This study examined the effects of two 8-week stress-management interventions (aerobic exercise and progressive relaxation) on reductions in trait anxiety, increases in self-efficacy, and enhancement of coping strategies for sedentary working women. It was expected that aerobic exercise, a relatively new treatment, would be as effective or more effective than progressive relaxation, a well researched treatment, as a stress-management intervention. The subjects were 72 females aged 24-59, (M = 39.8) solicited from the Vancouver community via newspaper advertisement asking for stressed volunteers to participate in two stress-management programs. They were interviewed and randomly assigned to an aerobic exercise or progressive relaxation treatment. The treatment sessions were conducted over an 8-week period with subjects meeting in groups for 1 1/2 hours per week. Prior to the first session subjects were administered: STAI-T (Spielberger, Gorsuch, & Lushene, 1970), the General Self-Efficacy Scale (Sherer et al., 1982), Ways of Coping Checklist (Lazarus 6 Folkman, 1984), and a 7-Day Exercise Recall Inventory (Blair, 1984). Subjects were assessed again at post treatment and at 8-week follow-up. Repeated measures, multivariate analysis of variance with preplanned contrasts, indicated that both treatment groups were effective in decreasing trait anxiety and increasing self-efficacy from pre- to post-treatment. These changes were maintained at 8-week follow-up. In addition, a one-way multivariate analysis of variance with repeated measures indicated that the total number of coping strategies, as well as the difference between the number of problem-focused and emotion-focused coping strategies, did not change significantly from pre- to post-treatment. Additionally, there was a negative relationship between low scores in self-efficacy and high scores in emotion-focused coping. In response to ancillary post-treatment and follow-up questionnaires, aerobic exercise was perceived by the participants as a more satisfactory stress-management treatment. Implications of these results and suggestions for future studies are discussed. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

Although there has been a great deal of research in the areas of social networks, social support and well-being over the past two decades, little of that research has been cross-cultural, and virtually none has been carried out in countries outside the West. The present study attempted to describe the structure and functioning of the social networks of a group of relatively modern urban Moroccan women, and the associations among their social networks, social support, physical health and psychological well-being. Extensive interviews were conducted with 108 married or previously-married women who were living in a middle-class neighborhood in Rabat, Morocco. Subjects were asked to identify social network members, defined as friends, family or others who provided various types of support in typically encountered life situations, or with whom the subject had negative interactions. Standardized self-report instruments were used to assess physical and psychological well-being, and to assess the occurrence of stressful life events. Additional observational data were collected on respondents' neighborhoods and immediate physical surroundings. A model describing the interactions between well-being, network structure and network function was tested using factor-analytic and set-regression techniques. Stressful life events predicted reduced physical well-being. Enhanced psychological functioning was predicted by reciprocity in relationships, marital satisfaction, and to a lesser degree, practical and emotional support. Contrary to predictions, patronage support was associated with both enhanced physical and psychological well-being. Results were generally consistent with Conservation of Resources (COR) theory, which predicts that the uniformly large and well-functioning networks found in this study would produce effect sizes that were small, but consistent with Western research findings.

Existing research on health disparities in breast cancer is heavily focused on outcomes for poor or low-income women. Little is known about the experience of privately insured Black breast cancer patients that have moderate to high SES. As a result, the present study was conducted to learn more about their experiences. It examines differences in physician prescribing of two breast cancer pain treatments, peripheral nerve block (PNB) and opioids, for Black and White women with like levels of health insurance coverage and socioeconomic status (SES). Three specific questions are addressed: 1. What, if any, race-based disparities exist in usage of PNBs at time of total mastectomy? 2. What, if any, race based disparities exist in the prescription of opioids for postoperative pain following total mastectomy? 3. What, if any, changes have occurred in the frequency of orders placed for PNBs and prescription opioids over time, to treat postoperative pain resulting from mastectomy? A cross-sectional designed was used relying on an existing national dataset, Optum Clinformatics Data Mart. The study period was January 1, 2012, through December 31, 2019. Study results revealed that while moderate to higher SES Black women have equitable access to PNB and opioids - a kind of shield from long established physician bias against Black women – this protection is quite porous. They still do not have open and ready access to PNB as a more advanced pain treatment. Nor do they have assurance that they are protected from the overprescribing of opioids, a class of drugs with serious and well-known safety risks. Therefore, on the surface, it appears that equity and racial inclusion are hallmarks of physician prescribing of postoperative breast cancer pain treatment. However, further interrogation reveals that ‘separate and somewhat equal’ is a more accurate characterization of their prescribing practices, based both on race and SES.

Experiencing early life adversity (ELA) increases the risk of anxiety disorders, such as generalized anxiety disorder and post-traumatic stress disorder, with disproportionally higher risk in women compared to men. Neurodevelopmental and behavioral outcomes following ELA are multifaceted and are influenced heavily by the type of adversity experienced and sex of the individual. A major contributor to emotional dysfunction and anxiety disorders resulting from ELA are changes in fear and threat circuitry. Children who experienced ELA have been reported to show an accelerated development of the amygdala, a region involved in processing threat, and greater cerebrospinal levels of corticotrophin releasing hormone (Crh), an orchestrator of neuroendocrine and behavioral responses to stress. Work in rodents have linked Crh signaling within the lateral central amygdala (CeAL) with processing and responding to threat, core features disrupted in anxiety-related disorders. Further, sex biases in risk and symptom presentation have been proposed to be related to sexual dimorphic signaling of Crh across the brain that differentially influence a variety of Crh-dependent behaviors. However, it remains unclear what properties of ELA portend differential neurobiological risk, what is the basis of sex-differences for negative outcomes, and how specific mechanistic changes give rise to certain endophenotypes. In this work, I use genetic, cellular, and behavioral approaches to explore the impact of ELA and sex on perinatal development in mice and the functional consequences of altered Crh neuron activity in the CeAL on threat responding in adulthood. In Chapter 1, I review how factors such as sex and type of ELA influence amygdala development and Crh. In Chapter 2, I assess the impact of two forms of ELA, maternal separation (MS) and limited bedding and nesting (LBN) on perinatal development and anxiety-like behavior. Both forms of ELA shifted the timing of somatic maturation and basal CORT levels and led to increased anxiety-like behaviors, but the degree of the impact depended on the sex and type of adversity experienced. In Chapter 3, I demonstrate that a distinguishing feature between types of ELA was the predictability of maternal care. The type of ELA also contributed to sex-differences in Crh related gene expression in the perinatal amygdala. Increased expression was primarily observed in males following MS and in females following LBN. In Chapter 4, I investigate the functional consequences of ELA in the form of LBN on the activity of CeALCrh+ neurons in vivo and their causal role in threat reactivity indexed by the startle response. LBN rearing led to sustained activity of CeALCrh+ in female mice but diminished in male mice. Persistent activity of this population was necessary for and predicted the magnitude of startle responding. In Chapter 5, I discuss important considerations when integrating new advancements in the study of ELA and the use of sex as a biological variable. Collectively, this work deepens our understanding of the neurobiological mechanisms impacted by sex and ELA and holds promise for future strategies that may consider the sex and specific experiences of the individual to target specific endophenotypes and address the underlying root causes of anxiety disorders.

Uganda has experienced substantive shifts in HIV prevention and treatment resulting in marked declines in HIV incidence and mortality rates across the country despite being among the top 5 highest new prevalence rates for HIV transmission and infection among women (Uganda Ministry of Health, 2019). Prior research has revealed that fear of stigma and discrimination, disclosure of HIV status, and quality of services are key factors in women’s healthcare decisions and care-seeking behaviors (Akatukwasa et al. 2021; Lancaster et al., 2016; Grossman & Stangl, 2013). Yet, there continue to be significant knowledge gaps regarding the mechanisms through which intersectional stigma exacerbates health outcomes for people living with HIV. This dissertation draws on baseline data, from the Kyaterekera project an efficacy trial testing the effects of a structural intervention on the HIV-health outcomes of women engaged in sex work within the Masaka region, Uganda. Using an explanatory sequential mixed method design, this study utilized Structural Equation Modeling (SEM) to test the direct and indirect effects of intersectional stigma on mental health, while also evaluating mechanisms (i.e., social support and quality of care) through which stigma impacts mental health, treatment adherence and subsequent viral load. There were no direct or indirect effects of intersectional stigma on mental health, but intersectional stigma was positively associated with social support. Additionally, depression and adherence were negatively associated with viral load. Next, in-depth interviews (n=52) explored personal and community-level factors that may influence women’s care-seeking attitudes and overall health decisions. The following themes were most salient for women: 1) disclosure risk, 2) Intersectional community stigma permeates marginalized women’s health decisions, 3) adaptive behaviors and coping strategies are essential to maximizing care experiences, and 4) the Care Seeking Cost-Benefit Tradeoff. Through an integrative framework, quantitative and qualitative findings were then juxtaposed through a joint display and found to be predominantly complementary (McCrudden, M. T., Marchand, G., & Schutz, P. A., 2021). Findings suggest that a positive association between intersectional stigma and social support may underscore the significant long-term effects of living with HIV. Moreso, holding other stigmatized social statuses. Moreso, this link between intersectional stigma and social support may be due to women anticipating the likelihood of experiencing community-level/interpersonal stigma with HIV disclosure and extensive contact with their social support network. Also, more contact with social networks, particularly those in which stigma norms and discriminatory attitudes are pervasive on the community/ interpersonal level (or perceived to be so) may account for the positive associations between HIV stigma and social support. Sex work had a higher degree of concealability than HIV. As such, sex work was disclosed less frequently than HIV to healthcare providers, family, and friends due to anticipatory community stigma. Despite the finding that the explanatory sequential design produced no direct or indirect effects of intersectional stigma on mental health or viral load via SEM, the exploratory analysis provides substantive insights into the negative impact of HIV-related intersectional stigma on women’s care-seeking experiences and broader health decisions. Women’s care-seeking attitudes and behaviors reveal the intrinsic adaptive skills, strength, and resilience they possess to address individual health needs despite known barriers to care. Overall, this study provides further support for holistic interventions that can enhance and build resilience and successful adaptive strategies to mitigate the effects of HIV-related intersectional stigma.

This study was done with the objective of designing and applying a nutrition education program based on a test of improved practices for pregnant women and women of childbearing age in the rural communities of Ibarra canton: La Riconada and Cuambo. For this, information was collected on knowledge, attitudes, and practices (KAP) regarding the eating habits of pregnant women. These results were used to identify content and recommendations to reinforce and/or instruct about eating during pregnancy. Nutrition education was based on the methodology of the improved practices test, which consisted of testing the recommendations in families' homes before recommending them and recording information on their acceptability. The results indicate that pregnant women in the two communities don't eat all the food groups every day. They need to increase the consumption of foods rich in calcium and iron, as well as foods that supply energy, protein, and fats. The pregnant women don't eat additional foods to cover these recommendations during the pregnancy. Despite the knowledge they have and the lessons they received, there are women who don't eat greens, vegetables, and fruits because they don't like them, and those who do eat them don't meet the established nutritional recommendations. The women prefer to eat artificial drinks with unboiled water, and they do not look after personal hygiene. The test of improved practices has been useful for observing if they really put in practice the knowledge about eating during pregnancy, and at the same time it helped design the educational proposal that served as a guide to help improve eating practices of pregnant women in the two rural communities, considering their motivations and recommendations.

The present study aimed to explore the objective and subjective experiences of “mistreatment” in maternity care in a diverse cohort of women who gave birth in New York City hospitals to identify the prevalence and risk factors of mistreatment and measure the relationship between mistreatment and mental health (Bohren et al., 2015). The study utilized a mixed-methods cross-sectional approach. To collect the quantitative data, 109 participants <1 year postpartum completed an anonymous online survey comprising a self-report measure of demographic, health and mental health information, several mental health questionnaires and two measures of mistreatment in maternity care. 8 of these participants were interviewed about their childbirth experience. The quantitative data was analyzed utilizing linear regression, moderation analysis and path analysis, and the qualitative data was thematically coded then analyzed using Reflexive Thematic (RT) analysis. These data were then triangulated using a mixed-methods model of mistreatment. In total, 10-15% of the sample experienced mistreatment in the form of Low to Very Low respect and/or autonomy in decision making in their maternity care. Forms of mistreatment included unwanted procedures, provider pressure to undergo procedures, dismissal of women’s concerns, racial discrimination, abandonment, and medical neglect. Approximately 25% of respondents received an unwanted intervention; this was the most significant predictor of mistreatment. This relationship was moderated by race, parity and birth plan. Black, Latinx and Hispanic women experienced the lowest levels of respect in maternity care. Mistreatment in maternity care was correlated with increased risk for postpartum mental illness: decreased respect and autonomy in childbirth was associated with increased postpartum depression and PTSD symptoms. Eight themes were identified in the qualitative analysis: Discrimination and Unfair Treatment, Confusion and Abandonment, Disregard for Patient Autonomy, Hospital-Level Drivers of Mistreatment, Women Treated as Passive, Normalization of Mistreatment, Self-Advocacy and Vulnerability and, Reclaiming Power through Knowledge. Together, the triangulated mixed- methods data were fit to render a comprehensive “model of mistreatment” to illustrate direct and indirect relationships between mistreatment, mental health, race, trauma history, and childbirth preparation. These findings demonstrate that mistreatment is a multi-determined phenomenon that is interdependent with mental health and requires systematic measurement in healthcare treatment, the integration of anti-racist and patient-centered care and improved childbirth education for patients.

This study addressed the long-standing crisis of Black severe maternal morbidity in the U.S., while the COVID-19 pandemic led to even worse outcomes. The purpose of the study was to identify significant predictors of the quality of patient-provider relationships during a birth hospitalization. The sample of Black women (N=182) gave moderate ratings for quality of patient provider relationships, and for level of trust, rapport, and communication with providers. Providers were rated as having a fair level of cultural sensitivity, competence, and humility—while 30.2% rated them as poor. For experiences of racism, discrimination and inequities in service delivery, combining categories of a “few times” and “many times,” 53.3% felt racially stereotyped or treated like a racial stereotype, 52.5% were treated with less respect than a White woman would have been, 39.7% were verbally abused or yelled at, 43.8% were scolded, ridiculed, mocked, and shamed, 47.2% felt belittled and put down, 42.7% felt threatened, coerced, lied to, and manipulated, and 46% felt their pain was not managed the same way as for a White woman. Women entered the hospital with risk factors of cardiovascular disease (20.3%), hypertension (23.6%), obesity (18.1%), and diabetes (13.7%). Further, 74.2% had COVID-19 in the past two years, 25.8% had long COVID-19, 34.1% had COVID-19 during their pregnancy, and 34.1% had COVID-19 at delivery. Medical events during their delivery hospitalization included hemorrhage (40.7%), blood clot (25.3%), and a hypertensive disorder of pregnancy (25.3%). Women had high rates (over 75%) of past year depression, anxiety, and trauma—with 68.1% receiving counseling; and higher rates (over 85%) the year post-partum—with 76.9% receiving counseling. Noteworthy significant predictors of a higher quality of patient-provider relationships were higher education, higher trust/ rapport/ communication with providers, and lower global racism/ discrimination/ inequities during service delivery—while entering the hospital with lower risk factors for pregnancy-related complications (69.8% of variance predicted). The study contributes to literature on the crisis of severe maternal morbidity for Black women in the U.S, as well as factors that need to be addressed to reduce it, while offering a cache of culturally appropriate measures for ongoing research.

Bakgrund Våld i nära relationer är en global folkhälsofråga. Enligt en WHO-studie har många kvinnor runt om i världen blivit utsatta för olika former av våld från sina partners. Hälsa definieras på olika sätt. Inom vårdvetenskapen definieras hälsa som en balans mellan fysiskt, psykiskt och socialt välbefinnande. Våld kommer vidare i olika former och kan utövas fysiskt, psykiskt, sexuellt och ekonomiskt. Kvinnor är särskilt utsatta för sådant våld. Sjuksköterskor har en viktig roll i att upptäcka och stödja kvinnor som utsätts. Dock finns brister i sjuksköterskors kunskap och självförtroende när det gäller att hantera dessa situationer. Syfte Syftet var att belysa kvinnors hälsa efter att de blivit utsatta för våld av en partner. Metod En icke-systematisk litteraturöversikt har genomförts baserat på 15 vetenskapliga artiklar, som omfattar såväl kvalitativa som kvantitativa ansatser. Artiklarna samlades in från databaserna PubMed och CINAHL genom att använda olika kombinationer av sökord. Artiklarna har alla blivit peer reviewed och genomgått en kvalitetsbedömning med de kriterier som fastställts av Sophiahemmet University för att utvärdera deras vetenskapliga klassificering och kvalitet. Resultat Resultatet sammanställdes under fyra huvudkategorier: fysisk-, psykisk- och social hälsa samt skadliga hälsobeteenden som konsekvens av partnervåld. Resultatet tyder på att våld i nära relation har konsekvenser för alla former av hälsa samt att det leder till skadliga hälsobeteenden. Kvinnans möjligheter att uppnå god hälsa försämras och risken att drabbas av ohälsa ökar av partnervåld. Slutsats Denna uppsats belyste kvinnors hälsa efter våld i nära relationer. Våldet har en negativ påverkan på fysisk, psykisk och social hälsa samt leder till ohälsosamt beteende. Alla inom vården bör kunna möta våldsutsatta kvinnor och erbjuda relevant hjälp och stöd. Denna litteraturöversikt hoppas kunna öka sjuksköterskors medvetenhet om våld i nära relationer och dess breda konsekvenser vilket är nödvändigt för upptäckt, förebyggande, kunskapsspridning och stöd till de drabbade kvinnorna. / Background  Violence in intimate relationships is a global public health issue. According to a WHO study, many women around the world have been exposed to various forms of violence from their partners. Health is defined in different ways. In nursing science, health is defined as a balance between physical, mental and social well-being. Violence comes in different forms and can be practiced physically, psychologically, sexually and financially. Women are particularly vulnerable to such violence. Nurses have an important role in detecting and supporting women who are exposed. However, there are gaps in nurses' knowledge and self-confidence when it comes to handling these situations. Aim  The aim was to shed light on women's health after being subjected to violence by a partner. Method  A non-systematic literature review has been carried out based on 15 scientific articles, which include qualitative as well as quantitative approaches. The articles were gathered from the PubMed and CINAHL databases by employing various combinations of keywords. The included articles have been peer-reviewed and subjected to a quality assessment using the criteria established by Sophiahemmet Univeristy for evaluating their scientific classification and quality. Results  The results were compiled under four main categories: physical health, mental health, social health, and harmful health behaviours as a consequence of partner violence. The results indicate that violence in a close relationship has several bad consequences on all types of health and that it leads to harmful health behaviour, which means that the abused woman cannot achieve good health. Conclusions  This essay highlighted women's health after intimate partner violence. The violence has a negative impact on physical, mental and social health and leads to unhealthy behaviour. Everyone in healthcare should be able to meet abused women and offer relevant help and support. This literature review hopes to increase nurses' awareness of intimate partner violence and its broad consequences, which is necessary for detection, prevention, knowledge dissemination and support for the affected women.

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