Which screening strategy using BMD measurements would be most cost effective for hip fracture prevention in elderly women? A decision analysis based on a Markov model.

INTRODUCTION: Hip fractures are responsible for excessive mortality, decreasing the 5-year survival rate by about 20%. From an economic perspective, they represent a major source of expense, with direct costs in hospitalization, rehabilitation, and institutionalization. The incidence rate sharply increases after the age of 70, but it can be reduced in women aged 70-80 years by therapeutic interventions. Recent analyses suggest that the most efficient strategy is to implement such interventions in women at the age of 70 years. As several guidelines recommend bone mineral density (BMD) screening of postmenopausal women with clinical risk factors, our objective was to assess the cost-effectiveness of two screening strategies applied to elderly women aged 70 years and older. METHODS: A cost-effectiveness analysis was performed using decision-tree analysis and a Markov model. Two alternative strategies, one measuring BMD of all women, and one measuring BMD only of those having at least one risk factor, were compared with the reference strategy "no screening". Cost-effectiveness ratios were measured as cost per year gained without hip fracture. Most probabilities were based on data observed in EPIDOS, SEMOF and OFELY cohorts. RESULTS: In this model, which is mostly based on observed data, the strategy "screen all" was more cost effective than "screen women at risk." For one woman screened at the age of 70 and followed for 10 years, the incremental (additional) cost-effectiveness ratio of these two strategies compared with the reference was 4,235 euros and 8,290 euros, respectively. CONCLUSION: The results of this model, under the assumptions described in the paper, suggest that in women aged 70-80 years, screening all women with dual-energy X-ray absorptiometry (DXA) would be more effective than no screening or screening only women with at least one risk factor. Cost-effectiveness studies based on decision-analysis trees maybe useful tools for helping decision makers, and further models based on different assumptions should be performed to improve the level of evidence on cost-effectiveness ratios of the usual screening strategies for osteoporosis.

Social freezing in Switzerland and worldwide--a blessing for women today?

This is a critical review of the medical, ethical, judicial and financial aspects of the so called "social freezing", the cryopreservation of a woman's oocytes for non-medical purposes. The possibility of storing the eggs of fertile women in order to prevent age-related fertility decline is being widely promoted by fertility centres and the lay press throughout the world. Research data has shown that social freezing should ideally be performed on women around 25 years of age in order to increase their chances of a future pregnancy. In reality, it is mostly performed after the age of 35. Unfortunately, social freezing is in general not a solution for the underlying societal problems to fit in with professionally active women and having children. It only delays the existing problems. Furthermore, it creates a lot of potential new problems. A great deal more should be undertaken to offer real solutions to the underlying societal problems which are in part: pre-school education, care in the event of childhood illness, and the many weeks of school holidays, acceptance of professionally active women having children, and more job offers with a workload <100%.). Furthermore, society should be informed about the decreasing chances of pregnancy with increasing maternal (and paternal) age as well as the increasing risks of miscarriage and obstetric/neonatal complications. Detailed information for woman considering social freezing is crucial. Every doctor, proposing social freezing to his patients, should be up to date with all these details. Follow-up studies on the outcome of these children are needed.

Management of fragility fractures in Switzerland: results of a nationwide survey.

A nationwide survey was conducted in Switzerland to assess the quality level of osteoporosis management in patients aged 50 years or older presenting with a fragility fracture to the emergency ward of the participating hospitals. Eight centres recruited 4966 consecutive patients who presented with one or more fractures between 2004 and 2006. Of these, 3667 (2797 women, 73.8 years old and 870 men, 73.0 years old in average) were considered as having a fragility fracture and included in the survey. Included patients presented with a fracture of the upper limbs (30.7%), lower limbs (26.4%), axial skeleton (19.5%) or another localisation, including malleolar fractures (23.4%). Thirty-two percent reported one or more previous fractures during adulthood. Of the 2941 (80.2%) hospitalised women and men, only half returned home after discharge. During diagnostic workup, dual x-ray absorptiometry (DXA) measurement was performed in 31.4% of the patients only. Of those 46.0% had a T-score < or =-2.5 SD and 81.1% < or =-1.0 SD. Osteoporosis treatment rate increased from 26.3% before fracture to 46.9% after fracture in women and from 13.0% to 30.3% in men. However, only 24.0% of the women and 13.8% of the men were finally adequately treated with a bone active substance, generally an oral bisphosphonate, with or without calcium / vitamin D supplements. A positive history of previous fracture vs none increased the likelihood of getting treatment with a bone active substance (36.6 vs 17.9%, ? 18.7%, 95% CI 15.1 to 22.3, and 22.6 vs 9.9%, ? 12.7%, CI 7.3 to 18.5, in women and men, respectively). In Switzerland, osteoporosis remains underdiagnosed and undertreated in patients aged 50 years and older presenting with a fragility fracture.

Citizen Jane : exploring the relationship between gender and cellular phones in societies of control

In this thesis, I argue that the mutually productive relationship between women (as gendered subjects) and cellular phone technology is one of control. Women use cellular phones to organize, manage and otherwise control the multiplicity of tasks required of them on a daily basis. At the same time, through using cell phones, women participate in regimes of control including surveillance and persistent connection. I explore this relationship at the level of everyday practice, and conclude by speculating about this relationship at a wider level of social control and organization. This argument emerges from the critical approach suggested by Slack and Wise (2005), who argue that technology and culture are inseparable. They provide articulations and assemblages as tools of analysis. I situate this analysis more broadly within Foucault's (1991) work on govemmentality, in its modem form of societies of control (Deleuze, 1995b).

Childlessness in a child-centered environment : the experiences of voluntarily childless female teachers /

In the literature on voluntary childlessness there is a lack of research on the types of occupations held by women who choose not to mother and how their fertility choice influences their occupational experiences. At the same time, the experience ofwomen with regard to the childfree choice has not been adequately addressed in contemporary feminist literature. In the field of education, much has been written about the association between mothering and teaching. Thus, childfree teachers become particularly interesting since they made seemingly paradoxical choices in that they chose not to bear and rear children yet they chose an occupation in which they are surrounded by and responsible for the daily care of many children. To gain an understanding of the work-related experiences of childfree women, in-depth interviews were conducted with 7 voluntarily childless female elementary school teachers from Southern Ontario. In addition, a focus group interview in which 3 of the 7 childfree teachers participated was conducted. Findings revealed that these women's "choice" to be childless was the result of complex circumstances and multiple motivations. Also, despite their decision to forgo the traditional female role of mother, these women held surprisingly conventional beliefs with regard to family and gender roles. In addition, these childfree women at times identified themselves as mother-like when teaching, yet at other times distanced themselves as teachers from mothers. Finally, results showed that these women experienced both direct and indirect pronatalist pressures outside as well as inside the workplace as a result of their childfree status.

Factors affecting a woman's decision to leave an abusive relationship : the theory of planned behaviour /

The present study tested the appHcabiUty of Ajzen's (1985) theory of planned behaviour (TPB), an extension of Fishbein and Ajzen's (1975) theory of reasoned action (TRA), for the first time, in the context of abused women's decision to leave their abusive relationships. The TPB, as a means of predicting women's decision to leave their abusive partners' was drawn from Strube's (1988, 1991) proposed decision-making model based on the principle that the decision-making process is a rational, deliberative process, and regardless of outcome, was a result of a logical assessment of the available data. As a means of predicting those behaviours not under volitional control, Ajzen's (1985) TPB incorporated a measure of perceived behavioural control. Data were collected in two phases, ranging from 6 months to 1 year apart. It was hypothesized that, to the extent that an abused woman held positive attitudes, subjective norms conducive to leaving, and perceived control over leaving, she would form an intention to leave and thus, increase the likelihood of actually leaving her partner. Furthermore, it was expected that perceptions of control would predict leaving behaviour over and above attitude and subjective norm. In addition, severity and frequency of abuse were assessed, as were demographic variables. The TPB failed to account significantly for variability in either intentions or leaving behaviour. All of the variance was attributed to those variables associated with the theory of reasoned action, with social influence emerging as the strongest predictor of a woman's intentions. The poor performance of this model is attributed to measurement problems with aspects of attitude and perceived control, as well as a lack of power due to the small sample size. The insufficiency of perceived control to predict behaviour also suggests that, on the surface at least, other factors may be at work in this context. Implications of these results, and recommendations such as, the importance of obtaining representative samples, the inclusion of self-esteem and emotions as predictor variables in this model, a reevaluation of the target behaviovu" as nonvolitional, and longitudinal studies spanning a longer time period for future research within the context of decision-making are discussed.

Wrap around analysis of the affordances and constraints for girls with physical disabilities participating in physical activities /

This is a qualitative study exploring the physical activity patterns of a group of women with physical disabilities through their lifespan. In-depth interviews were done with a group of 6 women aged 1 9 to 3 1 . The data were analyzed via content and demographic strategies. Participants in this study reported that their physical activity patterns and their experiences related to their physical activity participation changed over their lives. They were most physically active in their youth (under 14 years of age) and as they reached high school age (over 14 years of age) and to the present time, they have become less physically active. They also reported both affordances and constraints to their physical activity participation through their lifespan. In their youth, they reported affordances such as their parents' assistance, an abundance of available physical activity opportunities, and independent unassisted mobility, as all playing an important factor in their increased youth physical activity. In adulthood, the participants' reported less time, fewer opportunities for physical activity, and reliance on power mobility as significant constraints to their physical activity. The participants reported fewer constraints to being physically active in their youth when compared to adulthood. Their reasons for participation in physical activity changed from fun and socialization in their youth instead of for maintenance of health, weight, and function in adulthood. These affordances, constraints and reasons for physical activity participation were supported in the literature.

Women over thirty choosing education as a solution to a problem

This study explored motivations of mid-life women over 30 years old who had returned to school. It sought to fmd whether these women returned to solve a problem arising from life events, whether viewing a problem was related to internal or external motivation, whether this perception was related to having greater coping skills, and whether having greater coping was related to seeking support from internal or external sources. This study examined which emotions were most related to viewing a life event as a problem. Finally, it explored the results of previous research of mid-life women in their role as a student. Women (N==83) from three types of institutions volunteered for this study: a university (N==34), a college (N==28), and an adult education centre (N==21). Participants took home a questionnaire package - a I3-page questionnaire and consent form - that were completed and mailed back to the researcher in pre-paid envelopes. Results showed that women over 30 seek education as a solution to a life event problem. External motivation was related to a life event being a problem (p<.005). There was a significant difference in coping scores between institutions. Moods that were related to viewing a life event as problematic were: anger and depressive moods (p<. 001), fatigue and vigor (p<.O 1), and tension/anxiety (p<.05). Mid-life women students' satisfaction in this role was related to being externally motivated. These women sought support from both internal and external sources, rarely had social interactions with peers, and viewed this role as important, yet, temporary in that it will help them change their lives. Implications ofthe results suggest further exploration ofthe roles of anger and depression in motivating women over 30 to learn and finding ways of directing women to use their emotional intelligence to seek out learning.

Native women, theory and research : contexts and contestations

In this thesis I outline a critical approach to interpreting the considerable academic literature on Aboriginal women in North America. I locate the scholarship concerning Native women within an understanding of three developments related to a philosophy of science: (I) paradigmatic shifts concerning the philosophy of science, (2) materialist-idealist debates and (3) transitions in feminist theory characterized by what is tenned the shift from second to third wave feminism. My exploration of emergent themes suggests that the elements indicated above provide overlapping frameworks within which most scholarship about Indigenous women is positioned. I illustrate my finding that employing critical discourse analysis and postcolonial feminism as both method and theory provides a useful approach in attending to intersecting experiences of 'race, class, and gender.' I view these intersecting experiences as central to the socio-political positioning of Indigenous women within contemporary feminist theorizing. I conclude my thesis by reflecting on the conceptual struggles I experienced in fonnulating and organizing the thesis and the significance of my underlying epistemological position and value-orientation as both a feminist and Native woman.

The impact of social welfare reform and workfare on lone-parent female headed households in the Niagara Region

This thesis explores the impact of recent social welfare reforms on the lives of social assistance recipients. The focus is on single mothers who are dependent on social assistance in a small city in southern Ontario. This detailed examination is complemented with existing case studies in Canada, the United States and New Zealand, as well as aggregate data on poverty in Canada. Participants for the research study were recruited by flyer distribution and referral. Following recruitment, selected participants were scheduled for a tape- recorded interview. The final sample population consists of eight single mothers on social assistance and/or workfare participants. This information is supplemented with interviews from two Ontario Works caseworkers and two Women's Advocates from a local crisis housing organization. This research project is guided by a socialist feminist framework. Evidence from interview participants suggest that single mothers continue to struggle in terms of meeting basic needs, such as food, clothing and medications. Housing for low-income families is a concern expressed by the participants as well as by Women's Advocates who operate within the region. In addition, subsidized housing continues to be problematic in terms of both safety and availability. Recent social welfare refonns (reductions in welfare income and introduction of workfare features) have intensified the economic and social marginalization of these women. Participants, for example, voice concerns about valuing self-evaluation in their Ontario Works and workfare activities. Considerable evidence from interview participants suggest that single mothers remain economically marginalized.

District general orders of Maj.-Gen. Sir Isaac Brock from June 27th, 1812-Oct. 16th, 1812 [and] instructions sent to officers commanding forts / by Maj.-Gen. Brock shortly before the attack on Queenston. --

"Certain of these orders ... have been printed in Col. E. Cruikshank's Documentary history of Niagara." Created on behalf of the Women's Canadian Historical Society of Toronto

Women���s Literary Club of St. Catharines Fonds

The Women's Literary Club of St. Catharines was founded in 1892 by a local author, Emma Harvey (Mrs. J.G.) Currie (1829-1913) and held its last official meeting on February 19, 1994. The Club developed, flourished and eventually waned. After more than one hundred successful years, the last members deposited the Club's archives at Brock University for the benefit of researchers, scholars and the larger community. The ‘object of the Club’ was established as “the promotion of literary pursuits.” The Club was a non-profit social organization composed of predominantly white, upper middle class women from the St. Catharines and surrounding areas. Club meetings were traditionally held fortnightly from March to December each year. The last meeting of the year was a celebration of their Club anniversary. The early meetings of the Club include papers presented and music performed by Club members. The literary pursuits that would dominate the agendas for the entire life of the Club reflected an interest in selected authors, national and local history, classical history, musical performances and current cultural and newsworthy events. For example in 1893 a typical meeting agendas would contain papers on Henry Wadsworth Longfellow, Hawaii, Brook Farm, Miss Louisa May Alcott and “Education of Women 100 years Ago.” Within the first year of the Club’s existence, detailed minute books became the norm and an annual agenda or program developed. The WLC collection contains a near complete set of meeting minutes from 1892 until 1995 and a comprehensive collection of yearly programs from 1983-1967 which members took great care to publish each year. Mrs. Currie brought together a group of women with a shared interest in literature and history, who wanted to pursue that interest in a formal and structured manner. She was well educated and influenced at an early age by her tutor and mentor William Kirby, local historian, writer and newspaper editor from Niagara-on-the-Lake. While Currie’s private education influenced her love of literature and history, the Club movement of the 1890’s offered a more public forum for her to share knowledge and learning with other women. Mrs. Currie was the wife of St. Catharines lawyer, James G. Currie, who also served as a Member of Parliament for the county of Lincoln. Mrs. W.H. McClive, who was also married to a St. Catharines lawyer, worked closely with Currie and they began research into the possibility of a literary Club in St. Catharines. Currie corresponded with a variety of literary Clubs across North America before she and Mrs.McClive tagged onto the momentum of the Club movement and published “A Clarion call for Women of St. Catharines To Form a Literary Club” in the local paper The St. Catharines Evening Journal. in 1892 and asked like Clubs to publish the news of their new Club. The early years of the WLC set the foundation of how the Club meetings and events would unfold for the next 80 plus years. Photos and minutes from the first ten years reveal an excitement and interest in organized Club outings. One particular event, an annual pilgrimage to the homestead of Laura Secord, became a yearly celebration for the Club. Club President, Mrs. Currie’s own personal work on Laura Secord amplified the Club’s interest in the ‘heroine of 1812’ and she allocated the profits from her publication on Secord in order to create a commemorative plaque/monument in the name of Laura Secord. The Club celebrated this event with a regular pilgrimage to this site. The connection felt by Club members and this memorial would continue until the Club’s last meetings. The majority of members in the early years were of the upper middle classes in the growing city of St. Catharines. Many of the charter members were the wives of merchants, business men, lawyers, doctors, even a hatter. Furthermore, the position of president was most often held by a woman with a comprehensive list of interests. This is particularly the case in Isabel Brighty McComb (1876-1941). Brighty who became a member in 1903, became Club president in 1932 and stayed in her post until her death in 1941. Similar to Mrs. Currie, Brighty was a local historian and published 2 booklets on local history. Her obituary indicates her position in the community as an author and involved community member committed to lifetime memberships in the Imperial Order of Daughters of Empire, I.O.D.E., the National Organization of Women, N.O.W. and the United Empire Loyalist Society, as well as the WLC. She was a locally known ‘teacher of elocution’ and a devoted researcher of Upper Canadian history. In a Club scrapbook dedicated to her, the biographical sketch illustrates the professionalism surrounding Brighty. There is very little personal history mentioned and the focus is on her literary works, her published essay, booklets and poetry. This professional focus, evident in both her obituary and the scrapbook, illustrate the diversity of these women, especially in their roles outside of the home. The WLC collection contains a vast array of essay, lectures clippings and scrapbooks from past meetings. Organized predominantly by topic or author, the folders and scrapbooks offer a substantial amount of research opportunity in the literary history of Canada. The dates, scope of topics and authors covered offer historians an exciting opportunity to examine the consumption of particular literary trends, artists and topics within the context of a midsized industrial city in English Canada. This is especially important because the agenda adhered to by the Club was bent on promoting, discussing and reviewing predominantly Canadian material. By connecting when and what these women were studying, scholars many gain a better understanding of the broader consumption and appreciation of literary and social trends of Canadian women outside of publishing and institutional records. Furthermore, because the agendas were set by and for these women, outside of the constructs of an institutionalized canon or agenda, they offer a fresh and on the ground examination of literary consumption over an extensive length of time.

The Impact of Hospital Downsizing on Registered Nurses Displaced from Full -Time Employment

This research identified and explored the various responses of ten women Registered Nurses displaced from full-time employment as staff nurses in general hospitals in southern Ontario. These nurses were among the hundreds in Ontario who were displaced between October 1991 and October 1995 as a result of organizational downsizing and other health care reform initiatives. The purpose of this research was to document the responses of nurses to job displacement, and how that experience impacted on a nurse's professional identity and her understanding of the nature and utilization of nursing labour. This study incorporated techniques consistent with the principles of naturalistic inquiry and the narrative tradition. A purposive sample was drawn from the Health Sector Training and Adjustment Program database. Data collection and analysis was a three-step process wherein the data collection in each step was informed by the data analysis in the preceding step. The main technique used for qualitative data collection was semistructured, individual and group interviews. Emerging from the data was a rich and textured story of how job displacement disrupted the meaningful connections nurses had with their work. In making meaning of this change, displaced nurses journeyed along a three-step path toward labour adjustment. Structural analysis was the interpretive lens used to view the historical, sociopolitical and ideological forces which constrained the choices reasonably available to displaced nurses while Kelly's personal construct theory was the lens used to view the process of making choices and reconstruing their professional identity.

A Masters Student’s Journey: Trying to Balance Two Eyes of Research

This project is about a reflective research journey taken by a Masters student in the Child and Youth Studies Department at Brock University in St. Catharines Ontario. This journey consisted of a mixed method approach using the qualitative method of autoethnography along with the Indigenous research method of storytelling. The research was done using the concept of two-eyed seeing which consisted of trying to balance the two eyes of research: Indigenous and Western. The Non-Aboriginal researcher not only reflected on her own learning journey but also the lessons she learned from the voices of 48 women from Six Nations of the Grand River Territory. Like the trickster character Coyote, the researcher struggled, stumbled and was transformed by this journey.

Relationship between Socio-Demographic Factors and Familial and Partner Pressures to Conceive in HIV-Positive Women in Ontario

This study examined the relationship between socio-demographic factors and family and partner pressure to conceive in women living with HIV in Ontario, Canada. A total of 490 women, aged 18-52 years were included in the study. The HIV Pregnancy Planning Questionnaire was used to collect data on socio-demographic, medical, and pressure variables. Multivariate logistic regression analysis suggest that increased age, years lived in Canada, and living in Toronto were associated with lower odds, and being married and having 0-1 lifetime births were associated with higher odds of family pressure to conceive. Increased age was associated with lower odds, and being married and living in Toronto were associated with higher odds of partner pressure to conceive. Findings suggest that socio-demographic factors influence the fertility decision-making process. Health care providers should consider socio-demographic factors along with medical factors when assisting women living with HIV and their partners to make informed reproductive decisions.