Objectives. 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. Material and methods. 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. Results. 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. 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. 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. Conclusions. 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.

Women who live in Vancouver’s Downtown Eastside experience some of the most devastating health problems among residents of British Columbia. While crack cocaine use has been associated with many of these problems, we lack an understanding of how women who use crack cocaine experience these health problems and what they do to manage them. Informed by tenets of intersectionality and social geography, a critical ethnographic approach was used to examine the scope of health concerns experienced by women who are street-involved and use crack cocaine, the strategies they used to manage their health, and the social, economic, political, personal, and historical contexts that influenced these experiences. Data were collected over a seventeen month period and included a cross sectional survey (n=126), participant observations, and interviews (n=53). The women described experiencing poor physical and mental health throughout their lives; many of which were preventable. Respiratory problems, anxiety, sadness and insomnia were the most frequent concerns reported. They endured severe economic deprivation, unstable and unsanitary housing, and relentless violence and public scrutiny across a variety of contexts including their homes and on the street. These experiences were further influenced by structural and interpersonal relations of power operating within the health care, legal, and welfare systems. The women engaged in a several strategies to mitigate the harmful effects of factors that influenced their health including: (a) managing limited financial resources; (b) negotiating the health care system; (c) managing substance use; and (d) managing on your own. These strategies were influenced by the types of concerns experienced, perceptions of their most pressing concern, the nature of interpersonal relations with health care providers, and the limited social and economic resources available. Changes in the organizational policies and practices of the welfare, legal, and health care systems are needed to improve women’s health. Possible strategies include increased access to welfare and safe, affordable housing, safer alternatives to income, and improved collaboration between illness prevention and law enforcement programming. New approaches are required that build on women’s considerable strengths and are sensitive to ways in which gender, race, and class can disrupt opportunities to access services.

This thesis combines quantitative and qualitative methods to examine both women’s psychological wellbeing after miscarriage and the specific coping strategies that are associated with coping well with this event. Chapter 1 reviews the ways in which miscarriage has been defined and its estimated prevalence. As definitions of miscarriage tend to vary across Western countries, the research implications of this are discussed. Chapter 2 reviews the literature related to women’s psychological responses following miscarriage, discussing the main outcomes which have been examined, including depression, anxiety, stress and grief. As the literature is relatively small, and current research is limited by small and non-representative samples, Chapter 3 takes an epidemiological approach by cross-sectionally investigating the psychological correlates, and relevant sociodemographic, reproductive and health-related variables associated with miscarriage using a large population sample of young Australian women. Sociodemographic and reproductive variables most strongly predicted membership of the Miscarriage and No Miscarriage groups, while psychological wellbeing did not distinguish the two groups in the stepwise logistic regression. Using the same data but applying longitudinal methods, Chapter 4 examined whether trajectories of Mental Health, Stress and Optimism varied over time and according to women’s miscarriage status. Relevant sociodemographic and reproductive variables identified in Chapter 3 as possible confounding variables were controlled in these analyses. Miscarriage was found to affect trajectories of Mental Health, Stress and Optimism, with poorer outcomes on all variables for women reporting miscarriage by comparison to women who had never miscarried over a seven-year period. Because miscarriage has significant effects on women’s mental health and wellbeing, the next part of the thesis was dedicated to examining the predictors of, and coping strategies related to, coping well after miscarriage. Since the term coping well is not easily defined, Chapter 5 is a critical review of the theoretical frameworks of coping, with an emphasis on identifying the conceptualisation and measurement problems which have limited advancements in the field. Chapter 6 is a review of the psychological, reproductive and sociodemographic predictors of adjustment to miscarriage, highlighting the conflicting evidence and the need for multivariate methods when analysing these relationships. Using the Australian Longitudinal Study on Women’s Health data, Chapter 7 uses longitudinal methods to investigate predictors of Mental Health among young women reporting miscarriage. Optimism, social support and the number of miscarriages were strong predictors of Mental Health among women reporting miscarriage. Chapter 8 is a review of the research which has examined the coping styles and strategies that women use to cope with miscarriage. The majority of this research tends to be of a qualitative nature, and therefore the next step was to complete interviews with nine women to gain a more in-depth understanding of the specific coping strategies related to positive outcomes after miscarriage. Social support was reported as facilitating adjustment to miscarriage, consistent with the quantitative analyses. Acknowledgement and support from health professionals was also described as facilitating adjustment. While the quantitative analyses had also initially suggested that satisfaction with the general practitioner was an important predictor of adjustment, this variable did not reach significance when other reproductive and psychological variables were controlled for. Taking all the results into consideration, it appears that changes to social norms and attitudes regarding miscarriage may help women to cope with this challenging and distressing experience. Interventions to help women cope with miscarriage need to be grounded in an understanding of women’s need for social and family support, and understanding from health professionals. However, it is essential that interventions should be comprehensively evaluated, and future research in this area is warranted.

No description available.

This thesis combines quantitative and qualitative methods to examine both women’s psychological wellbeing after miscarriage and the specific coping strategies that are associated with coping well with this event. Chapter 1 reviews the ways in which miscarriage has been defined and its estimated prevalence. As definitions of miscarriage tend to vary across Western countries, the research implications of this are discussed. Chapter 2 reviews the literature related to women’s psychological responses following miscarriage, discussing the main outcomes which have been examined, including depression, anxiety, stress and grief. As the literature is relatively small, and current research is limited by small and non-representative samples, Chapter 3 takes an epidemiological approach by cross-sectionally investigating the psychological correlates, and relevant sociodemographic, reproductive and health-related variables associated with miscarriage using a large population sample of young Australian women. Sociodemographic and reproductive variables most strongly predicted membership of the Miscarriage and No Miscarriage groups, while psychological wellbeing did not distinguish the two groups in the stepwise logistic regression. Using the same data but applying longitudinal methods, Chapter 4 examined whether trajectories of Mental Health, Stress and Optimism varied over time and according to women’s miscarriage status. Relevant sociodemographic and reproductive variables identified in Chapter 3 as possible confounding variables were controlled in these analyses. Miscarriage was found to affect trajectories of Mental Health, Stress and Optimism, with poorer outcomes on all variables for women reporting miscarriage by comparison to women who had never miscarried over a seven-year period. Because miscarriage has significant effects on women’s mental health and wellbeing, the next part of the thesis was dedicated to examining the predictors of, and coping strategies related to, coping well after miscarriage. Since the term coping well is not easily defined, Chapter 5 is a critical review of the theoretical frameworks of coping, with an emphasis on identifying the conceptualisation and measurement problems which have limited advancements in the field. Chapter 6 is a review of the psychological, reproductive and sociodemographic predictors of adjustment to miscarriage, highlighting the conflicting evidence and the need for multivariate methods when analysing these relationships. Using the Australian Longitudinal Study on Women’s Health data, Chapter 7 uses longitudinal methods to investigate predictors of Mental Health among young women reporting miscarriage. Optimism, social support and the number of miscarriages were strong predictors of Mental Health among women reporting miscarriage. Chapter 8 is a review of the research which has examined the coping styles and strategies that women use to cope with miscarriage. The majority of this research tends to be of a qualitative nature, and therefore the next step was to complete interviews with nine women to gain a more in-depth understanding of the specific coping strategies related to positive outcomes after miscarriage. Social support was reported as facilitating adjustment to miscarriage, consistent with the quantitative analyses. Acknowledgement and support from health professionals was also described as facilitating adjustment. While the quantitative analyses had also initially suggested that satisfaction with the general practitioner was an important predictor of adjustment, this variable did not reach significance when other reproductive and psychological variables were controlled for. Taking all the results into consideration, it appears that changes to social norms and attitudes regarding miscarriage may help women to cope with this challenging and distressing experience. Interventions to help women cope with miscarriage need to be grounded in an understanding of women’s need for social and family support, and understanding from health professionals. However, it is essential that interventions should be comprehensively evaluated, and future research in this area is warranted.

This thesis combines quantitative and qualitative methods to examine both women’s psychological wellbeing after miscarriage and the specific coping strategies that are associated with coping well with this event. Chapter 1 reviews the ways in which miscarriage has been defined and its estimated prevalence. As definitions of miscarriage tend to vary across Western countries, the research implications of this are discussed. Chapter 2 reviews the literature related to women’s psychological responses following miscarriage, discussing the main outcomes which have been examined, including depression, anxiety, stress and grief. As the literature is relatively small, and current research is limited by small and non-representative samples, Chapter 3 takes an epidemiological approach by cross-sectionally investigating the psychological correlates, and relevant sociodemographic, reproductive and health-related variables associated with miscarriage using a large population sample of young Australian women. Sociodemographic and reproductive variables most strongly predicted membership of the Miscarriage and No Miscarriage groups, while psychological wellbeing did not distinguish the two groups in the stepwise logistic regression. Using the same data but applying longitudinal methods, Chapter 4 examined whether trajectories of Mental Health, Stress and Optimism varied over time and according to women’s miscarriage status. Relevant sociodemographic and reproductive variables identified in Chapter 3 as possible confounding variables were controlled in these analyses. Miscarriage was found to affect trajectories of Mental Health, Stress and Optimism, with poorer outcomes on all variables for women reporting miscarriage by comparison to women who had never miscarried over a seven-year period. Because miscarriage has significant effects on women’s mental health and wellbeing, the next part of the thesis was dedicated to examining the predictors of, and coping strategies related to, coping well after miscarriage. Since the term coping well is not easily defined, Chapter 5 is a critical review of the theoretical frameworks of coping, with an emphasis on identifying the conceptualisation and measurement problems which have limited advancements in the field. Chapter 6 is a review of the psychological, reproductive and sociodemographic predictors of adjustment to miscarriage, highlighting the conflicting evidence and the need for multivariate methods when analysing these relationships. Using the Australian Longitudinal Study on Women’s Health data, Chapter 7 uses longitudinal methods to investigate predictors of Mental Health among young women reporting miscarriage. Optimism, social support and the number of miscarriages were strong predictors of Mental Health among women reporting miscarriage. Chapter 8 is a review of the research which has examined the coping styles and strategies that women use to cope with miscarriage. The majority of this research tends to be of a qualitative nature, and therefore the next step was to complete interviews with nine women to gain a more in-depth understanding of the specific coping strategies related to positive outcomes after miscarriage. Social support was reported as facilitating adjustment to miscarriage, consistent with the quantitative analyses. Acknowledgement and support from health professionals was also described as facilitating adjustment. While the quantitative analyses had also initially suggested that satisfaction with the general practitioner was an important predictor of adjustment, this variable did not reach significance when other reproductive and psychological variables were controlled for. Taking all the results into consideration, it appears that changes to social norms and attitudes regarding miscarriage may help women to cope with this challenging and distressing experience. Interventions to help women cope with miscarriage need to be grounded in an understanding of women’s need for social and family support, and understanding from health professionals. However, it is essential that interventions should be comprehensively evaluated, and future research in this area is warranted.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2008. / Härtill 4 uppsatser.