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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
171

Sustainable Adapted Treatments for Eating Disorders: The Role of Cultural Adaptation in Prevention

Javier, Sarah J. 01 January 2017 (has links)
Despite demonstrating eating disorder rates equivalent to White women, African American and Asian American women are less likely to seek treatment and are more likely to terminate treatment prematurely. One of the most successful programs for eating disorder prevention has only focused on surface-level cultural adaptations. Prevention literature maintains that deep-structure cultural adaptation (e.g., integrating cultural values and beliefs) can enhance outcomes for ethnic minorities. This dissertation examined the feasibility of Sustainable Adapted Treatments for Eating Disorders (SATED), a pilot intervention that included a culturally- targeted pre-treatment to an eating disorder dissonance-based intervention. A sample of 72 women (ages 18-30) were recruited via the SONA pool, student organizations, and community organizations. In Study 1, 47 women participated in focus groups (i.e., 21 African American women and 26 Asian American women). Grounded theory was used to analyze data, and this data was then used to develop a culturally-informed pre-treatment. Pre-treatment protocols (30- 45 minutes) were developed for both African American and Asian American groups and were refined prior to implementing the intervention. In Study 2, a pilot intervention, 25 women were assigned either to a pre-treatment condition, or 30-45 minute, individualized session (N = 12) or a no pre-treatment condition (N = 13) prior to completing an eating disorder DBI which took place over two 2-hour sessions. Participants completed a battery of questionnaires at baseline, post-intervention, and at 2 to 3-month follow-up. Constructs assessed included eating disorder symptomatology, attitudes towards seeking professional psychological help, and body dissatisfaction. Overall feasibility and acceptability of the pre-treatment and pilot intervention were assessed via triangulation of methods including third-party observations, in-depth interviews, and fidelity checks. Preliminary findings from the questionnaires indicated that there was a general downward trend for eating pathology across both the pre-treatment and no pre- treatment condition, except for eating restraint. Body dissatisfaction decreased for both groups from baseline to post-test, but increased at follow-up. Attitudes towards treatment-seeking increased for both groups from baseline to follow-up. Results may inform feasibility issues that accompany translational research with ethnic minorities and inform a future definitive trial.
172

Long-Acting Reversible Contraceptives In Vermont: A Survey Based Assessment Of Current Knowledge Of Providers Of Women Of Reproductive Age

O'Brien, Erin 01 January 2016 (has links)
Unintended pregnancies are a long-standing public health issue nationally, with percentages hovering around 50% for at least the last five years. Vermont is doing slightly better than the national average, but is faced with it's own challenges due to it's rural nature. Agencies and organizations, such as the World Health Organization, March of Dimes and the Vermont Department of Health have made decreasing unintended pregnancies one of their priorities to improve maternal and fetal health outcomes, as well as social and economic opportunities for families. Current evidence-based guidelines call for long- acting reversible contraceptives (LARCs), including intrauterine devices (IUDs) and implants, as the first-line recommendation by healthcare providers for decreasing unintended pregnancies. This study, in collaboration with several Vermont state organizations and agencies, engaged healthcare professionals throughout the state with an electronically disseminated survey aimed at assessing their knowledge of LARCs. The aim of this study was to ascertain whether healthcare professionals caring for women of reproductive age, are using current evidence-based practice guidelines to counsel women in their contraceptive choices. Survey results revealed that the majority of the respondents consider themselves to be knowledgeable about and had received a high level of training in IUD counseling and/or insertion. Areas of uncertainty were primarily about side effects and the insertion and removal processes of the implant, as well as a few categories of medical eligibility. This was especially apparent when results were stratified by urban and rural regions of Vermont. Although there seems to be a high level of provider confidence in knowledge about LARCs and reported counseling of LARCs as first-line, there is a discrepancy between what providers think they know and current evidence based contraception guidelines. Many factors exist that could explain this discrepancy, including but not limited to lack of training, provider bias, and system barriers. This study aims to illuminate gaps in provider knowledge to improve uptake of LARCs and over time make a shift in the numbers of unintended pregnancies in Vermont.
173

A Mixed-Methods Examination of Racial Differences in Females' Perceptions and Experiences of Sexual Objectification

Leighton-Herrmann, Ellyn 01 January 2014 (has links)
Sexual objectification has become a pervasive problem, negatively affecting the mental and physical health of many women. Understanding the influence of visual media, social-support networks and social interactions on young women's health is essential to addressing issues related to objectification. We do not have an in-depth understanding of how Black and White young adult women make meaning of objectification. Further, the existing literature suggests that experiences of objectification are likely different for Black and White women. The current research employed two studies, one qualitative and one quantitative, to address these particular gaps. Study 1 used focus groups to assess young Black and White women’s attitudes and experiences related to objectification. Four focus groups were conducted with university students, two with White women (N=11) and two with Black women (N=17). Results indicated that sexual objectification is a complex and unfortunate reality in the women’s daily lives; driven by the media, men and even other women. Participants’ immediate responses to objectifying experiences are multi-faceted and the potential consequences of long-term exposure can be detrimental to a woman’s well-being. Racial differences arose in relation to standards of beauty as well as examples of and reactions to objectifying experiences. Study 2 study assessed two different models of sexual objectification for White and Black women. Female, undergraduate and graduate students completed an online questionnaire about sources of objectification; 155 White women and 173 Black women were included in the analyses. The results suggest there are significant relationships between certain sociocultural sources of objectification, body image preoccupation and the associated consequences of depression, eating disturbances. Skin color dissatisfaction was an additional negative outcome for Black participants. The models for Black and White participants were not equivalent. Understanding how women experience sexual objectification and racial differences has implications for how objectification and related outcomes are measured. This information also has implications for developing appropriately tailored programming related to the objectification and psychological well-being of women. The information from these studies can hopefully be used to inform individuals of the risks associated with sexual objectification, as well as develop educational programs on college campuses.
174

African American Women's Health: An Examination of Resource Needs, Context, and Public Policy over the Life Course

Newbille, Cynthia 15 December 2010 (has links)
African American Women's Health: An Examination of Resource Needs, Context, and Public Policy over the Life Course
175

The Psychometric Properties of the Inner Strength Questionnaire for Women with Chronic Health Conditions

Lewis, Kristi Leanne 01 January 2004 (has links)
The purpose of this research was to develop and test an instrument to measure or quantify the construct of inner strength. Inner strength was synthesized into a theory based on twelve years of qualitative data from direct participant quotes, defined by Roux et al. (2002) as a central human resource that promotes well-being and healing. The inner strength questionnaire (ISQ) has undergone extensive psychometric evaluation which resulted in several versions. The third version had 37-items and was believed to have four subscales that mirrored the theoretical themes that emerged through the qualitative data. The sample was composed of 281 women with a variety of chronic health conditions including breast cancer, multiple sclerosis, diabetes, and heart disease. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to assess the structure of the ISQ. Internal consistency was used to assess the reliability of each hypothesized subscale and the entire ISQ. Convergent and discriminant validity, were analyzed using the multitrait-multimethod by Campbell and Fiske (1959). For convergent validity, the entire instrument and each of the subscales was correlated with similar theoretical subscales of the Mastery of Stress Instrument (Younger, 1993). For discriminant validity, the Center for Epidemiological Studies in Depression (CESD) was correlated with the entire ISQ. Both the EFA and CFA revealed a four factor model. The four factors were labeled 1) mental, 2) connectedness, 3) knowing and searching, 4) physical. The reliability for all items on the ISQ was 0.91. The reliabilities for each of the subscales were 0.85 for mental, 0.96 for connectedness, 0.85 for knowing and searching, and 0.83 for physical. The multitrait-multimethod matrix revealed correlation coefficients for the relationship between the ISQ and MSI to be 0.55 and a correlation coefficient of -0.19 between the ISQ and the CESD.A four factor model is supported by the statistical data. Through face-to-face interviewing and input from content expert reviewers, ten items were eliminated from the 37-item (version 3) instrument to form a new version of the instrument. The new instrument supports the metasynthesis generated by Roux (2002) except for the fifth theme, entitled "new normal", which was found to be a consequence of having inner strength, not a component of inner strength.
176

Perspectiva de mulheres sobre uma atividade educativa voltada ao assoalho pélvico: estudo qualitativo / Women\'s perspective about an educational activity related to the pelvic floor: a qualitative study

Fernandes, Ana Carolina Nociti Lopes 21 March 2019 (has links)
A eficácia do treinamento dos músculos do assoalho pélvico (TMAP) está diretamente relacionada à adesão da paciente, enquanto a adesão também está relacionada à obtenção de bons resultados, estabelecendo-se um ciclo que poderia ser influenciado pelo componente educativo direcionado as necessidades da paciente realizado inicialmente nos programas de reabilitação. Trata-se de um estudo qualitativo com objetivo de descrever a perspectiva de mulheres sobre um programa educativo voltado ao assoalho pélvico (AP) feminino e o impacto deste em suas vidas; contextualizar especificidades das atividades educativas vivenciadas pelas participantes; descrever a perspectiva das mulheres sobre a aquisição de novos hábitos de vida a curto (1 semana), médio (3 meses) e longo prazo (5-16 meses) e; descrever as barreiras e facilitadores para participar da atividade educativa e utilizar as orientações recebidas. Foram acompanhados oito grupos educativos durante um período de um ano. Foram realizados três momentos de entrevistas semiestruturadas uma semana, três meses e de cinco a 16 meses após a participação no grupo educativo. As entrevistas foram realizadas com 19, 14 e nove mulheres respectivamente. Foi realizada análise temática dos dados qualitativos. Os temas emergentes da análise foram: (1) Conhecimento desenvolvido com e/ou prévio ao grupo educativo; (2) Sobre o grupo educativo...; (3) Mudança em hábitos de vida após a participação no grupo educativo; (4) Relacionamento com sintomas de disfunções do AP; (5) Representação social e; (6) Busca e adesão ao tratamento para disfunções do AP. O grupo educativo informativo voltado ao AP feminino apresenta estrutura bem definida e adequada sob a perspectiva das mulheres. As mulheres pareceram ter uma boa aceitação da atividade para gerar modificação em hábitos de vida a curto e médio prazo, entretanto a adesão é reduzida a longo prazo. Foram identificados várias barreiras e facilitadores para aderir as orientações do grupo educativo. Os facilitadores mais frequentes foram as informações discutidas no grupo educativo; o desejo das mulheres em melhorar; a o uso de lembretes como a cartilha com o TMAP e; associar o TMAP à atividades de vida diária. Já as principais barreiras foram não lembrar de realizar o TMAP; não entender como realizar o exercício; não reconhecer que tem disfunções do AP; a função da mulher como cuidadora e; carga horária de trabalho / The effectiveness of pelvic floor muscle training (PFMT) is directly related to patient adherence, while adherence is also related to obtaining good results. This cycle could be influenced by the educational component directed to the needs of the patient performed initially in rehabilitation programs. This is a qualitative study that aims to describe the perspective of women about an educational program focused on the female pelvic floor (PF) and its impact on their lives; to contextualize specificities of the educational activity experienced by the participants; to describe the perspective of women to acquire new life habits in a short (1 week), medium (3 months) and long term period of time (5-16 months) after the educational program and; to describe the barriers and facilitators to participate in the educational activity and adhere to the received instructions. Eight educational groups were followed during an one-year period. Three time points of semi-structured interviews were conducted at one week, three months and five to 16 months after the women´s participation in the educational group. Th interviews were conducted with 19, 14 and nine women respectively. Thematic analysis of qualitative data was performed. The emerging themes of the analysis were: (1) Knowledge developed with and / or prior to the educational group; (2) About the educational group...; (3) Change in life habits after the educational group; (4) Relationship with PF dysfunctions symptoms; (5) Social representation and; (6) Search and adherence to PF dysfunction treatment. The educational group focused on the female PF has a well-defined and adequate structure from the perspective of women. The women seemed to have a good acceptance of the activity to promote changes in life habits in the short and medium term, however the adherence was reduced in the long term. Several barriers and facilitators to adherence to the instructions performed by the educational activity have been identified. The most frequent facilitators were: the information discussed in the educational group; the desire of women to improve their PF symptom; the use of reminders as the booklet with PFMT and; associate the PFMT to daily life activities. The main barriers were: not to remember to perform PFMT; not to understand how to perform the exercise; not to recognize that they have PF dysfunctions symptoms; the role of the woman as a caregiver and her workload
177

Atuação da enfermeira obstétrica: compreendendo a sua vivência e a realidade da assistência / Performance of midwife: understanding their experience and the reality of assistance

Esser, Maria Angelica Motta da Silva 19 September 2016 (has links)
Muitos esforços mundiais têm sido empregados para melhorar as condições de saúde na gestação e nascimento. A cada ano, aproximadamente 350 mil mulheres morrem durante a gravidez ou parto, sendo que 99% dessas mortes acontecem em países em desenvolvimento. O Ministério da Saúde vem desenvolvendo ações no sentido de melhorar o quadro da assistência materna, promovendo atividades para qualificar os profissionais e fomentar a atenção obstétrica e neonatal humanizada baseada em evidências científicas, além de garantir os direitos sexuais e reprodutivos das mulheres brasileiras. O cenário encontrado é de marginalização da enfermagem obstétrica; a enfermeira obstétrica apresenta dificuldades na atuação, tanto na realização de consultas obstétricas quanto no acompanhamento do parto e nascimento. Sua prática se mostra desprivilegiada de poder, pois não há reconhecimento da sua qualificação profissional. Este estudo tem como objetivos compreender a vivência da enfermeira obstétrica no cenário da admissão, pré-parto, parto e pós-parto imediato e interpretar os aspectos facilitadores e dificultadores de sua inserção nos serviços de atenção maternal. Trata-se de uma pesquisa qualitativa, desenvolvida com um grupo de enfermeiras obstétricas da cidade de Londrina-PR. A coleta de dados foi desenvolvida no mês de dezembro de 2015 através das seguintes etapas: 1. Entrevista individual e semiestruturada com 20 enfermeiras obstétricas, tendo como critério de seleção a atuação nos serviços de atenção materna, nos setores de admissão, pré-parto, parto e pós-parto imediato por pelo menos um ano; 2. Aplicação da metodologia Photovoice com a participação de 10 enfermeiras obstétricas, pretendendo compreender as fragilidades e potencialidades encontradas em sua prática assistencial. Nesta fase, as enfermeiras obstétricas produziram e apresentaram as fotografias em um grupo focal para discussão, gerando os temas de análise, que, em conjunto com os dados obtidos nas entrevistas individuais, formaram a base teórica que possibilitou alcançar os objetivos propostos no estudo. O referencial teórico adotado foi a antropologia interpretativa, com o enfoque na cultura das organizações, que permitiu a análise e compreensão dos dados. Os resultados foram descritos e analisados em torno de cinco categorias temáticas, das quais as três iniciais emergiram das entrevistas iniciais e as outras duas do grupo focal com a metodologia photovoice, a saber: Acolhimento e vínculo: cuidados assistenciais que transmitem segurança à parturiente; Autonomia na enfermagem obstétrica: percepções da prática assistencial; Sentimentos emanados na atenção da enfermeira obstétrica nos cenários da admissão, pré-parto, parto e pós-parto imediato; Fatores facilitadores na assistência da enfermeira obstétrica: potencialidades emanadas nos cenários de admissão, pré- parto, parto e pós-parto imediato; Fatores dificultadores na assistência da enfermeira obstétrica: fragilidades afloradas nos cenários de admissão, pré-parto, parto e pós-parto imediato. A situação encontrada é a de desprivilégio da assistência obstétrica: em quase todas as instituições prevalece ainda o modelo biomédico, concentrado em intervenções e com poucas ações de humanização. Mesmo quando as enfermeiras obstétricas estão inseridas na assistência, elas encontram obstáculos para o desenvolvimento de sua prática assistencial, tanto pela equipe multiprofissional em que estão inseridas quanto pelas organizações onde atuam. Foram apontados como facilitadores/potencialidades o estabelecimento do planejamento familiar, a humanização na assistência ao parto, o trabalho em equipe, a educação continuada e permanente, a autonomia, a infraestrutura adequada. Já como pontos fragilidades/dificuldades, a ausência de pré-natal completo, a falta de realização de partos nas maternidades onde atuam, a ausência ou demora no estabelecimento do contato precoce mãe e filho, a falta de informatização nos processos burocráticos, a violência obstétrica e a falta de estrutura adequada. Por fim, considera-se que os resultados apontaram para uma realidade cultural que não pode ficar omissa. As enfermeiras obstétricas são profissionais capacitadas para atuarem na humanização da assistência e contribuírem para a redução de índices de morbimortalidade materna em nosso país. Logo, os achados deste estudo podem fomentar ações e mudanças nas organizações de saúde. / Many worldwide efforts have been employed to improve health conditions during pregnancy and birth. Each year, approximately 350,000 women die during pregnancy or childbirth, and 99% of these deaths occur in developing countries. The Ministry of Health has been developing actions to improve the framework for maternal care, promoting activities to qualify professionals and foster obstetric and neonatal care humanized based on scientific evidence, and ensure sexual and reproductive rights of Brazilian women. The setting is found marginalization of midwifery, midwife has difficulty in acting, both in performing obstetrical consultations and in monitoring the labor and birth. His practice shown underprivileged power because there is no recognition of their professional qualifications. This study aims to understand the experience of midwife at the admission stage, pre-natal, delivery and immediate postpartum period and interpret the advantages and constraints of their inclusion in the maternal care services. This is a qualitative research conducted with a group of midwives in the city of Londrina. Data collection was developed in December 2015 through the following steps: 1. Individual interview and semi-structured interviews with 20 midwives, with the selection criteria acting in maternal care services, the admission sectors, pre- labor, delivery and immediate postpartum period for at least 1 year; 2. Photovoice Methodology application with the participation of 10 midwives, intending to understand the weaknesses and strengths found in their care practice. At this stage, midwife produced and presented the photos in a focus group for discussion, generating the analysis of topics, together with the data obtained in individual interviews formed the theoretical basis which allowed achieve the objectives proposed in the study. The theoretical framework adopted was the interpretive anthropology, with a focus on culture of organizations, which allowed the analysis and understanding of the data. The results were described and analyzed around five thematic categories, the first three emerged from the initial interviews and the other two focus group with photovoice methodology, namely: Reception and attachment: supportive care that transmit security to the woman in labor; Autonomy in midwifery: perceptions of nursing practice; Feelings emanating from the care of the midwife in the admission of scenarios, antepartum, delivery and immediate postpartum; Factors facilitators in the midwife assistance: emanating potential in admission scenarios, antepartum, delivery and immediate postpartum; Hindering factors in midwife care: weaknesses touched upon the admission of scenarios, antepartum, delivery and immediate postpartum. The situation found is the marginalization of obstetric care in almost all institutions still prevails the biomedical model, focused on interventions and few humanizing actions, even when midwives are placed in care, they are obstacles to the development of its care practice, both by the multidisciplinary team where they are inserted as the organizations where they work. Were appointed as facilitators / potential establishment of family planning, the humanization of childbirth care, teamwork, continuous and permanent education, autonomy, adequate infrastructure. Already as points weaknesses / difficulties the absence of complete prenatal care, the lack of completion of deliveries in hospitals where they operate, the absence or delay in early contact establishment mother and child, the lack of computerization in bureaucratic processes, obstetric violence and lack of adequate structure. Finally, it is considered that the results pointed to a cultural reality that cannot be silent. Midwife are professionals trained to work in the humanization of care and contribute to the reduction of maternal morbidity and mortality rates in our country. Thus, the findings of this study can foster action and change in healthcare organizations.
178

A experiência  da reconstrução mamária para mulheres com câncer de mama. / The experience of breast reconstruction for women with breast cancer

Inocenti, Aline 09 March 2012 (has links)
Este estudo descritivo, com abordagem qualitativa, teve como objetivo compreender como é a experiência da reconstrução mamária na vida de mulheres com câncer de mama. Para obtenção dos dados, foram realizadas entrevistas semiestruturadas com 14 mulheres submetidas à cirurgia para reconstrução mamária e cadastradas em um serviço especializado em reabilitação pós-mastectomia. Para tratamento dos dados, utilizou-se o método de análise temática proposto por Bardin, o qual proporcionou a obtenção de dois temas principais: o primeiro abordou a experiência das mulheres entre o diagnóstico e a realização da cirurgia reconstrutora e agrupou categorias referentes aos sentimentos e às atitudes das mulheres diante do diagnóstico de câncer de mama e como se deu o processo decisório pela reconstrução mamária. No segundo, as categorias estiveram relacionadas à forma como a mulher se vê, depois da reconstrução, e o que a mesma significou em sua vida, como ela percebe seus benefícios e convive com as limitações decorrentes da cirurgia reconstrutora, bem como o papel das diversas redes de apoio em sua trajetória. Neste estudo, dentre outros motivos apontados pelas mulheres na escolha da reconstrução, destacou-se a influência do médico na decisão pela cirurgia. A recuperação da mama devolveu a algumas mulheres sua autoestima e a sensação de estarem completas novamente, ajudou-as a recuperar sua autoimagem e a superar o trauma causado pela doença, proporcionando-lhes, por exemplo, a segurança para manterem ou iniciarem um relacionamento afetivo e sexual com um parceiro. As complicações no pós-operatório desencorajaram as mulheres a finalizarem a cirurgia e provocaram o medo de uma nova perda, as cicatrizes e deformidades na mama causaram insatisfação e a perda da sensibilidade do retalho ocasionou, em alguns casos, comprometimentos na esfera sexual e na percepção da neomama. Observou-se que as redes de apoio às mulheres com câncer se mostraram presentes em todas as fases do adoecer, desde o diagnóstico até a reabilitação. A família, os amigos e o grupo de reabilitação foram as fontes de suporte mais frequentes, e a participação deles mostrou-se fundamental para a reinserção das mulheres na sociedade. Os dados obtidos neste estudo podem oferecer subsídios para a implementação de ações no âmbito do atendimento às mulheres com câncer de mama, as quais devem envolver paciente, família e profissionais de saúde. / This descriptive and qualitative study aimed at understanding how is the experience of breast reconstruction in the lives of women with breast cancer. To obtain data, semi-structured interviews with 14 women undergoing surgery for breast reconstruction enrolled in a specialized rehabilitation service post-mastectomy were performed. Data processing was organized using the methodology of thematic analysis proposed by Bardin, which provided the achievement of two main themes: the first showed the experience of women during the period between diagnosis and reconstructive surgery and grouped categories related to feelings and attitudes of women after the diagnosis of breast cancer and how was the decisionmaking process for breast reconstruction. In the second, the categories were related to how the woman sees herself after reconstruction and what it meant in her life, how she realizes its benefits, how she lives with the limitations resulting from reconstructive surgery as well the role of the various support networks in her trajectory. In this study, among other reasons reported by women to choose the reconstruction, it is highlighted the influence of the physician in deciding on doing the surgery. The recovery of the breast helped to build the selfesteem to some women and restore the sense of being whole again; helped them regain their self-image and overcome the trauma caused by the disease which provided, for example, the security to maintain or initiate an affective and sexual relationship with a partner. The postoperative complications discouraged women from doing surgery and caused fear of a new loss; the scars and breast deformities caused dissatisfaction, and the loss of sensation of the areola and nipple caused, in some cases, problems in the sexual sphere and breast awareness. It was observed that the support networks for women with breast cancer assisted them in all stages of illness, from diagnosis to rehabilitation. Family, friends and the rehabilitation group were the most frequent sources of support and their participation proved vital for the reintegration of women in society. The data obtained in this study may provide support for the implementation of actions related to the care of women with breast cancer, which should involve patient, family and health professionals.
179

Investigation of Disparities in Cervical Cancer Prevention in the United States: HPV Vaccination and PAP Screening in 18-30 Year Old Women

Newransky, Chrisann January 2013 (has links)
Thesis advisor: James Lubben / In 2011, an estimated 12,710 women suffered from cervical cancer and 4,290 died from it in the U.S. HPV vaccination (HPV-V) and PAP screening (PAP-S) could reduce this burden. Using 2010 National Health Interview Survey data, current disparities in the use of PAP-S and HPV-V in U.S. women aged 18-30 years were investigated. An adapted Behavioral Model of Health Care Utilization guided the study. Main outcomes were PAP-S in prior year and ever-HPV-V, both initiation and completion. Adjusted predictor estimates were obtained through multivariate logistic regressions with appropriate statistical procedures and weights for complex survey design. A sub-analysis focused on unvaccinated women. The sample had 3,129 women aged 18-30 years, representing about 27 million women of similar age in the U.S. PAP-S, HPV-V initiation and completion rates were 53.5%, 17.9%, and 10.3%, respectively. Hispanics were 33% less likely than Non-Hispanic-Whites to initiate HPV-V. Non-Hispanic-Blacks were 55% more likely and 57% less likely than Non-Hispanic-Whites to receive PAP-S and complete HPV-V, respectively. Non-Hispanic Asians were 36% less likely than Non-Hispanic-Whites to receive PAP-S, but this result was borderline significant. Younger age and being unmarried were predictors of lower PAP-S but higher HPV-V. Ever gave birth was a predictor of higher PAP-S but lower HPV-V. Preventative behaviors (PAP-S and flu vaccination) were predictors of higher HPV-V. STI-history was a predictor of higher HPV-V and PAP-S. Not having health insurance for over one year or recent health provider visit were predictors of lower PAP-S and HPV-V. Living in the South was a predictor of lower HPV-V. Household income was not a predictor of any outcomes. Most common reported reason for no HPV-V was "no need." Study findings indicate interventions to mitigate disparities in cervical cancer prevention are needed. Tailored education interventions for both women and health care providers along with opportunities associated with the 2010 Affordable Care Act, such as broader access to health care, emphasis on health information technology, and initiatives with PAP screening and adult vaccination as potential quality indicators for performance/payment, can reduce these disparities. Future research should focus on the feasibility of alternative venues for receiving HPV-V and PAP-S. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.
180

A saúde reprodutiva de mulheres portadoras e ex-portadoras de hanseníase em uma capital do Nordeste - Brasil / The reproductive health of women suffering and former carriers of leprosy in a capital Northeast - Brazil

Tavares, Clodis Maria 10 March 2014 (has links)
A detecção de casos novos de hanseníase permanece elevada no mundo, no Brasil e em Alagoas. Trata-se de uma importante morbidade que leva a incapacidades físicas, preconceito e estigma. A ênfase dada à saúde reprodutiva de mulheres portadoras e ex-portadoras de hanseníase deve-se ao fato de a gestação induzir recidivas, exacerbar lesões pré-existentes e aumentar a evolução da forma indeterminada para outras formas clínicas, o que exige um acompanhamento para uma prática anticonceptiva segura. O objetivo geral foi conhecer a situação da saúde reprodutiva das mulheres portadoras e ex-portadoras de hanseníase na rede de atenção básica do município de Maceió. Trata-se de um estudo descritivo de corte transversal com abordagem quantitativa. O estudo foi realizado em 14 Unidades Básicas de Saúde (UBS) dos 07 Distritos Sanitários do município de Maceió/Alagoas. A população foi constituída por 60 mulheres. Os dados nos revelam que a maioria das mulheres se encontrava na faixa etária de 30 a 49 anos (75%), tinham companheiro (70%), eram analfabetas ou com o ensino fundamental incompleto (53,3%). Em relação à ocupação, 45% eram do lar e 55% desempenhavam outras ocupações remuneradas. Essas mulheres coabitavam com uma a três pessoas (36,7%) ou com seis a quatorze pessoas (28,3%). Quanto à religião, 61,7% eram católicas. A maioria buscou detecção por demanda espontânea (30,0%). Quanto à forma clínica, 30,0% era Dimorfa, 20% Tuberculóide, 15% Indeterminada, 10% Virchowiana e 25,0% formas clínicas não classificadas. Eram multibacilares 56,7%. Quanto às reações hansênicas, 16,7% informaram tê-las antes do diagnóstico, 28,3% durante o tratamento e 21,7% no pós-tratamento; 8,3% das reações eram do tipo I e 66,7%, do tipo II. Das mulheres, 5% estavam grávidas no diagnóstico, 1,7% no período puerperal e 1,7% amamentando. Em relação à história reprodutiva, 63,3% engravidou de uma a três vezes e 26,6% de quatro a dez vezes e 75% tiveram de um a três partos. Três mulheres estavam grávidas no momento do diagnóstico. Conheciam métodos contraceptivos, como condom masculino (98,3%), pílula (88,3%), laqueadura tubária (86,7%) e outros; os utilizavam, em maior índice, pílula (73,3%), condom masculino (70,0%), laqueadura tubária (53,3%) e outros. Quanto ao conhecimento dos métodos anticoncepcionais e características sociodemográficas, os maiores percentuais foram: condom masculino (100%), pílula (87,8%), laqueadura tubária (85,7%), injeção (75,6%), tabela (71,4%), DIU (64,3%). Realizando uma análise inferencial os dados denotam relação significativa com associação entre temperatura e ocupação, aleitamento materno e número de pessoas na família, pílula e número de pessoas, injeção e escolaridade, injeção e ocupação, diafragma e número de pessoas, espermicida e número de pessoas, vasectomia e se estudava, com p>0,05. Médicos e enfermeiros contribuíram mais na oferta de informações sobre contraceptivos, meios midiáticos exerceram grande influência. O principal local de recebimento dos contraceptivos foi a UBS. Concluímos que as mulheres em idade fértil portadoras e ex-portadoras de hanseníase estão sendo pouco aconselhadas para a anticoncepção, tornando-se susceptíveis ao risco de uma gravidez indesejável, levando-as a apresentar reações imunológicas graves / The detection of new leprosy cases in the world remains high in Brazil and Alagoas. This is an important morbidity that leads to physical disability, prejudice and stigma. The emphasis on reproductive health of women suffering and former carriers of leprosy is due to the fact pregnancy induce relapses, exacerbate pre-existing injuries and increase the evolution of indeterminate form for other clinical forms, which requires monitoring for a safe contraceptive practice. The overall objective was to know the situation of reproductive health of women suffering and former carriers of leprosy in primary health care in the city of Maceió network. This is a descriptive cross-sectional study with a quantitative approach. The study was conducted in 14 Basic Health Units (BHU) of the 07 health districts of the city of Maceió / Alagoas. The study population consisted of 60 women. The data reveal that a majority of women in the age group 30-49 years (75%) had a partner (70%) were illiterate or with incomplete primary education (53.3%). In terms of occupation, 45% were housewives and 55% played other paid occupations. These women lived with one to three people (36.7%) or six to fourteen people (28.3%). As for religion, 61.7% were Catholic. Most searched detection by spontaneous demand (30.0%). Clinical forms, 30.0% were borderline, 20% Tuberculoid, Indefinite 15%, 10% and 25.0% Lepromatous clinical forms not classified. 56.7% were multibacillary. As for leprosy reactions, 16.7% reported having them before diagnosis, during treatment 28.3% and 21.7% after treatment; 8.3% of the reactions were of type I and 66.7% type II. Among women, 5% were pregnant at diagnosis, 1.7% in the postpartum period and 1.7% breastfeeding. Regarding reproductive history, 63.3% of pregnant once to three times, and 26.6% for four to ten times, and 75% had one to three deliveries. Three women were pregnant at the time of diagnosis. Knew contraception, and male condom (98.3%), pill (88.3%), female sterilization (86.7%) and others; used them in highest pill (73.3%), male condom (70.0%), female sterilization (53.3%) and others. Regarding knowledge of contraceptive methods and sociodemographic characteristics, the highest percentages were male condom (100%), pill (87.8%), female sterilization (85.7%), injection (75.6%), table (71 , 4%), IUD (64.3%). Performing an inferential data analysis showed a significant relationship with association between temperature and occupation, breastfeeding and number of family members, and number of people pill, injection and education, and occupation injection, diaphragm and number of people, number of people and spermicide, vasectomy and studied with p> 0.05. Doctors and nurses have contributed more to offer information about contraceptives, exerted great influence from the media. The principal place of receipt of contraceptives was BHU. We conclude that women of childbearing age bearers and former carriers of leprosy are being advised to little contraception, making it susceptible to the risk of an unwanted pregnancy, leading them to develop severe immune reactions

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