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Introdução No Brasil a obesidade é um importante problema de saúde pública com prevalência mais elevada em mulheres do que em homens. A gestação e o período pós-parto são momentos críticos devido à ocorrência de ganho ponderal excessivo na gravidez e retenção de peso pós-parto. Objetivos Estudar a influência da paridade sobre o IMC em mulheres brasileiras com idade entre 20 e 49 anos .Investigar o possível efeito de modificação do poder aquisitivo,escolaridade e utilização do SUS sobre a associação entre paridade e IMC. Métodos Foram analisados dados da Pesquisa Nacional de Demografia e Saúde 2006, inquérito que utilizou amostragem complexa representativa de todo o território brasileiro. A associação entre o fator de estudo (paridade: 0,1,2, 3 e + ) e o desfecho (IMC) foi testada mediante análise de regressão linear. O efeito ajustado do fator de estudo sobre o IMC foi avaliado em modelo múltiplo contendo como variáveis de controle: idade, classes de poder aquisitivo ABEP (A+B1, B2+C+D e E), e escolaridade (<8 e 8 anos de estudo completo). Para testar as interações de interesse foram realizados modelos múltiplos, em separado,incluindo três variáveis que combinam paridade dicotômica (nulíparas e demais) com poder aquisitivo,escolaridade e utilização do SUS.Foram considerados significativos valores de p inferiores a 0,05. Resultados Das 13.087 mulheres investigadas foram excluídas do estudo 14,4 % (gestantes, mulheres com filhos menores de 6 meses e aquelas com dados incompletos para peso e altura). A análise foi conduzida em uma amostra de 11.961 mulheres, levando-se em consideração a estrutura complexa da amostra. A média de IMC para o conjunto das mulheres brasileiras foi de 25,6 Kg/m2 (IC95%: 25,4 - 25,8). O IMC médio foi maior entre as pertencentes à classe de poder aquisitivo intermediária (B2,C,D) e baixa (E). Observou-se elevação do IMC com o aumento do número de filhos e idade. Na análise ajustada,confirmou-se a associação positiva entre paridade e IMC (p de tendência < 0,001). Dentre as interações testadas foi estatisticamente significativa a existente entre poder aquisitivo,paridade e IMC. As mulheres com um filho ou mais pertencentes à classe intermediária de poder aquisitivo quando comparadas às nulíparas da classe alta, apresentaram um incremento de 1,40 unidades de IMC (IC95% : 0,64 2,19 p < 0,001 ). Nas demais classes (A+B1) e (E) não foi detectada associação estatisticamente significativa entre paridade e IMC.Conclusões Nas mulheres brasileiras,a paridade exerce influência positiva sobre o IMC após controle de variáveis de confundimento. Detectou-se interação entre poder aquisitivo, paridade e IMC: o efeito da paridade é estatisticamente significativo apenas nas mulheres da classe intermediária de poder aquisitivo (B2,C eD). / Introduction - In Brazil, obesity is a public health problem and its prevalence is higher among women. Pregnancy and the postpartum period are critical moments for the occurrence of excessive weight gain and weight retention. Objectives - To study the influence of parity on BMI in Brazilian women aged between 20 and 49 years. To investigate the possible modifying effect of the purchasing power, schooling and the use of public health system in the relation between parity and BMI. Methods - We used data from the National Demographic and Health Survey 2006, a survey with a complex sample, nationally representative of the Brazilian territory. The association between the study factor (parity: 0,1,2, and 3 +) and the outcome (BMI) was tested by linear regression analysis. The effect of parity on BMI was evaluated by a multivariate model adjusted by control variables: age, score ABEP (A + B1, B2 + C + D and E) and education (<8 and 8 years of study). To test the interactions, multivariate models were performed in separate with three different variables combining parity (nulliparous and others) with purchasing power, education and use of the public health system. The level of significance adopted was p < 0,05. Results - From the 13.087 women screened, 14,4% were excluded (pregnant women, women with children under 6 months and those with incomplete data for height and weight). The analysis was conducted on a sample of 11.961 women, adjusted by the complex structure. The mean BMI of the Brazilian women was 25,6 kg/m2 (95% CI: 25,4 to 25,8). It was higher among women in the middle class purchasing power (B2, C, D) and in the lower class (E). The BMI was elevated with the increase of parity and age. In adjusted analysis, the positive association of parity on BMI was confirmed (p trend <0,001). There was a statistically significant interaction among purchasing power, parity and BMI. When compared to nulliparous upper class women, those with one or more children in the middle class had an increase of 1,40 BMI units (95% CI: 0,64 to 2,19 p <0,001). Among the other purchasing classes (A + B1) and (E) there wasnt significant association between parity and BMI. Conclusion In the Brazilian women, parity influences positively the mean BMI, after adjustment for confounding variables. An interaction was detected among purchasing power, parity and BMI: the effect of parity is statistically significant only in women from the middle class (B2, C and D).

Introdução No Brasil a obesidade é um importante problema de saúde pública com prevalência mais elevada em mulheres do que em homens. A gestação e o período pós-parto são momentos críticos devido à ocorrência de ganho ponderal excessivo na gravidez e retenção de peso pós-parto. Objetivos Estudar a influência da paridade sobre o IMC em mulheres brasileiras com idade entre 20 e 49 anos .Investigar o possível efeito de modificação do poder aquisitivo,escolaridade e utilização do SUS sobre a associação entre paridade e IMC. Métodos Foram analisados dados da Pesquisa Nacional de Demografia e Saúde 2006, inquérito que utilizou amostragem complexa representativa de todo o território brasileiro. A associação entre o fator de estudo (paridade: 0,1,2, 3 e + ) e o desfecho (IMC) foi testada mediante análise de regressão linear. O efeito ajustado do fator de estudo sobre o IMC foi avaliado em modelo múltiplo contendo como variáveis de controle: idade, classes de poder aquisitivo ABEP (A+B1, B2+C+D e E), e escolaridade (<8 e 8 anos de estudo completo). Para testar as interações de interesse foram realizados modelos múltiplos, em separado,incluindo três variáveis que combinam paridade dicotômica (nulíparas e demais) com poder aquisitivo,escolaridade e utilização do SUS.Foram considerados significativos valores de p inferiores a 0,05. Resultados Das 13.087 mulheres investigadas foram excluídas do estudo 14,4 % (gestantes, mulheres com filhos menores de 6 meses e aquelas com dados incompletos para peso e altura). A análise foi conduzida em uma amostra de 11.961 mulheres, levando-se em consideração a estrutura complexa da amostra. A média de IMC para o conjunto das mulheres brasileiras foi de 25,6 Kg/m2 (IC95%: 25,4 - 25,8). O IMC médio foi maior entre as pertencentes à classe de poder aquisitivo intermediária (B2,C,D) e baixa (E). Observou-se elevação do IMC com o aumento do número de filhos e idade. Na análise ajustada,confirmou-se a associação positiva entre paridade e IMC (p de tendência < 0,001). Dentre as interações testadas foi estatisticamente significativa a existente entre poder aquisitivo,paridade e IMC. As mulheres com um filho ou mais pertencentes à classe intermediária de poder aquisitivo quando comparadas às nulíparas da classe alta, apresentaram um incremento de 1,40 unidades de IMC (IC95% : 0,64 2,19 p < 0,001 ). Nas demais classes (A+B1) e (E) não foi detectada associação estatisticamente significativa entre paridade e IMC.Conclusões Nas mulheres brasileiras,a paridade exerce influência positiva sobre o IMC após controle de variáveis de confundimento. Detectou-se interação entre poder aquisitivo, paridade e IMC: o efeito da paridade é estatisticamente significativo apenas nas mulheres da classe intermediária de poder aquisitivo (B2,C eD). / Introduction - In Brazil, obesity is a public health problem and its prevalence is higher among women. Pregnancy and the postpartum period are critical moments for the occurrence of excessive weight gain and weight retention. Objectives - To study the influence of parity on BMI in Brazilian women aged between 20 and 49 years. To investigate the possible modifying effect of the purchasing power, schooling and the use of public health system in the relation between parity and BMI. Methods - We used data from the National Demographic and Health Survey 2006, a survey with a complex sample, nationally representative of the Brazilian territory. The association between the study factor (parity: 0,1,2, and 3 +) and the outcome (BMI) was tested by linear regression analysis. The effect of parity on BMI was evaluated by a multivariate model adjusted by control variables: age, score ABEP (A + B1, B2 + C + D and E) and education (<8 and 8 years of study). To test the interactions, multivariate models were performed in separate with three different variables combining parity (nulliparous and others) with purchasing power, education and use of the public health system. The level of significance adopted was p < 0,05. Results - From the 13.087 women screened, 14,4% were excluded (pregnant women, women with children under 6 months and those with incomplete data for height and weight). The analysis was conducted on a sample of 11.961 women, adjusted by the complex structure. The mean BMI of the Brazilian women was 25,6 kg/m2 (95% CI: 25,4 to 25,8). It was higher among women in the middle class purchasing power (B2, C, D) and in the lower class (E). The BMI was elevated with the increase of parity and age. In adjusted analysis, the positive association of parity on BMI was confirmed (p trend <0,001). There was a statistically significant interaction among purchasing power, parity and BMI. When compared to nulliparous upper class women, those with one or more children in the middle class had an increase of 1,40 BMI units (95% CI: 0,64 to 2,19 p <0,001). Among the other purchasing classes (A + B1) and (E) there wasnt significant association between parity and BMI. Conclusion In the Brazilian women, parity influences positively the mean BMI, after adjustment for confounding variables. An interaction was detected among purchasing power, parity and BMI: the effect of parity is statistically significant only in women from the middle class (B2, C and D).

It is estimated that four in five women will give birth while one in eight women will be diagnosed with breast cancer at some point in her lifetime. It is also known that pregnancy at a young age is associated with a marked decrease in the risk of breast cancer and that this protection is different according to breast cancer subtypes. This thesis explores the impact of reproductive history on breast cancer biology and provides the molecular characterization of breast cancer diagnosed during pregnancy. The last part investigates the effect of RANKL inhibition on the biology of breast cancer in young women. In the first study, we investigated the impact of parity and age at first pregnancy on the clinicopathological features, the genomic and transcriptomic landscape, and the immune microenvironment of 313 breast cancers. For the first time, we highlighted a link between reproductive history and the genomic landscape of subsequent breast cancer. We demonstrated that, independently of clinicopathological features, age at first birth is associated with specific genomic alterations that could explain the differences in risk reduction associated with pregnancy according to breast cancer subtypes. This study represents a first step toward the recognition that reproductive factors matter in order to fully understand breast cancer biology and advocates that reproductive history should be routinely collected in future studies addressing the biology of breast cancer but also of other female cancers. The second study is focused on the molecular characterization of breast cancer diagnosed during pregnancy (BCP). We conducted a comparative analysis of a unique cohort of BCP patients and non-pregnant control patients by integrating gene expression, copy number alterations, and whole-genome sequencing data. We showed that BCP has unique molecular characteristics including an enrichment of non-silent mutations, a higher frequency of mutations in mucin gene family and an enrichment of mismatch repair deficiency mutational signature. This provides important insights into the biology of BCP and suggests that these features may be implicated in promoting tumor progression during pregnancy. In addition, it provides an unprecedented resource for further understanding of the biology of breast cancer in young women and how pregnancy could modulate tumor biology. In a previous study, the laboratory had reported up-regulation of RANKL in young and pregnant breast cancer patients. Therefore, in the last chapter, we investigated the biological effect of denosumab, a RANKL inhibitor, in a preoperative study including 27 young primary breast cancer patients. We demonstrated evidence that denosumab induces modulation of the tumor immune microenvironment with an increased level of tumor-infiltrating lymphocytes. This effect was likely due to upregulation of inflammatory cytokines and depletion of immunosuppressive regulatory T cells within the tumor microenvironment. These findings suggest a role for denosumab in reshaping the tumor immune microenvironment of breast cancer and that its use in combination could improve immunotherapy efficacy. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

abstract: Social determinants of health present significant barriers to utilization of maternal health services in transitional countries. This dissertation study examined associations between household autonomy and utilization of prenatal services among women of reproductive age in Armenia and Azerbaijan. Using nationally representative survey data, this study explored if household autonomy of women positively influenced the timing of the first prenatal visit, the number of prenatal care visits, and the content of care during visits. Results showed that household autonomy was positively associated with the timing of the first visit for prenatal care and the number of prenatal care visits. The content of care was negatively associated with the autonomy of women. Findings also pointed to an endogenous influence of a woman's position in the household structure. Additionally, this study analyzed associations between women's reproductive history and utilization, and economic disparities in utilization of prenatal care. The findings demonstrated that a history of complications during pregnancy and stillbirths were positively associated with utilization of prenatal care. Economic disparities in utilization of care were identified. Future interventions to increase utilization of maternal health services should account for traditional household structures in transitional countries. Women from poor families should receive support from social assistance and the health sector in accessing services pertaining to their health and well-being. / Dissertation/Thesis / Doctoral Dissertation Social Work 2015

Thesis (Ph.D. in Epidemiology) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 100-117). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

<p>The objectives of this case-control study, investigating 51 in-patient women with acute pelvic inflammatory disease (PID) and 50 healthy women attending for routine gynecological check-up, were to investigate the background and reproductive history of women, who are considered at low risk of sexually transmitted infection presenting with PID, to examine whether intrauterine device (IUD) use <i>per se</i> and long use affects the microbiology and clinical course of the disease, to identify risk factors for PID and to examine whether IUD use is an independent risk factor for PID.</p><p>The most striking difference regarding the background and reproductive history between women with PID and healthy women over age 25 were related to socio-demographic factors and not to common risk factors for PID.</p><p>There was little difference between healthy women and women with current PID with regard to single microbes. The finding of combinations of several anaerobic or aerobic/anaerobic microbes appeared to be associated with PID, particularly in women over 35. The pathogenesis of non-sexually transmitted PID appears to be associated with a synergistic effect between several pathogens, possibly facilitated by the presence of an IUD.</p><p>IUD use <i>per se</i> was associated with an increased risk of PID in women 35 and older. There was an association between IUD use and complicated PID in women over 35, which was possibly influenced by long-term IUD use. Age over 35 and IUD use, independently of each other, were associated with an increased risk of failed conservative treatment, necessitating surgery in patients with PID.</p><p>An observational study showed that Latvian obstetrician-gynecologists participate actively in contraceptive counseling and are very experienced with regard to IUD use. Physicians’ attitudes and perceptions towards IUD are generally positive and their clinical considerations are in good agreement with that of doctors in other countries. Antibiotics are widely used around IUD insertion by doctors, possibly driven by a liberal attitude towards IUD use in women with a potential risk of STI. The study could identify some possible gaps in the theoretical knowledge about the IUD and other methods.</p>

The objectives of this case-control study, investigating 51 in-patient women with acute pelvic inflammatory disease (PID) and 50 healthy women attending for routine gynecological check-up, were to investigate the background and reproductive history of women, who are considered at low risk of sexually transmitted infection presenting with PID, to examine whether intrauterine device (IUD) use per se and long use affects the microbiology and clinical course of the disease, to identify risk factors for PID and to examine whether IUD use is an independent risk factor for PID. The most striking difference regarding the background and reproductive history between women with PID and healthy women over age 25 were related to socio-demographic factors and not to common risk factors for PID. There was little difference between healthy women and women with current PID with regard to single microbes. The finding of combinations of several anaerobic or aerobic/anaerobic microbes appeared to be associated with PID, particularly in women over 35. The pathogenesis of non-sexually transmitted PID appears to be associated with a synergistic effect between several pathogens, possibly facilitated by the presence of an IUD. IUD use per se was associated with an increased risk of PID in women 35 and older. There was an association between IUD use and complicated PID in women over 35, which was possibly influenced by long-term IUD use. Age over 35 and IUD use, independently of each other, were associated with an increased risk of failed conservative treatment, necessitating surgery in patients with PID. An observational study showed that Latvian obstetrician-gynecologists participate actively in contraceptive counseling and are very experienced with regard to IUD use. Physicians’ attitudes and perceptions towards IUD are generally positive and their clinical considerations are in good agreement with that of doctors in other countries. Antibiotics are widely used around IUD insertion by doctors, possibly driven by a liberal attitude towards IUD use in women with a potential risk of STI. The study could identify some possible gaps in the theoretical knowledge about the IUD and other methods.

This study aimed at identifying the socio-demographic and service related factors influencing intra uterine contraceptive device (IUD) utilization among family planning clients in Addis Ababa. With a quantitative, cross sectional descriptive design approach, data was collected using structured questionnaires administered by healthcare supervisors. A total of 366 family planning clients and 35 family planning service providers were interviewed. The findings indicated that the level of education, occupation, parity and fertility plan have significant (p<0.05) association with utilization of IUD. Healthcare service provider’s knowledge and skills for provision of intra uterine contraceptive device services were low. Community members lack awareness and knowledge of the benefit and side effects of the device. Therefore, community members need education to promote adherence and effective use of IUD. Similarly, healthcare service providers need skill training and education to ensure quality provision of IUD service / Health Studies / M.A. (Public Health)

This study aimed at identifying the socio-demographic and service related factors influencing intra uterine contraceptive device (IUD) utilization among family planning clients in Addis Ababa. With a quantitative, cross sectional descriptive design approach, data was collected using structured questionnaires administered by healthcare supervisors. A total of 366 family planning clients and 35 family planning service providers were interviewed. The findings indicated that the level of education, occupation, parity and fertility plan have significant (p<0.05) association with utilization of IUD. Healthcare service provider’s knowledge and skills for provision of intra uterine contraceptive device services were low. Community members lack awareness and knowledge of the benefit and side effects of the device. Therefore, community members need education to promote adherence and effective use of IUD. Similarly, healthcare service providers need skill training and education to ensure quality provision of IUD service / Health Studies / M.A. (Public Health)