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Objective: Yoga may improve physical function and reduce disease symptoms in adults with rheumatoid arthritis (RA). However, little is known about how patients with RA are practicing yoga in the community. The objective of this qualitative study was to explore community yoga practice characteristics and thoughts about yoga practice for adults with RA. Design: Participants completed a semi-structured telephone interview with open-ended questions. Thematic analysis was used to analyze interview transcripts. Participants: A convenience sample of 17 adults with rheumatologist-diagnosed RA who had participated in yoga within the past year were asked about the decision to start, continue, and stop yoga; the perceived benefits of yoga; components of yoga sessions; and general thoughts about yoga as it relates to RA. Results: Although eight different styles of yoga were practiced, commonalities in yoga class components (such as stretching, strengthening, deep breathing, meditation, and positive messaging from the instructor) reveal examples of preferred types of yoga for patients with RA. Three main themes emerged, each with multiple subthemes: (1) motivators (physical fitness, influence of others, reduced price), (2) barriers (cost, symptom burden, class difficulty), and (3) benefits of yoga practice (mind-body, a tool for coping, pride/achievement, social, and 'yoga meets you where you are'). Conclusion: In this study, patients with RA described how yoga practice helped improve physical and psychosocial symptoms related to their disease. Yoga practice, a dynamic exercise, encompassing many different styles, can provide many benefits for adults with RA; however, yoga may not be beneficial for every adult with RA. [ABSTRACT FROM AUTHOR]

Background Poor sleep during pregnancy has been associated with poorer birth outcomes. High body mass index ( BMI) is often associated with poor sleep, but little is known about the relationship between gestational weight gain and sleep in late pregnancy. The purpose of this study was to evaluate the relationships of both gestational weight gain and pre-pregnancy BMI to objective and subjective measures of sleep during late pregnancy. Methods Pregnant women (n=128) were recruited from prenatal clinics and childbirth classes primarily serving low-income women. Their sleep (disruption and duration) was objectively assessed in their last month of pregnancy with 72 hours of wrist actigraphy monitoring. Their perceived sleep quality was assessed with the Pittsburgh Sleep Quality Index. Pre-pregnancy and late pregnancy height and weight were assessed by self-report and used to calculate BMI and gestational weight gain, which were then grouped into standardized categories. Results Mean Pittsburgh Sleep Quality Index score was 6.8 ± 3.1 (range 2-16). Sixty percent had excess gestational weight gain and it was associated with poorer perceived sleep quality, but was unrelated to objective measures of sleep duration and disruption. Pre-pregnancy BMI was unrelated to all sleep parameters. However, analyses of the interaction of pre-pregnancy BMI and gestational weight gain indicated that excess weight gain was associated with shorter sleep duration and more sleep disruption, but only among women who were overweight before pregnancy. Conclusion Pregnancy is an opportunity to promote long-term women's health with a better understanding of the relationship between weight management and healthy sleep habits. [ABSTRACT FROM AUTHOR]

Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the US report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore the factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transgender women. This secondary analysis is based on data collected from the Symptom and Genetic Study that included a convenience sample of 22 self-identified transgender women, 201 non-transgender men, and 72 non-transgender women recruited in northern California. Self-reported medication adherence was assessed using the AIDS Clinical Trials Group Adherence Questionnaire. Gender differences in demographic and clinical variables were assessed, as were differences between transgender women reporting high and low adherence. Transgender women had lower adherence to medications compared to non-transgender males and non-transgender females (p = .028) and were less likely to achieve viral suppression (p = .039). Within the transgender group, Black/African-Americans reported better adherence than participants who were Whites/Caucasian or other races (p = .009). Adherence among transgender women was unrelated to medication count and estrogen therapy, but consistent with other reports on the HIV population as a whole; transgender women with high adherence were more likely to achieve viral suppression compared to the transgender women with low adherence. Despite the high incidence of HIV infection in the transgender population, few studies focus on TWLWH, either in regard to their adherence to antiretroviral therapies or to their healthcare in general. To address ongoing health disparities, more studies are needed focusing on the transgender population's continuum of care in HIV therapies. [ABSTRACT FROM PUBLISHER]

Purpose: Bladder symptoms are common in women and result in use of healthcare resources and poor quality of life. Bladder symptoms have been linked to age and menopause, but debate exists in the literature. This article examines factors associated with bladder symptoms and compares women in late reproductive stage with those in menopausal transition. Materials and Methods: We analyzed cross-sectional data from a prospective cohort study of midlife women (mean age, 48; range, 44-54 years) in northern California. The sample consisted of 158 women in late reproductive stage or menopause transition. Assessments included anthropometrics, menstrual cycle lengths and symptoms, urine samples for follicle-stimulating hormone level, and self-reported health perception and depressive symptoms. Analyses included descriptive bivariate statistics, group comparisons, and regression models. Results: The most common bladder symptoms were nocturia (72%) at least once per night and urinary incontinence (50%) at least once per week. Incontinence was less prevalent in African American women compared to European Americans and Latinas ( p = 0.001) and more prevalent in late reproductive stage than in menopause transition ( p = 0.024). Controlling for age, women in late reproductive stage were more likely to report nocturia compared to those in menopause transition. Reproductive stage ( p = 0.016), higher body mass index ( p = 0.007), and race ( p = 0.017) contributed to the variance in weekly nighttime urinary frequency. Conclusion: Bladder symptoms were associated with reproductive stage. Women in late reproductive stage were more likely to experience nocturia and incontinence than those in menopause transition. The higher rates of nocturia and incontinence in late reproductive stage are intriguing. Future studies should include analysis of pelvic organ prolapse degree and other structural differences. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence and risk factors for maternal morbidity during childbirth hospitalization. Methods: Maternal morbidities were determined using ICD9-CM and vital records codes from linked hospital discharge and vital records data for 1,572,909 singleton births in California during 2005-2007. Socio-demographic, obstetric and hospital volume risk factors were estimated using mixed effects logistic regression models. Results: The maternal morbidity rate was 241/1000 births. The most common morbidities were episiotomy, pelvic trauma, maternal infection, postpartum hemorrhage and severe laceration. Preeclampsia (adjusted odds ratio [AOR]: 2.96; 95% confidence interval 2.8,3.13), maternal age over 35 years, (AOR: 1.92; 1.79,2.06), vaginal birth after cesarean, (AOR: 1.81; 1.47,2.23) and repeat cesarean birth (AOR: 1.99; 1.87,2.12) conferred the highest odds of severe morbidity. Non-white women were more likely to suffer morbidity. Conclusions: Nearly one in four California women experienced complications during childbirth hospitalization. Significant health disparities in maternal childbirth outcomes persist in the USA. [ABSTRACT FROM AUTHOR]

heilemann m.v., choudhury s.m., kury f.s. & lee k.a. (2012) Factors associated with sleep disturbance in women of Mexican descent. Journal of Advanced Nursing 68(10), 2256-2266. Abstract Aims. The aims were to identify the most useful parameters of acculturation in relation to self-reported sleep disturbance and describe risk factors for sleep disturbance in women of Mexican descent. Background. Little is known about acculturation as a factor for poor sleep in the context of other personal factors such as income or sense of resilience or mastery for Latinas in the United States. Design. This study was a secondary analysis of cross sectional survey data. Methods. Personal factors were incorporated into a modification of the Conceptual Framework of Impaired Sleep to guide our secondary analysis of self-reported sleep disturbance. Data were collected from a convenience sample of 312 women of Mexican descent of childbearing age (21-40 years) located in an urban California community were collected and previously analysed in relation to depressive symptoms and post-traumatic stress disorder. The General Sleep Disturbance Scale (in English and Spanish) was used to assess sleep disturbance. Data was collected in 1998 from September through December. Results. Early socialization to the United States during childhood was the most useful acculturation parameter for understanding self-reported sleep disturbance in this sample. In a multivariate regression analysis, three factors (higher acculturation, lower income and higher depressive symptoms) were statistically significant in accounting for 40% of the variance in sleep disturbance. Conclusion. When low income Latinas of Mexican descent report sleep problems, clinicians should probe for environmental sleep factors associated with low income, such as noise, over-crowding and exposure to trauma and violence, and refer the woman to psychotherapy and counselling rather than merely prescribing a sleep medication. [ABSTRACT FROM AUTHOR]

The article discusses a study that explores maternal experiences of interactions with health care providers related to milk supply concerns in the first month after birth. Findings reveal that interactions with providers were positive for some mothers but others felt pressure, guilt and fear. The study recommends that all providers should have an understanding of how to communicate routine advice before the start of counseling as it can affect maternal breastfeeding decisions.

Mentorship is crucial for academic productivity and advancement for clinical and translational (CT) science faculty. However, little is known about the long-term effects of mentor training programs. The University of California, San Francisco (UCSF), Clinical and Translational Science Institute launched a Mentor Development Program (MDP) in 2007 for CT faculty. We report on an evaluation of the first three cohorts of graduates from the MDP. In 2010, all Mentors in Training (MITs) who completed the MDP from 2007 to 2009 ( n= 38) were asked to complete an evaluation of their mentoring skills and knowledge; all MITs (100%) completed the evaluation. Two-thirds of MDP graduates reported that they often apply knowledge, attitudes, or skills obtained in the MDP to their mentoring. Nearly all graduates (97%) considered being a mentor important to their career satisfaction. Graduates were also asked about the MDP's impact on specific mentoring skills; 95% agreed that the MDP helped them to become a better mentor and to focus their mentoring goals. We also describe a number of new initiatives to support mentoring at UCSF that have evolved from the MDP. To our knowledge, this is the first evaluation of the long-term impact of a mentor training program for CT researchers. Clin Trans Sci 2012; Volume 5: 362-367 [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on the frequency of fatigue experienced by adult patients with HIV/AIDS. According to the authors, the high evening fatigue pattern was linked with anxiety and the high morning pattern was linked with anxiety and depression. They add that the pattern of morning fatigue showed minimal fluctuation compared with the evening pattern showing the largest fluctuation. They indicate that the fatigue was linked with anxiety, depression, and sleep disturbance.

Objective: This observational study aimed to determine the relationship between time of birth and maternal morbidity during childbirth hospitalization.Study Design: Composite maternal morbidities were determined using International Classification of Diseases, Ninth Revision, Clinical Modification and vital records codes, using linked hospital discharge and vital records data for 1,475,593 singleton births in California from 2005 through 2007. Time of birth, day of week, and sociodemographic, obstetric, and hospital volume risk factors were estimated using mixed effects logistic regression models.Results: The odds for pelvic morbidity were lowest between 11 PM-7 AM compared to other time periods and the reference value of 7-11 AM. The odds for pelvic morbidity peaked between 11 AM-7 PM (adjusted odds ratio [AOR], 1101-1500 = 1.07; 95% confidence interval [CI], 1.06-1.09; 1501-1900 = 1.08; 95% CI, 1.06-1.10). Odds for severe morbidity were higher between 11 PM-7 AM (AOR, 2301-0300 = 1.31; 95% CI, 1.21-1.41; 0301-0700 = 1.30; 95% CI, 1.20-1.41) compared to other time periods. The adjusted odds were not statistically significant for weekend birth on pelvic morbidity (AOR, Saturday = 1.00; 95% CI, 0.98-1.02]; Sunday = 1.01; 95% CI, 0.99-1.03) or severe morbidity (AOR, Saturday = 1.09; 95% CI, 1.00-1.18; Sunday = 1.03; 95% CI, 0.94-1.13). Cesarean birth, hypertensive disorders, birthweight, and sociodemographic factors that include age, race, ethnicity, and insurance status were also significantly associated with severe morbidity.Conclusion: Even after controlling for sociodemographic factors and known risks such as cesarean birth and pregnancy complications such as hypertensive disorders, birth between 11 PM-7 AM is a significant independent risk factor for severe maternal morbidity. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Recent public health efforts focus on reducing formula use for breastfed infants during the birth hospitalization. No previous randomized trials report the effects of brief early formula use. The objective of the study was to determine if small formula volumes before the onset of mature milk production might reduce formula use at 1 week and improve breastfeeding at 3 months for newborns at risk for breastfeeding problems. METHODS: We randomly assigned 40 exclusively breastfeeding term infants, 24 to 48 hours old, who had lost ≥5% birth weight to early limited formula (ELF) intervention (10 mL formula by syringe after each breastfeeding and discontinued when mature milk production began) or control (continued exclusive breastfeeding). Our outcomes were breastfeeding and formula use at 1 week and 1, 2, and 3 months. RESULTS: Among infants randomly assigned to ELF during the birth hospitalization, 2 (10%) of 20 used formula at 1 week of age, compared with 9 (47%) of 19 control infants assigned during the birth hospitalization to continue exclusive breastfeeding {P = .01). At 3 months, 15 (79%) of 19 infants assigned to ELF during the birth hospitalization were breastfeeding exclusively, compared with 8 (42%) of 19 controls (P= .02). CONCLUSIONS: Early limited formula may reduce longer-term formula use at 1 week and increase breastfeeding at 3 months for some infants. ELF may be a successful temporary coping strategy for mothers to support breastfeeding newborns with early weight loss. ELF has the potential for increasing rates of longer-term breastfeeding without supplementation based on findings from this RCT. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To describe the percentages of men with and without changes in sexual function from the beginning to end of radiation therapy and evaluate for differences in demographic and clinical characteristics, mood states, and quality of life (QOL) among patients who did and did not experience changes in sexual function.Design: Descriptive, longitudinal.Setting: Two radiation therapy departments in northern California.Sample: 70 men with prostate cancer who underwent primary or adjuvant radiation therapy.Methods: Self-report questionnaires, medical record reviews, and repeated measures analysis of variance.Main Research Variables: Changes in sexual function; depression, anxiety, and QOL.Findings: Patients were categorized into one of four sex groups (No Problem X 2, Problem-No Problem, No Problem-Problem, and Problem X 2) based on their responses to "Is your sexuality impacted by your illness?" at the beginning and end of radiation therapy. About 50% had a problem with sexual function either at the beginning or end of radiation therapy. Overall, men without sexual problems at both the beginning and end of radiation therapy had significantly less anxiety and depression and higher QOL scores than patients who developed a problem at the end and patients who had a problem at both time points.Conclusions: Changes in sexual function during the course of radiation therapy affect patients' mood and QOL.Implications for Nursing: Clinicians should evaluate the effects of radiation therapy on sexual function and monitor patients with prostate cancer for depression and anxiety as well as for changes in QOL. [ABSTRACT FROM AUTHOR]

The objective of this qualitative study was to examine extrinsic barriers to substance abuse treatment among pregnant and parenting women enrolled in residential perinatal substance abuse treatment programs in Northern California. Life history interviews were conducted with 36 women to examine help-seeking behaviors before treatment enrollment. Data analysis used the analytic framework of Mandelbaum (1973) to describe dimensions, turnings, and adaptations of participants. Results indicated that the majority (n = 34) of participants sought prenatal care but identified fear of punitive actions from helping insitutions and individuals as a major barrier. Other extrinsic barriers included substance abuse treatment program barriers, partners, the status of opiate dependency, and the status of pregnancy. Biological, socio-cultural, and psychosocial dimensions of participants' care-seeking experiences were identified. The turning was pregnancy and adaptations included preserving the family, managing fear and manifesting faith. Findings describe the transformation of the therapeutic alliance and the gendered impact of two decades of the War on Drugs in the United States. Participants' coping strategies suggest that the desire for child custody and concern for fetal and child well-being was a priority and motivated care seeking despite extrinsic barriers perceived to be threatening to the woman's safety and autonomy. [ABSTRACT FROM AUTHOR]

Up to 50% of people living with HIV have some neurocognitive impairment. We examined associations of sleep and fatigue with self-reported cognitive problems in 268 adults living with HIV. Multivariate regression was used to examine associations between cognitive problems, self-reported sleep quality, actigraphy-measured total sleep time and wake after sleep onset, and fatigue severity. Poorer self-reported sleep quality (p < .001), short or long total sleep time (<7 or >8 vs. 7-8 hours, p = .015), and greater fatigue (p < .001) were associated with lower self-reported cognitive function scores after controlling for demographic and clinical characteristics. However, objective measure of wake after sleep onset was unrelated to self-reported cognitive function scores. Findings suggest that assessing and treating poor sleep and complaints about fatigue would be areas for intervention that could have a greater impact on improving cognition function than interventions that target only cognitive problems., (Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this experimental pilot study was to measure the effects of a mindfulness-based yoga intervention on sleep in pregnant women., Methods: Fifteen healthy, nulliparous women in their second or third trimesters with singleton pregnancies attended weekly mindfulness meditation and prenatal Hatha yoga classes in the community for 7 weeks. Sleep variables, as estimated by 72 hr of continuous wrist actigraphy and the General Sleep Disturbance Scale (GSDS), were recorded at baseline (Time 1) and postintervention (Time 2). Control data were obtained by evaluating sleep in the third-trimester group at Time 1. Due to small sample size, data were analyzed using parametric and nonparametric statistics., Results: Women who began the intervention in the second trimester had significantly fewer awakenings, less wake time during the night, and less perceived sleep disturbance at Time 2 than at baseline. Those who began during the third trimester had poorer sleep over time in spite of the intervention. Women who began the intervention in their second trimester had less awake time at Time 2 compared to third-trimester controls at Time 1., Conclusions: Mindful yoga shows promise for women in their second trimester of pregnancy to diminish total number of awakenings at night and improve sleep efficiency and merits further exploration. Results from this pilot study provide the data to estimate sample size and design and implement powered and more controlled studies in the future.

Objective: To examine socioeconomic status (SES) as a risk factor for depressive symptoms in late pregnancy and the early postpartum period. A secondary objective was to determine whether SES was a specific risk factor for elevated postpartum depressive symptoms beyond its contribution to prenatal depressive symptoms., Design: Quantitative, secondary analysis, repeated measures, descriptive design., Setting: Participants were recruited from paid childbirth classes serving upper middle class women and Medicaid-funded hospitals serving low-income clients in Northern California., Participants: A sample of 198 first-time mothers was assessed for depressive symptoms in their third trimester of pregnancy and at 1, 2, and 3 months postpartum., Main Outcome Measure: Depressive symptoms were measured with the Center for Epidemiological Studies-Depression (CES-D) Scale., Results: Low SES was associated with increased depressive symptoms in late pregnancy and at 2 and 3 months, but not at 1 month postpartum. Women with four SES risk factors (low monthly income, less than a college education, unmarried, unemployed) were 11 times more likely than women with no SES risk factors to have clinically elevated depression scores at 3 months postpartum, even after controlling for the level of prenatal depressive symptoms., Conclusion: Although new mothers from all SES strata are at risk for postpartum depression, SES factors including low education, low income, being unmarried, and being unemployed increased the risk of developing postpartum depressive symptoms in this sample., (Copyright 2010 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate for differences in subjective and objective measures of sleep between physically active and inactive female family caregivers of oncology patients at the initiation of their spouses' radiation therapy and evaluate for differences in demographic, clinical, and symptom characteristics between women in the 2 activity groups., Design: Descriptive, cross-sectional study., Setting: Two radiation treatment centers., Participants: Female family caregivers of patients who began radiation therapy for prostate, lung, or brain cancer., Methods: Women were categorized as inactive (n=38) or active (n=30) based on self-report ratings of activity over a period of 2 days. Activity groups were compared on demographic and clinical characteristics, self-reported measures of sleep and other symptoms, and objective measures of sleep using wrist actigraphy., Results: Inactive women had a higher number of comorbid conditions, lower levels of attentional function, less self-reported sleep time, a longer sleep onset latency, and a higher percentage of daytime sleep as measured by actigraphy compared with active women., Conclusions: Inactivity in female family caregivers of oncology patients is associated with poorer self-reported sleep and decreased attentional function.

This research describes interpersonal violence (IPV) exposure in a community-based sample of midlife women from three ethnic groups and explores relationships among these exposures and variables associated with health outcomes. IPV, physical health, depression, and social support were measured by self-report questionnaires. More than 33% reported a history of physical abuse or sexual abuse and at least 20% reported both. Approximately 20% experienced sexual harassment in the past year. IPV exposure was associated with more chronic health problems and depressive symptoms. IPV, whenever it occurs, is detrimental to women's health regardless of socioeconomic status or ethnicity.

Objective: To describe sleep characteristics in high-risk antepartum inpatients., Design: Prospective descriptive design., Setting: Tertiary hospital in southern California., Participants: A convenience sample of 39 antepartum women., Methods: Data were collected from participants' medical records, questionnaires (General Sleep Disturbance Scale), actigraphy on days 3 to 4 after admission, and a sleep diary that included reasons for awakening and morning and evening fatigue ratings., Results: Week gestation ranged from 24 to 35 weeks. Sleep time varied from 310 to 492 minutes and averaged 6.7 hours/night. The women were awakened 9 to 32 times/night and averaged 18 awakenings. They napped an average of 124 minutes throughout the day. Women averaged 3.9 on the General Sleep Disturbance Scale when retrospectively considering 7 days before hospitalization and scored 4.1 when considering the current 3 days of hospitalization. In the diary, most rated their sleep quality as Fairly Good or Very Good (62%-71%), but 29% said Very Bad on night 2, and 38% said Very Bad on night 3., Conclusion: Frequent interruptions during the night do not allow for mothers to receive the restorative sleep they need.

Whereas few studies with Latina samples include strength factors (resilience, mastery, life satisfaction, and perceived energy level) as variables, even fewer include strength factors together with acculturation in the same study. As part of a larger study, the purpose of this analysis is to describe and examine the relationships between strength factors, risk factors such as acculturation and substance use, resource factors including financial adequacy and education, and the health and illness factor of perceived health status among a convenience sample of 315 low-income women of Mexican descent, ages 21 to 40. Cross-sectional survey data were collected and analyzed. Results show intragroup differences related to the well-being of women of Mexican descent living with low incomes in urban settings.

Purpose: The purpose of this study was to examine the reasons midlife women report for changing healthcare providers and to determine if there were any differences in reasons given for the change based on gender or ethnicity., Data Sources: This was an analysis of data collected from a healthy community-based sample of midlife women as part of a longitudinal 5-year study of changes in health outcomes during transition to menopause. Women were queried about their experience in changing healthcare providers., Conclusions: Over 42% indicated that they had changed health providers because of dissatisfaction with care. The component accounting for the majority of the variance was related to communication issues. There were no significant differences across ethnic groups in decision to change providers or in reasons for their dissatisfaction with care. However, their reports of experiencing racism in the healthcare system were troubling., Implications for Practice: The ability of the provider to communicate with women may have implications in women's choices in health care later in life.

Background: The majority of research related to depression among women of Mexican descent has focused on risk factors and resources without considering intrinsic strength factors that may have a protective function. An additional focus on mastery, resilience, and life satisfaction will expand the context for understanding the mental health of women of Mexican descent., Objectives: This study describes the level of depressive symptoms experienced by low-income women of Mexican descent living in an urban community in northern California and compares the level of symptoms by exposure to the United States (US) during childhood. Rather than focus only on negative demographic characteristics (such as lower socioeconomic status) associated with high levels of depressive symptoms, this study also focused on strengths and resources that may minimize or modify depressive symptoms., Methods: Questionnaires were completed by a cross-sectional convenience sample of 315 women of Mexican descent, aged 21-40 years. Data were analyzed using descriptive statistics and multiple regression., Results: Women who spent all of their childhood years in Mexico before coming to the US had a lower level of depressive symptoms (p <.05) and more satisfaction with life than women who were exposed to the US in childhood (p =.001). While income, adequacy of financial resources, partner status, alcohol use, and childhood exposure to the US accounted for 13% of the variance in depressive symptoms, intrinsic strength factors such as mastery, life satisfaction, and resilience accounted for an additional 31% of the variance (p <.001)., Discussion: Although intrinsic strength factors have rarely been included in research related to depression in women of Mexican descent, they were more directly related to lack of depressive symptoms than traditional demographic risk factors.