Factors associated with induced abortion over time: secondary data analysis of five waves of the Australian Longitudinal Study on Women's Health.

OBJECTIVE: A trend analysis of associations with induced abortion. METHODS: Secondary analysis of the 1973/78 cohort of the Australian Longitudinal Study of Women's Health of women responding to two or more consecutive surveys out of five (N=9,042), using generalised estimating equations. RESULTS: New abortions dropped from 7% to 2% at surveys 4 and 5. By survey 5, 16% of respondents reported abortions, only 2% of them new. Women aged in their twenties were more likely to terminate a pregnancy if they reported less-effective contraceptives (aOR2.18 CI 1.65-2.89); increased risky drinking (aOR1.65 CI 1.14-2.38); illicit drugs ≤12 months (aOR3.09 CI 2.28-4.19); or recent partner violence (aOR2.42 CI 1.61-3.64). By their thirties, women were more likely to terminate if they reported violence (aOR2.16 CI 1.31-3.56) or illicit drugs <12 months (aOR2.69 CI 1.77-4.09). Women aspiring to be fully- (OR1.58 CI 1.37-1.83) or self-employed (OR1.28 CI 1.04-1.57), with no children (OR1.41 CI 1.14-1.75) or further educated (OR 2.08 CI 1.68-2.57) were more likely to terminate than other women. CONCLUSIONS: Abortion remains strongly associated with factors affecting women's control over reproductive health such as partner violence and illicit drug use. Implications for public health: Healthcare providers should inquire about partner violence and illicit drug use among women seeking abortion, support women experiencing harm and promote effective contraception.

Undergraduate nursing students' attitudes toward mental health nursing.

OBJECTIVES: The purpose of this study was to describe undergraduate nursing students' attitudes toward mental health nursing and how these attitudes influenced their professional career choices in mental health nursing. DESIGN: A descriptive, online survey was utilized to examine students' perceptions of mental health nursing. A total of 229 junior and senior nursing students were recruited from eight nursing colleges in Midwestern United States to participate in this survey. RESULTS: Students of different ages, genders, ethnicities, and nursing programs did not report significantly different perceptions of: (a) knowledge of mental illness; (b) negative stereotypes; (c) interest in mental health nursing as a future career; and (d), and beliefs that psychiatric nurses provide a valuable contribution to consumers and the community. Negative stereotypes were significantly different between students who had mental health nursing preparation either in class (p=0.0147) or in clinical practice (p=0.0018) and students who had not. There were significant differences in anxiety about mental illness between students who had classes on mental health nursing (p=.0005), clinical experience (p=0.0035), and work experience in the mental health field (p=0.0012). Significant differences in an interest in a future career in mental health nursing emerged between students with and without prior mental health experience and between students with and without an interest in an externship program with p-values of 0.0012 and <0.0001, respectively. CONCLUSIONS: The more exposure that students have to mental health nursing through clinical experiences, theory classes, and previous work in the field, the more prepared they feel about caring for persons with mental health issues.

The impact of violence against women on reproductive health and child mortality in Timor-Leste.

OBJECTIVES: To determine differences in reproductive health and infant and child mortality and health between abused and non-abused ever-married women in Timor-Leste. METHODS: Secondary data analysis of Timor-Leste Demographic Health Survey (1,959 ever-married women aged 15-49 years). Associations with violence estimated using multinomial logistic regression adjusted for sociodemographic variables and age of first intercourse. RESULTS: Overall, 45% of ever-married women experienced violence: 34% reported physical only and 11% reported combined physical, sexual and/or emotional violence. Compared to non-abused women, women reporting physical violence only were more likely to use traditional contraception (AdjOR 2.35, 95%CI 1.05-5.26) or report: a sexually transmitted infection (AdjOR 4.46, 95%CI 3.27-6.08); a pregnancy termination (AdjOR 1.42, 95%CI 1.03-1.96); a child who had died (AdjOR 1.30, 95%CI 1.05-1.60), a low birth weight infant (AdjOR 2.08, 95%CI 1.64-2.64); and partially vaccinated children (AdjOR 1.35, 95%CI 1.05-1.74). Women who reported combined abuse were more likely to report: a sexually transmitted infection (AdjOR 3.51, 95%CI 2.26-5.44); a pregnancy termination (AdjOR 1.95, 95%CI 1.27-3.01); few antenatal visits (AdjOR 1.76 95%CI 1.21-2.55); and a child who had died (AdjOR 1.45, 95%CI 1.06-2.00). CONCLUSIONS: Violence exposes women to poor reproductive health, infant and child mortality and poor infant and child health. IMPLICATIONS: Preventing and reducing violence against women should improve women and children's health outcomes in Timor-Leste.

Religion and spirituality: influence on health/risk behavior and cancer screening behavior of African Americans.

In spite of the diversity in the principles, expression and practice, it is believed that significant improvements can occur in the health status of African Americans if health education and outreach efforts are presented and promoted through religious, spiritual and faith-based venues. Several reports published in the peer-reviewed literature address issues related to religion, spirituality and cancer control among African Americans. This growing body of literature describes outcomes of several cancer prevention and control programs designed for and conducted within the African American faith community. However, few efforts have been undertaken to examine the influence of religion and spirituality on health/risk behavior and cancer screening practices of African Americans within the faith community. This report presents the outcomes of an exploratory study undertaken to examine the influence of religion and spirituality on the health/risk behavior and cancer screening practices of African American congregants. Data suggest a need for tailored and targeted health education, outreach and programming among the targeted group of congregants focused specifically on tobacco control, diet and nutrition, exercise and physical activity, weight management, and cancer screening. The same appears to be the case relative to the need for education, outreach and programming focused on communication with primary care providers.

Ionizing radiation induces heritable disruption of epithelial cell interactions.

Ionizing radiation (IR) is a known human breast carcinogen. Although the mutagenic capacity of IR is widely acknowledged as the basis for its action as a carcinogen, we and others have shown that IR can also induce growth factors and extracellular matrix remodeling. As a consequence, we have proposed that an additional factor contributing to IR carcinogenesis is the potential disruption of critical constraints that are imposed by normal cell interactions. To test this hypothesis, we asked whether IR affected the ability of nonmalignant human mammary epithelial cells (HMEC) to undergo tissue-specific morphogenesis in culture by using confocal microscopy and imaging bioinformatics. We found that irradiated single HMEC gave rise to colonies exhibiting decreased localization of E-cadherin, beta-catenin, and connexin-43, proteins necessary for the establishment of polarity and communication. Severely compromised acinar organization was manifested by the majority of irradiated HMEC progeny as quantified by image analysis. Disrupted cell-cell communication, aberrant cell-extracellular matrix interactions, and loss of tissue-specific architecture observed in the daughters of irradiated HMEC are characteristic of neoplastic progression. These data point to a heritable, nonmutational mechanism whereby IR compromises cell polarity and multicellular organization.

Transforming growth factor-beta1 mediates cellular response to DNA damage in situ.

Transforming growth factor (TGF)-beta1 is rapidly activated after ionizing radiation, but its specific role in cellular responses to DNA damage is not known. Here we use Tgfbeta1 knockout mice to show that radiation-induced apoptotic response is TGF-beta1 dependent in the mammary epithelium, and that both apoptosis and inhibition of proliferation in response to DNA damage decrease as a function of TGF-beta1 gene dose in embryonic epithelial tissues. Because apoptosis in these tissues has been shown previously to be p53 dependent, we then examined p53 protein activation. TGF-beta1 depletion, by either gene knockout or by using TGF-beta neutralizing antibodies, resulted in decreased p53 Ser-18 phosphorylation in irradiated mammary gland. These data indicate that TGF-beta1 is essential for rapid p53-mediated cellular responses that mediate cell fate decisions in situ.