Cette étude descriptive vise à explorer les relations entre les déterminants de la santé, les données socio-démographiques et le point de services par rapport à l'utilisation du test Papanicolaou par les femmes autochtones de la région du Nipissing. L'échantillon se compose de 76 femmes autochtones et métis qui ont répondu à un questionnaire oral téléphonique ou face à face. Il y a des relations significatives entre l'utilisation du test Pap, tel que mesuré par la fréquence d'utilisation et le moment du dernier et du prochain test, et les déterminants de la santé et le point de services. Les résultats peuvent servir de tremplin pour des études ultérieures servant à améliorer la planification des soins de santé pour les femmes autochtones.

Few studies have focused on the amount of support provided by nurses on labour and delivery units. The purpose of this study was to examine the amount of nursing support provided by nurses during the intrapartum period as well as to identify factors that influence the provision of support. Support was operationalized within four categories: physical comfort measures; emotional support; instructional/informational support; and advocacy. The work sampling method was used to determine the percentage of time nurses spent in supportive care activities. Using this approach, each nurse, who met the inclusion criteria, was observed instantaneously at randomly selected times and the activity was recorded. Twelve nurses were observed over six non-consecutive day shifts on a labour unit of a teaching hospital in Montreal. A total of 404 observations were made. Nurses also were interviewed to determine their perceptions of what constituted supportive nursing care as well as the factors that facilitated or inhibited the provision of this care. Findings of the work sampling portion of the study indicated that nurses spent only 12.4% of their total time providing supportive care to labouring women. Interviews with six of the nurses that were observed suggested that their perceptions of the components of supportive care were comparable to what had been identified in the literature and with this study's operational definition of support with one exception: obtaining epidural analgesia was considered a key component of nursing support during labour. Further analysis revealed a major barrier to the provision of supportive care by nurses: the environmental control of labouring women and their partners by health care providers through the use of technology and rigid adherence to policy and procedure. (Abstract shortened by UMI.)

The problem. Group B Streptococci (GBS) are one of the most frequent causes of life-threatening infections in newly born infants, who acquire the micro-organism while passing through the genital tracts of their asymptomatic colonized mothers. Some previous studies have suggested that maternal genital colonization by GBS is associated with preterm rupture of the fetal membranes and preterm delivery. In this thesis both a prevalence study and a historical cohort study were conducted, to investigate the prevalence of maternal GBS colonization at 28 weeks of gestation, and whether there is an association between colonization and preterm rupture of the fetal membranes. Background information. Different rates for maternal GBS colonization during pregnancy have been reported, ranging from 4.6% up to 40%. The association between maternal GBS colonization and preterm rupture of the membranes has been reported in some studies, but other studies have not supported this view, which led to differsnces in opinions and the lack of a specific conclusion. The variations in the findings of these studies may have been due to several factors, which include differences in cultured sites and phase of pregnancy at which culture was obtained, in addition to the wide variations in the definition of premature rupture of the membranes used by various authors. (Abstract shortened by UMI.)

Long term preventive hormone replacement therapy (LTP-HRT) is attracting considerable attention for its potential in reducing the incidence of coronary heart disease and osteoporosis associated fractures in post-menopausal women. The study objectives were: (1) to describe women's decisions and decisional conflict regarding LTP-HRT after being presented with the evidence of benefits and risks and clarifying values; (2) to describe the difference between those who accept or decline LTP-HRT in terms of: (a) expectations of LTP-HRT benefits and risks, and (b) the importance women attach to the benefits and the risks; and (3) to describe the factors women identify as contributing to their decision to take or not take LTP-HRT or being unsure about taking LTP-HRT. The typical woman who participated in the study was 57 years of age; had some post secondary education; and was currently using HRT. Over half the women had at least one CHD risk factor and had a hysterectomy. Less than 15% of the respondents reported having osteoporosis or a first degree relative with breast cancer. Women's decisions to take LTP-HRT were distributed as follows: 56% yes; 26% no; and 18% unsure. Women who accepted or declined LTP-HRT did not have statistically significant differences in expectations of risk of CHD, osteoporosis, and breast cancer with and without hormone therapy. In contrast, women's importance ratings of LTP-HRT benefits and side effects did differ significantly between those accepting and declining LTP-HRT. The reasons most often identified by women who chose LTP-HRT were prevention of CHD and osteoporosis (61%) and relief of hot flashes (54%). Those who chose not to take LTP-HRT gave reasons such as dislike of taking pills (47%), and risk of cancer (11%). (Abstract shortened by UMI.)

The development and release of clinical practice guidelines continue unabated. Yet the question remains: do practice guidelines guide practitioners? This study examines the implementation of guidelines published by Canada's National Advisory Committee on Immunization (NACI) on hepatitis B screening in pregnancy. Hepatitis B is transmitted to infants from their chronic carrier mothers during the perinatal period. Asymptomatic HBsAg positive mothers are at risk of transmitting their infection to their newborns at a rate of 20 to 30%. Mothers who are also HBeAg positive transmit the infection at a rate of 70-90%. Ninety percent of infants infected in the perinatal period will become chronic carriers. Such infants have an increased risk for chronic active hepatitis, cirrhosis and hepatocellular carcinoma. Twenty-five percent will die of chronic liver disease in early adulthood. The use of hepatitis B immune globulin and vaccine after birth can prevent up to 90% of hepatitis B infections in infants. Successful immunoprophylaxis of an infant requires that her carrier mother be identified prior to giving birth. In 1989, after years of recommending screening on a selective high risk basis, NACI recommended screening all pregnant women for hepatitis B surface antigen (HBsAg). If testing was not done during pregnancy it was to be done at the time of delivery.

Incidence of cancer of the corpus uteri (of which 89% is endometrial adenocarcinoma) in Canada is declining in women under 70 years of age; in women 70 and over incidence increased from 1969 until 1982 since when it has been stable. These incidence data use as a denominator all women in the population, rather than just women with intact uteri, who constitute the real population at risk. A descriptive analysis was done using data from national databases on incidence, mortality, morphology, method of diagnosis, surgical procedures and population numbers, focussing on incidence in women $\ge$70 years of age. A variety of models for the hysterectomy adjustment all resulted in a trend of increasing incidence in women over 70 years of age; this effect is most important in the most recent period, where the adjustment changes stable crude rates into increasing adjusted ones. Decreasing proportions of diagnosis by death certificate only, and decreasing mortality/incidence ratios in recent periods suggest some improvement in diagnosis in elderly women. Incidence of cancer of the corpus uteri, adjusted for hysterectomy prevalence, is increasing in women over 70 years of age in Canada. There is a cohort effect which may represent residual increased risk from unopposed estrogen use in the 1970s. There is also some (weak) evidence to suggest improved diagnosis of this cancer in elderly women in recent periods. Absolute numbers of cases in women $\ge$70 years are definitely increasing as the population ages. (Abstract shortened by UMI.)

Low birthweight of newborns is a major determinant of perinatal survival as well as postnatal morbidity. It represents major public health problem and is of great economic concern in developing countries. This study investigated the impact of four groups of risk factors: genetic and constitutional factors, namely infant sex, ethnic origin, maternal height and maternal pre-pregnancy weight; demographic/psychosocial and nutritional factors related to the mother, namely maternal age prior to pregnancy, maternal education, occupation, total family income, total gestational weight gain, use of iron and/ or vitamin supplements and haemoglobin level; obstetric factors such as parity, interpregnancy interval, gestational age of previous birth, prior spontaneous abortion, prior stillbirth, prior child death and period of gestation at delivery; and antenatal care (i.e number of antenatal care visits). To identify and quantify risk factors for low birthweight I conducted a hospital-based case-control study at the Kuala Lumpur Maternity Hospital, Malaysia. The case-control study of 295 low birthweights and 590 controls showed that Indian ethnic origin, previous premature birth, low maternal pre-pregnancy weight (46-50 kg), brief use of iron and/or vitamin supplements (2-4 weeks) and prematurity were significant independent risk factors for low birthweight. The results of this study showed that low maternal pre-pregnancy weight, premature birth, poor quality of antenatal care are important and potentially modifiable risk factors. Hence the results suggest that nutritional and health intervention programmes (i.e improvement in nutritional status and antenatal care) can reduce the incidence of low birthweight.

Trichomonas vaginalis is a protozoan parasite that causes a common sexually transmitted disease, trichomoniasis. Despite its high prevalance, the pathogenesis and immunogenicity of T. vaginalis are not well understood. Because currently available therapies are not always effective in treatment or in disease control and because of the impact of T. vaginalis on the health of women, a vaccination strategy could be an effective method of prevention. We studied the protective effects of subcutaneous immunization with T. vaginalis using a mouse model of vaginal infection. Balb/c mice were either immunized with T. vaginalis suspended in Freund's complete adjuvant (FCA) at day $-$56 and boosted with Freund's incomplete adjuvant (FIA) at day $-$28, or immunized only at day $-$28 with either Tv/FCA or Tv/FIA. Control mice were sham immunized and boosted with phosphate-buffered saline suspended in FCA and FIA respectively. At day 0 all mice were intravaginally inoculated with T. vaginalis. Mice immunized and boosted had significantly less intravaginal infection and had an elevated serum and vaginal antibody response compared to single immunization or control mice. Immunization with whole T.vaginalis appears to confer protection against intravaginal challenge with T. vaginalis in this animal model of infection.

A secondary analysis of data from a sample of pregnant smokers is described, which focuses on examining knowledge, attitudes and beliefs related to women's decision to continue smoking during pregnancy. Pregnant women are examined at each of the first three stages of change: women not considering quitting in the next six months (Precontemplation), women considering cessation in this time frame (Contemplation), and women planning on stopping smoking in the next 30 days (Preparation). Pregnant women (n = 2461) were surveyed in a cross-sectional convenience sample of prenatal clinic attendees in a city of approximately 350,000 people, over a one-year period. 32% of pregnant smokers were in the Precontemplation stage, 35% in Contemplation, and 33% in Preparation. In general, participants' level of knowledge was high about maternal and fetal risks of smoking during pregnancy. However, similar items assessing personal perceptions of risk showed that many women thought their personal risk was lower than pregnant smokers in general. Negative affect was the dominant motive, and Level 1 reasons (doubting the evidence of harm) were cited as being most important factors related to continued smoking. Overall, participants gave higher ratings to the cons of smoking than to the pros. Women in Preparation had significantly higher knowledge of risks from smoking during pregnancy than Contemplators, but did not differ significantly from Precontemplators, while Precontemplators did not differ significantly from Contemplators on this variable. Women in Preparation had a significantly higher personal perception of risk for the fetus of smoking during pregnancy than women in the other two stages. As expected, Precontemplators perceived significantly lower Cons of smoking than women in the other two stages, who did not differ significantly from each other. (Abstract shortened by UMI.)

A growing body of literature suggests that healthy and well-nourished women can safely participate in most forms of physical activity during pregnancy. In addition, participation in physical activity during pregnancy may have potential health benefits, such as reducing the risk of gestational diabetes mellitus. These potential benefits are reflected in a recent opinion issued by the American College of Obstetricians and Gynecologists (ACOG), in which women without medical or obstetric complications are recommended to accumulate 30 minutes or more of moderate intensity physical activity on most, if not all, days of the week. Despite these recommendations, little is known concerning current patterns of physical activity among pregnant women. The first study of this dissertation addressed this limitation by providing estimates of the frequency, intensity, and duration of commonly performed activities during pregnancy among a racially and economically diverse sample of women receiving prenatal care. Comprehensive 24-hour recalls were used to measure physical activity in all activity domains and the factors associated with activity were identified. The second study in this dissertation evaluated the reliability and validity of the Kaiser Physical Activity Survey (KPAS) when used to assess pregnancy physical activity. The KPAS assesses all domains of physical activity and is more practical than 24-hour recalls to measure activity in large epidemiologic studies. These results suggest that the KPAS is a reliable and reasonably accurate instrument for estimating physical activity among pregnant women. These findings should help to address the need for valid instruments to assess pregnancy physical activity in etiologic research, as most prior studies have focused on leisure time activity using questionnaires not validated for use among pregnant women. The final study in this dissertation used the KPAS to examine the association between physical activity during pregnancy and gestational weight gain among Hispanic women. This study was unique in its use of a measure of total activity energy expenditure, rather than a measure of leisure exercise, as the exposure of interest. Consistent with prior literature, moderate levels of physical activity was not efficacious in preventing excess weight gain during pregnancy.