study in Ottawa, Ontario that involved in-depth interviews with Syrian refugee women and individuals who provide health services to them. When accessing SRH services Syrian women identified a preference for women providers, faced difficulty adjusting to societal norms during the perinatal period, felt that contraception counselling was not culturally informed, and struggled with their maternal mental health. Key informants mainly echoed these findings and expressed a need for more cultural competency/humility training, interpretation services, and trauma-informed counselling. The path to improving SRH services for Syrian women is complex, but highly warranted.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

The development of safer and more accessible contraceptive options is necessary to reduce the high number of unintended pregnancies worldwide. As monoclonal antibody engineering continues to revolutionize drug development, a variety of strategies are being harnessed to establish antibody-based contraceptives. Human Contraception Antibody (HCA), an immunoglobulin G1 (IgG1) monoclonal antibody that potently agglutinates human sperm, is a promising candidate for nonhormonal immunocontraception in women. Our group recently established the safety and efficacy of a topical IgG1 HCA-formulated dissolvable vaginal film. Though successful, we are currently working to further optimize and improve the HCA product. In this study, we characterized engineered variants of HCA. Bioactivities, specifically agglutination and effector functions, of multimeric and fragment crystallizable (Fc)-mutated variants were compared and inform further engineering of an optimal clinical profile. We then established an atomized mRNA mechanism for delivery of HCA to the female reproductive tract (FRT). The use of mRNA could provide several advantages including: efficiency, reversibility, safety, durability, and cost-effectiveness. mRNA-encoded HCAs were expressed in several models of the FRT and were functional, sperm-specific, and safe. We also analyzed Fc N-glycans at the conserved glycosylation site on IgGs that regulate effector functions and compared the site-specific glycosylation on antibodies generated by two HCA expression platforms of interest, namely Nicotiana benthamiana and mRNA-transfected vaginal cells. Disparities in glycan site occupancy and glycoform populations between the two platforms were observed. Platform-specific HCA glycans resulted in differing levels of sperm phagocytosis, an Fc function. In summary, these studies provide a clearer understanding of engineered variants and delivery platforms to further advance the development of HCA as a novel, antibody-based female contraceptive.

In 2018 a new contraceptive method in the form of a programmable microchip implant will be made available to women. This research attempts to unpack the interaction design implications of the marriage between contraceptive methods and digital technology that the contraceptive microchip represents. The contraceptive microchip comes with a remote control component that is handed to the user so that they can de-activate and re-activate their own fertility. This research uses a range of methods including performance-based speculative design in order to unpack the interaction design implications of the contraceptive microchip. The first major contribution of this research is the compilation of areas of concern for potential adopters of the contraceptive microchip relating to the implantation of digital technology. The second major contribution is the exploration into how the remote control component of the contraceptive microchip could mediate sexual relationships.

The purpose of this paper is to examine the female hormonal cycle throughout a woman's life and its effects on the singing voice. Dealing with vocal issues brought on by hormonal fluctuations can be extremely frustrating for the professional singer, as these issues can wreak havoc on performance and practice schedules. The best weapon of defense against its unpredictability is information. Unfortunately, data on the female hormonal cycle and its effects on the voice is not covered in most standard vocal pedagogy books. Information on the subject is often relegated to a small section of a chapter, and even then usually describes only the symptoms: edema, hoarseness, and loss of high notes and power. The question as to why these symptoms happen every month and during menopause, and whether there is anything that can be done to alleviate them, remains largely unanswered. A candid discourse on the subject of hormones and the female voice has begun, but now must brought into the open. It is a subject that needs to be broached in voice studios everywhere. Can the effects of hormonal fluctuations on the voice be managed? What treatments are there for the symptoms; are they safe; are they effective? How can we further the dissemination of information on this subject? This paper will attempt to answer these questions by compiling data from the studies and research of esteemed doctors and scientists on this subject into one document, making it easy for young students and interested voice teachers to access this important information. It is my goal with this monograph to help and inform my readers. The human larynx is directly influenced by lifelong cyclical hormonal fluctuations. A woman's monthly cycle, which lasts from puberty to menopause, causes changes in hormone concentrations. These changes can affect a woman's physical and emotional states, causing bloating, and temporary abnormalities in sleep, mood, concentration levels, and energy. These effects are also seen in the vocal tract, where edema, vocal fatigue, decreased range, and lowering of the fundamental frequency can occur. The monthly symptoms of hormonal change are called premenstrual syndrome, or PMS. Similarly, the symptoms manifested in the larynx are called premenstrual vocal syndrome, or PMVS. This paper is an examination and exploration of the effects of PMS and PMVS on the singing voice. To do so, it provides a brief overview of the steroid hormones: estrogen, progestogen, and androgen. These three hormones are responsible for the development and maturation of primary and secondary sexual characteristics. It is only through studying the specific functions of each of the steroid hormones that it is made clear why some women suffer so profoundly each month from PMS and PMVS. Additionally, this paper provides information regarding the benefits and drawbacks of oral contraceptives, or OCPs. OCPs contain synthetic hormones that mimic the body's own natural hormones, and they regulate the body's levels of estrogen and progesterone, which prevents ovulation. In addition to their contraceptive use, OCPs are used to treat endometriosis, acne, and irregular periods. By preventing the body's hormonal levels from fluctuating, OCPs have proven highly effective as a treatment of PMS and PMVS. Further, the changes to the voice during pregnancy will be examined. The increased hormonal concentrations associated with pregnancy act upon the reproductive organs, muscles, bone, cerebral cortex, and mucosa, as well as the larynx. This paper also explores what happens to the voice throughout the stages of menopause, the symptoms of which can range from moderate to quite severe. Treatment options are discussed, including both hormone replacement therapy and alternative methods. Lastly, this paper shares information gathered from a survey of singers regarding their own experiences with PMS and PMVS, OCPs, pregnancy, and menopause. / Music Performance

Objectifs et hypothèses :Cette thèse a pour objectif d'explorer les causes de la non observance en contraception orale qui se traduit par un nombre important d'IVG chez des femmes pourtant sous contraception. Nous avons formulé 3 hypothèses : il existe des différences significatives entre les femmes présentant des difficultés d'adhésion thérapeutique et celles qui n'en présentent pas. La 2ème hypothèse a trait à l'existence de relations significatives entre les causes de non observance et la motivation générale. La 3ème hypothèse énonce l'existence de différences significatives entre les moyennes des deux groupes concernant les causes de non observance, la motivation générale et ses différentes dimensions. Population : Elle est composée de 50 femmes âgées de 20 à 55 ans utilisatrices de la contraception orale, (soit deux groupes : 25 femmes présentant des difficultés d'observance et 25 femmes ne présentant pas des difficultés d'observance). Instruments : Deux questionnaires ont été mis au point et utilisés : 1) Un questionnaire sur l'observance en contraception orale et une échelle d'évaluation des causes de non observance en contraception orale. 2) Une échelle de Motivation Globale EMG-28 destinée à l’évaluation du degré de motivation à l'observance de la contraception orale en examinant les degrés d'auto-détermination de la motivation dans la vie en général. Résultats : Les résultats indiquent l'existence de causes de non observance liées à l'utilisatrice (oublis, fausses croyances, peur des effets indésirables, manque d'information), à la contraception orale (routine, lassitude, contrainte de la prise journalière) et à la relation entre le prescripteur et l'utilisatrice (qualité de l'information donnée, relation thérapeutique, écoute, logique de prescription). Conclusion : Le processus d'utilisation de la contraception orale se révèle très complexe. Une prise en charge motivationnelle s'avère nécessaire chez les femmes en situation d'échec de contraception, comme nous le montrons avec les deux cas cliniques présentés. / Objectives and assumptions : This thesis aims explore the causes of non adherence in oral contraception which lead to TOP among women however under contraception. We formulated 3 assumptions: there are significant differences between the women presenting adherence problems and those without problems. The 2nd assumption supposes the existence of significant relations between the causes of non adherence and the general motivation. The 3rd assumption states the existence of significant differences between the averages of the two groups concerning the causes in non adherence, the general motivation and its various components. Population : A survey was carried out based on a sample of 50 women users of oral contraception in Amiens, including a group of 25 women which exhibit adherence problems. Tools : Two questionnaires were developed within the framework of this thesis, 1) A questionnaire on adherence in oral contraception and a scale for the evaluation of the causes of non adherence in oral contraception. 2) A Scale of Global Motivation EMG28 intended to evaluate the degree of motivation for adherence to oral contraception by examining the self-determination degree of motivation in life in general. Results : Collected data confirm the assumptions posed. It reveals existence of causes of non observance related on the user (missing pills, beliefs, fear of undesirable effects, information lack, on the oral contraception (routine, lassitude, constraints …) and the relation between the prescriber and the user (therapeutic relation, quality of information given, model of prescription). Conclusion : The process of use of oral contraception appears very complex. A motivational therapy is necessary among women in situation of failure of contraception, as we show it with clinical cases presented.

As práticas contraceptivas na adolescência apresentam dinâmica própria, em que as decisões acerca do uso de algum método variam em função de uma série de elementos, como o conhecimento sobre anticoncepção, a experiência sexual e o relacionamento vigente. Por conta de serem essencialmente solteiros, os adolescentes alternam os métodos de acordo com o tipo de relacionamento, seja ocasional ou estável, bem como ao longo deste. É justamente nos momentos de alternâncias e descontinuidades no uso de métodos que a anticoncepção de emergência pode surgir como opção para a prevenção da gravidez não planejada. Mesmo que já esteja disponível em alguns serviços da rede pública de saúde no país, pouco se sabe sobre o seu conhecimento e uso. Assim, este estudo teve como objetivo analisar o nível do conhecimento e o uso da anticoncepção de emergência entre adolescentes estudantes do ensino médio. Para isto, foi conduzido um estudo quantitativo do tipo transversal. A população de estudo constou de estudantes solteiros de 15 a 19 anos de idade que estavam matriculados em escolas públicas e privadas do município de Arujá, São Paulo. Os estudantes foram selecionados considerando a amostragem probabilística por conglomerado, realizado em duas etapas (estratificação por escola e sistemática por turma) (n=669). Os dados foram coletados por meio de um questionário autoaplicado, no qual as variáveis dependentes foram o conhecimento sobre a anticoncepção de emergência (incluindo apenas aqueles que a conheciam) e o uso da anticoncepção de emergência (incluindo apenas aqueles que iniciaram a vida sexual). As variáveis independentes dizem respeito às características sociodemográficas e ao comportamento sexual e contraceptivo. A análise de regressão linear múltipla identificou como variáveis associadas ao nível do conhecimento da anticoncepção de emergência o tipo de escola, o ano escolar, o sexo, a relação sexual e conhecer alguém que já usou o método. Por sua vez, a análise de regressão logística múltipla identificou como variáveis associadas ao uso da anticoncepção de emergência a religião, o namoro atual e conhecer alguém que já usou o método. Os resultados obtidos demonstraram que os adolescentes de ambos os tipos de escola sabem pouco sobre a anticoncepção de emergência, apesar de uma parcela significativa ter usado este método. Demonstraram, também, que o nível de conhecimento da anticoncepção de emergência não afetou o uso deste método. / Contraceptive practices in adolescence present specific dynamics, in which decisions about the use of a method vary upon contraception knowledge, sexual experience and dating. As adolescents are mostly single, they alternate the use of contraceptive methods according to their relationships, whether occasional or permanent, as well as along it. Whenever there are alternations and discontinuities in the use of regular methods, emergency contraception may emerge as an option to prevent an unplanned pregnancy. Even though it is already available in some primary health services, little is known about adolescents knowledge and use. This study aimed to analyze the level of knowledge and use of emergency contraception among high school adolescent students. So we conducted a cross-sectional quantitative study. The study population was single students from 15 to 19 years of age enrolled in public and private high schools in the city of Arujá, São Paulo, Brazil. Students were selected based on a cluster sampling, conducted in two stages (stratificatied sampling by school and systematic sampling by class) (n = 669). Data were collected through a self-administered questionnaire, in which the dependent variables were knowledge about emergency contraception and the use of emergency contraception (considering only those who reported sexual initiation). Independent variables were sociodemographic characteristics and sexual and contraceptive behavior. From multiple logistic regression analysis, data showed that associated variables to the level of knowledge of emergency contraception were school type, school year, sex/gender, sexual intercourse and knowledge of someone who has used the method. On the other hand, variables associated with the use of emergency contraception were religion, current dating and knowledge of someone who has used the method. Results showed that adolescents from both schools know little about emergency contraception, although more than a half have used this method. Level of knowledge of emergency contraception did not affect the use of this method.

Introdução: A dinâmica do uso dos métodos contraceptivos é importante entre os universitários, pois estes apresentam altas aspirações educacionais e profissionais, o que afeta a intenção reprodutiva. Ainda, por serem na maioria solteiros, os jovens alternam os métodos de acordo com o tipo de relacionamento. Neste contexto, a anticoncepção de emergência é uma opção, sobretudo nos casos de descontinuidades. Porém, pouco se sabe sobre as descontinuidades e sua relação com o uso da anticoncepção de emergência no Brasil. Objetivo: Analisar a frequência e os determinantes da descontinuidade contraceptiva em um período de 12 meses; avaliar o uso da anticoncepção de emergência após as descontinuidades, e avaliar as descontinuidades após o uso da anticoncepção de emergência. Métodos: Estudo de coorte retrospectivo, realizado com amostra probabilística de mulheres universitárias da Universidade de São Paulo. As alunas foram selecionadas por amostragem aleatória simples sem reposição (n=1.679). Os dados foram coletados através de um questionário de autopreenchimento respondido online. No Stata 14.2, os dados foram analisados por meio de regressão logística multinomial e multivariada, e equações de estimação generalizadas. Resultados: Primeiro, observou-se que as jovens com relacionamentos casuais, com menor nível socioeconômico, matriculadas nos cursos de Humanas e Ciências da Saúde, com menos anos de experiência sexual, com múltiplos parceiros sexuais e que usavam métodos menos eficazes, apresentaram maior probabilidade de descontinuar uma ou várias vezes. Segundo, as usuárias de pílula e preservativo que tinham relacionamentos casuais, com menor nível socioeconômico e que tiveram gravidez anterior, foram mais propensas a descontinuar, abandonar ou mudar para um método menos eficaz. Terceiro, uma proporção significativa de mulheres não usou anticoncepção de emergência após descontinuarem ou abandarem o método. Quarto, a anticoncepção de emergência foi mais utilizada após inconsistências no uso do método. Quinto, as jovens que usaram um método antes do uso da anticoncepção de emergência, sem religião, com um relacionamento estável, e que tiveram um parceiro sexual na vida, foram mais propensas a usar contracepção após a anticoncepção de emergência. Sexto, as jovens com relacionamento estável, de nível socioeconômico mais baixo, matriculadas nos cursos de Humanas e que tiveram um parceiro sexual na vida tiveram maior probabilidade de mudar para um método menos eficaz após o uso da anticoncepção de emergência. Por fim, poucas jovens apresentaram descontinuidades dentro de 30 dias após o uso da anticoncepção de emergência. Conclusões: A descontinuidade contraceptiva difere por tipo de método. A anticoncepção de emergência é subutilizada após as descontinuidades. A parceria influência na dinâmica do uso de contraceptivos. Ainda, aspectos educacionais, nível socioeconômico e número de parceiros sexuais são características importantes a serem consideradas na implementação de programas de planejamento familiar focados em mulheres jovens. / Introduction: Contraceptive use dynamics is relevant to undergraduate students as they present high educational and professional aspirations, which affects reproductive intention. Also, they are mostly single, so they alternate the contraception according to their relationships. In that case, emergency contraception is an option, mainly in situations of discontinuation. However, little is known about discontinuation and its relation to the use of emergency contraception in Brazil. Objective: To analyze the frequency and correlates of contraceptive discontinuation within 12-months; to assess emergency contraception use after discontinuation, and evaluate dicontinuation after emergency contraception use. Methods: We conducted a 12-month retrospective cohort study on a sample of undergraduate women at University of São Paulo, Brazil. Students were selected by simple random sampling without replacement (n=1,679). Data were collected online using a self-administered questionnaire. In Stata 14.2, we used multinomial and multivariate logistic regression, and generalized estimating equation to analyze the data. Results: First, we observed that women with casual relationships, lower socioeconomic status, enrolled in Human and Health Sciences programs, with less years of sexual experience, with multiple sexual partners in lifetime, and who use less effective method were more likely to discontinuation one or several times. Second, pill and condom users who had casual relationships, with lower socioeconomic status, and who had previous pregnancy were more likely to discontinue and to abandon or switch to a less effective method. Third, a significant proportion of women did not use emergency contraception after discontinuing or abandoning contraception. Fourth, emergency contraception was mostly used after inconsistent use of contraception. Fifth, women who used contraception prior to emergency contraception use, had no religion, were in stable relationships, and had only one sexual partner were more likely to use contraception after emergency contraception. Sixth, women with stable relationships, from lower socioeconomic status, enrolled in Human Sciences programs, and who had one sexual partner were more likely to switch to a less effective method after emergency contraception use. Lastly, few women presented gaps in contraception within 30- days after emergency contraception use. Conclusions: Discontinuation does differ by type of method. Emergency contraception is underutilized after discontinuation. Partnership has an important influence on contraceptive use dynamics. Also, educational background, socioeconomic status, and number of lifetime sexual partners are important characteristics that should be considered when implementing family planning programs focused on young women.

Reproduction de : Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2008. / Titre provenant de l'écran-titre. Bibliogr. f. 48-51.