Hormonal factors and insulin-like growth factor-1 in North American postmenopausal women

Background: Mechanisms underlying the effect of estrogen exposure on breast cancer risk remain unclear. Insulin-like growth factor-1 (IGF-1) levels have been positively associated with breast cancer and are a potential mechanism. Objectives: The objectives of this thesis are: 1) to explore whether the reproductive risk factors and the lifetime cumulative number of menstrual cycles (LCMC), as measures for long-term estrogen exposure, are associated with IGF-1 levels, and 2) to examine the effect of an aromatase inhibitor (AI) on IGF-1 levels, and the potential interaction with BMI. Methods: A cross sectional study and a randomized controlled trial nested with the MAP.3 chemoprevention trial were used to address objective 1 and 2, respectively. 567 postmenopausal women were selected. Anthropometric measurements, lifestyle factors, reproductive characteristics and serum IGF-1 concentrations were collected at baseline and one year. Objective 1. The LCMC was computed as a composite measure of the reproductive characteristics. Multivariable linear regression models were used to assess the association between IGF-1 levels and LCMC and the hormonal risk factors, while adjusting for potential covariates. Objective 2. Changes in IGF-1 were compared between the exemestane and placebo, and effect modification by BMI was tested with an interaction term. Results: Objective 1. Women aged 55 years or older at menopause had 16.26 ng/mL (95% CI: 1.76, 30.75) higher IGF-1 compared to women aged less than 50 years at menopause. Women in the highest category of menstrual cycles (≥500 cycles) had an average 19.00 ng/mL (95%CI: 5.86, 32.14) higher concentration of IGF-1 compared to women in the lowest category (<350). Exogenous hormones had no effect on postmenopausal IGF-1 levels. Objective 2. Exemestane significantly increased IGF-1 levels by 18% (95% CI: 14%-22%); while, placebo had no effect on IGF-1. The changes in IGF-1 were significantly different between the treatment arms (P<0.0001) and no significant interaction was observed between treatment and BMI on IGF-1 changes (P=0.1327). Conclusion: Objective 1. Larger number of menstrual cycles and a later age at menopause are positively associated with IGF-1. IGF-1 may be one mechanism by which prolonged estrogen exposure increases cancer risk. Objective 2. We conclude that the reduced cancer risk observed with AI therapy likely occurs in an IGF-1 independent mechanism. Further studies exploring the clinical consequences of increased IGF-1 on AI therapy are needed.

READING AND RESPONDING: FINDING AND MAKING MEANING IN THE LIFE WRITING OF DIASPORIC IRANIAN JEWISH WOMEN

This project investigates the English-language life writing of diasporic Iranian Jewish women. It examines how these women have differentially imagined their diasporic lives and travels, and how they have in turn been imagined and accepted or rejected by their audiences. In the first chapter, I use “home” as a lens for understanding three distinct life writing texts, showing how the authors write about what it means to have a home and to be at home in contrasting and even contradictory ways. I show how, despite potential hegemonic readings that perpetuate unequal relationships and a normative definition of the ideal home, the texts are open to multiple contestatory readings that create spaces for new formulations and understandings. In the second chapter, I look more closely at the intersections between trauma stories and the life writing of Iranian Jewish women, and I argue that readers use life writing texts about trauma to support an egocentric reconstruction of American democracy and dominance. I also show how a critical frame for understanding trauma can yield interpretations that highlight, rather than ignore, relationships of power and privilege. In the final chapter of the thesis, I present a case study of two online reading groups, and I show that communal reading environments, though they participate in dominant discourses, are also spaces where resistance and subversion can develop.

Disruptive Threads and Renegade Yarns: Domestic Textile Making in Selected Women's Writing 1811-1925

Images of domestic textiles (items made at home for consumption within the household) and textile making form an important subtext to women’s writing, both during and after industrialization. Through a close reading of five novels from the period 1811-1925, this thesis will assert that a detailed understanding of textile work and its place in women’s daily lives is critical to a deeper understanding of social, sexual and political issues from a woman’s perspective. The first chapter will explore the history of the relationship between women and domestic textile making, and the changes wrought to the latter by the Industrial Revolution. The second chapter will examine the role of embroidery in the construction of “appropriate” feminine gentility in Jane Austen’s Mansfield Park (1814). The third chapter, on Elizabeth Gaskell’s Cranford (1853), will explore how the older female body became a repository for anxieties about class mobility and female power at the beginning of the Victorian era. The fourth chapter will compare Sara Jeannette Duncan’s A Social Departure (1890) and Kate Chopin’s The Awakening (1899) to consider how later Victorian women both internalized and refuted public narratives of domestic textile making in a quest for “self-ownership.” The last chapter, on Martha Ostenso’s Wild Geese (1925), examines the corrosive, yet ultimately redemptive, relationships of a family of women trapped by abuse and degradation. For all five authors, images of textiles and textile making allow them to speak to issues that were usually only discussed within a community of women: sexuality, desire, aging, marriage, and motherhood. In all five works, textile making “talks back” to the power structures that marginalize women, and lends insight into the material and emotional circumstances of women’s lives.

PHYSICAL ACTIVITY EXPERIENCES OF PERSIAN WOMEN RECENTLY IMMIGRATED TO CANADA

New immigrants to Canada are generally in similar or better physical and mental health than people born in Canada, however, many studies suggest that their health tends to decline quickly after immigration. Lower physical activity levels among new immigrants might be contributing to this phenomenon. There is a paucity of information regarding the physical activity behaviour of the Canadian immigrant population in general and of West Asian women, such as Iranians (Persians), in particular. Given that this group is characterised by an increasing population growth and lower rates of physical activity, it is critical to understand how best to address physical activity promotion in this population. Purpose: To understand the physical activity experiences of Persian women recently immigrated to Toronto, Canada in order to develop recommendations for the design and implementation of tailored physical activity programs. Methods: A qualitative interpretive description approach was chosen to collect and describe ideas, experiences, and perceptions of physical activity within 10 new immigrant women. Using an inductive approach, two fundamental techniques of immersion and crystallization were used throughout the analysis. Thematic analysis was conducted by performing a sequential process of open and axial coding. Emerged themes were further conceptualized through a socio-ecological lens. Results: The facilitators and barriers to physical activity among the women were situated within five overarching categories, 1) Perceptions about physical activity, 2) New physical environment and social structure, 3) Cultural heritage values, 4) Settlement and immigration factors, and 5) Physical activity program features. Discussion: Findings revealed that Persian new immigrant women’s engagement in physical activity after immigration is influenced by factors across the individual, sociocultural, environmental, institutional, and policy levels. Newcomer women’s physical activity was influenced by their transition from their society of origin to the host society and the challenges and successes experienced throughout the settlement and acculturation process. The most noticeable barrier to physical activity in Canada for the women emerged as the lack of communication of physical activity information to newcomers. A set of recommendations is provided for developing efficient physical activity programs for Persian immigrant women, which may also be relevant for other immigrant groups in Canada.