[Truncated abstract] Early psychosocial stress is conjectured to place individuals on a developmental trajectory leading to earlier pubertal maturation, earlier initiation of sexual activity and earlier reproduction than those with less early psychosocial stress. This may have an adaptive function to minimise the chances of lineage extinction, which is more likely in environments of high risk and uncertainty. Previous studies have examined the relationship between early psychosocial stress and life history stages (e.g., age at puberty, age at first sex and age at first birth). However, these studies are limited in that they either examined only a few early psychosocial stressors, examined psychosocial stress relatively late in individuals' lives and/or were restricted to women. Thus, the first aim of the present thesis was to examine these findings in both genders using a measure of early psychosocial stress comprised of 24 categories of retrospectively assessed stressors (e.g., sexual abuse, physical abuse, parental divorce, rated quality of family life) during the first 7 years of life. It was hypothesised that individuals with high, as opposed to low, levels of early psychosocial stress would pass through life history stages earlier. The second aim was to examine how early psychosocial stress affects characteristics associated with life history traits, such as individuals? length, number and type of heterosexual relationships, number of sex partners, adult attachment styles, number of pregnancy terminations, and attitudes and behaviours towards contraceptive use. High levels of early psychosocial stress were predicted to be associated with characteristics reflecting a quantitative, as opposed to a qualitative, reproductive approach (e.g., more sex partners, more short-term relationships, insecure attachment styles). The third aim was to examine how early psychosocial stress is related to mate choice because numerous studies have identified what traits individuals' desire in a mate but not whether early psychosocial stress affects these choices. ... Early psychosocial stress generally had no effects on age at first sex, age at first birth, the number of pregnancy terminations, and mate choices. On the other hand, individuals with high, as opposed to low, levels of early psychosocial stress were more likely to be insecurely attached, had more short-term sexual relationships (men only), had more extra-pair copulations, were more likely to be divorced/separated, had a greater lifetime number of sex partners (men only), and had lower self-rated frequencies of contraception use. Overall, some of these findings are consistent with life history theory, which suggests that individuals with high levels of early psychosocial stress (i.e., those living in environments of high risk and uncertainty) should reach biological maturation earlier, engage in behaviours that facilitate earlier and more frequent reproduction to minimise the chances of lineage extinction. Implications for public health, limitations of the present study and future directions are also discussed.

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2003.

The diploma work deals with problems of the risk sexual behaviour of teenagers. The aim was to compare knowledge of teenagers about prevention of the risk sexual behaviour at the Secondary medical school and at the secondary schools without medical orientation. Quantitative research was put into practice for the purpose of the fulfilment of this aim. The method of the technique of interviewing and the standardized questionnaire were adopted and the data collection was realized with respondents from 4th classes of the selected secondary schools in Klatovy in 2007. It follows from the general evaluation that although respondents from the Secondary medical school have more knowledge about prevention of the risk sexual behaviour, at the present time negative characterizations of the sexual behaviour were found out. One of the problems is an area of the preventive impact in families and schools. The sex education of respondents from the secondary schools without medical orientation is completely insufficient. They are interested in it more at Secondary medical school but also here prevention is based only on giving information. We should lead teenagers to the restriction of the risk sexual behaviour not only by the influence of the area of knowledge but also of the area of their attitudes and skills. Next important role in prevention is played especially by the family and the school, which must work together, then out-of-school activities and doctors. Young people, who have clear aims in life, fixed individual values, communicate with their parents and are led in these important questions, have bigger strength to brave the pressure of people of the same age, advertisements and mass medias, which encourage them to the premature sexual life.

Background: Preconception care (PCC) is highly recommended evidence-based intervention to optimize women’s health in particular and in so doing reduce the incidences of adverse pregnancy outcomes (APO). PCC targets modification of risk factors to APO occurring before and just at early weeks of conception. Nevertheless, in Ethiopia, the need to implement PCC as part of the continuums of the comprehensive Maternal, Neonatal and Child Health Care services is not yet studied. Purpose/Aim of the study: This study aimed to develop a guideline to assist the incorporation of PCC in Ethiopian health system thereby reduce the highly incident APOs in the country, which is the purpose of the study. Methodology: This study applied the explanatory sequential mixed method to determine the determinants to the non-implementation PCC in Ethiopia. In addition, a policy document analysis was conducted to identify the existence of policy guiding the implementation of PCC in Ethiopia. Finally, the study applied a Delphi technique to increase the utility and acceptance of the guideline developed. The study was guided by a theory based framework called a Framework for Determinants of Innovation Processes (FDOIP). RESULT: Nearly all (84.7%) of the healthcare providers (HCPs) never ever practiced PCC. Even among those who ever practiced, the majority (74%), practiced it poorly. More than two third (68.6%) had poor PCC knowledge. HCP’s with good PCC knowledge had likely hood of practicing PCC by four times greater than those with poor PCC knowledge (AOR=4.4, 95% CI: 2.5-7.6). The policy document analysis identified the absence of policy guiding the practice of PCC in Ethiopia. The HCP’s curriculums also didn’t include PCC. The determinants to non-implementation of PCC, as perceived by the qualitative study participants include absence of national PCC policy , absence of PCC guideline, lack of institutional PCC plan, presence of other competing demand, lack of laboratory facilities and setup, lack of accountable body, absence of Individual or organization introduced PCC to the country, absence of trained manpower on PCC, absence of known expert in PCC, Poor public awareness about preconception health and PCC, Unplanned Pregnancy and poor health seeking behaviour. CONCLUSION The study revealed the absence of a standard and complete PCC practices by the HCPs. Nearly all HCPs never ever implement PCC. Even those very few practitioners were found practicing PCC poorly that is in a substandard, incidental, and in an inconsistent way. There is no formal policy document guiding the implementation of in Ethiopia. The HCPs training curriculum didn’t include PCC. The guideline developed base on the study findings of the study recommended to incorporating PCC in Ethiopia health system. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in Afrikaans / Die effek van die klient-verpleegkundige-verhoudings op kliente se keuse en volgehoue gebruik van kontraseptiewe metodes het tot op hede baie min aandag geniet. Die doel van hierdie studie was 'n ondersoek na die ongetroude klient se persepsie van die verpleegkundige se houding. Die steekproef het bestaan uit 99 kliente (tussen die ouderdomme van 15 en 50 jaar) wat die betrokke reproduktiewegesondheidsklinieke in die Kaapse Metropool besoek het. Die eerste 20 kliente wat die kliniek besoek het, is genader om 'n vraelys in te vul. Hierdie studie toon 'n algehele positiwiteit, naamlik 58,3% teenoor die houding van geregistreerde verpleegkundiges. Die meerderheid van die kliente (88,0%) het aangedui dat hulle weer die kliniek sal besoek wat dus die kliente se tevredenheid toon. / The effect of the client-registered nurse relationship on clients' choice and continuous use of contraceptive methods has until now received very little attention. The purpose of this study was to explore unmarried clients' perception of the attitude of the registered nurse. The sample existed of 99 clients (between the ages of 15 and 50 years) who visited the relevant reproductive health clinics in the Cape Metropole. The first 20 clients who visited the clinic were approached to complete a questionnaire. This study shows an overall positivity of 58,3% with regard to the attitude of registered nurses. Most of the clients (88,0%) indicated that they would visit the clinic again, which indicate their satisfaction. / Health Studies / M.A. (Nursing Science)

The diploma thesis deals with the change of the family in today's society, its roles, and the ways of cohabitation which replace the family. It evaluates the significance of marriage and parenthood for children and for their future lives. It describes the difficulties related to responsible parenthood and the role of parents during their children's adolescence. It evaluates the mentioned issues from the point of view of Christian ethics. It also touches on the problems of the current society in terms of infertility and assisted reproduction as well as ethical issued connected with them.

Abstract Cardiovascular diseases are the leading cause of death worldwide and type 2 diabetes is reaching a global epidemic. Epidemiological studies have identified numerous risk factors and pharmacotherapies in relation to these cardiometabolic diseases. However, the detailed molecular mechanisms of these risk factors and drug therapies generally remain incompletely understood. Elucidating the underlying molecular effects would be essential for better understanding of the disease pathogenesis and also for discovering new therapeutic targets. Quantitative serum metabolomics, which allows for simultaneous quantification of multiple circulating metabolic measures, provides a hypothesis-free approach to systematically inspect the metabolic changes in response to endogenous and exogenous stimuli. Metabolomics thus presents a valuable tool to study the detailed molecular effects of disease risk factors and drug therapies. However, current metabolomics studies are mostly conducted in small cross-sectional studies and the causal relations of the risk factors on the metabolic measures are generally unclear, providing limited public health impact. The present thesis serves as a proof-of-concept to illustrate that well-designed observational studies can be used to infer causality. With the exemplars of assessing molecular effects of two risk factors (body mass index and sex hormone-binding globulin) and two drug therapies (statins and oral contraceptives), the thesis demonstrates that an improved causal inference can be achieved in observational studies via the combination of multiple study designs, including cross-sectional, longitudinal and Mendelian randomization analysis. This robust study design approach together with metabolomics data can be also extended to study the molecular effects of other risk factors and drug therapies. With an improved molecular understanding of a wide range of risk factors and therapies, better understanding of disease pathogenesis is ensured. / Tiivistelmä Sydän- ja verisuonitaudit ovat johtava kuolinsyy maailmassa ja tyypin 2 diabetes on saavuttamassa globaalin epidemian mittasuhteet. Epidemiologiset tutkimukset ovat löytäneet useita riskitekijöitä ja lääkehoitoja edellä mainituille yleisille taudeille. Tyypin 2 diabetekseen ja sydän- ja verisuonitauteihin liittyvät yksityiskohtaiset molekylaariset mekanismit ymmärretään kuitenkin puutteellisesti. Molekylaaristen yksityiskohtien tarkempi ymmärtäminen olisi siten erittäin merkittävää sekä tautiprosessien ymmärtämiseksi että lääkehoitojen kehittämiseksi. Seerumin kvantitatiivinen metabolomiikka mahdollistaa useiden metabolisten suureiden samanaikaisen määrittämisen verenkierrosta ja tarjoaa siten hypoteesittoman lähestymistavan sekä sisäisten että ulkoisten ärsykkeiden aiheuttamien metabolisten muutosten systemaattiseen tutkimukseen. Metabolomiikka on siten arvokas työkalu yksityiskohtaisten molekylaaristen mekanismien tutkimuksessa, olipa kyseessä taudin riskitekijät tai lääkehoito. Metabolomiikkatutkimuksia on kuitenkin pääasiassa tehty pienissä poikittaistutkimuksissa ja riskitekijöihin liittyvien metabolisten suureiden syy- ja seuraussuhteet ovat yleisesti epäselviä, josta johtuen metabolisten suureiden kansanterveydellinen sovellettavuus on ollut heikkoa. Tämä väitöskirja esittelee tutkimuskonseptin hyvin suunniteltujen havaintotutkimuksien soveltamiseksi syy- ja seuraussuhteiden arvioinnissa. Työ sisältää esimerkit kahden riskitekijän (painoindeksi ja sukupuolihormoneja sitova globuliini) ja kahden lääkehoidon (statiinit ja ehkäisypillerit) molekylaaristen vaikutusten kausaalisista tutkimuksista. Tulokset havainnollistavat, että kausaalisten johtopäätösten luotettavuutta voidaan parantaa yhdistämällä useita tutkimusasetelmia, kuten poikittais- ja pitkittäistutkimuksia sekä Mendelististä satunnaistamista. Esitettyjä luotettavia tutkimusasetelmia, yhdessä metabolomiikkadatan kanssa, voidaan laajentaa muiden riskitekijöiden ja lääkehoitojen molekylaaristen vaikutusten tutkimuksiin. Parantunut molekyylitason ymmärrys useista riskitekijöistä ja lääkehoidoista johtaa myös parempaan tautiprosessien ymmärtämiseen.

MPH / Department of Public Health / Condoms protect against unplanned pregnancy and sexually transmitted infections, including HIV, among all population groups including adolescents. Correct use of condoms prevents between 80% and 95% of HIV transmission. Furthermore, the usefulness of condoms in preventing pregnancy or STIs rests on the user. Thus, the possibility of pregnancy or STI transmission is greater when condoms are not utilised appropriately and regularly with every sexual act. The aim of the study was to determine the knowledge, attitudes and practices of high school learners on the use of condoms in the Greater Giyani Municipality. A quantitative, descriptive research design was used. The researcher used a probability-stratified random sampling method to select respondents from schools that were selected to participate in the study. A self-administered questionnaire consisting of close-ended questions was used to collect data. The questionnaires were given to learners to complete. Data were analysed using the Statistical Package for Social Sciences (SPSS), version 24. Descriptive and inferential statistics were used during data analysis. Data are presented in charts and frequency tables. Most of the respondents were aged 15-17 years (57.8%). There were more female than male respondents in the study and most respondents lived with both parents (14.9%). There were more respondents in Grade 12 (37.3%) than in other grades: 27.7% of the respondents were in Grade 10, while 35% were in Grade 11. Most of the respondents (88.7%) knew that condoms offer protection against HIV/AIDS, STIs and pregnancy, but many held negative attitudes towards condoms (56.5%) because they thought that condoms reduced pleasure during sexual intercourse. The majority (77.3%) of the respondents had engaged in sex, and half of these (50%) sometimes used condoms when they engaged in sexual intercourse. Male respondents were found to have power over xiii their partners on the making of decisions regarding condom use. Peer pressure was found to be one of the most significant factors that influenced condom use. Parents and guardians of the respondents were discovered to have communicated about sexual issues with their children. High school learners should be encouraged to refrain from using substances such as alcohol, because when they are under the influence of these substances and engage in sexual intercourse they can be unwilling to use condoms . / NRF

Background: One in ten people in the U.S. are affected by a substance use disorder (SUD), roughly one third of whom are women. Rates of unintended pregnancy are higher in this population than in the general public. Little is understood about how women with SUD use prescription contraception and think about pregnancy. Methods: By analyzing Medicaid claims data and conducting qualitative interviews with women with SUD, this doctoral thesis seeks to: 1) compare any use of and consistent, continued coverage by prescription contraceptives between women with and without SUD; 2) determine the extent to which SUD is associated with pregnancy, abortion, and adverse feto-maternal outcomes in women who use prescription contraception; and 3) explore facilitators of and barriers to contraceptive utilization by women with SUD, using qualitative interviews. Results: Compared to women without SUD, women with SUD are less likely to use any prescription contraceptive, particularly long-acting reversible methods. Among women who do use long-acting methods, SUD is associated with less continued, consistent coverage by a prescription contraceptive. Among women who use contraception, SUD is also associated with increased odds of abortion. When interviewed, women with SUD report fatalistic attitudes towards pregnancy planning, and have difficulty conceptualizing how susceptibility to pregnancy may change over time. Women with SUD also report that pregnancy has substantial impact on their drug treatment prospects. Conclusions: This study is the first to examine contraceptive utilization by women with SUD who are enrolled in Medicaid or state-subsidized insurance. Our study may help to inform clinical practice and policy development to improve the reproductive health and wellbeing of women with SUD.

No description available.