Self-selected Women Research Articles

Dancing toward Well-Being: Effects on Mood and Well-Being of a 12-Week Flamenco Dance Workshop in Women Aged 60–80 Years

The objective of this study was to examine the effect of a flamenco dance program on the mood and subjective well-being of 34 self-selected women from the community, aged between 62 and 79 years. The mean age was 70.11 (SD = 5.13). Participants voluntarily enrolled in a 12-week flamenco dance workshop conducted by the Autoestima Flamenca Association, with one two-hour session per week. Every two weeks, mood measurements (sadness, anxiety, anger and joy) were taken, and subjective well-being assessments were conducted before and after each session. It was found that the participants’ overall mood and subjective well-being improved significantly following the intervention. These improvements were observed at both the individual and group levels. Overall, our findings suggest that participation in a free 12-week flamenco dance program had a positive impact on mood and subjective well-being in this segment of the population.

Dreams prior to biopsy for suspected breast cancer: A preliminary survey

Warning dreams prior to the onset of symptoms have been reported in a previous survey of self-selected women with breast cancer. There is no available data on how many women with suspected breast cancer have such dreams, so anonymous surveys were offered to women who came for biopsy at a university breast imaging center over a period of 3 months. 163 women completed the survey reporting that 64% usually remember their dreams, 41% have had dreams that came true, and 5% keep a dream diary. 5.5% reported dreaming the word “cancer,” but only one woman was prompted to have a breast evaluation because of a dream. This pilot data will be used in planning a future study with pathological correlation.

Age shock: misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40

What do older women understand of the relationship between age and fertility prior and subsequent to delivering their first child? Women who were first-time parents over the age of 40 did not accurately perceive the relationship between age and fertility prior to conceiving with IVF. While increases in women's age at their first birth have been most pronounced in relatively older women, the rapidity of fertility decline is not appreciated by most non-infertility specialist physicians, the general public or men and women who are delaying childbearing. Qualitative retrospective interviews were conducted from 2009 to 2011 with 61 self-selected women who were patients in one of two fertility clinics in the USA. All participants had delivered their first child following IVF when the woman was 40 years or older. The data include women's responses to the semi-structured and open-ended interview questions 'What information did you have about fertility and age before you started trying to get pregnant?' and 'What did you learn once you proceeded with fertility treatment?' Of the women, 30% expected their fertility to decline gradually until menopause at around 50 years and 31% reported that they expected to get pregnant without difficulty at the age of 40. Reasons for a mistaken belief in robust fertility included recollections of persistent and ongoing messaging about pregnancy prevention starting in adolescence (23%), healthy lifestyle and family history of fertility (26%), and incorrect information from friends, physicians or misleading media reports of pregnancies in older celebrity women (28%). Participants had not anticipated the possibility that they would need IVF to conceive with 44% reporting being 'shocked' and 'alarmed' to discover that their understanding of the rapidity of age-related reproductive decline was inaccurate'. In retrospect, their belated recognition of the effect of age on fertility led 72% of the women to state that they felt 'lucky' or had 'beaten the odds' in successfully conceiving after IVF. Of the women, 28% advocated better fertility education earlier in life and 23% indicated that with more information about declining fertility, they might have attempted conception at an earlier age. Yet 46% of women acknowledged that even if they had possessed better information, their life circumstances would not have permitted them to begin childbearing earlier. Both the self-selected nature of recruitment and the retrospective design can result in biases due to memory limitations or participant assimilation and/or contrast of past events with current moods. The cohort did not reflect broad homogeneity in that the participants were much more likely to be highly educated, Caucasian and better able to pay for treatment than national population norms. As attitudes of older women who were unsuccessful after attempting IVF in their late 30s or early 40s are not represented, it is possible (if not likely) that the recollections of women who did not conceive after IVF would have been more strongly influenced by feelings of regret or efforts to deflect blame for their inability to conceive. While the failure to appreciate the true biological relationship between aging and fertility may be common and may reflect inaccessibility or misinterpretation of information, it is not sufficient to explain the decades-long socio-demographic phenomenon of delayed childbearing.

‘It’s not just a pap-smear’: Women speak of their experiences of hospital treatment after miscarriage

This exploratory study sought to investigate how a small sample of self-selected women attending hospital for a miscarriage in the first 20 weeks of pregnancy experienced the treatment they received. Six women who had a miscarriage between June 2006 and December 2007, and sought treatment at six Melbourne metropolitan hospitals, participated in semi-structured interviews during August–September 2008. Thematic analysis revealed that participants perceived hospital responses to miscarriage to be inadequate. Findings suggested that there was no consistent response, there was little compassion or acknowledgement of the miscarriage and that information provision was largely absent; social workers were rarely involved. Participants indicated that they wanted a more consistent and specialized hospital response, with timely access to diagnostic testing equipment as necessary, the offer of social work, information provision and staff to be compassionate in their care and to acknowledge their pregnancy loss.

Patient Satisfaction of BRCA1/2 Genetic Testing by Women at High Risk for Breast Cancer Participating in a Prevention Trial

With the increasing availability of cancer risk counseling and genetic testing, we need to determine the most effective way to provide complex and sensitive information to patients. This study was designed to determine the satisfaction of results delivery in women who participated in a breast cancer prevention trial and chose to undergo free and confidential BRCA1/2 genetic testing. Self-selected women at high-risk for breast cancer who were eligible to participate in a phase II chemoprevention trial, were offered free and confidential pre-test counseling and BRCA1/2 full sequencing. Subjects were not randomized but rather had the option of in person or telephone results disclosure. Those subjects with an identified germline alteration were required to follow-up with an in person consultation; this was optional for those with a negative result. A satisfaction survey was mailed to subjects after receiving their results. Ninety-seven percent (116/119) of the eligible subjects underwent genetic testing. Ninety-one percent (105/116) of those women tested responded to the follow-up survey. Twenty-four of the 26 women with an identified germline alteration responded. Nearly all of the responders were satisfied with the counseling and testing process. All of the respondents felt they made a wise decision in having the testing and would recommend that other women in a similar situation undergo genetic testing. We found that the majority of women at high risk for breast cancer participating in a prevention trial will choose to undergo anonymous and free BRCA1/2 genetic testing, be informed of the results, and are accepting of receiving results initially by phone.

Self-Selected Women With Polycystic Ovary Syndrome Are Reproductively and Metabolically Abnormal and Undertreated

There is at present no uniformly agreed upon definition of polycystic ovary syndrome (PCOS), and variation in the diagnostic criteria used has limited the development of effective interventions. This study, carried out in44 women who identified themselves as having PCOS and 80 control women, was aimed at determining the prevalence of hyperandrogenemia, menstrual irregularity, and insulin resistance in the former group. Hormonal and other medications were continued during the study, but the participants fasted. The control and study groups were matched for age, body weight, ethnicity, and lack of a personal or family history of hypertension and diabetes. PCOS had been most often diagnosed from ovarian morphology as determined by ultrasonography or laparoscopy, followed by blood tests, the history, and physical factors. Fasting levels of 17a-hydroxyprogesterone were normal except for a woman with atypical congenital adrenal hyperplasia. All study women had normal prolactin levels. Women in the PCOS group had significantly elevated blood pressures and increased waist-hip ratios compared with control women, and they were twice as likely to have a history of irregular menses. Nulliparity also was more prevalent in the women with self-selected PCOS, and they had used fertility measures more often in an attempt to conceive a child. Study women were relatively hyperandrogenemic and also had significantly elevated levels of luteinizing hormone (but not follicle-stimulating hormone). Multiple metabolic abnormalities noted in study women included increases in fasting insulin, total cholesterol, and low-density lipoprotein cholesterol as well as a decrease in fasting high-density lipoprotein cholesterol. None of the women were receiving treatment specific for these metabolic abnormalities. Women who claim to have PCOS are highly likely to have appropriate symptoms and signs, and they deserve a full workup for the reproductive and metabolic alterations associated with this condition.

Self-selected women with polycystic ovary syndrome are reproductively and metabolically abnormal and undertreated

Objective: To determine whether self-selected women with polycystic ovary syndrome (PCOS) are abnormal compared with a control population. Design: Case-control. Setting: Support group meeting organized and initiated by patients. Patient(s): Forty-five self-selected women with PCOS and 80 control women. Intervention(s): Self-selected women with PCOS at a peer support conference completed a questionnaire, had a brief physical, and gave a fasting blood sample. Main Outcome Measure(s): Historical, biometric, and assay results. Result(s): Sixty percent of the women attending the conference participated in the study. Most had been diagnosed with PCOS on the basis of ovarian morphology (35%). They were more likely to be nulliparous and have a history of oligomenorrhea (96%). They were hyperandrogenemic (significantly elevated testosterone and DHEAS levels) compared with control women. Self-selected women with PCOS displayed multiple metabolic abnormalities compared with control women, including elevations in blood pressure, waist-hip ratio, fasting insulin, fasting total cholesterol, and fasting low-density lipoprotein cholesterol levels, as well as a significant decrease in fasting glucose-insulin ratio and high-density lipoprotein cholesterol levels. Conclusion(s): Self-selected women with PCOS have reproductive and metabolic abnormalities. The majority of these women received inadequate treatment despite having risk factors for endometrial cancer, diabetes, and/or heart disease. Our study also suggests that women attending or participating in a PCOS support group are willing and likely to participate in clinical studies.

Breast complaints and risk of breast cancer. Population-based study of 2,879 self-selected women and long-term follow-up

The aim of this study was to provide information about risk of breast cancer (BC) in women with breast complaints undergoing spontaneously clinical examination. The records of 2,879 self-selected symptomatic new patients observed consecutively were reviewed, and the chief breast complaint such as pain, lump and nipple discharge had been recorded. Patients were divided in three groups: Group A, 1,186 (41.2%) patients aged < 41 years; Group B, 809 (28.1%) patients aged 41–55 years; and Group C, 884 (30.7%) patients aged > 55 years. Pain was most common ( P < 0.01) in Group A (60.8%), and lump in Groups B (53.3%) and C (89.7%). A total of 318 (11.0%) women had histologically confirmed BC (Group A = 3.5%, Group B = 30.5%, Group C = 66.0%), accounting for 3.2, 16.4 and 12.0% of patients with pain, lump and nipple discharge, respectively. Breast complaints were equally ( P = NS) distributed between patients with and without BC. The relative risk (RR) of BC developing ranged between 0.5–1.4, 0.5–1.9, and 0.6–3.0 in Groups A, B, and C, respectively. It ranged between 0.3 and 0.7 in patients with breast pain, and was significantly higher (RR = 1.9–3.0) only in patients with breast lump aged > 40 years. In conclusion, in symptomatic patients BC risk is strictly related to age, and independent of the referred symptoms. Therefore, further investigations have to be warranted only when risk factors different from breast complaints are present.

"Anybody's child": severe disorders of mother-to-infant bonding.

This paper describes severe, disorders of maternal affection and behaviour and suggests that there is an early process of mother-to-infant bonding which can go seriously wrong. Forty-four self-selected women who had suffered from at least one episode of postnatal mental illness described an unexpected and often catastrophic failure to love one or more of their babies. These women reported absent affection, sometimes hate, rejection, neglect or impulses to harm, in relation to at least one of their children. These feelings often began immediately or very shortly after the birth, and with one exception, were specific to one child; such characteristics are best encapsulated by the term 'maternal bonding disorder'. Twenty-nine of the women were multiparae; first-borns were not significantly more likely to be the focus for such feelings. There was no direct evidence of predisposing maternal personality traits or previous experiences. Postnatal mental illness and recalled severe pain during labour were significantly associated with such disorders which, in their severe forms, did not occur in the absence of postnatal mental illness. The nature of the link between postnatal mental illness and disorders of maternal bonding remains unclear. Because, in multiparae, the disorder often 'missed' the first child, factors such as maternal personality traits or early childhood experiences cannot be regarded as sufficient causes.

Effectiveness of the non-spermicidal fit-free diaphragm

Standard instructions for diaphragm use call for an individually sized latex diaphragm, used in conjunction with spermicide jelly. However, some investigators have reported that the diaphragm can be effective without a spermicide. A non-randomized trial designed to measure the contraceptive effectiveness of the diaphragm used without spermicide was conducted. A total of 110 self-selected women were enrolled to use a non-spermicide fit-free (60mm) diaphragm for a period of one year. They were advised to wear the diaphragm continuously, removing it once each day for washing but not within six hours after intercourse. Product-related problems related to insertion, retention and removal were few at both the 6- and 12-month follow-up visits, most commonly odor. The 12-month life table accidental pregnancy rate during typical use was 24.1 per 100 women (29.5 per 100 women without female barrier experience and 17.9 per 100 women with barrier experience). Over 85% of the women who returned for follow-up visits reported using the diaphragm during every act of intercourse. Until better data refute the traditional recommendations, users should be advised to add spermicide to fitted latex diaphragms.

Self-management of urinary incontinence among women 31 to 50 years of age.

In this exploratory and descriptive study, the self-management of urinary incontinence among women 31 to 50 years old is described. Eight self-selected women participated in unstructured tape-recorded interviews that were guided by an interest in understanding women's perceptions about their incontinence. Self-management comprised five specific methods: (a) modifying or avoiding the activities that cause involuntary leaking of urine, (b) keeping the bladder empty, (c) avoiding or limiting beverages that stimulate voiding, (d) wearing protective pads, and (e) doing exercises to strengthen the pelvic floor muscles. Successful self-management was characterized by perceptions of control and normality; unsuccessful self-management by perceptions of noncontrol and abnormality and a consideration of medical management. Three types of medical encounters experienced by participants are described. The study indicates that participants responded differently to two temporal stages in their development of incontinence, and this difference affected how incontinence was managed at the time. The implications of this finding for nursing practice and nursing research are discussed.

The mammographic breast pattern and oral contraception

The relationship of oral contraceptive usage to breast parenchymal patterns has been studied in 5319 self-selected women presenting to a breast screening unit. Among premenopausal women, 46.1% had taken an oral contraceptive ("the pill") in the past, and 9.5% were still taking the pill. These patients showed a decreased incidence of P2 patterns and an increased incidence of N1 patterns. Of the post-menopausal women, 14.7% had been on the pill. Similar differences of incidence of parenchymal patterns are noted in these women. The significance of these changes is unclear.

Mammographic and pathological correlations in a breast screening programme

Mammography was performed as a screening procedure on 5000 self-selected women aged between 35 and 60 years. The biopsy rate, on areas regarded as suspicious of malignancy, was 2.58% with cancer being found on histology in 18.6% of biopsied cases. Aggregated microcalcification alone was the commonest indication for biopsy but was never associated with carcinoma when all the visible foci of calcification were rounded in form. However, benign disease sometimes occurred with irregular foci of calcification. Rounded mass lesions, mostly, but not entirely, well defined, provided the second commonest indication for biopsy but were benign in the vast majority of cases. Generally ill-defined masses were often malignant when associated with microcalcification and/or spiculation. Localised ductal dilatations, with or without microcalcification, were always benign in this series. Architectural distortion was uncommon but was associated with carcinoma in each of the two cases. Spiculation was a reliable, but not invariable, indicator of malignancy. The significance of these radiological and pathological correlations is discussed with regard to case management.

Evidence of breast cancer mortality reduction: aggressive screening in women under age 50.

Five year follow-up data for breast cancer screening of 10,531 self-selected women are presented. The data are compared with the Health Insurance Plan of New York population and it appears that the magnitude of the mortality reduction in these two populations is similar. However, contrary to the New York findings, the data demonstrate that the benefit to screening this population was maximal in women under age 50. No breast cancer deaths have been recorded in 5 years of follow-up in this younger population (6,030 individuals). Interpretation of the data is that aggressive screening for breast cancer can favorably alter breast cancer mortality, particularly in younger women.

Analysis of clinically occult and mammographically occult breast tumors

Findings by xeromammography and clinical examination were compared in 16,000 self-selected women aged 45-64 who participated in a voluntary breast cancer screening program. A total of 138 malignancies were detected: 108 (78%) by mammography and 78 (57%) by clinical examination. Mammography was more effective for large breasts, fatty breasts, and in older women. Conversely, clinical examination was more effective for small breasts, dense breasts, and retroareolar lesions. Clinical detection decreased strikingly for lesions with negative lymph nodes, in situ and microinvasive lesions, deeply situated lesions, and lesions where microcalcifications were the sole mammographic finding.