Women’s Patterns of Participation in Mammography Screening in Denmark

The objective of the study is to analyse individual women’s participation patterns in mammography screening in Denmark. The study is set in the capital of Copenhagen and the county of Fyn representing around 95,000 women aged 50–69. The Central Population Register (CPR) was used to define the total target group, and supply information on migrations and deaths. Invitation and participation data came from the mammography screening programmes in Copenhagen (1991–1999) and Fyn (1993–2001), containing personal identification number, data on invitation date, participation and examination date for each screening round. In Copenhagen the coverage went from 70.5% in the first round to 63.1% in the fourth round, and the equivalent data for Fyn is 84.6% in the first round and 82.8% in the fourth round. Of the women eligible for at least three invitation rounds, 52.6% in Copenhagen and 76.4% in Fyn were faithful users, i.e. had participated in all screenings they were invited to. The conclusion is that the programme participation rates tend to overestimate the protection of the individual women covered by the programme. Behind the urban–rural gradient in programme participation is an even greater gradient in programme protection.     

Tobacco Use Among Married Women in Nepal: The Role of Women’s Empowerment

This study documented the prevalence and correlates of tobacco use among women of reproductive age in Nepal using nationally representative data. We utilized the 2006 Nepal Demographic and Health Survey that interviewed 10,793 women and 4,397 men. We analyzed the couple’s data or households (N = 2,600) in which both husband and wife were interviewed. We examined the effects of women’s empowerment—measured by education, employment, intra-household decisions, and age—on their tobacco use controlling for other individual and household characteristics. Women’s empowerment had mixed effects on tobacco use. While women’s education was inversely associated with their tobacco use, their age, employment and ability to make intra-household mobility decisions were positively associated with smoking. Women with primary and beyond primary education were 48 and 92 % less likely to smoke compared to women with no education, respectively. Tobacco use among women increased dramatically with age from 8 % in teen years to 42 % in their forties. A 1 year increase in age increased the odds of tobacco use by 6 %. Women whose husbands smoked were twice as likely to smoke. Nepal should not only restrict tobacco use in public places by implementing its Tobacco Control and Regulatory Act of 2010 but also focus on encouraging smoke-free homes by increasing awareness about the health consequences of tobacco use and secondhand smoke among populations most likely to smoke that include nearly all men, employed women, women with low levels of education, women whose spouses smoke and those who are 30 and above in age. Additionally, a long term goal should be to ensure at least 5th grade of education for all girls.     

The Multidimensionality of “Pains of Imprisonment” Among Incarcerated Women in Israel

This study re-examined Gresham Sykes's initial conceptualization of “pains of imprisonment” as it applied to women inmates. It contextualized these pains within the women's social experiences both inside and outside the only women's prison in Israel. Semi-structured interviews with 42 female prisoners were conducted. Two counter-themes emerged from our analysis. The first one portrayed prison as punishment, a “painful condition,” a stressful event that included deprivation, negative meaning, suffering, and pain. The opposite—and more dominant—theme framed incarceration as a positive experience, during which the prisoners received nurturing, care, and treatment, which they had not been afforded in the outside world. We found that “pains of imprisonment” was a multidimensional and complex phenomena that included contradicting emotions, thoughts, and behaviors. “Pains of imprisonment” was part of a larger group of pains that extended beyond the time and place of prison.     

Association of Comorbidity with Disability in Older Women: The Women’s Health and Aging Study

There is substantial evidence that physical disability results from chronic diseases and that the number of chronic diseases is associated with the presence and severity of disability. There is some evidence that interactions between specific diseases are of import in causing disability. Beyond arthritis, however, little is known of the disease pairs that may be important to focus on in future research. This study explores the associations between multiple disease pairs and different types of physical disability, with the objective of hypothesis development regarding the importance of disease interactions. The study population comprised a representative sample of 3841 women 65 years and older living in Baltimore, screened for participation in the Women’s Health and Aging Study. The study design was cross-sectional. An interviewer-administered screening questionnaire was administered regarding self-reported physical disability in 15 tasks of daily life, history of physician diagnosis of 14 chronic diseases, and MiniMental State examination. Task difficulty was empirically grouped into six subsets of minimally overlapping disabilities, with a comparison group consisting of those with no difficulty in any task subset. Multiple logistic regression models were fit assessing the relationship of major chronic diseases and of interactions of disease pairs with each disability subtype and with any disability, adjusting for confounders. Fourteen percent of the population reported mobility difficulty only; 5%, upper extremity difficulty only; 9%, both of these difficulties but no others; 7%, difficulty in higher function but not self-care tasks; 7%, self-care task difficulty but not higher function tasks; and 15%, difficulty in both higher function and self-care (weighted data). Almost all in the latter three groups had difficulty, as well, in mobility or upper extremity tasks. In regression models, specific disease pairs were synergistically associated with different types of disability. For example, important disease pairs that recurred in their associations with different disability types were the presence of arthritis and visual impairments, arthritis and high blood pressure, heart disease and cancer, lung disease and cancer, and stroke and high blood pressure. In addition, the type of disability that a disease was associated with varied, depending on the other disease that was present. Finally, when interactions were accounted for, many diseases were no longer, in themselves, independently associated with a given type of disability. Partitioning disability into six subtypes was more informative in terms of associations than was evaluating a summary category of “any disability.” These findings provide a basis for further hypothesis development and testing of synergistic relationships of specific diseases with disabilities. If testing confirms these observations, these findings could provide a basis for new strategies for prevention of disability by minimizing comorbid interactions.     

The Association of Women’s Empowerment with Stillbirths in Nepal

Introduction

Globally, 2.6 million stillbirths occur each year. Empowering women can improve their overall reproductive health and help reduce stillbirths. Women empowerment has been defined as women’s ability to make choices in economic decision-making, household and health care decision-making. In this paper, we aimed to evaluate if women’s empowerment is associated with stillbirths.

Methods

Data from 2016 Nepal Demographic Health Surveys (NDHS) were analysed to evaluate the association between women’s empowerment and stillbirths. Equiplots were generated to assess the distribution of stillbirths by wealth quintile, place of residence and level of maternal education using data from NHDS 1996, 2001, 2006, 2011 and 2016 data. For the association of women empowerment factors and stillbirths, univariate and multivariate analyses were conducted.

Results

A total of 88 stillbirths were reported during the survey. Univariate analysis showed age of mother, education of mother, age of husband, wealth index, head of household, decision on healthcare and decision on household purchases had significant association with stillbirths (p < 0.05). In multivariate analysis, only maternal age 35 years and above was significant (aOR 2.42; 1.22–4.80). Education of mother (aOR 1.48; 0.94–2.33), age of husband (aOR 1.54; 0.86–2.76), household head (aOR 1.51; 0.88–2.59), poor wealth index (aOR 1.62; 0.98–2.68), middle wealth index (aOR 1.37; 0.76–2.47), decision making for healthcare (aOR 1.36; 0.84–2.21) and household purchases (aOR 1.01; 0.61–1.66) had no any significant association with stillbirths.

Conclusions

There are various factors linked with stillbirths. It is important to track stillbirths to improve health outcomes of mothers and newborn. Further studies are necessary to analyse women empowerment factors to understand the linkages between empowerment and stillbirths.

     

Understanding Women’s Choices: How Women’s Perceptions of Quality of Care Influences Place of Delivery in a Rural Sub-County in Kenya. A Qualitative Study

Maternal and Child Health Journal - Maternal mortality is still unacceptably high in Kenya. The Kenyan Government introduced a free maternity service to overcome financial barriers to access. This...     

Women’s Quality of Life in the Premenopausal and Postmenopausal Periods

Purpose The purpose of this research was to determine the relationship between menopausal symptoms and quality of life in women in the pre and postmenopausal periods.Methods and instruments All 171 women in the climacteric period who registered at the Pamukkale University Education and Research Hospital Obstetrics and Gynecology Clinic between January and July 2001 were included in the study. A questionnaire asking for sociodemographic information, complaints related to the climacteric period, and HRT use, as well as the WHOQOL brief, were used in order to obtain data.Findings One hundred of the women who participated in the study were premenopausal and 71 were postmenopausal and the mean age was 47.39 (SD=6.65). No significant difference was found in pre and postmenopausal women in the comparison of their quality of physical life, psychological, social relationships and environment scores (p>0.05). The physical quality of life scores for those without vasomotor complaints in the pre and postmenopausal periods were significantly higher in those with a high educational level and women who had been menopausal between 1–5 years and more than 10 years (p<0.05). Age and HRT use in postmenopausal women were not found to affect quality of life scores (p>0.05).Result We did not find any significant difference in the quality of life of pre and postmenopausal women.     

Testing Women’s Trust in Other Women and Same-Sex Attracted Males in Three Cultures

Heterosexual women trust mating-relevant advice received from gay men more than that received from heterosexual women. This trust is predicated on women’s perception that gay men lack ulterior sexual motives and romantically pursue other gay men. However, this trust may not hold in all cultures. For example, in both Samoa and the Istmo Zapotec of Southern Mexico, women take part in mate competition against feminine same-sex attracted males—referred to as fa’afafine and muxe, respectively—who regularly engage in sexual activity with masculine men. The present studies sought to replicate and extend research on women’s trust in males who are same-sex attracted. Experiments were conducted in Canada, Samoa, and the Istmo Zapotec, with women randomly assigned to consider the likelihood of various mate-poaching behaviors performed by either a rival woman or a same-sex attracted male. In Canada, women were more trusting of cisgender gay men than other women. Similarly, Samoan women were more trusting of fa’afafine than other women. In the Istmo Zapotec, women were equally distrustful of women and feminine muxe gunaa, whereas more masculine muxe nguiiu were rated as more trustworthy than women and muxe gunaa. These results illustrate that women’s trust in same-sex attracted males varies both between and within cultural contexts, perhaps impacted by the relative femininity of the male in question.

     

The ‘Sacred’ Institution of Marriage: The Case of Disabled Women in Zimbabwe

The purpose of this paper is to show that women with disability in Zimbabwe dispute the fallacious belief that they are unbefitting as marital partners on the grounds of disability as generally alluded by society. The findings of a pilot study carried out in Zimbabwe among 16 women with disability revealed that the women value heterosexual marriage. Women with disability are constantly trying to conform to heteronormative ideas of sexuality in an effort to gain respectability, within a context which esteems heterosexuality and denigrates different sexual orientations. All unmarried participants reported that they aspire to marry or to remarry, and the married participant expressed a desire to sustain her marriage, in a setting where participants appear to believe that marriage would “normalize” them. There is evidence that in trying to construct a normative identity, participants make perpetual efforts to “fit in” with the sexual norms that prevail in an environment where heterosexual marriage is regarded as a “sacred” institution which is fore grounded as the only point of entry into the terrain of normal adulthood sexuality. This paper focuses on the theme of matrimonial relationships, which is embedded with five sub-themes; (1) roora (bride price); (2) family interference; (3) rejection by husbands; (4) desertion and divorce; and (5) economic/emotional abuse. The theme and its integral sub-themes shows that women with disability are determined, resilient and hopeful as they constantly seek to secure the respectability which arises from the acquisition and sustenance of heterosexual marriage within the context of this study.     

Who are the Women Who Work in Their Last Month of Pregnancy? Social and Occupational Characteristics and Birth Outcomes of Women Working Until the Last Month of Pregnancy in France

Introduction The prenatal leave law in France protects women during pregnancy and their employment. We aimed to estimate the proportion of women who worked late in their pregnancy, to analyze the occupational, social and medical factors associated with late prenatal leave and to compare the pregnancy outcome of these women and those who left earlier in the pregnancy. Methods The sample was extracted from the 2010 French National Perinatal Survey. All women who delivered within a 1-week period were interviewed before discharge from the maternity unit. Women with a singleton live birth at or after 37 weeks’ gestation and who were working during pregnancy (n = 8463) were included. Data were collected on employment, date of leave, and sociodemographic and medical characteristics. Results Overall, 328 women (3.9 %) took a late prenatal leave (at or after 37 weeks’ gestation). Women who left late were older than 30 years old, with a high educational level and were living in an urban area. Being self-employed and having a managerial or upper-intellectual occupation was highly associated with late leave, before and after controlling for relevant variables. Perinatal and delivery outcomes were similar for women who took a late leave and those who left before 37 weeks’ gestation. Discussion Occupational characteristics are the main determinants of late prenatal leave. Women working in the last month of pregnancy had a favorable social and occupational situation and did not did not experience an adverse pregnancy or birth outcome. Other studies are needed to understand the reasons for late leave and evaluate the post-partum fatigue and health of these women.     

Aspirin in the primary prevention of cardiovascular disease in the Women’s Health Study: Effect of noncompliance

Randomized evidence for aspirin in the primary prevention of cardiovascular disease (CVD) among women is limited and suggests at most a modest effect for total CVD. Lack of compliance, however, can null-bias estimated effects. We used marginal structural models (MSMs) to estimate the etiologic effect of continuous aspirin use on CVD events among 39,876 apparently healthy female health professionals aged 45 years and older in the Women's Health Study, a randomized trial of 100 mg aspirin every other day versus placebo. As-treated analyses and MSMs controlled for time-varying determinants of aspirin use and CVD. Predictors of aspirin use differed by randomized group and prior use and included medical history, CVD risk factors, and intermediate CVD events. Previously reported intent-to-treat analyses found small non-significant effects of aspirin on total CVD (hazard ratio (HR) = 0.91, 95 % confidence interval (CI) = 0.81-1.03) and CVD mortality (HR = 0.95, 95 % CI = 0.74-1.22). As-treated analyses were similar for total CVD with a slight reduction in CVD mortality (HR = 0.88, 95 % CI = 0.67-1.16). MSMs, which adjusted for non-compliance, were similar for total CVD (HR = 0.93; 95 % CI: 0.81, 1.07) but suggested lower CVD mortality with aspirin use (HR = 0.76; 95 % CI: 0.54, 1.08). Adjusting for non-compliance had little impact on the estimated effect of aspirin on total CVD, but strengthened the effect on CVD mortality. These results support a limited effect of low-dose aspirin on total CVD in women, but potential benefit for CVD mortality.     

Work–Family Trajectories and the Higher Cardiovascular Risk of American Women Relative to Women in 13 European Countries

Objectives. To investigate whether less-healthy work–family life histories contribute to the higher cardiovascular disease prevalence in older American compared with European women.Methods. We used sequence analysis to identify distinct work–family typologies for women born between 1935 and 1956 in the United States and 13 European countries. Data came from the US Health and Retirement Study (1992–2006) and the Survey of Health, Aging, and Retirement in Europe (2004–2009).Results. Work–family typologies were similarly distributed in the United States and Europe. Being a lone working mother predicted a higher risk of heart disease, stroke, and smoking among American women, and smoking for European women. Lone working motherhood was more common and had a marginally stronger association with stroke in the United States than in Europe. Simulations indicated that the higher stroke risk among American women would only be marginally reduced if American women had experienced the same work–family trajectories as European women.Conclusions. Combining work and lone motherhood was more common in the United States, but differences in work–family trajectories explained only a small fraction of the higher cardiovascular risk of American relative to European women.Life expectancy is shorter in the United States than in many Western European countries. Older Americans are also more likely to report poorer health and to suffer chronic conditions, particularly American women.1,2 Explanations for this so-called US health disadvantage include differences in the prevalence of smoking and other behavioral risk factors, rates of disease and injury, financial barriers to health care access, and psychosocial stress.2–6 Although higher smoking prevalence histories among older women in the United States is one of the driving explanations,3 none of these factors fully accounts for the female US health disadvantage.Lives of American women changed substantially in the second half of the previous century. Female labor force participation increased more in the United States than in many European countries,7 and marriage rates decreased more rapidly for US women as a result of a higher fraction of American women never marrying as well as higher divorce rates.8,9 By contrast, although fertility rates declined in all countries,10 they declined less in the United States than in many European countries, leaving more American women facing the prospect of combining work and family roles, often in the context of lone motherhood.Women who are married, employed, and have children are generally healthier than their unmarried, nonemployed, and childless counterparts.11,12 Whereas the role accumulation theory suggests that combining family and work roles is beneficial for women’s health, the multiple role theory poses that combining these roles may increase levels of stress, which has a negative impact on health.13 These negative impacts may, however, depend on the availability of supportive policies that enable parents to combine work with family roles.We hypothesized that work–family trajectories may be differentially related to cardiovascular health in the United States than in Europe, as a result of the different work–family policy environment in the United States and Europe. If combining family and work roles is beneficial for a woman’s health, women experiencing a more family-friendly policy environment such as that in Europe may benefit more from role accumulation, resulting in better cardiovascular health. If combining roles is detrimental for a woman’s health, American women may experience more strain from work–family stress than European women as a result of a less supportive policy environment in the United States.The aim of this study was to assess whether less-healthy work–family life histories among American women have contributed to their cardiovascular health disadvantage in older age relative to women in 13 European countries. We used unique retrospective data for 13 European countries and the United States to construct full life histories and work–family trajectories, and linked them to stroke and heart disease outcomes in older ages. We examined the association between work–family trajectories and late-life cardiovascular outcomes and assessed whether the distribution and risks associated with these work–family trajectories explain why older American women have higher stroke and heart disease prevalence than older women in Europe.     

What Factors are Responsible for Higher Prevalence of HIV Infection among Urban Women than Rural Women in Tanzania?

Background

Tanzania is the country hit the hardest by the HIV epidemic in Sub-Saharan Africa. The present study was carried out to examine the factors of HIV infection among women who lived in an urban area in Tanzania.

Methods

The Tanzania HIV/AIDS and Malaria Indicator Survey (2011–12) data was used. The sample size for urban and rural women who had been tested for HIV and ever had sex was 2227 and 6210 respectively. Bivariate and multivariate logistic regression analyses were used.

Results

The present study found that rural women were significantly less likely to be HIV-infected compared to urban women (OR = 0.612, p<0.00). About 10% urban women were HIV-infected whereas 5.8% women in rural areas were HIV positive. Women who had more than five sex partners were significantly four times more likely to be HIV-infected as compared to women who had one sex partner (OR = 4.49, p<0.00).

Conclusion

The results of this study suggest that less-educated women, women belonging to poor or poorer quintile, women spending nights outside and women having more than one sex partner were significantly more likely to have HIV infection among urban women as compared to rural women. There is an urgent need for a short and effective program to control the HIV epidemic in urban areas of Tanzania especially for less-educated urban women.     

An Assessment of Romani Women’s Autonomy and Timing of Pregnancy in Serbia and Macedonia

Background Roma are Europe’s largest minority population. Serbia and Macedonia have the greatest proportion of Roma outside of the European Union. Our objective was to examine women’s agency and how it related to desired timing of pregnancy among Romani women in Macedonia and Serbia. Methods We surveyed 410 Romani women who had given birth in the last 2 years between November 2012–February 2013 in Serbia and Macedonia using purposeful snowball sampling. Log-Poisson models were used to examine the association between women’s inclusion in healthcare decision- making and desired timing of pregnancy. Results Romani women in Macedonia and Serbia were excluded from the labor market, with over 80% being unemployed, approximately 30% had no schooling, and 17% were not included in healthcare decisions. Romani women who were sole decision-makers in relation to their health were 1.4 times more likely to desire the timing of their most recent pregnancy [RRR?=?1.4, CI (1.1, 1.8)]. Conclusions Romani women who have great involvement in their own healthcare decisions were more likely to desire the timing of their current pregnancy. Women’s inclusion in such important decisions is important and empowerment programs that address gender inequity are needed in Romani communities, particularly for control of timing of pregnancy.     

Acute Effect of Poly-γ-Glutamic Acid on Calcium Absorption in Post-Menopausal Women

Objective: Poly-γ-glutamic acid (PGA) increases calcium (Ca) solubility in vitro and in vivo, and is associated with reduced bone loss in post-menopausal Japanese women. This study is the first to examine the effect of PGA on Ca absorption in humans.

Methods: A single-blind, randomized, crossover study with a 3–4 week wash-out was performed to determine the effect of PGA (80.6% glutamic acids) on Ca absorption measured by the double stable isotope method. Twenty-four healthy, non-smoking, postmenopausal women (mean age: 56.4 ± SE 0.9) were given 200 g of orange juice containing 200 mg Ca as Ca-44 enriched CaCO₃, with or without 60 mg of PGA, after an overnight fast. The two tests were separated by 3–4 weeks. An intravenous injection of Ca-42 (CaCl₂ solution) was given 30 min after consuming the drink and a complete urine collection carried out from 24–48 h post-dosing. Ca absorption was calculated from the Ca isotope ratios measured by thermal ionization quadrupole mass spectrometry (TIQMS).

Results: Mean Ca absorption with PGA was significantly higher (P < 0.01) than without PGA, 39.1 (SE 1.6) % and 34.6 (SE 1.9) %, respectively. The effect of PGA on increasing Ca absorption was more marked in a sub-group of subjects whose baseline Ca absorption (without PGA) was lower than the population mean value.

Conclusion: Postmenopausal women who received a single dose of PGA increased their intestinal Ca absorption particularly those individuals with lower basal absorptive capacity.     

Scope of Knowledge About Zika Among Women in US–Mexico Border Communities

Maternal Zika virus infection (ZIKV) has serious health consequences for unborn offspring. Knowledge about prevention is critical to reducing risk, yet what women in the high-risk US–Mexico border region know about protecting themselves and their babies from ZIKV is mostly unknown. This study aimed to assess knowledge of ZIKV among pregnant and inter-conception women and to identify sources of information that might address knowledge gaps. Clients in five federally-funded, border region Healthy Start programs (N?=?326) were interviewed in late 2016 about their knowledge of ZIKV prevention methods and whether they believed themselves or their babies to be at risk. Sources of information about ZIKV and demographic characteristics were also measured. Chi square tests identified important associations between variables; adjusted odds ratios (AOR) and 95% confidence intervals for knowledge and beliefs were calculated. Among the 305 women aware of ZIKV, 69.5% could name two ways to prevent infection. Only 16.1% of women named using condoms or abstaining from sex as a prevention method. While 75.3% heard about ZIKV first from TV/radio, just 9.5% found the information helpful. Women who received helpful information from health care providers had greater odds of knowing two prevention methods (AOR?=?2.0; 1.1–3.7), when to test for ZIKV (AOR?=?5.2; 2.1–13.2), and how long to delay pregnancy after infection in a male partner (AOR?=?1.9; 1.1–3.2). Those who said web-based and social media sources were helpful had greater odds of knowing when to test for ZIKV (AOR?=?2.8; 1.3–6.3). Results can inform messaging for safe pregnancy and ZIKV prevention.     

Poverty of Opportunity Forcing Women Into Prostitution—A Qualitative Study in Pakistan

Our aim for this study was to explore the factors influencing women to initiate and continue as sex workers and to explore their perceptions about human immuno deficiency virus/acquired immune deficiency syndrome (HIV/AIDS), sexually transmitted infections (STIs), and health seeking behavior. We conducted a qualitative study based on interviews with 20 purposively selected women selling sex. Content analysis of data resulted in identification of one main theme: “Poverty of opportunity forcing women into prostitution.” The identified driving forces behind women resorting to sell sex were poverty, materialism, and the desire to move up in society. They continued to sell sex due to poverty of opportunity and influencing social factors.