A mortalidade materna é um importante indicador de saúde que reflete as condições socioeconômicas e a qualidade de vida de um determinado local. Na maioria das vezes, essas mortes podem ser evitadas por meio de assistência pré-natal de qualidade, assistência hospitalar especializada e recursos humanos aptos às emergências obstétricas. Objetivo: descrever os óbitos maternos declarados ocorridos nos municípios da área de abrangência do Departamento Regional de Saúde de Ribeirão Preto, no período de 2011 a 2016, identificando os principais problemas da assistência prestada. Método: estudo descritivo, retrospectivo com abordagem quantitativa, com análise de dados secundários do Sistema de Informação de Mortalidade, referente aos óbitos maternos declarados. Resultados: a maioria dos óbitos maternos ocorreram em mulheres na faixa etária de 20 a 29 anos (63,9%), com média de idade de 28,1 anos, sendo a maioria solteira (50%), raça branca (66,7%), primíparas (41,7%), com ocupações diversas. O acesso ao pré-natal foi perceptível na captação precoce (72,2%) e no número de consultas durante o pré-natal. A morte materna de causa direta resultou em 77,8% dos óbitos e as principais causas de morte foram hipertensão, infecção e hemorragia. A rede de atenção à saúde da mulher no ciclo gravídico-puerperal possui boa cobertura de atenção básica, equivalente em cobertura de saúde suplementar e possui 20 maternidades em seu território, entre elas, duas com habilitação em gestação de alto risco. Conclusão: a morte materna continua sendo um desafio para a assistência obstétrica, e é fundamental que as boas práticas se tornem rotina. Instituições e profissionais precisam estar adequados e alinhados aos protocolos de atendimento, baseados em evidencias cientificas para um atendimento rápido e preciso. No íntimo de cada morte materna há uma tragédia familiar e um impacto social devastador / Maternal mortality is an important health indicator that reflects the socioeconomic conditions and quality of life of a given location. Most of the time, such deaths can be prevented through quality prenatal care, skilled hospital care, and skilled human resources for obstetric emergencies. Objective: To describe the maternal deaths reported in the municipalities in the coverage area of the Regional Health Department of Ribeirão Preto, from 2011 to 2016, identifying the main problems of care provided. Method: descriptive, retrospective study with quantitative approach, with analysis of secondary data of the Mortality Information System, referring to the reported maternal deaths. Results: the majority of maternal deaths occurred in women between the ages of 20 and 29 years (63.9%), with a mean age of 28.1 years, being the majority single (50%), Caucasian (66.7% %), primiparous (41.7%), with different occupations. Access to prenatal care was noticeable at precocious screening (72.2%) and in the number of prenatal consultations. Direct maternal death resulted in 77.8% of deaths and the main causes of death were hypertension, infection and hemorrhage. The women\'s health care network in the pregnancy-puerperal cycle has good coverage of basic care, equivalent in supplementary health coverage, and has 20 maternity hospitals in its territory, including two with high risk pregnancy. Conclusion: Maternal death continues to be a challenge for obstetric care, and it is essential that good practices become routine. Institutions and professionals need to be adequate and in line with the protocols of care, based on scientific evidence for fast and accurate care. At the heart of every maternal death there is a family tragedy and a devastating social impact

This study explores the relationship between race and surgical treatment and radiation therapy use for localized breast cancer patients in the state of Florida in 2001. The study will be useful in raising awareness of the relationship between Black race and appropriate breast cancer treatment within the Florida Cancer Data System. The Healthy People 2010 initiatives call to eliminate racial disparities and the high placement of breast cancer on the national research agenda make this study timely and insightful for health policymakers, clinicians and other health researchers. Also, the study evaluates the effect of other health system and patient related factors such as insurance provider and rural versus urban residence, to the appropriate use of cancer therapy in order to present an up-to-date and accurate picture of the quality of breast cancer care for women in the state of Florida. The study used multivariate logistic regression modeling and chi-square distribution to compare models in order to disentangle the effects of age, rural residence, marital status and primary health insurance provider from race and to determine how these factors influenced breast conserving surgery versus mastectomy use. Further, the second research question exclusively focused on the population that received breast conserving surgery in order to examine the impact of race and the other covariates as explanatory measures of appropriate receipt of radiation therapy. The first hypothesis found that there was no statistically significant difference between Black and White women in terms of receipt of breast conserving surgery for treatment of localized breast cancer. The second hypothesis, which focused on appropriate receipt of radiation therapy following breast conserving surgery, found that there was a statistically significant interaction between Black race and Medicaid as primary health insurance provider. The study concludes by examining possible areas of improvement in data collection in the State of Florida. Also, the study contains recommendations as to previously unexplored facets of breast cancer research and breast cancer health policy that could be beneficial in the reduction of health and healthcare disparities in other geographic areas and in other diseases.

The focus of this research was to: 1) study the perceptions of female students attending the university Student Health Center, concerning available services, 2) learn how they describe their decisions to obtain care, and 3) identify perceived barriers to reproductive health care and contraception. This exploratory study used a mixed-methods approach that included clinic public-space observations, interviews with health care providers and staff at Student Health Services (SHS), surveys distributed to clients of the campus clinic, and in-depth interviews to contextualize emergent themes. Topics addressed included sexual health behaviors and perceptions, influence of peers and partners, the propagation of health myths, and past experiences with SHS. Gathering practitioner perspectives on student barriers to care, goals of the clinic, and perceived health needs of the student community, allowed for measurement of incongruence between student and staff, thereby adding greater context to results. SHS sought recommendations in order to improve student's use of the Sexual Health and Gynecology clinic, increase accuracy of student's sexual health knowledge, and guide future clinic operations. SHS is now working with the College of Public Health to create improvement projects based on my results, including a peer education program. Research such as this can result in greater student awareness of available services, and more productive communication between patients and provide. Implications on the larger issues of gender and the search for health care, acceptance and knowledge of STI testing, and client comfort are addressed, and provide opportunity for future work in this area.

Toxoplasma gondii infects approximately one third of the population worldwide. There is strong evidence that a relationship between T. gondii titer and depressive symptoms exists. There is also evidence suggesting a protective effect of RhD positive blood factor on toxoplasma-induced behavioral and personality changes. This protective effect may influence the relationship between T. gondii and prenatal depressive symptoms. The purpose of this secondary data analysis was to examine the possible protective effect of RhD positive blood factor on prenatal depressive symptoms in 56 pregnant women with T. gondii infection. The cross-sectional design was utilized to answer the question “Does positive RhD blood factor provide a protective effect on prenatal depressive symptoms of patients infected with T. gondii when controlling for ethnicity, race, income, marital status, age and stress?” The conceptual model hypothesized that there was a relationship between socio-demographic variables (age, income, marital status, race, and ethnicity), stress, positive T. gondii titers, RhD positive blood factor, and prenatal depressive symptoms. Pearson correlations and multiple regression were utilized to explore the aims of this study demonstrated in the four statistical models. Significant relationship between stress and positive T.gondii seropositivity on prenatal depressive symptoms was identified. There was no significant relationship identified between RhD positive blood factor on the pregnant women infected with T. gondii which could be attributed to the small sample size.

Polycystic ovary syndrome (PCOS) is a chronic illness that affects approximately five million premenopausal women in the United States and is associated with significant cosmetic, reproductive, metabolic, and psychological consequences. Despite its prevalence, few studies have explored the lived experiences and illness perceptions of women living with PCOS. Identifying illness perceptions of women living with (WLW) PCOS is important, because mounting research suggests that a person's perceptions of their chronic illness and its management determine that person's coping behaviors (e.g., adherence, self-management) and, consequently, illness outcomes. In this dissertation, the Common Sense Model (CSM) is used as a framework to identify the illness perceptions of PCOS held by WLW the syndrome. As such, this dissertation is the first to test the ecological validity of the CSM in a population of women diagnosed with PCOS. In addition, the relationship between illness perceptions and (1) infertility, a common symptom of the syndrome, and (2) health-related quality of life (HRQoL) is explored. Lastly, this study makes a novel contribution to the literature by describing one of the first samples of WLW PCOS recruited through a social networking site. This includes a discussion of the participant's demographic information, fertility experiences, and HRQoL. This is a two-phase mixed methods study. Phase one consisted of an online quantitative survey capturing data on 376 participants' demographic information and medical history. Data were also collected on each participant's HRQoL using the SF-36, a generic, well-validated measure of the phenomenon. Of the 376 survey participants, 34 were interviewed via phone or video chat in the fall 2013 and spring 2014 semesters. Quantitative data were downloaded from Qualtrics® and analyzed using SAS statistical software version 9.3. In this analysis, descriptive statistics were generated to describe sample characteristics and SF-36 domain scores were calculated for each participant. In the qualitative analysis, data were analyzed through a series of sorting techniques and transcripts were imported into NVivo 10 and subjected to content analysis. The mean age of survey participants was 31.8 years (SD=5.8). Respondents were primarily non-Hispanic (92.5%), white (88.3%), straight (94.4%), and married (73.4%) with a college education (64.1%). On average, participants reported living with PCOS for 7.6 years (SD=6.1). Approximately half of the sample reported having biological children (47.9%) and currently trying to conceive (42.1%), and most participants reported a history of infertility (70.7%). In addition, almost half of the total sample reported heights and weights that placed them in the morbidly obese category (BMI>35). Lastly, a history of depression (63.6%) and anxiety (68.6%) was common among participants. Few survey participants reported their general health as being excellent (2.6%) or very good (27.4%). Similarly, women reported the lowest levels of functioning on the dimension of vitality, meaning that, in general, women reported feeling tired and being low in energy. Conversely, women reported the highest scores on the dimensions of physical functioning and role limitations due to physical health, meaning that, in general, women did not report that their health limited their physical abilities or caused problems with work or other daily activities. Interview findings suggest that WLW PCOS generally have illness perceptions of the syndrome that are consistent with the domains identified in the CSM. In addition, it was found that, in relation to their illness cognitions, WLW PCOS described the extent to which they felt they had a comprehensive understanding of the syndrome, a phenomenon labeled illness coherence. Similarly, participants identified PCOS as a common condition (i.e. labeled perceived prevalence). Lastly, a number of relationships were identified between illness perceptions and (1) infertility status and (2) HRQoL scores. Overall, this dissertation identifies a number of implications for patient education, provider education, clinical practice, and policy improvements. Examples include addressing (1) unmet information needs, (2) significant psychological morbidity and unmet mental health needs, (3) breastfeeding challenges and need for breastfeeding support, (4) poor quality of care and low patient satisfaction, and (5) limited access to care - all among women living with PCOS.

Introdução: A dor pélvica crônica em mulheres é uma condição que gera incapacidades, como interferências na qualidade de vida, déficit na eficiência das atividades laborais e prejuízos na interação com o meio social. É uma condição complexa e seu manejo envolve muitos desafios. Os mecanismos de enfrentamentos adotados pelas mulheres com dor pélvica crônica podem interferir em todas as etapas do manejo desta condição, envolvendo busca pelo diagnóstico, adesão ao tratamento e qualidade de vida. Objetivo: Compreender os mecanismos de enfrentamento utilizados por mulheres com dor pélvica crônica. Pacientes e Métodos: Foram incluídas 66 mulheres com diagnóstico de dor pélvica crônica. Utilizamos entrevistas semiestruturadas, áudio gravadas e transcritas na íntegra. Os textos transcritos foram submetidos à análise temática com auxílio do software. Resultados: Identificamos cinco temas que sintetizam os mecanismos de enfrentamento e de aceitação adotados por mulheres com dor pélvica crônica: Interação social prejudicada devido as adversidades trazidas pela dor; Viver em função das adversidades trazidas pela dor; Abster da relação sexual devido ao medo de sentir dor; Enxergar na automedicação a solução para a dor; Adaptar-se positivamente diante das adversidades trazidas pela dor. Conclusão: Nossos resultados apontam para as possíveis consequências e impactos clínicos das estratégias de enfrentamento e de aceitação da dor no que concerne a adesão das terapêuticas propostas ou já em seguimento clínico. Desta forma, as estratégias regulam a aderência ou não as propostas terapêuticas oferecidas pelo serviço de saúde / Introduction: Chronic pelvic pain in women is a condition that generates disabilities, such as interferences in quality of life, deficits in the efficiency of work activities, and impairments in interaction with the social environment. It is a complex condition and its handling involves many challenges. The coping mechanisms adopted by women with chronic pelvic pain can interfere in all stages of the management of this condition, involving search for diagnosis, adherence to treatment and quality of life. Objective: To understand in depth the coping mechanisms used by women with chronic pelvic pain. Patients and Methods: We included 66 women diagnosed with chronic pelvic pain. We used semi-structured interviews, recorded audio and transcribed in full. The transcribed texts were submitted to thematic analysis with the help of the software \"RQDA\". Results: We identified five themes that summarize the coping and acceptance mechanisms adopted by women with chronic pelvic pain: Impaired social interaction due to adversity brought on by pain; Living in the face of adversity brought on by pain; Abstain from sexual intercourse due to fear of pain; View the solution to pain in selfmedication; To adapt positively in the face of adversity brought on by pain. Conclusion: Our results point to the possible clinical consequences and impacts of coping and pain acceptance strategies regarding the adherence of the therapies proposed or already under clinical followup. In this way, the strategies regulate adherence or not to the therapeutic proposals offered by the health service

This collaborative qualitative research explored ways of improving Aboriginal women’s health and well-being in an urban Adelaide primary health care setting. This involved respectful knowledge sharing, working effectively together and addressing issues related to colonisation, discrimination and exclusion. It was identified that while Aboriginal and non-Aboriginal professionals are committed to ‘Closing the Gap’ in health disparities, many have questioned how best to do so within the current health system. Therefore, this research focused on filling gaps in knowledge about the spaces where Aboriginal community women, and Aboriginal and non Aboriginal health professionals can work collaboratively regardful and regardless of health system polices, programs and practices. A strong commitment to local community preferences and national Aboriginal health research ethics enabled Aboriginal community women and Aboriginal and non-Aboriginal heath professional co-researchers to be actively and meaningfully involved with me in both the research processes and outcomes. A modified Participatory Action Research (PAR), with repeated cycles of Look and Listen, Think and Discuss and Take Action emerged as an effective model of collaborative practice, suitable for health care and research. Four unique yet interconnected areas of collaboration developed, each highlighting particular aspects of culturally safe knowledge sharing and collaboration in health care. The first involved working with Aboriginal community women, acknowledging and addressing their most health and well-being priorities related to high levels of stress in their lives. Collaborative action involved creating a women’s friendship group, seeking and accessing a range of services, and co-presenting our findings at conferences The second Collaboration Area offers insights into the practicalities and difficulties experienced by staff as they tried to provide health services for Aboriginal women in a newly developing Aboriginal health organisation. The third Collaboration Area focused on the challenges and benefits of collaboration between sectors, in particular a local high school and the Aboriginal health service. We explored effective ways to work across sectors and engage young Aboriginal women in health programs. The ongoing impact of discrimination, exclusion and colonisation for this next generation of Aboriginal women was highlighted. The fourth Collaboration Area involved wider collaboration and road testing our collaborative methodology in a broader environment. A diverse group of co-researchers came together to plan, implement and evaluate a de-colonising national action research action learning conference embedded in Aboriginal preferred ways of knowing and doing. Findings are discussed under the three central themes of knowledge sharing, working together and addressing health care access and colonisation and key recommendations for the future are proposed. This research has reinforced the need identified in Aboriginal health documents for policy, program and practice commitment to holistic and collaborative approaches such as comprehensive primary health care and participatory action research. While the National Apology and Close the Gap campaign have provided opportunities for change, these need to be followed by tangible action at all levels of health care.

Since women dominate the health care system as consumers, it is important to understand how women want to be treated by medical staff, and the factors that contribute to satisfactory hospital experiences. The present research comprised two separate but integrated studies exploring these issues. The first study adopted an atheoretical approach. Qualitative and quantitative methods were used to examine the importance of hospital experiences in the lives of women, and the role of power within those experiences. Closed answer items about hospital experiences were completed by 124 women who had had a hospital stay of at least one night. In addition, ten of the women provided open-ended oral and written comments about their hospital experiences, which were used as the basis of the qualitative data. The majority of the women were satisfied with their hospital stay, but a small group recalled experiences of powerlessness associated with the non-medical aspects of their treatment, such as behaviours on the part of health professionals that influenced participants� sense of control as hospital inpatients. The qualitative data reflected similar issues to the quantitative data and provided �process� information by demonstrating how health professionals� behaviour could contribute to patients� feelings of powerlessness. The results suggested that hospital experiences were a salient part of these women�s lives. The richness of the qualitative data suggested that qualitative methodology would be a productive way to further study this area. The second study was an extension of the first via in-depth interviews with 19 women who perceived their hospital experiences as life-altering. The interview content and the analysis were based on a narrative approach that used the theoretical framework of McAdams� (1993) Life Story Model of Identity. Using McAdams� methodology enabled the researcher to evaluate how women constructed meaning from their hospital experiences, and the main issues they faced. The life story interview also proved a useful way to explore issues of loss and self-growth in the face of traumatic hospital experiences. Transcripts of descriptions of positive and negative experiences were analysed according to McAdams� themes of agency (sense of power and control) and communion (relationships with others), and sequences of redemption and contamination. Redemption sequences involve the storyline moving from a bad, affectively negative life scene, to a good, affectively positive life scene. In a contamination sequence, the narrator describes a change from a good, affectively positive life scene, to a subsequently bad, affectively negative life scene (McAdams & Bowman, 2001). Participants also rated their experiences according to Hermans� (Hermans & Oles, 1999) list of affects. There was strong agreement between McAdams� coding of agency and communion and Hermans� agentic and communal indices: the women�s hospital stories strongly emphasised the negative or opposite of McAdams� agentic theme �Self Mastery through Control�, which indicated powerlessness, and Hermans� affects, which involved low self-enhancement. It may be useful for future studies to conceptualise McAdams� themes as bipolar by incorporating currently coded themes and their reverse; in particular, by expanding ideas of agency to incorporate powerlessness, as this theme was pervasive in women�s hospital experiences. The rating of affects added to the findings as this showed a latent dimension of communion manifested as isolation. The common agency and communion themes were apparent in the two distinct but related aspects of hospitalisation that affect patients� sense of control: the medical condition and the manner in which patients are treated by medical staff. The findings of the main study built on the pilot study by showing how ideas of control and powerlessness can inform better practice. For example, respectful, dignified and fair treatment by health professionals played a part in determining redemption sequences; women also indicated this was how they wanted to be treated. Due to the vulnerability of the �sick role�, disrespectful or offhand treatment by health professionals had particularly distressing effects evident in contamination sequences, such as negative changes to sense of self and attitudes toward the health care system. In some cases, such treatment led to participants� avoiding subsequent interactions with doctors and to sustained feelings of helplessness. The present thesis demonstrates that doctors, nurses and other health professionals need to allow time to attend to the affective as well as the medical aspects of the encounter. Health professionals need a good bedside manner, compassion, and communication skills, as these characteristics play a part in maintaining female patients� sense of self and their faith in and satisfaction with the health care system.

<p><b>Objectives</b>. To study medication utilization and adherence to prescribed therapy in a female population in central Sweden. To study usage of hormone replacement therapy (HRT) in this population and to assess how HRT users compare to non-users regarding symptom reporting, general health and other variables. To evaluate symptom prevalence adjusted for potential symptom affecting variables. </p><p><b>Material and methods</b>. A cross-sectional postal questionnaire study was performed in 1995 in seven counties in central Sweden. A questionnaire was sent to a random sample of 4,200 women aged 35-64, of whom 2,991 responded (71.2%). The questionnaire contained questions on psycho-socio-economic background, quality of life, self-reported health, height and weight, climacteric symptom prevalence, and menopausal status and symptoms. It also comprised questions on medication prescribed during the past year. </p><p><b>Results</b>. 40% used prescribed medication and 12% took four drugs or more. Age, educational level, self-rated health, and BMI remained significantly correlated to drug use in multivariate analysis. Adherence ranged from 15%-98% depending on age, a scheduled check-up, perceived importance of medication, concern about medication, taking cardiovascular and respiratory disease drugs. The highest adherence was found for hormonal medication the lowest for musculoskeletal medication. </p><p>HRT was used by 15% of the women. 13 % used other symptom relieving therapy. HRT users reported higher score of vasomotor symptoms, except for sweating during the daytime. </p><p>Prevalence of general symptoms did not necessarily increase with age. Especially symptoms related to stress-tension-depression decreased with age. Four different symptom prevalence patterns were found. </p><p><b>Conclusions</b>. Age, health status, educational level and body mass index (BMI) appear to affect drug use. Adherence to therapy is highest among elderly women who regard their medication as important and have a scheduled check-up. HRT relieves some vasomotor symptoms but does not affect other symptoms or self-rated health. Prevalence of symptoms related to Stress-tension-depression appears to decrease with age.</p>

Thesis (M.Sc.)--Memorial University of Newfoundland, 2005. / Bibliography: leaves 115-122.