Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

Thesis (Ph. D.)--Deakin University, 2003. / Title from PDF title page (viewed on Dec. 15, 2005). Includes bibliographical references (leaves 202-225).

BACKGROUND: Breastfeeding and lactation are cited as sensitive periods in the life course that contribute to the accumulation of risks or opportunities ultimately shaping vulnerability or resilience later in life. As such, breastfeeding and lactation are critical components of health equity. Despite this, Black women in the U.S. initiate and continue to breastfeed at lower rates than White women and other groups. Underlying reasons for racial inequities in breastfeeding rates are poorly understood. Exposure to racism, one manifestation of historical oppression in the U.S. has been cited as a determinant of poor health outcomes for decades but has not been extensively described in the context of breastfeeding. AIMS: To investigate the association between experiences of racism and 1.) breastfeeding initiation 2.) breastfeeding duration 3.) and the association between selected life-course factors and breastfeeding initiation and duration among participants of the Black Women’s Health Study. METHODS: This study was a prospective secondary analysis of the Black Women’s Health Study. The sample included all participants who enrolled in 1995, responded to the racism assessment in 1997 and reported the birth of a first child following the racism assessment resulting in an N=2, 995 for the initiation outcome and N= 2,392 for the duration outcome. In addition to the racism assessment, we also included life-course factors (nativity, neighborhood segregation and social mobility). For each aim, we calculated odds ratios and 95% confidence intervals using binomial and multinomial logistic regression using two models. The first adjusted for age, the second adjusted for age, BMI, education, marital status, geographic region, neighborhood SES and occupation. RESULTS: Associations between daily and institutional summary racism variables and breastfeeding initiation and duration were small and not statistically significant. Experiences of racism in the job setting was associated with lower odds of breastfeeding duration at 3-5 months compared with 3 months 95% CI [0.60, 0.98]. Experiences of racism with the police was associated with higher odds of breastfeeding initiation and duration at 3-5 months [1.01, 1.77] and at 6 months [1.10, 1.82] compared with women who did not report this experience. The participant’s nativity and the nativity of her parents were life-course factors that predicted lower odds of breastfeeding initiation and duration. Neighborhood segregation did not reach statistical significance after adjusting for covariates but results trended toward lower odds of breastfeeding initiation and duration for women who reported living in a predominately Black neighborhood (compared with White) up to age 18 and for women who reported living in a predominately Black neighborhood in 1999. CONCLUSION: Experiences of institutional racism in the job setting was associated with lower odds of breastfeeding duration. In addition to explicit experiences of racism, this study provides preliminary evidence surrounding life-course factors and breastfeeding. Individual level interventions may mitigate harmful effects of racism but structural level interventions are critical to close the gap of racial inequity in breastfeeding rates in the U.S.

Made available in DSpace on 2013-01-07T15:55:04Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 21.pdf: 9559079 bytes, checksum: c092ccff9d5d2fd6a34b8be811ac6167 (MD5) Previous issue date: 2010 / Este trabalho procura analisar a articulação entre as ideias de diferentes atores sociais vinculados ao movimento da reforma sanitária, ao movimento feminista e ao Estado na configuração de uma política pública de saúde da mulher, o Programa de Assistência Integral à Saúde da Mulher (PAISM), lançado em outubro de 1983, pelo Ministério da Saúde. Os conceitos de saúde pública defendidos pelo movimento da reforma sanitária articulados às concepções e práticas educativas sobre o corpo e a saúde da mulher do movimento feminista, influenciaram no desenho do PAISM. Entre meados das décadas de 1970 e 1980, a mobilização política pelo ideal da consolidação de uma sociedade democrática no Brasil possibilitou um consenso entre diferentes setores da oposição ao regime militar e ao neomalthusianismo, na elaboração do PAISM, que procurava incorporar entre as demandas básicas de saúde da população, aquelas que diziam respeito especificamente às mulheres, entre elas a contracepção, antecipando diretrizes internacionais nesse campo e tornando-se referência para futuras políticas de saúde da mulher.

Orientadores: Egberto Ribeiro Turato, Renata Cruz Soares de Azevedo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T15:37:18Z (GMT). No. of bitstreams: 1 Ribeiro_DioneViegasAlmeida_M.pdf: 581363 bytes, checksum: ac8bd86693253b3b41839c5ed6fbfa22 (MD5) Previous issue date: 2009 / Resumo: Neste estudo foi contemplada uma amostra de mulheres dependentes de substâncias psicoativas em tratamento em ambulatório universitário especializado no município de Campinas, SP. Nossa hipótese inicial era que a adesão de mulheres dependentes de substâncias psicoativas ao tratamento, seria diretamente influenciada pelo significado da droga em suas vidas, ou pelo significado que o atendimento e acolhimento no serviço especializado têm para essas mulheres dependentes de substâncias. Partindo desse pressuposto, delineamos como objetivo geral conhecer e discutir os significados psicológicos da adesão de mulheres dependentes de substâncias psicoativas ao tratamento, considerando para tanto as suas vivências no serviço de atendimento e em relação a sua própria vinculação com a droga. Para atingir nossos objetivos lançamos mão do método clínicoqualitativo, que nos permite discutir sobre as relações entre os significados simbólicos atribuídos pelos sujeitos ao tratamento e à droga. A amostra de sujeitos foi construída pelo critério da intencionalidade do pesquisador, sendo usada para o fechamento amostral, a estratégia da saturação de dados coletados, usual em pesquisas qualitativas, sendo definido, portanto, em campo o número de sujeitos estudados. A técnica de coleta de dados empregada foi a entrevista semidirigida de questões abertas, que permite o estabelecimento de uma relação mais profunda entre o entrevistador e o entrevistado, aliada a uma observação global do sujeito, bem como suas reações do tipo transferencial e as impressões contratransferenciais do pesquisador. Os procedimentos consistiram na anotação das informações colhidas em um Roteiro/Diário de Campo que contemplou três partes: dados de identificação do sujeito; questões sobre as percepções da dependente sobre seu tratamento, a droga e o significado dela em sua vida; e anotações do comportamento global do sujeito durante a entrevista e dados de auto-observação. A técnica de tratamento dos dados colhidos foi a da Análise Qualitativa de Conteúdo, propiciando a categorização/subcategorização a partir de leituras do conjunto das entrevistas transcritas. A discussão/interpretação dos resultados foi feita à luz de referenciais teóricos provenientes da psicologia médica e da psicodinâmica. Como resultado desta pesquisa foram formuladas as categorias: motivação para o tratamento; desmotivação para o tratamento e dificuldade de adesão; o significado simbólico da droga. Concluiu-se que os motivos que levaram as mulheres dependentes entrevistadas a procurar tratamento, são múltiplos, mas percebemos que isso ocorre quando a droga usada passa a ser percebida como algo que oferece grande desprazer, ou traz perdas significativas. / Abstract: In this study a sample of psychoactive substances-dependent women was observed while in treatment at a specialized universitary outpatient clinic in the city of Campinas, State of São Paulo. Our initial hypothesis contemplated that the adherence to the treatment by psychoactive substancesdependent women would be directly influenced by the meaning of the drug in their lives, or by the meaning that the service and welcome found at the specialized service have for these substancedependent women. Based on this, we outlined as our general purpose to know and discuss the psychological meanings of the adherence to the treatment by psychoactive substance-dependent women, considering their experience at the outpatient service and their own attachment to the drug. To reach our goals we used the clinical-qualitative method, which allows us to discuss the relationships between the symbolic meanings assigned by the subjects both to the treatment and to the drug. The subjects sample was built by using the gathered data saturation strategy, commonly used in qualitative researches, and the number of participants was defined in the field. The data gathering technique used was the semi-directed interview with open questions, which allows the establishment of a deeper rapport between the interviewer and the interviewee, combined with a global observation of the subject, as well as her reactions of the transferential type and the countertransferential impressions of the researcher. The procedures consisted of annotations of the gathered information in a Field Script/Diary, which encompassed three parts: identification data of the professional; questions about the addicted women's perception of their treatment, the drug and its meaning in their life; and annotations of the subject's global behavior during the interview and self-observation data. The technique used to treat the gathered data was the Qualitative Content Analysis, providing the categorization/subcategorization from the readings of the set of transcribed interviews. The discussion/interpretation of the results was made based on theoretical referentials from medical psychology and psychodynamics. As a result of this research the following categories were formulated: motivation for the treatment; demotivation for the treatment and difficulty to adhere; the symbolic meaning of the drug. It was concluded that there were multiple reasons why the interviewed substance-dependent women sought out treatment, but we noticed that this used to happen with the perception of the drug as the source of great displeasure or significant loss. / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

The widespread use of highly active antiretroviral therapy (HAART) has resulted in longer lifespans for HIV seropositive women in the United States, during which preventive health care is recommended. Failing to complete recommended cancer screening tests can result in cancer being diagnosed at a later stage with a poorer prognosis. The purpose of the study, based on the ecosocial theory, was to describe the sociodemographic and clinical variables of HIV seropositive women who failed to complete recommended screening tests for breast, cervical, and colorectal cancers, and determine if the presence of hypertension, obesity, diabetes, depression, or tobacco use impacted the completion of these screening tests. The electronic medical records of 142 HIV seropositive women were reviewed. Univariate analysis, bivariate analysis, and logistic regression were conducted to create a model associated with the completion of preventive health care screening tests. For breast cancer, cervical cancer, and colorectal cancer, 69%, 71.8%, and 69.7% failed to complete screening, respectively. Number of years living with HIV infection and HIV stage were associated with breast cancer screening; distance between residence and health care facility, and HIV stage were associated with cervical cancer screening; and age and marital status were associated with colorectal cancer screening. Addressing issues related to the completion of cancer screening tests over the lifespans of HIV seropositive women can result in positive social change by preventing disease and disability, which can negatively impact these women, their families, and their communities.

The unidimensional approach that has dominated research on premenstrual syndrome (PMS) has been remiss in visualizing the diversity of factors that may be involved in women's menstrual cycle experiences. Traditional menstrual cycle research reflects a stereotypic negative bias that does not encompass the complexity of the phenomena. For example, even though, the majority of menstrual cycle literature has focused on negative changes during the perimenstruum, some women report positive changes. This research represents an endeavor of a unique nursing intervention aimed at reframing perceptions of menstrual cycle experiences for the purpose of diminishing perimenstrual impairment. The intervention was a health promotion program which provided social support and a positive reframing component among women with PMS across four menstrual cycles. Utilizing a pre-experimental design, data was collected on eighteen women. Daily measures included prospective assessment of perceptions of perimenstrual changes (impairment and activation). Retrospective assessments of moods (anxiety and depression), social resources (personal resources and marital satisfaction), and perimenstrual change perceptions were gathered at three time periods, before, during, and after the experimental condition. Data analysis included descriptive and multivariate analyses strategies. Results indicated that although perimenstrual activation did not increase significantly, impairment did decrease. In addition, there were significant changes from baseline to follow-up on state depression and personal resource variables. This study is among the first to develop and empirically test a nursing intervention that utilized the psychotherapeutic technique of positive reframing aimed at decreasing women's negative menstrual cycle experiences. This study lends support for further investigation of women's diverse menstrual cycle experiences which challenges assumptions guiding menstrual cycle research which has continued to perceive menstruation within an illness perspective. Until researchers agree on the cause, definition, significance, and management of PMS, studies such as this one, may provide scientists a more expansive view of women's menstrual cycle experiences. Results of this study are of benefit to nurses and health care providers who are in a unique situation to facilitate support groups by virtue of the variety of their work settings.

Breast and cervical cancer disparities among Hispanic and American Indian women are a significant public health problem. Breast cancer is the most common neoplasm among Hispanic women. Cervical cancer has a higher incidence and mortality among Hispanic women compared to non-Hispanic White women. Breast cancer detection often comes late for American Indian women and breast cancer survival for this population is relatively poor. Hispanic and American Indian women who reside in rural areas of Arizona are especially at-risk of non-participation in breast and cervical cancer screening programs. This dissertation utilized data from two sources: a health-education intervention trial designed to increase mammography screening among women living in a rural area along the U.S.-Mexico border of Arizona and survey data from multiple years of the Arizona Behavioral Risk Factor Survey (BRFS) focusing on breast and cervical cancer screening self-reported behaviors. The purpose of the dissertation research was to identify factors associated with cancer screening behaviors among Hispanic and American Indian women that reside in rural Arizona settings. Hispanic women who participated in the promotora-based educational intervention program were more likely to report receiving a mammogram at the followup compared to women who did not participate in the program. Results from both the baseline community survey and the BRFS showed that Hispanic women who received prior recommendations from a clinician to get both mammography and Pap smear were more likely to report they received a mammogram within the past year and a Pap smear within the past three years. Rural Hispanic and American Indian women reported lower rates of ever having had breast and cervical cancer screening compared to their urban counterparts. Breast and cervical cancer screening use in these populations can potentially be increased with at least two strategies. First, clinician recommendation of both mammograms and Pap smears and opportunistic screening during regular clinic visits may increase breast and cervical cancer screening coverage. Secondly, culturallyappropriate interventions that utilize promotoras or lay health advisors could increase screening rates. In conclusion, Hispanic and American Indian women that reside in rural areas of Arizona, whether throughout the State or along the U.S.-Mexico border, are two underserved populations in Arizona with low rates of breast and cervical cancer screening that need to be addressed in order to reduce the burden of cancer in these populations.

Background: Epidemiologic evidence supports the association between shiftwork and the development of cardiovascular disease. Sleep disturbances are associated with a variety of adverse cardiometabolic outcomes and they may lie on the causal pathway between the exposure to shiftwork and cardiovascular disease. Objectives: 1) To describe sleep quality in a group of shift-working and day-working female hospital employees; 2) To determine the association between shiftwork status and sleep disturbances in this group and to determine the effect of lifetime exposure to shiftwork on current sleep disturbances; and 3) To explore whether sleep disturbances mediate the relationship between shiftwork and cardiometabolic risk. Methods: A cross-sectional study was conducted among female hospital employees: participants were 132 women working only during the day, and 98 women who worked a shift schedule of two 12-hour days, followed by two 12-hour nights and five days off. Sleep quality was assessed with the Pittsburgh Sleep Quality Index questionnaire. The primary outcome of interest was the metabolic syndrome defined in accordance with the 2009 Joint Interim Studies consensus statement. Results: Shiftwork was associated with poor sleep latency (odds ratio (OR)= 2.08 95% CI: 1.11-3.92), poor sleep efficiency (OR=2.35 95% CI: 1.21- 4.54), and poor global sleep quality (OR=1.88 95% CI: 1.02-3.49), while the impact of past shiftwork history was inconclusive. The OR for the association of shiftwork with the metabolic syndrome was 2.00 (95% CI: 0.89-4.51), and there was no evidence of mediation by sleep disturbances in the relationship of shiftwork and the metabolic syndrome. Conclusion: In this study, a rapid forward rotating 2-shift system is associated with self-reported poor sleep quality, while the long-term effects of sleep disturbances on cardiometabolic risk requires further study. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-09-24 21:16:38.768

Since June of 2013, Plan B and its generics have been available over-the-counter without age restriction nationwide. Even so, pharmacy-based economic, physical, and staff-associated barriers still exist, potentially leading adolescent customers to fail to obtain emergency contraception (EC) in a sufficiently timely manner to prevent pregnancy. This study explores these pharmacy-based barriers to EC in the state of Kentucky focusing on comparisons of urban and non-urban pharmacies and chain and private pharmacies. Using a secret-shopper survey technique, the researcher called 220 Kentucky pharmacies acting as a 15-year-old girl seeking information about EC. Among other findings, a logistic regression analysis revealed that private pharmacies were 97% less likely to carry EC compared to chain pharmacies (OR= .027; p