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Articles 271 - 300 of 313
Full-Text Articles in Women's Health
El Rol Del Parto Mapuche En El Mundo De La Medicina Moderna / The Role Of Mapuche Birth In A World Of Modern Medicine, Nita Chai
Independent Study Project (ISP) Collection
Research Question: Is there existing demand for Mapuche birth practices and what are the barriers to incorporating them in the Chilean healthcare system? Objective: Analyze the current role of Mapuche birth practicesby determining what is the demand from the Mapuche for their use, describing the quality of communication between Mapuche women andmodern professionals, and identifying the perspectives of modern professionals on Mapuche birth practices. Background: Childbirth is an integral process for the human race. For many indigenous communities, the arrival of a new life holds cultural significance that is recognized through ceremonies during or after childbirth. Chile has implemented health …
The Benefits Of Breastfeeding, Helen L. Byers
The Benefits Of Breastfeeding, Helen L. Byers
Senior Honors Theses
It is important to educate women of childbearing age, their families, and society of the benefits that breastfeeding has over bottle-feeding and formula-feeding. The benefits of breastfeeding are in three main categories. First, the developmental, physical, emotional, and spiritual benefits of the baby will be discussed. Then the physical, emotional, and spiritual benefits for the mother will be talked about along with possible contraindications or difficulties. Finally, the financial benefits of breastfeeding over feeding an infant from the bottle will be discussed as it relates to the family and government. The goal is to persuade that breastfeeding is a superior …
Immigrant Women's Experiences Of Maternity-Care Services In Canada: A Systematic Review Using A Narrative Synthesis, Gina M A. Higginbottom, Myfanwy Morgan, Mirande Alexandre, Yvonne Chiu, Joan Forgeron, Deb Kocay, Rubina Barolia
Immigrant Women's Experiences Of Maternity-Care Services In Canada: A Systematic Review Using A Narrative Synthesis, Gina M A. Higginbottom, Myfanwy Morgan, Mirande Alexandre, Yvonne Chiu, Joan Forgeron, Deb Kocay, Rubina Barolia
School of Nursing & Midwifery
Background: Canada's diverse society and its statutory commitment to multiculturalism means that a synthesis of knowledge related to the healthcare experiences of immigrants is essential to realise the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for the tailoring of services to user needs. We therefore assessed the experiences of immigrant women accessing maternity-care services in Canada. In particular, we investigated the experiences of immigrant women in Canada in accessing and navigating maternity and related healthcare services from conception to 6 months postpartum in Canada. …
Maternal Characteristics And Clinical Diagnoses Influence Obstetrical Outcomes In Indonesia, Asri Adisasmita, Carl V. Smith, Ayman A.E. El-Mohandes, Poppy Elvira Deviany, Judith J. Ryon, Michele Kiely, Quail Rogers-Bloch, Reginald F. Gipson
Maternal Characteristics And Clinical Diagnoses Influence Obstetrical Outcomes In Indonesia, Asri Adisasmita, Carl V. Smith, Ayman A.E. El-Mohandes, Poppy Elvira Deviany, Judith J. Ryon, Michele Kiely, Quail Rogers-Bloch, Reginald F. Gipson
Publications and Research
This Indonesian study evaluates associations between near-miss status/death with maternal demographic, health care characteristics, and obstetrical complications, comparing results using retrospective and prospective data. The main outcome measures were obstetric conditions and socio-economic factors to predict near-miss/death. We abstracted all obstetric admissions (1,358 retrospective and 1,240 prospective) from two district hospitals in East Java, Indonesia between 4/1/2009 and 5/15/2010. Prospective data added socio-economic status, access to care and referral patterns. Reduced logistic models were constructed, and multivariate analyses used to assess association of risk variables to outcome. Using multivariate analysis, variables associated with risk of near-miss/death include postpartum hemorrhage (retrospective …
Uncovering The Concealed Part Of Motherhood-Postpartum Depression In Mothers, Hunaina Hadi, Shamsa Hadi
Uncovering The Concealed Part Of Motherhood-Postpartum Depression In Mothers, Hunaina Hadi, Shamsa Hadi
School of Nursing & Midwifery
Introduction: Motherhood is the most pleasing experience of a woman's life. Birth of a child gives birth to new hopes and ambitions. But Post-partum Depression is a condition when this blessing turns into curse. It can affect the mother, the partner and the child and can even lead to infanticide as well as maternal death, often by suicide.
Method: A qualitative systematic review was conducted through electronic medium to explore the relevant literature. Various databases i.e. Pubmed, Google search engines, Science Direct, JPMA, the Cumulative Index to Nursing and Allied Health Literature CINHAL and SAGA were used. Manual search was …
Developing A Workplace Sexual Violence Framework Related To Women Truck Drivers, Kim Bourne
Developing A Workplace Sexual Violence Framework Related To Women Truck Drivers, Kim Bourne
Nursing Faculty Publications
No abstract provided.
Exploring The Relationships Between Mindfulness And Biobehavioral Factors Associated With Cvd In Women, Susan Ghodrat, Jo Lynne W. Robins
Exploring The Relationships Between Mindfulness And Biobehavioral Factors Associated With Cvd In Women, Susan Ghodrat, Jo Lynne W. Robins
UROP Posters
Purpose: This study examined the relationship between mindfulness and specific biobehavioral factors associated with increased cardiovascular disease risk in women. Design: A secondary data analysis was conducted on baseline data collected in a larger study examining the effects of tai chi on cardiovascular disease risk in women. Subjects: 96 women aged 35-50 years with increased waist circumference and a family history of cardiovascular disease. Measures: Biological measures included: fasting glucose, insulin and lipids, as well as C-reactive protein and cytokines. Behavioral measures included: mindfulness, fatigue, perceived stress, depressive symptoms, social support, self-compassion and spiritual thoughts and behaviors. Results: Mindfulness was …
The Balanced Counseling Strategy Plus: A Toolkit For Family Planning Service Providers Working In High Hiv/Sti Prevalence Settings (Supplemental Material In French), Population Council
The Balanced Counseling Strategy Plus: A Toolkit For Family Planning Service Providers Working In High Hiv/Sti Prevalence Settings (Supplemental Material In French), Population Council
Reproductive Health
The Balanced Counseling Strategy Plus (BCS+) toolkit, developed and tested in Kenya and South Africa, provides information and materials that healthcare providers need to offer complete, high-quality family planning counseling to clients living in areas with high rates of HIV and STIs. Content is in accordance with the 2015 WHO Medical Eligibility Criteria. The BCS+ provides evidence on clinical indications for the provision of family planning methods, counseling cards, instructions for providers, and guidance for supplemental counseling and services that family planning clients may need. The BCS+ includes user's guide, trainer's guide, algorithm, method brochures, and counseling cards. This publication …
The Balanced Counseling Strategy Plus: A Toolkit For Family Planning Service Providers Working In High Hiv/Sti Prevalence Settings, Population Council
The Balanced Counseling Strategy Plus: A Toolkit For Family Planning Service Providers Working In High Hiv/Sti Prevalence Settings, Population Council
Reproductive Health
The Balanced Counseling Strategy Plus (BCS+) toolkit, developed and tested in Kenya and South Africa, provides information and materials that healthcare providers need to offer complete, high-quality family planning counseling to clients living in areas with high rates of HIV and STIs. Content is in accordance with the 2015 WHO Medical Eligibility Criteria. The BCS+ provides evidence on clinical indications for the provision of family planning methods, counseling cards, instructions for providers, and guidance for supplemental counseling and services that family planning clients may need. This publication is the English language version of the user's guide, trainer's guide, algorithm, method …
The Balanced Counseling Strategy Plus: A Toolkit For Family Planning Service Providers Working In High Hiv/Sti Prevalence Settings (With Zika Information), Population Council
The Balanced Counseling Strategy Plus: A Toolkit For Family Planning Service Providers Working In High Hiv/Sti Prevalence Settings (With Zika Information), Population Council
Reproductive Health
The Balanced Counseling Strategy Plus (BCS+) toolkit, developed and tested in Kenya and South Africa, provides information and materials that healthcare providers need to offer complete, high-quality family planning counseling to clients living in areas with high rates of HIV and STIs. Content is in accordance with the 2015 WHO Medical Eligibility Criteria. The BCS+ provides evidence on clinical indications for the provision of family planning methods, counseling cards, instructions for providers, and guidance for supplemental counseling and services that family planning clients may need. This publication is the English language version with Zika information of the user's guide, trainer's …
The Balanced Counseling Strategy Plus: A Toolkit For Family Planning Service Providers Working In High Hiv/Sti Prevalence Settings (Supplemental Material In Dari), Population Council
The Balanced Counseling Strategy Plus: A Toolkit For Family Planning Service Providers Working In High Hiv/Sti Prevalence Settings (Supplemental Material In Dari), Population Council
Reproductive Health
The Balanced Counseling Strategy Plus (BCS+) toolkit, developed and tested in Kenya and South Africa, provides information and materials that healthcare providers need to offer complete, high-quality family planning counseling to clients living in areas with high rates of HIV and STIs. Content is in accordance with the 2015 WHO Medical Eligibility Criteria. The BCS+ provides evidence on clinical indications for the provision of family planning methods, counseling cards, instructions for providers, and guidance for supplemental counseling and services that family planning clients may need. The BCS+ includes user's guide, trainer's guide, algorithm, method brochures, and counseling cards. This publication …
The Balanced Counseling Strategy Plus: A Toolkit For Family Planning Service Providers Working In High Hiv/Sti Prevalence Settings (Spanish Translation), Population Council
The Balanced Counseling Strategy Plus: A Toolkit For Family Planning Service Providers Working In High Hiv/Sti Prevalence Settings (Spanish Translation), Population Council
Reproductive Health
The Balanced Counseling Strategy Plus (BCS+) toolkit, developed and tested in Kenya and South Africa, provides information and materials that healthcare providers need to offer complete, high-quality family planning counseling to clients living in areas with high rates of HIV and STIs. Content is in accordance with the 2015 WHO Medical Eligibility Criteria. The BCS+ provides evidence on clinical indications for the provision of family planning methods, counseling cards, instructions for providers, and guidance for supplemental counseling and services that family planning clients may need. This publication is the Spanish language version of the user's guide, trainer's guide, algorithm, method …
Government Efforts And Personal Opinion Explain The Medicalization Of Pregnancy And Childbirth Through Time In Lower Mustang, Nepal, Ruth Baker
Independent Study Project (ISP) Collection
The way that women approach pregnancy and childbirth in rural Nepal has seen an amazing change in the past twenty to thirty years. The medicalization of this entire process, from pre-‐ to post-‐natal care, comes with government efforts for the increased education of women about family planning, nutrition, hygiene, and the proposed benefits of institutional versus in-‐home delivery. In 9 villages of Lower Mustang, interviews conducted with Government Health Post workers, Female Health Volunteers, and women of different ages sought to discern personal experience and opinion about pregnancy and childbirth from the perspective of both local women and those with …
Examination Of Possible Protective Effect Of Rhesus D Positive Blood Factor On Toxoplasma-Related Depressive Symptoms In Pregnancy, Lisa Lynn Parnell
Examination Of Possible Protective Effect Of Rhesus D Positive Blood Factor On Toxoplasma-Related Depressive Symptoms In Pregnancy, Lisa Lynn Parnell
USF Tampa Graduate Theses and Dissertations
Toxoplasma gondii infects approximately one third of the population worldwide. There is strong evidence that a relationship between T. gondii titer and depressive symptoms exists. There is also evidence suggesting a protective effect of RhD positive blood factor on toxoplasma-induced behavioral and personality changes. This protective effect may influence the relationship between T. gondii and prenatal depressive symptoms. The purpose of this secondary data analysis was to examine the possible protective effect of RhD positive blood factor on prenatal depressive symptoms in 56 pregnant women with T. gondii infection. The cross-sectional design was utilized to answer the question “Does positive …
Hispanic Mothers' Normative Beliefs And Intentions About The Discussion Of Sex-Related Topics With Their Adolescent Daughters, Dana M. Rodriguez
Hispanic Mothers' Normative Beliefs And Intentions About The Discussion Of Sex-Related Topics With Their Adolescent Daughters, Dana M. Rodriguez
Dissertations (1934 -)
Hispanic adolescent females continue to have rates of pregnancy and STIs, which exceed those of white non-Hispanic peers. When mothers engage in the discussion of sex-related topics (DSRTs) with their adolescent daughters, it has been shown to delay or decrease sexual intercourse. However, it has been found that Hispanic parents talk less with their daughters about sex-related topics (SRTs) when compared to other ethnic groups. Understanding why Hispanic mothers may or may not intend to engage in DSRTs is important in order to design culturally appropriate programs aimed at increasing their DSRTs. A sequential mixed-methods predictive correlational design framed by …
Unmet Need For Contraception And Unintended Pregnancies Among Women Of Reproductive Age Group: A Situation Analysis, Sumera Aziz Ali, Savera Aziz Ali
Unmet Need For Contraception And Unintended Pregnancies Among Women Of Reproductive Age Group: A Situation Analysis, Sumera Aziz Ali, Savera Aziz Ali
School of Nursing & Midwifery
Each year approximately 210 million pregnancies occur worldwide and more than one-third (75 to 80 million) of these are unintended, more than half of these (46 million) unintended pregnancies undergo unsafe abortions. In Pakistan 16% of the births are reported to be unwanted and if the unwanted fertility is eliminated, total fertility in Pakistan would be 3.1 births per woman. Total demand for family planning in Pakistan is 55%, while the contraceptive prevalence rate is 35% and unmet need for family planning is 20%. Reasons for unmet need and unintended pregnancy include lack of permission, fear of side effects, poor …
Screening Asymptomatic Women For Cardiovascular Risk, Kathryn Nelson-Murphy
Screening Asymptomatic Women For Cardiovascular Risk, Kathryn Nelson-Murphy
Evidence-Based Practice Project Reports
Cardiovascular disease (CVD) has long been recognized as a significant health problem in the U.S., and is the leading cause of preventable death in women, collectively causing about one death per minute (Caboral, 2013). A myriad of modifiable risk factors including dyslipidemia, hypertension, smoking, obesity, and type II diabetes are associated with 80-90% of CVD morbidity and mortality. Despite sobering statistics, valid risk prediction screening tools, and national preventive guidelines, adequate screening in clinical practice settings is sadly deficient. An evidence-based practice project was designed and implemented at a large OB/GYN practice in southern Ohio to address this identified gap …
The Baby Friendly Hospital Initiative, Kathryn E. Brackett
The Baby Friendly Hospital Initiative, Kathryn E. Brackett
Senior Honors Theses
Abstract
The Baby-Friendly Hospital Initiative (BFHI) is a worldwide movement started by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) that is aimed at providing hospitals with a certification that guarantees the best possible patient-centered care for mothers and infants. It focuses on breastfeeding as optimal infant nutrition, and implements strategies to encourage and support mothers to breastfeed their infants exclusively for six months after birth. The Ten Steps to Successful Breastfeeding are a set of 10 simple, easy to understand guidelines developed by WHO and UNICEF for implementing this initiative in the hospital setting and …
Perinatal Distress In Women In Low- And Middle-Income Countries: Allostatic Load As A Framework To Examine The Effect Of Perinatal Distress On Preterm Birth And Infant Health, Shahirose Sadrudin Premji
Perinatal Distress In Women In Low- And Middle-Income Countries: Allostatic Load As A Framework To Examine The Effect Of Perinatal Distress On Preterm Birth And Infant Health, Shahirose Sadrudin Premji
School of Nursing & Midwifery
In low- and middle-income countries (LMIC), determinants of women's and children's health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother-infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic-pituitary-adrenal axis, sympathetic, …
Assessing Provider Adherence To An Emergency Contraception Guideline In Reproductive Age Women, Amber E. Davis
Assessing Provider Adherence To An Emergency Contraception Guideline In Reproductive Age Women, Amber E. Davis
DNP Projects
Purpose: To determine current provider adherence to the 2010 ACOG Emergency Contraception (EC) guidelines, specifically by assessing provider EC counseling with patients at well-woman annual exam visits or during contraceptive counseling visits. A second aim of this study is to identify provider facilitators and barriers of EC discussion with patients.
Methods: Using a retrospective design, 90 medical records of patients presenting to a university clinic within the previous year were reviewed for the discussion of EC during annual exams or contraceptive counseling. Forty-five medical records were reviewed prior to implementation of the Ambulatory Electronic Health Record (AEHR) and forty-five medical …
A Mother's Paradox: Choosing A Birthing Method In The 21st Century, Jenae Franklin
A Mother's Paradox: Choosing A Birthing Method In The 21st Century, Jenae Franklin
Pitzer Senior Theses
Investigating childbirth, one of the biggest moments of a woman’s life, this thesis examines the reasons behind women’s preferred birthing methods. This research explores the fundamental decisions women make during the birthing process: the amount of prenatal care mothers will receive, the type of health care provider they will use, picking the place of delivery, views on technological and medical interventions, and outlooks on natural childbirth. In addition to an extensive literature review, in-depth interviews with mothers, midwives, and obstetricians are used to examine the various controversies of childbirth. This thesis begins with a review of the transition from midwives …
College Age Female Smokers And The Efficacy Of Smoking Cessation On College Campuses, Gretchen Suzanne Strobel
College Age Female Smokers And The Efficacy Of Smoking Cessation On College Campuses, Gretchen Suzanne Strobel
All Graduate Theses, Dissertations, and Other Capstone Projects
Young females are smoking on campuses in increasing rates in the last two decades. This thesis is secondary data analysis of a primary study with data from 472 female respondents, ages 18 to 24, enrolled or registered for classes at Minnesota State University, Mankato in the Spring, Summer and Fall semester of 2011. This sample included current smokers, former smokers, and nonsmokers. This research study will discuss the relationship between the age one starts smoking and any association with participation in unprotected intercourse and the concomitant use of estrogen containing oral contraceptives. Among the respondents a majority started smoking between …
Exploration Of Weight Gain In Female Breast Cancer Survivors, Mary Kay Johnson
Exploration Of Weight Gain In Female Breast Cancer Survivors, Mary Kay Johnson
All Graduate Theses, Dissertations, and Other Capstone Projects
Breast cancer is no longer a guaranteed death sentence. Many women today can look forward to a long and healthy life after treatment for breast cancer. However, weight gain is an ongoing, distressing and common problem for women treated for breast cancer. The primary purpose of this study was to gain knowledge about the phenomena of weight gain in females treated for breast cancer. A descriptive cross-sectional study was conducted in a natural setting. Sample: Electronic medical records for 100 female breast cancer survivors who visited a private suburban medical oncology clinic for treatment and/or on-going follow-up for a breast …
Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan
Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan
Reproductive Health
Before the introduction of Accredited Social Health Activists (ASHAs) in India, mid-level auxiliary nurse midwives (ANMs) were responsible for community health education and services such as antenatal care, delivery, IUCD insertion, and sterilization referrals. The Population Council studied how community extension work and some primary care responsibilities have been shifted to ASHAs, who are tasked with identifying pregnant women; facilitating ANC check-ups; motivating women for institutional deliveries during ANC checkups; and organizing child immunization. Establishing dual worker cadres in India by shifting community extension tasks from ANMs to local ASHAs has been well conceived. Task shifting has allowed ANMs, as …
Gender Roles And Their Influence On Life Prospects For Women In Urban Karachi, Pakistan: A Qualitative Study, Tazeen S. Ali, Gunilla Krantz, Raisa Gul, Nargis Asad, Eva Johansson, Ingrid Mogren
Gender Roles And Their Influence On Life Prospects For Women In Urban Karachi, Pakistan: A Qualitative Study, Tazeen S. Ali, Gunilla Krantz, Raisa Gul, Nargis Asad, Eva Johansson, Ingrid Mogren
School of Nursing & Midwifery
BACKGROUND: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women's and men's life prospects.
OBJECTIVE: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances.
DESIGN: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied.
FINDINGS: TWO MAJOR THEMES EMERGED DURING ANALYSIS: 'Reiteration of gender roles' and 'Agents of change'. The first theme included perceptions …
Poor Women With Sexually Transmitted Infections: Providers’ Perspectives On Diagnoses, Genevieve R. Cox
Poor Women With Sexually Transmitted Infections: Providers’ Perspectives On Diagnoses, Genevieve R. Cox
Sociology
This article presents results from a study of health care providers, mainly nurses and nurse practitioners, who routinely diagnose sexually transmitted diseases (STDs) in rural low-income populations in West Virginia (WV). A qualitative analysis of eighteen semi-structured interviews reveals that providers who consistently work with low-income populations believe patients undergo a negative change in self-image in response to a chronic STD diagnosis. Providers express concerns about a number of issues related to low-income, rural women’s access to sexual health care and see the need for more sexuality education, more funding for free and reduced cost clinics, and more available health …
Acceptance Of The Human Papillomavirus Vaccine Amount College Age Adults: Survey Research, Emily Pippo
Acceptance Of The Human Papillomavirus Vaccine Amount College Age Adults: Survey Research, Emily Pippo
Honors Capstones
Capstone submitted as a graduation requirement for BSU Honors Program.
Evaluation Of Health Newsletter Effectiveness On Dietary Habits In Low-Income Middle-Aged Women, Nichole Jennifer Hassebroek
Evaluation Of Health Newsletter Effectiveness On Dietary Habits In Low-Income Middle-Aged Women, Nichole Jennifer Hassebroek
All Graduate Theses, Dissertations, and Other Capstone Projects
There is little known about the effectiveness of the SagePlus newsletters at motivating dietary habit changes. The purpose of this study was to determine the effectiveness of the SagePlus newsletter in motivating low-income, middle-aged women who are participating in the SagePlus program to adopt healthier eating habits, specifically to eat more fruits and vegetables. A nonexperimental, descriptive correlational design was used in this study. Phone calls were placed to current SagePlus participants who had been enrolled in the program between six and 12 months. Forty English-speaking participants were contacted and agreed to participate in the telephone survey from a potential …
Evaluation Of The Sageplus Steps Program To Promote Physical Activity And Decrease Cardiovascular Risk In Low-Income Women, Callie Anne Avis
Evaluation Of The Sageplus Steps Program To Promote Physical Activity And Decrease Cardiovascular Risk In Low-Income Women, Callie Anne Avis
All Graduate Theses, Dissertations, and Other Capstone Projects
There is little known about the effectiveness of the Steps Program specifically used in the SagePlus program in Minnesota to promote physical activity and reduce cardiovascular risk. The purpose of this study was to evaluate the effectiveness of the SagePlus Steps Program for low-income middle-aged women ages 40 to 64 to meet a daily physical activity goal of 10,000 steps and reduce their cardiovascular disease risk, measured by their Framingham Risk Score. A nonexperimental, descriptive correlational design was used to guide data collection for this study. Demographic data, step counts after weeks 1, 4, 12, and 24, activity level at …
Everything's Better In Moderation: Young Women's Gender Role Attitudes And Risky Sexual Behavior, Tamara Leech
Everything's Better In Moderation: Young Women's Gender Role Attitudes And Risky Sexual Behavior, Tamara Leech
Department of Public Health Scholarship and Creative Works
Purpose This study examines the association between gender role attitudes and risky sexual behavior among young women. Previous studies have posed seemingly contradictory arguments: that either traditional attitudes or egalitarian attitudes are associated with riskier behavior. Methods Data are based on the children of the National Longitudinal Survey of Youth, representing 520 sexually active 18–19-year-old women. Propensity radius matching was used to assess differences in rates of multiple sexual partners and sex outside of a committed relationship. Results Relative to moderate gender role attitudes, both egalitarian gender role attitudes and traditional gender role attitudes are associated with higher rates of …