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Figueirêdo, Rudgy Pinto de. "O estudo da morbidade materna e do concepto em uma maternidade pública de João Pessoa, Paraíba." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-13032014-083803/.
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Introdução - O estudo da morbidade materna contribui para um melhor entendimento do quadro da saúde materna, no Brasil, e para o conhecimento dos problemas obstétricos que podem levar (ou não) ao internamento das gestantes. Os dados de morbidade materna são vitais para os gestores de políticas públicas de saúde, os quais precisam saber quantas mulheres necessitam de cuidados obstétricos básicos para tornar a gestação e o parto mais seguros. Objetivos - Estudar a morbidade materna e os conceptos de puérperas numa maternidade da rede pública de João Pessoa, Paraíba, e identificar mulheres com diagnósticos considerados potencialmente graves e sugestivos de morbidade materna near miss. Método - Trata-se de um estudo transversal que fez parte de uma pesquisa maior sobre a morbimortalidade materna. Foi selecionada uma amostra de 414 puérperas por um processo de amostragem aleatória sistemático, cujos dados foram coletados, prospectivamente, de setembro a novembro de 2011, a partir dos prontuários clínicos e entrevistas complementares, numa maternidade pública de referência e acentuada demanda no município. Resultados - Foram estudadas 383 gestações que terminaram em parto e 391 conceptos. Entre as puérperas, predominou a faixa etária dos 20 aos 34 anos, cor parda, baixa escolaridade, baixa renda e sem ocupação formal no mercado de trabalho. Metade delas tiveram parto cesariano e 17 por cento dos recém-nascidos apresentaram problemas de saúde. Foram identificadas as seguintes intercorrências no parto: lacerações do períneo, hematomas, traumatismos, hemorragias e hipertensões. No puerpério, destacaram-se os transtornos hipertensivos, as hemorragias do pós-parto e as infecções. Entre os 64 diagnósticos sugestivos de near miss, estão as síndromes hipertensivas (58 por cento ) e as síndromes hemorrágicas (32,8 por cento ). Na análise comparativa entre os grupos de puérperas com morbidades sugestivas e não sugestivas de near miss, as seguintes variáveis apresentaram diferenças estatisticamente significantes (p<0,001): problemas de saúde na gestação anterior e atual, hipertensão, gestação de risco e uso de anti-hipertensivos. Não foram encontradas diferenças estatísticas entre as características dos neonatos e a morbidade materna, sugestiva ou não de near miss. Conclusão - O estudo permitiu conhecer as características maternas e a prevalência (15,5 por cento ) de morbidades sugestivas de near miss que ocorrem, seja no parto seja no puerpério. Ampliar o conhecimento sobre os aspectos que envolvem a morbidade materna torna-se crucial para o adequado enfrentamento de complicações no ciclo gravídico-puerperal, além de apoiar o Plano de Ação para acelerar a redução da mortalidade materna e morbidade materna grave.Introduction The study of maternal morbidity contributes to a better understanding of the maternal health scene in Brazil and to the fuller knowledge of obstetric problems that may lead (or not) to the hospitalization of pregnant women. Maternal morbidity data are vital for the administrators of public health policies, who need to know how many women are expected to need basic obstetric care so as to make pregnancy and delivery safer. Objectives To study maternal morbidity and the conceptuses of puerperae in a public maternity hospital in João Pessoa, Paraíba, and identify women with a diagnosis considered potentially threatening and suggestive of being possible near misses. Method - This is a transverse study that is part of a larger project on maternal morbimortality. A sample of 414 puerperae was selected by a process of systematic random sampling, the data on whom were collected, prospectively, from September to November 2011, on the basis of clinical case notes and complementary interviews, at a public maternity hospital of reference in great demand in the municipality. Results - A total of 383 pregnancies which were carried through to delivery and 391 conceptuses were studied. There predominated, among the puerperas: the 20 - 34 year age-group, of brown skin color, low level of schooling, low income and no formal professional occupation. Half of them underwent caesarian section and 17 per cent of the new-born presented health problems. The following incidents were identified during labour: lacerations of the perineum, haematomas, traumatisms, haemorrhages and hypertensions. During the puerperium, hypertensive disorders, post-partum hemorrhage and other puerperal infections were noteworthy. The most frequent mention in the case notes of maternal causes was of hypertensive disturbances of pregnancy. Among the 64 diagnoses suggestive of near-miss, are the hypertensive (58 per cent ) and the haemorrhagic syndromes (32.8 per cent ). In the comparative analysis of the groups of puerperae with morbidities suggestive of near-miss, the following variables presented statistically significant differences (p<0.001): health problems during the previous and present pregnancy, hypertension, risk pregnancy and use of hypertensive medications. No statistical differences between the characteristics of the newborn and those of maternal morbidity (whether suggestive of near miss or not) were found. Conclusion - The study allowed the identification of maternal characteristics and the prevalence (15.5 per cent ) of the morbidities suggestive of maternal near-miss which occur either during labour or puerperium. It is crucial that our knowledge of the aspects of maternal mortality should be expanded so that the complications of the pregnancy-puerperal cycle may be adequately treated and to provide support for the Action Plan to speed up the reduction of maternal mortality and severe maternal morbidity.
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Wilson, Claudia. "Maternal cognitive stimulation, maternal sensitivity and maternal depression as predictors of later emotion regulation." Thesis, University of Oxford, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.419335.
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Hohnen, Bettina. "Maternal attributions for premature labour and their relationship to maternal mental health and maternal bonding." Thesis, Open University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.369032.
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Turner, Samantha Marie. "Prenatal maternal attachment style and maternal infant feeding practices." Thesis, Bangor University, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.239967.
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Webb, Rebecca. "Maternal mental health, processing of emotion and maternal sensitivity." Thesis, City, University of London, 2017. http://openaccess.city.ac.uk/21219/.
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Background: Research suggests that postnatal affective disorders such as anxiety, depression and post-traumatic stress disorder (PTSD) are associated with lower levels of maternal sensitivity. Understanding the mechanisms through which maternal affective disorders influence maternal sensitivity is important as it could lead to more tailored effective interventions to improve outcomes for women and their infants. One mechanism that is yet to be explored is the way in which mothers' process infant-related information. This thesis therefore developed a cognitive model that aimed to examine this mechanism. Aim: The aim of this thesis was to test this cognitive model of maternal sensitivity using a range of experimental, observational and questionnaire studies. The model proposed that maternal affective symptoms would be associated with maternal processing of infant-related information, which in turn would be associated with maternal sensitivity. Methods & Results: The aims were addressed through a systematic review and a study of women with (n = 23) and without (n = 47) affective symptoms and their infants (aged 2-8 months) after birth. The systematic review found that mothers with perinatal affective disorders are faster to disengage from sad infant faces and are more accurate at identifying sadness in infant faces (Article 1). To assess how mothers process infant-related information, validated pictures of infants' emotional faces were needed. Therefore, a validated set of infant emotional expressions was created and validated on student midwives and nurses and members of the general public. The images were found to have high criterion validity and good test-retest reliability (Article 2). Mothers processing of infant-related information and its relationship with maternal sensitivity was tested using a series of questionnaires, computerised and observational tasks. Results are reported in Articles 3, 4 and 5. Conclusion: Overall, the cognitive model of maternal sensitivity was only partly supported, in that maternal affective symptoms explained more of the variance of maternal sensitivity than maternal processing of infant-related information. Despite this, the work in this thesis provides a novel contribution to the literature by developing and testing a model based on previous research and by using robust measures such as eye-tracking technology and observational measures of mother-infant interaction. However, interpretation of the data is hindered due to methodological issues such as small sample sizes, homogeneous sample and demand characteristics. Therefore, more research is needed to test this model on a larger, more heterogenous sample.
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Padovani, Flavia Helena Pereira. "Indicadores emocionais de ansiedade, disforia e depressão e verbalizações maternas acerca do bebê, da amamentação e da maternidade em mães de bebês nascidos pré-termo de muito baixo peso, durante a hospitalização do bebê e após a alta, compraradas a mães de bebês nascimentos a termo." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/59/59137/tde-29012007-170107/.
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O presente estudo teve por objetivo: a) avaliar os indicadores de ansiedade, disforia e depressão em um grupo de mães de bebês nascidos pré-termo de muito baixo peso (GPT) e comparar esses indicadores com os de um grupo de mães de bebês nascidos a termo (GAT); b) comparar indicadores de ansiedade, disforia e depressão de mães de bebês nascidos prétermo de muito baixo peso avaliados em dois momentos distintos, durante o período de hospitalização do bebê e após a sua alta hospitalar; c) comparar os conteúdos verbais acerca do bebê, da amamentação e da maternidade expressos pelo grupo de mães de bebês pré-termo de muito baixo peso e pelo grupo de mães de bebês a termo. O GPT foi formado por 50 mães de bebês nascidos pré-termo de muito baixo peso (?1.500 gramas), enquanto que o GAT foi composto por 25 mães de bebês nascidos a termo com peso de nascimento igual ou superior a 2.500g. Foram utilizados os seguintes instrumentos e materiais: Entrevista Clínica Estruturada para DSM III?R (SCID/NP), Inventário de Ansiedade Traço-Estado (IDATE), Inventário de Depressão de Beck (BDI), Roteiro de Entrevista, Escala de Eventos Vitais e Prontuários médicos dos bebês. Primeiramente, aplicou-se a SCID/NP para a identificação das mães com antecedentes psiquiátricos, as quais foram excluídas da amostra final. Em seguida, para o GPT foram realizadas duas sessões, durante o período de hospitalização do bebê (1a avaliação): na primeira, aplicou-se o Roteiro de Entrevista e a Escala de Eventos Vitais e na segunda, foram aplicados os instrumentos IDATE e BDI. Após a alta hospitalar do bebê, foi realizada mais uma sessão com o GPT para reaplicação do IDATE e do BDI (2a avaliação). Para o GAT, os instrumentos de avaliação foram aplicados em uma única sessão, nos primeiros dias de vida do bebê. Em relação à análise de dados, os instrumentos de avaliação de ansiedade e disforia/depressão foram corrigidos de acordo com as normas dos testes e foram realizadas as análises comparativas entre os grupos (GPT X GAT) e intra-grupo (GPT ? 1a avaliação X GPT ? 2a avaliação). As respostas maternas ao Roteiro de Entrevista foram submetidas à análise de conteúdo temático e quantificadas em termos de freqüência e porcentagem. Os resultados mostraram uma incidência de 32% das mães do GPT e 4% das mães do GAT com escores indicativos de sintomas clínicos de ansiedade do tipo estado. A análise comparativa entre os grupos mostrou diferença estatisticamente significativa entre essas incidências; no GPT houve significativamente mais mães com sintomas clínicos de ansiedade-estado do que no GAT (p=0,006). Após a alta hospitalar dos bebês, houve uma redução estatisticamente significativa do número de mães do GPT com sintomas clínicos de ansiedade-estado (1a avaliação=35%; 2a avaliação=12%; p=0,006). Quanto aos conteúdos verbais maternos expressos pelos GPT e GAT, verificou-se que, no tópico sobre questões relacionadas ao bebê, 12% das mães do GPT verbalizaram sobre reações e sentimentos maternos, focalizadas predominantemente em emoções negativas, enquanto que apenas 1% do GAT apresentou esse tipo de verbalização. No tópico sobre amamentação, o GPT expressou mais preocupações e dúvidas em relação à amamentação (46%) do que as mães do GAT (4%), relativas principalmente ao leite materno secar, acabar ou ser insuficiente para satisfazer ao bebê. No tópico sobre maternidade, por sua vez, os dois grupos apresentaram conteúdos verbais semelhantes, predominando a identificação de diversos fatores que influenciam na maternidade (GPT=41%; GAT=47%). Os achados sugerem a necessidade de se avaliar indicadores de ansiedade e disforia/depressão em mães de bebês pré-termo de muito baixo peso, internados em UTIN, a fim de subsidiar decisões sobre o suporte psicológico oferecido às mães para regulação emocional, durante o período de internação hospitalar do bebê.The aim of the present study was: a) to assess the indicators of anxiety, dysphoria and depression in a group of mothers of very low birthweight preterm neonates (GPT) and to compare these indicators with the ones of one group of mothers of fullterm neonates (GFT); b) to compare indicators of anxiety, dysphoria and depression of mothers of very low birthweight preterm neoantes that were assessed in two distinct moments, during the period of hospitalization and after their hospital discharge; c) to compare the verbal contents about the baby, the breastfeeding and the maternity that were expressed by the group of mothers of very low birthweight preterm neoantes and by the group of mothers of fullterm ones. The GPT was constituted by 50 mothers of neoantes that were born preterm and with very low birthweight (?1,500 grams), while the GFT was constituted by 25 mothers of neoantes that were born fullterm with birthweight equal or more than 2,500 grams. It was used the following instruments and materials: Structured Clinical Interview for DSM III-R Non-Patient (SCID/NP), State-Trait Anxiety Inventory (IDATE), Beck Depression Inventory (BDI), Interview Profile, Vital Events Scale and medical chart. First, it was administrated the SCID/NP to identify the mothers with psychiatric background, which were excluded from the final sample. After this, for the GPT, it was realized two sessions, during the hospitalization period of the baby (1st assessment): in the first one, it was administrated the Interview Profile and the Vital Events Scale, and in the second one, it was administrated the instruments IDATE and BDI. After the hospital discharge of the baby, it was realized one more session with the GPT for the re-administration of IDATE and of BDI (2nd assessment). For the GFT, the assessment instruments were administrated in only one session, in the first days of the baby?s life. In relation to the data analyses, the assessment instruments of anxiety, dysphoria/depression were corrected according to the tests? norms and it was realized the comparative analyses between groups (GFT X GPT) and within groups (GPT ? 1st assessment X GPT ? 2nd assessment). The maternal answers to the Profile Interview were submitted to the thematic content analyses and were quantified in terms of frequency and percentage. The results indicated incidence of 32% of the mothers of the GPT and 4% of the mothers of the GFT with scores that indicate clinical symptoms of anxiety-state type. The comparative analyses between groups showed statistically significant differences between these incidences; in the GPT there were significantly more mothers with clinical symptoms of anxiety-state than in the GFT (p=0,006). After the babies? hospital discharge, there was a statistically significant reduction in the number of mothers of the GPT with clinical symptoms of anxiety-state (1st assessment = 35%; 2nd assessment = 12%; p = 0,006). In relation to the maternal verbal contents that were expressed by GPT and GFT, it was verified that, in the topic about questions that are related to the baby, 12% of the mothers of the GPT verbalized about maternal feelings and reactions, focused, predominantly on negative emotions, while just 1% of the GFT presented this kind of verbalization. In the topic about breastfeeding, the GPT expressed more preoccupation and doubts related to breastfeeding (46%) than the mothers of the GFT (4%), these related principally to the fact of drying the maternal milk, finishing the milk or not being enough to satisfy the baby. In the topic about maternity, though, both groups presented similar verbal contents, predominating the identification of several factors that have influence in maternity (GPT = 41%; GFT = 47%). The findings suggest the necessity of assessing indicators of anxiety and dysphoria/depression in mothers of preterm and very low birthweight infants, that are admitted in the ICU, with the objective of subsiding decisions about the psychological support that is offered to the mothers to the emotional regulation, during the period of baby?s hospital admission.
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Winstanley, Julie Anne. "A material-discursive-intrapsychic (MDI) approach to understanding women's maternal experiences." Thesis, University of Huddersfield, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.430295.
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Steadman, Joanna. "Maternal mental illness, mother-infant interactions and maternal cognitive functioning." Thesis, University of Southampton, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442852.
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Emmanuel, Elizabeth Noela. "Maternal role development: the influence of maternal distress following childbirth." Thesis, Lambert Publishing, 2005. https://www120.secure.griffith.edu.au/rch/items/5d031f29-35cc-ce62-a394-0b1055800da1/1/.
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Little is known about the relationship between maternal role development and maternal distress following childbirth. Initial work on maternal role development (MRD) was undertaken three decades ago, and despite many changes to maternity care delivery and to society more generally, the relevance of MRD to contemporary birthing women has not been assessed. MRD may be influenced by a number of factors. Of particular interest to this thesis is emotional distress. Maternal distress may manifest itself as depression and anxiety, but has not been well described in the literature. Feelings of distress may adversely affect women's adaptation to motherhood. This study therefore, aimed to examine MRD and the influence of maternal distress following childbirth.
A longitudinal prospective study with a cohort of 614 women was conducted and data collected at 36 weeks gestation and at six and 12 weeks following childbirth. MRD was measured using a revised standardised tool, the What Being the Parent of a Baby is Like (WPL-R) (Pridham & Chang, 1989). Maternal distress was measured using the Edinburgh Postnatal Depression Scale (EPDS) (Cox, Holden & Sagovsky, 1987) with a score of plus or minus 10.
Analysis confirmed significant changes in MRD subscale scores across time. The main difference was in self-perceptions of parenting (F (2, 390) = 25.2, p less than .001) accounting for 11.4% of variance. Changes as a person, in lifestyle and relationships and the importance and priority of the infant in the mother's life were noted, particularly in women who reported low and moderate expectations of motherhood.
Incidence of maternal distress was 42% (n = 252) of women at 36 weeks gestation, which decreased to 19.2% (n = 97) at six weeks following childbirth, and 15.5% (n = 73) at 12 weeks postpartum. This effect across time was significant (F (2, 918) = 174.9, p less than .001) and accounted for 27.6% of variance when tracking the incidence of maternal distress from pregnancy to the postpartum period.
MRD was associated with maternal distress across time. At 36 weeks gestation, overall maternal expectations were correlated with maternal distress (r = .20, p less than .001) whilst at six and 12 weeks postpartum, analysis yielded negative associations between self-perceptions of parenting and maternal distress, and positive associations between changes as a person, in lifestyle, and in relationships and maternal distress.
The results of the present study provide a better understanding of the experiences and perceptions of contemporary birthing women that differed from original conceptualisations. MRD, although similar to initial proposed theoretical constructs, takes longer than previously thought. The present study also confirmed previous propositions that motherhood for many women in contemporary society is distressing.
Studies on MRD enable us to better understand how women respond to the difficulties of motherhood over time. Health care services need to provide greater support for mothers by recognising the challenges of childbearing and the intensity and demands of motherhood. Midwives need to re-examine their practice and support women from a fresh perspective. This view entails an appreciation of a high proportion of women reporting distress symptoms; assessing for risk, particularly in relation to domestic violence; and fostering social support, which was found to be an important mediator for MRD.
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Emmanuel, Elizabeth Noela. "Maternal Role Development: The Influence of Maternal Distress Following Childbirth." Thesis, Griffith University, 2005. http://hdl.handle.net/10072/367379.
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Little is known about the relationship between maternal role development and maternal distress following childbirth. Initial work on maternal role development (MRD) was undertaken three decades ago, and despite many changes to maternity care delivery and to society more generally, the relevance of MRD to contemporary birthing women has not been assessed. MRD may be influenced by a number of factors. Of particular interest to this thesis is emotional distress. Maternal distress may manifest itself as depression and anxiety, but has not been well described in the literature. Feelings of distress may adversely affect women's adaptation to motherhood. This study therefore, aimed to examine MRD and the influence of maternal distress following childbirth. A longitudinal prospective study with a cohort of 614 women was conducted and data collected at 36 weeks gestation and at six and 12 weeks following childbirth. MRD was measured using a revised standardised tool, the What Being the Parent of a Baby is Like (WPL-R) (Pridham & Chang, 1989). Maternal distress was measured using the Edinburgh Postnatal Depression Scale (EPDS) (Cox, Holden & Sagovsky, 1987) with a score of plus or minus 10. Analysis confirmed significant changes in MRD subscale scores across time. The main difference was in self-perceptions of parenting (F (2, 390) = 25.2, p less than .001) accounting for 11.4% of variance. Changes as a person, in lifestyle and relationships and the importance and priority of the infant in the mother's life were noted, particularly in women who reported low and moderate expectations of motherhood.
Incidence of maternal distress was 42% (n = 252) of women at 36 weeks gestation, which decreased to 19.2% (n = 97) at six weeks following childbirth, and 15.5% (n = 73) at 12 weeks postpartum. This effect across time was significant (F (2, 918) = 174.9, p less than .001) and accounted for 27.6% of variance when tracking the incidence of maternal distress from pregnancy to the postpartum period. MRD was associated with maternal distress across time. At 36 weeks gestation, overall maternal expectations were correlated with maternal distress (r = .20, p less than .001) whilst at six and 12 weeks postpartum, analysis yielded negative associations between self-perceptions of parenting and maternal distress, and positive associations between changes as a person, in lifestyle, and in relationships and maternal distress. The results of the present study provide a better understanding of the experiences and perceptions of contemporary birthing women that differed from original conceptualisations. MRD, although similar to initial proposed theoretical constructs, takes longer than previously thought. The present study also confirmed previous propositions that motherhood for many women in contemporary society is distressing.
Studies on MRD enable us to better understand how women respond to the difficulties of motherhood over time. Health care services need to provide greater support for mothers by recognising the challenges of childbearing and the intensity and demands of motherhood. Midwives need to re-examine their practice and support women from a fresh perspective. This view entails an appreciation of a high proportion of women reporting distress symptoms; assessing for risk, particularly in relation to domestic violence; and fostering social support, which was found to be an important mediator for MRD.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing
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Polido, Carla Betina Andreucci 1969. "Morbidade materna grave e sexualidade = Severe maternal morbidity and sexual functioning." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312759.
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Orientadores: José Guilherme Cecatti, Rodolfo de Carvalho PacagnellaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-27T18:17:52Z (GMT). No. of bitstreams: 1 Polido_CarlaBetinaAndreucci_D.pdf: 9580415 bytes, checksum: 7a66fbe0b5c7b89a2918fd10375d6d95 (MD5) Previous issue date: 2015
Resumo: Introdução: Morbidade materna grave e near miss materno são indicadores de saúde mais abrangentes, quando comparados à razão de morte materna. Esse conceito recente permite não apenas a identificação do número de mulheres que morrem durante gestação e/ou parto, mas também o estudo da prevalência de condições potencialmente ameaçadoras de vida. No entanto, pouco se conhece sobre as possíveis consequências em longo prazo após esses episódios nos diversos aspectos da vida das sobreviventes. A gestação e o parto podem modificar a resposta sexual feminina, mas poucos estudos avaliaram esse desfecho após eventos de morbidade materna grave. Objetivos: Realizar uma revisão sistemática sobre aspectos de sexualidade, incluindo função sexual, em mulheres que apresentaram qualquer tipo de complicação durante gestação ou parto. Avaliar aspectos da resposta sexual feminina em mulheres com e sem morbidade materna grave. Métodos: Revisão sistemática nas bases de dados PubMed, EMBASE e SciELO, avaliando a associação de morbidade materna geral e grave com alterações da função e/ou resposta sexual feminina. A revisão seguiu o protocolo do método proposto para estudos observacionais (PRISMA). A resposta sexual feminina foi estudada como um dos desfechos da Coorte de Morbidade Materna Grave (COMMAG). O questionário Female Sexual Function Index (FSFI) foi aplicado às mulheres expostas (com antecedente de morbidade grave) e não expostas (com antecedente de gestação sem complicações). Além do FSFI, questões gerais sobre saúde geral e reprodutiva complementaram o estudo. Resultados: Lesões perineais maiores (terceiro e quarto graus) foram avaliadas como desfechos de morbidade geral em 12 estudos, e a morbidade materna grave foi analisada em 2 estudos. A morbidade geral e a grave foram associadas com maior tempo para a retomada da atividade sexual após o parto. A morbidade também se associou a uma maior frequência de dispareunia após o parto. Escores totais do FSFI não foram significativamente diferentes entre grupos de exposição e controle. Pela heterogeneidade entre eles, os estudos individuais permitiram apenas uma síntese qualitativa dos resultados, mas não metanálise. Para avaliação da resposta sexual feminina no COMMAG, foram incluídas 638 mulheres previamente internadas durante gestação ou parto na maternidade do CAISM/UNICAMP. Dessas, 315 tinham antecedente de morbidade materna grave, e 323 eram mulheres sem complicações durante gestação ou parto. Os escores totais médios do FSFI encontrados foram abaixo dos valores de ponto de corte para suspeita de disfunção, sem diferença entre os grupos estudados. Mulheres com antecedente de morbidade materna grave retomaram atividade sexual mais tardiamente após o parto do que as do grupo controle, porém sem diferença entre os grupos a partir do terceiro mês pós-parto. A análise múltipla identificou associação de valores mais baixos de FSFI com baixo de peso materno e ausência de parceria. Conclusões: Alterações da resposta sexual feminina podem ser consequências em longo prazo da ocorrência de episódios de morbidade materna grave. Com o crescimento da população de mulheres que sobrevivem a esses episódios, a abordagem da sexualidade no seguimento dessa população se faz premente
Abstract: Introduction: Severe maternal morbidity and maternal near miss currently are better health indicators than maternal mortality ratio. Together with the identification of women who died during pregnancy and/or childbirth, the new concept allows also to investigate the prevalence of potential life-threatening conditions. However, little is known about possible long-term consequences after those episodes over several aspects of the lives of survivors. It has already been described that uncomplicated pregnancy and childbirth might modify female sexual response. Notwithstanding, only few studies have evaluated aspects of sexuality of women after episodes of severe maternal morbidity. Objectives: To perform a systematic review of aspects of sexuality, including sexual function, in women who had had any kind of complication during pregnancy or childbirth. To evaluate aspects of female sexual response in women with and without severe maternal morbidity. Methods: Investigation included a systematic review through the databases PubMed, EMBASE, and SciELO, assessing general and severe maternal morbidity associated with altered female sexual response. The review followed the protocol method proposed for observational studies (PRISMA). The female sexual response has been studied as one of the outcomes at a retrospective cohort study on maternal severe morbidity (COMMAG). The Female Sexual Function Index questionnaire (FSFI) was applied at exposed women (severe morbidity) and unexposed (pregnancy without complications). Along with FSFI, the survey included also questions on general and reproductive health. Results: Major perineal injuries (3rd and 4th degree) were evaluated as general morbidity outcomes at 12 studies, and severe maternal morbidity was analyzed at 2 studies. Compared to control group, both women exposed to general and severe morbidity delayed resumption of sexual activity after childbirth. The exposed group had also more frequently dyspareunia after childbirth. The mean total FSFI scores were similar at both groups. The heterogeneity of the studies allowed only a qualitative synthesis, and meta-analysis was not feasible. To assess female sexual response at the cohort study, 638 women who delivered at UNICAMP's maternity unit were included. 315 of them were severe maternal morbidity cases, and 323 were women who had had uncomplicated pregnancy or childbirth. The mean total scores of FSFI were similar in both groups, though below cut-off values for suspected dysfunction. Women after severe maternal morbidity resumed sexual activity after birth later, when compared to control group. However, there was no significant difference at three months. Multivariate analysis showed association of lower FSFI scores with maternal low maternal weight and no partner. Conclusions: Altered female sexual response might be a long-term consequence after episodes of severe maternal morbidity. Since there is a growing population of women who survive these episodes, proper evaluation of sexual functioning among those women should be conducted
Doutorado
Saúde Materna e Perinatal
Doutora em Ciências da Saúde
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Enes, Giovana da Silva Tavares 1982. "Fibrose cística = estreitando laços maternos = Cystic fibrosis : strengthening maternal ties." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308361.
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Orientador: Antonio Fernando RibeiroDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A Fibrose Cística é uma doença autossômica recessiva, sistêmica, hereditária, crônica e progressiva e pode levar à morte. São características da doença as secreções mucosas espessas e viscosas que obstrui os ductos das glândulas exócrinas e contribuem para o aparecimento de doença pulmonar obstrutiva crônica, insuficiência pancreática com má digestão e má absorção e conseqüente desnutrição secundária, além de níveis elevados de eletrólitos no suor. Por ser uma doença crônica, ela exige cuidados sistemáticos pela vida toda, e na maioria dos casos quem exerce a função de cuidadora é a mãe. Além de viver uma nova experiência de ser mãe, ela terá que conviver com a frustração dele ser doente.Com este estudo foi possível compreender a relação que mãe e filho doente crônico constroem desde o momento do diagnóstico e conhecimento do tratamento, permeados por sentimentos como culpa e solidão. Assim, essas mães renunciam suas próprias vidas em função do cuidado do filho. Cuidados esse compartilhado com uma equipe de saúde multiprofissional ainda deficitária. Apesar de ter sido avaliado por elas como positivo, as sugestões por melhorias também surgiram: como uma melhor articulação entre os serviços de saúde nos diversos níveis, uma maior divulgação da doença e o aumento do número de dias de atendimento. Outro aspecto importante encontrado foi sobre importância do papel do psicólogo não só na atuação com o paciente e a família durante todo o tratamento; mas também na necessidade de oferecer um espaço para que os profissionais de saúde despreparados pudessem compartilhar suas angústias e frustrações o que reflete diretamente na assistência prestada
Abstract: The Cystic Fibrosis is a disease systemic, hereditary, chronic and progressive and it can lead to the death. There are characteristic of the disease the thick and viscous mucous secretions what it obstructs the ducts of the exocrine glands and contribute to the appearance of chronic obstructive pulmonary disease, pancreatic insufficiency with bad digestion and bad absorption and consequent secondary malnutrition, besides elevated levels of electrolytes in the sweat. Because of being a chronic disease, she demands systematic cares for the life completely, and in most of the cases who plays the function of care is the mother. Besides surviving a new experience of being a mother, she will have to coexist in spite of the fact that his frustration to be doente.Com this study there were possible understood the relation what mother and chronic sick son build from the moment of the diagnosis and knowledge of the treatment, permeated by feelings as fault and solitude. So, these mothers renounce his lives themselves in function of the care of the son. Taken care this shared one with a team of still deficient multiprofessional health. In spite of having been valued by them like positive, the suggestions for improvements also appeared: like a better articulation between the health services in several levels, a bigger spread of the disease and the increase of the number of service days. Another considered important aspect was on importance of the paper of the psychologist not alone in the acting with the patient and the family during the whole treatment; but also in the necessity of offering a space so that the unprepared health professionals could share his anguishes and frustrations what thinks straightly about the given presence
Mestrado
Saude da Criança e do Adolescente
Mestre em Ciências
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Astore, Mireille. "The Maternal Abject." University of Sydney. Sydney College of the Arts, 2002. http://hdl.handle.net/2123/500.
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Abstract In this Research paper and through my Studio practice, I search for what binds me and separates me from my children. I investigate abjection theories through Julia Kristeva and Georges Bataille and focus on a particular form I call the maternal abject. This occurs at the time an infant separates from its mother, acquires language and maps its own body. I am proposing that the mapping of the body is the point at which an individual perceives social structures and learns about prohibitions and taboos, hence the abject. I also investigate the relationship between the maternal abject and the artistic process through the writings of Kristeva. Abjection is illustrated through the works of Mona Hatoum, Fiona Hall, Hieronymus Bosch, and Paul Quinn. The maternal abject is illustrated through the works of Mary Kelly, Cindy Sherman, Frida Kahlo, Louise Bourgeois. A possible reading of the maternal abject is given through the works of Gregory Crewdson, Joel-Peter Witkin and Francis Bacon. The studio work is in two parts. The first part is a series of layered photomedia images. The layers consist of a naked female body, which has been merged with Renaissance like Madonna and Child images. Texture, such as stones and spikes, is embedded to signify the fragility and strength of the body. Children are also present and are merged with the adult female body. All images are cradled in a darkened atmosphere in order to draw the viewer inside the images. The second part is a bassinet, which has been drilled and pierced by thousands of pearl-headed steel pins. This piece signifies the dichotomy of the motherhood experience, which on the one hand is rewarding and fulfilling and on the other an abject and isolating experience of no apparent economic value. The two parts interact so that the bassinet piece with its threatening exterior acts as an aggressor towards the photomedia images.
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Turel, Friyan. "Maternal Birth Trauma." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/18401.
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Objectives: 3D/4D translabial ultrasound (4D TLUS) is used to image the levator ani muscle and the anal sphincter to diagnose maternal birth trauma. We tested the validity of these methods. Secondly, we studied the pelvic floor of Nepali women. Finally, we undertook a medium to long-term outcomes in women after OASI. Methods: The first study was a retrospective analysis of 172 nulliparae. All had an interview, clinical examination and 4D TLUS. For the Nepal study, 129 consecutive women attending a gynaecology clinic were offered the same. The long-term follow-up of 146 women after OASI included the above plus anal manometry. Results: Datasets of 162 and 153 nulliparae were available for levator and anal sphincter assessment. One woman was diagnosed with an avulsion, another with a significant external anal sphincter defect. In Nepal, 21% had significant cystocele, 38% uterine and 8% posterior compartment prolapse. 60% had uterine retroversion which was associated with uterine prolapse. There were 2 avulsions and 2 significant EAS defects. The OASI study showed a >50% prevalence of anal incontinence (AI) of high bother over 6 years after the index birth. Women after 3c/4th degree tear had more AI (58 vs 44%), lower MRP P<0.001, MSP P<0.001 and more residual EAS (P<0.001) and IAS (P=0.012) defects compared to 3a/3b tear. Residual IAS defects (P=0.001) and avulsion (P=0.048) were independent risk factors for AI. Conclusions: 1.) Published criteria for the diagnosis of maternal birth trauma on TLUS are unlikely to result in false-positive findings. 2.) POP is common in Nepali women, especially uterine prolapse. Retroversion is common and associated with uterine prolapse. Patterns of POP in Nepal seem to be different from Western populations. Maternal birth trauma is not prevalent. 3.) In a long-term follow-up after OASI, symptoms of AI were present in 51%. Higher tear grade were associated with more AI, more residual defects and lower manometric pressures.
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Button, Elizabeth. "An experimental manipulation of maternal expectations : the impact on maternal control, maternal criticism and perfection in young people." Thesis, University of East Anglia, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.588764.
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Background: Several authors have suggested one pathway by which perfectionism may develop is through interactions with parents who hold excessively high expectations and engage in high levels of criticism and control. Given the research linking perfectionism to psychopathology, understanding factors that contribute to its development is important. Method: An experimental between subjects design was used to test theorised causal links between parental beliefs, parental behaviour, and perfectionism in young people. Sixty-eight young people (aged 12-14 years) and their mothers completed baseline measures of perfectionism. Participants were randomised into an experimental group, where maternal expectations of their child on two experimental tasks were increased, or into a control group, where expectations were not increased. Dependent variables were maternal criticism, maternal control, and the perfectionistic beliefs and behaviour of young people during the experimental tasks. Results: Mothers in the experimental condition reported greater expectations for their child's performance and displayed higher levels of control. Young people in the experimental group reported higher perceived expectations to perform to a high standard (socially prescribed perfectionism), and more perfectionistic behaviours compared to the control group. There were no differences between groups on maternal criticism or self-orientated perfectionistic beliefs (high standards and self- criticism) reported by young people. Conclusion: The results provide preliminary support for theorised causal links between maternal expectations, maternal control, and socially prescribed perfectionism. The findings did not support theorised links between high maternal expectations and criticism, or between maternal behaviour and self-orientated perfectionism in young people. Whilst replication of findings is essential, the results suggest when working with young people whose perfectionism is causing a clinical problem it may be important to consider parental beliefs and behaviours in the assessment, formulation, and intervention. Future studies should use experimental and longitudinal designs to further investigate causal factors involved in the development of perfectionism.
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Chavoor, Tracie A. "Maternal Acculturation Levels and Their Effect on Children's Food Intake, Maternal Perceptions of Body Size and Maternal Stress." DigitalCommons@CalPoly, 2013. https://digitalcommons.calpoly.edu/theses/1010.
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In the U.S., obesity has hit alarming rates and affects Hispanic children disproportionately. Acculturation, the shift from one culture’s values, beliefs and practices to those of a new culture, may have both negative and positive health effects on immigrants. The objectives of this study were to determine the association between the level of acculturation (low acculturation or high acculturation) of low-income Latina mothers and the foods consumed by their children (0 to 36 months old). The association between acculturation and maternal perceptions of infant and toddler body size, maternal perceptions of her own body size and maternal parenting stress were also investigated. This was accomplished in 3 stages. First, data was collected cross-sectionally from 68 participants of WIC. Mothers answered many questionnaires including Food Frequency Questionnaires for their children, body size perception scale questionnaires and a parenting stress test. General linear regression models were performed to investigate an association between acculturation and food frequency, maternal perceptions of body size and parenting stress. Each model controlled for child’s age, maternal age, BMI (m/kg2) and education level. Second, key informant interviews were conducted with nine public health professionals to help gain a better understanding of some of our findings and to develop questions for the third stage: focus groups. Third, a total of 32 mothers participated in focus groups to discuss their perceptions on acculturation and child-feeding habits, and children’s body size. In addition, three mothers completed one-on-one interviews. From the cross-sectional analysis of the first study stage, the level of acculturation did not have a significant effect on any of the factors measured. For all mothers, however an increase in child’s age was associated with an increase in both the amount of healthy foods and less healthy foods consumed; an increase in mother’s BMI was associated with an increase in the children’s consumption of less healthy foods (beta coefficient of -0.042; p = 0.035). An increase in child’s age was associated with an increased likelihood of a mother to correctly estimate her own body size (beta coefficient of 0.041; p = 0.043). An increase in maternal BMI was associated with an increased likelihood to underestimate her own weight as well as that of her child. During the second stage, a theme emerged from the focus groups that the mothers try to feed the children the way they were fed growing up but they encounter difficulties when they can’t find the same ingredients and when their children start to prefer American foods. For all groups health was the number one factor they considered when choosing what to feed their children. The low acculturated mothers stated they wanted more education on how to assess if their child is at a healthy weight and admitted to not thinking about weight very much. In both groups, the mothers reported getting information about their child’s weight from health care professionals but many mothers from the bi acculturated group mentioned not believing the doctor when they told them their child was overweight. Overall, the findings suggest that children’s diets are not different by mother’s acculturation level and that the children start to prefer American foods from a young age. Parental education for several areas were identified: 1) for mothers to learn how to continue with the healthful aspects of a traditional diet 2) teach parents about appropriate stages of growth for their children; 3) when trying to teach about food focus on other areas of health rather than weight since weight does not seem to resonate as a concern.
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Javaid, Muhammad Kassim. "Maternal nutrition, maternal body composition during pregnancy and neonatal bone mass." Thesis, University of Southampton, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.427333.
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Buckley, Jenifer. "Maternal impressions : the discourse of maternal imagination in the Eighteenth Century." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/371689/.
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Maternal imagination is the notion that a pregnant woman could alter the development of her foetus with the power of her thoughts and feelings. At the beginning of the long eighteenth century this notion circulated in both medical and popular understandings of pregnancy, however by the nineteenth century the concept was largely dismissed in the medico-scientific community. This thesis charts the discursive migration of the concept of maternal imagination in a way that complicates the standard chronology. I argue that the discourse was widely dispersed and played a role in significant cultural debates concerning man-midwifery, politeness, domestic hierarchy, gender roles, and the philosophy of creative imagination. Exploring the rich interplay of medicine and literature, the thesis examines a range of print material such as newspapers, pamphlets, novels, popular health guides, midwifery treatises and poetry. This broad scope has demonstrated contradictions inherent within the discourse, such as the increasing sense that imagination was at once both creative and destructive. Those who employed the discourse appropriated the concept of maternal imagination to support a range of agendas; to satirise or support man-midwives, to create distrust or sympathy for women, or to ascribe either authority or culpability to the power of imagination. Metamorphosing through the age of politeness, the culture of sensibility and the related glorification of maternity, the discourse of maternal imagination, rather than diminishing as has often been assumed, reaches an apex in the late eighteenth- entury assimilation of its physiological aspects into the language of Romantic creativity. In a duality typical of its complex evolution, the discourse both contributes to the nineteenth-century view of a fragile female intellect, and to a peculiarly pathological version of the imagination process that could apply to both women and men.
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Finning, Kirstin M. "Prediction of fetal RhD blood group status using fetal genetic material in maternal blood." Thesis, University of the West of England, Bristol, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275889.
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Hernandez, Ileana. "The Moderating Mediation Effects of Maternal Psychological Control and Maternal Acceptance on the Relation Between Maternal Acculturation and Youth Anxiety." FIU Digital Commons, 2012. http://digitalcommons.fiu.edu/etd/599.
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The present study examined the relations among maternal psychological control, maternal acceptance, maternal acculturation and youth anxiety within the framework of a (partially) moderated mediation model. The sample consisted of 535 Hispanic-Latino youth (46% girls; M = 9.79 years) and their mothers. The study’s data were analyzed using structural equation modeling in the MPlus statistical software program.
Results indicated that maternal psychological control and youth anxiety are significantly and positively related. Results also indicated that more acculturated mothers were more psychologically controlling than less acculturated mothers. Results further provided evidence for a partial mediational role of maternal psychological control on the relation between maternal acculturation and youth anxiety symptoms. In addition, there was a direct, positive relation between maternal acculturation and youth anxiety symptoms. No significant findings were observed regarding the moderating role of maternal acceptance on the relation between maternal psychological control and youth anxiety. The findings’ theoretical and clinical implications are further discussed.
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AlBanna, Badia Sami. "The connection between maternal depressive symptoms and maternal insensitivity the mediating or moderating role of maternal perception of the infant /." College Park, Md. : University of Maryland, 2005. http://hdl.handle.net/1903/2959.
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Thesis (M.A.) -- University of Maryland, College Park, 2005.Thesis research directed by: Dept. of Psychology. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.
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Wang, Cong Kerynn. "Caesarean delivery on maternal request: systematic review on maternal and neonatal outcomes." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46942609.
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Castellini, Alessandro. "Translating maternal violence : the discursive construction of maternal filicide in 1970s Japan." Thesis, London School of Economics and Political Science (University of London), 2013. http://etheses.lse.ac.uk/978/.
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The present dissertation takes late postwar Japan as its case study and investigates the ways in which ambivalence to/in motherhood’ emerges at the very site where maternal violence and, more specifically, maternal filicide disrupts social norms of acceptable maternal behaviour. In 1970s Japan the number of cases of mothers who killed their own children saw a dramatic increase to the point of reaching, within media representations in particular, the dimension of a social phenomenon. Within the framework of idealizations of maternal identity, formulated in terms of continuous love, self-sacrifice and domesticity, filicidal mothers came to be labelled as either "bad" (cruel, monstrous) or "mad" (mentally unstable, neurotic). The apparent proliferation of maternal child-killing and what was perceived as the unjust treatment meted out to these criminalized mothers became a major concern for a new women’s liberation movement emerging in Japan between the late 1960s and the early 1970s, known as ūman ribu (woman lib). Ribu contested the widespread characterization of mothers who kill as either devilish or mentally ill, and drew on the numerical increase of cases of maternal filicide as evidence of a symptomatic malfunctioning of the dominant gender ideology in modern Japanese society. Postwar Japan also witnessed a boom in women’s literature whose focus on the grotesque, on worlds of dreams and madness and on the morbid portrayal of female antisocial behaviours constituted fertile terrain for the proliferation of disquieting images of motherhood and maternal violence. This thesis focuses on the work by Japanese writer Takahashi Takako as a specific case study to address the discursive construction of filicidal mothers in women’s literature. This study acknowledges motherhood as a heated site of contested meanings and focuses on a close textual reading of media coverage, the rhetoric of ribu and women’s literature in order to explore the discursive constructions of mothers who kill which characterised early 1970s Japan. It sheds light on the problematic interactions between the different discourses under consideration and identifies the relationship between motherhood and violence as a hot-spot where clashing discourses produce a constant re-articulation of maternal and female identity.
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Nitzan-Green, Yonat. "Saying it through the maternal body : understanding maternal subjectivity through art practice." Thesis, University of Southampton, 2010. https://eprints.soton.ac.uk/165505/.
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In referring to psychoanalyst and theorist Julia Kristeva‟s claim that the maternal body has no subject, this research aimed at finding answers to the following question: in what ways might a maternal subjectivity be understood through art practice? The research focused on three themes: fragmentation, invisibility and boundaries. Initially, these themes were researched in the context of the maternal body and the abject. The engagement with the maternal body has led to expanding the inquiry to include kibbutz childhood memory, in general, and bodily memories, in particular. This has led to revealing a childhood trauma. It was established that fragmentation, invisibility and questions of boundaries are rooted in trauma. Trauma has been further explored, to be revealed as a sequence of traumas, including the Israeli-Palestinian conflict and intergenerational trauma, which span private and public spheres. The methodology research in action has been developed through the use of the „observer-participant‟ position, as well as the methods of persona and performative acts. Installation has been developed as a shared space, where traumatic memory has been re-visited and audience became witness. The research contributes to new knowledge in the field of trauma, in the contexts of maternal subjectivity, kibbutz childhood and the Israeli-Palestinian conflict. The text provides a critical reflection for the practice, both construct this research.
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Price, Robin Owen. "Maternal health and fetal brain development : altered fetal neurogenesis following maternal inflammation /." May be available electronically:, 2009. http://proquest.umi.com/login?COPT=REJTPTU1MTUmSU5UPTAmVkVSPTI=&clientId=12498.
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Chung, Sangbun. "The effect of maternal blood phenylalanine level on mouse maternal phenylketonuria offspring." Diss., The University of Arizona, 1999. http://hdl.handle.net/10150/289025.
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Maternal phenylketonuria is a disease process caused by the adverse effects of high maternal blood phenylalanine (PHE) on the fetus. Unless treated, maternal PKU results in teratogenic effects on the fetus that can lead to mental retardation, microcephaly, intrauterine growth retardation, congenital cardiovascular defects, low birth weight, spontaneous abortion and fetal death. Although PKU has been recognized as a major challenge for many years, surprisingly little is known about the pathophysiologic mechanism(s) of PHE toward the fetus. To more thoroughly investigate the pathogenesis of this heritable disease and to explore potential therapeutic actions, the genetic mouse model Pahenu2 was used. The overall goals of this project were to use the Pah enu2 mouse to examine the effect of maternal blood PHE level on: (1) The pregnancy outcome of maternal PKU offspring as measured by the incidence of spontaneous abortion and certain key measures of development at birth (i.e., head circumference, weight, and crown-rump length of offspring); and (2) The fetal nutritional status of maternal PKU offspring as assessed by the levels of PHE, tyrosine (TYR), and other essential amino acids (EAA) at birth. In this study, we clearly observed that elevated maternal blood PHE levels, whether they were caused by the maternal diet or maternal genotype, were responsible for the fetal abnormalities in maternal PKU. With regard to fetal developmental outcomes, significant reductions in birth weight, crown-rump length, and head circumference were seen in offspring gestated under high maternal blood PHE conditions. The incidence of fetal loss was significantly different between treatment and control groups. Reductions in the levels of alanine, glutamine, and glutamic acid were observed in fetal blood among offspring born to mutant mothers with high blood PHE levels. None of the branched chain amino acids were reduced in maternal PKU offspring. These findings strongly suggest that there are important maternal genotype and dietary components but no fetal genotype component to this maternal PKU model. Given that these maternal factors also appear to be the most important components of human maternal PKU, this model seems certain to provide a valid animal model to overcome the difficulties of human studies.
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Carreon-Bailey, Rebecca Socorro. "Influences of maternal parenting behaviors: Maternal mental health, attachment history and eduction." CSUSB ScholarWorks, 2006. https://scholarworks.lib.csusb.edu/etd-project/2989.
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Studies have found that the type of parenting a child receives affects his or her subsequent development. This study investigates the relative influence of maternal parenting behavior and the impact of multiple variables influencing the quality of mothers' parenting behaviors. This knowledge will help to understand how early attachment experiences impact future parenting behavior.
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Högberg, Ulf. "Maternal mortality in Sweden." Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 1985. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1866.
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Every year about half a million women die from complications of pregnancy, parturition and puerperium, most of which are preventable. The purpose of this thesis was to chart the distribution and decline in maternal mortality in Sweden between 1751 and 1980, and furthermore to characterize positive (predisposing) factors and negative (protective) factors of maternal mortality. Maternal mortality declined from 900 to 6.6 per 100,000 live births in these 230 years. Maternal deaths accounted for 10070 of all female deaths in the reproductive ages between 1781 and 1785, but only 0.2.0/0 between 1976 and 1980. However, in the 19th century 40-450/0 of the female deaths in the most active childbearing ages were maternal deaths. The children left motherless had an extremely high mortality. Indirect maternal deaths and puerperal sepsis accounted for the bulk of maternal deaths in the rural areas. Only a minority of maternal deaths occurred in lying-in hospitals. Midwifery services in rural areas and antiseptic techniques were most effective in preventing maternal deaths during the late 19th century. The changing distribution ofage and parity amongst the parturients had a definite impact on the mortality decline, enhanced by time, contributing to 500/0 of the mortality decline over the last 15 years. The expontential decline of cause-specific mortality and case fatality rates during the last 40 years is furthermore explained by the emergence ofmodern medicine - antibiotics, antenatal and obstetric care. The earlier serious problem of illegal abortions was eradicated by legislation and changes in hospital practice. The maternal mortality decline has levelled out during the 1970s, the relative importance of embolism as a cause of death is increasing. Advanced age and intercurrent disease are the most difficult risk factors to overcome. To conclude, this study indicates that the reason why maternal mortality has declined faster than otherhealth indices is that the major part of the maternal deaths can be prevented by medical technology, including family planning, antenatal and obstetric care. This experience should be of interest to developing countries where high rates of maternal mortality prevails.
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Baxter, Julie-Ann. "Maternal attributions and attachment." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0005/MQ46015.pdf.
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Nantume, Samali. "Maternal mortality in Uganda." Thesis, Sumy State University, 2014. http://essuir.sumdu.edu.ua/handle/123456789/36349.
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The World Health Organization (WHO) defines maternal health as the health of women during pregnancy, childbirth and the postpartum period. According to estimates from UNICEF, Uganda’s maternal mortality ratio, the annual number of deaths of women from pregnancy-related causes per 100,000 live births stands at 435. Women die as a result of complications during and following pregnancy and childbirth and the major complications include severe bleeding, infections, unsafe abortion and obstructed labor.
When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/36349
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Croft, Simone. "Maternal and child psychopathology." Thesis, University of Sheffield, 2015. http://etheses.whiterose.ac.uk/12417/.
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Evidence suggests that maternal depressed mood (MDM) and childhood emotional and behavioural disorders (EBDs) frequently co-occur. The aim of this thesis is to investigate the nature of how these psychopathologies develop together across childhood. This epidemiology study uses a large British birth cohort, the Millennium Cohort Study, which charts the development of over 19,000 families throughout the UK. Five subscales of child behaviour were assessed using the preschool Strengths and Difficulties Questionnaire (SDQ) measured at age 3 and the standard school-age SDQ assessed at ages 5, 7, and 11. MDM was measured concurrently using the Kessler 6 scale. A prerequisite stage of analysis involved testing the psychometric invariance properties of the preschool SDQ (Chapter 2). The reliability and construct validity of this measure was established. Measurement invariance across time and predictive criterion validity were demonstrated across preschool to school-age developmental stages. The preschool SDQ was used in conjunction with the school-age SDQ and MDM scales to confirm reciprocity of mother and child behaviours across childhood in Chapter 3. Bidirectional effects were significant and positive across each assessment. The magnitude of effects did not differ by developmental stage, child gender or by agent (mother/child). In Chapter 4, features of change in mother and child behaviours were assessed. Using second order parallel process growth models, initial levels of MDM and all child behaviours were positively and significantly correlated indicating interrelatedness of maternal and child psychopathologies. Child externalizing behaviours at age 3 were significantly negatively correlated with change in MDM over time thus declines in MDM were lower for mothers of children high in externalizing behaviours. MDM at age 3 was significantly, positively correlated with change in peer problems, thus children of mothers with high levels of MDM at age 3 had slower declines in peer problems over time. Results from these studies confirm the interrelatedness of mother and child psychopathologies. Quantitative differences in the relationship between MDM and internalizing compared to MDM and externalizing problems emerged. The practical and clinical implications of these studies are discussed.
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CANTARUTTI, ANNA. "Maternal and Child Health." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2017. http://hdl.handle.net/10281/158179.
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Secondo l'Organizzazione Mondiale della Sanità (OMS), ogni giorno, in tutto il mondo, circa 1.000 donne muoiono per cause legate alla gravidanza o al parto e, ogni anno, più di otto milioni di bambini nei paesi a basso e medio reddito muoiono prima di raggiungere i cinque anni di vita. L'OMS è stata chiara: la salute materno-infantile è un tema di enorme importanza sanitaria e richiede investimenti, progetti, energie e impegno, rappresentando una componente fondamentale della salute pubblica delle popolazioni umane.
Migliorando l'approccio e l'accesso alle cure sanitarie, rendendo più disponibili assistenza qualificata, trattamenti farmacologici e la formazione degli operatori, ma anche semplici interventi preventivi durante la gravidanza, nel corso della gravidanza, del parto e dei primi anni di vita del bambino è possibile, infatti, prevenire le morti evitabili.
A fronte della complessità dell’insieme dei temi e delle problematiche relative al percorso nascita e alla salute materno-infantile, ho ritenuto di suddividere in più fasi il mio progetto sviluppando diversi profili, come quello socio-economico, farmacologico, e clinico.
Sono state utilizzate diverse metodologie statistiche a seconda dell’obiettivo dello studio. Le associazioni tra le diverse esposizioni della madre, prima e/o durante la gravidanza, e gli esiti neonatali selezionati, sono state valutate attraverso modelli di regressione logistica. In alcuni studi c’è stata la necessità di imputare i dati mancanti. Vista la natura di questi ultimi, arbitrary missing data pattern, è stato utilizzato il modello “fully conditional specification (FCS)”, ipotizzando l'esistenza di una distribuzione congiunta per le variabili mancanti. Per rendere le stime più robuste, a seguito della presenza di confondenti non misurati, è stato utilizzato l'approccio rule-out descritto da Schneeweiss. Per valutare il ruolo che gli eventi avversi neonatali alla nascita svolgono nel rapporto tra l’esposizione della madre durante la gravidanza e gli esiti neonatali in questione, ho utilizzato la “mediation analysis” descritta da VanderWeele e Vansteelandt. Infine, a seguito dell’utilizzo di dati osservazionali, le caratteristiche basali di esposti e non esposti potrebbero essere sbilanciate. Ho quindi utilizzato la tecnica del “propensity score startification” che permette di creare gruppi di pazienti con simile probabilità di ricevere il trattamento. Il propensity score è stato stimato sia attraverso il metodo classico della regressione logistica, sia utilizzando l’algoritmo “high-dimensionale propensity score” per valutare le centinaia di diagnosi, procedure, e prescrizioni più significative.
Lo scopo della mia tesi è quello di identificare i possibili fattori per sviluppare e migliorare la salute materno-infantile da un aspetto socio-demograficho, farmacologico, e clinico.
Ho strutturato la mia tesi in diverse sezioni. Procederò in prima istanza, dando una panoramica dei metodi utilizzati nei vari studi effettuati durante il mio dottorato, procedendo con una descrizione dettagliata di questi ultimi.According to the World Health Organization (WHO), every day, worldwide, about 1,000 women die due to causes related to pregnancy or childbirth and, every year, more than eight million children in low and middle income countries die before reaching five years of age. The WHO was clear: maternal and child health is a topic of enormous medical importance and requires investments, projects, energy and commitment; it is an essential part of the public health of human populations. Improving the approach and access to health care, making qualified assistance, drug treatment and training of the operators more available, but also elementary preventive interventions during pregnancy, childbirth and the early years of a child's life, can prevent avoidable deaths and reduce several neonatal outcomes. Given the complexity of all the issues and problems concerning births and maternal and child health, through this thesis I propose a path divided into several stages which covers various topics starting from the socio-economic profile of the mother, moving to the pharmacological profile of pregnancy, up to the prevention of stillbirths. Several statistical methods were implemented to answer the different questions depending on the aim of each study. Log-binomial regression was used for estimating the association between the mother’s exposure during pregnancy and the selected neonatal outcomes. The fully conditional specification (FCS) model was performed to generate appropriate values of missing data for those women with missing covariates. The rule-out approach described by Schneeweiss was implemented to make our estimates, which might be affected by unmeasured confounder, more robust. The mediation analysis described by VanderWeele and Vansteelandt was used to assess the role that some adverse neonatal events at presentation (mediator) play in the relationship between the mother’s exposure during pregnancy (exposure) and adverse neonatal events later in life (outcome). Lastly, the Propensity Score Stratification derived from the predicted probability of treatment estimated in a logistic-regression model, as well as the high-dimensional propensity score algorithm to evaluate hundreds of inpatient diagnosis, procedures, and pharmacy claims, were completed to account for all potential confounders. The aim of my thesis is to identify factors to develop and improve the health care related to maternal- fetal and maternal-child world (before and after birth, respectively) from a sociodemographic, farmacoepidemiology, and clinical point of view. The layout of the thesis has been divided into different sections. I will proceed in the first instance by giving an overview of the methods used in the various studies carried out during my PhD, proceeding with a detailed description of the latter.
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Harty, Michal. "The association between maternal self-efficacy and maternal perception of child language competence." Diss., Pretoria : [s.n.], 2004. http://upetd.up.ac.za/thesis/available/etd-10052005-090227.
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Muehlenbachs, Atis. "Maternal-fetal conflict during placental malaria : hypertension, trophoblast sVEGFR1 expression and maternal inflammation /." Thesis, Connect to this title online; UW restricted, 2006. http://hdl.handle.net/1773/5104.
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Girsén, A. (Anna). "Preeclampsia and maternal type-1 diabetes: new insights into maternal and fetal pathophysiology." Doctoral thesis, University of Oulu, 2009. http://urn.fi/urn:isbn:9789514291104.
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Abstract
Abnormal placentation is associated with preeclampsia and placental insufficiency, both of which increase the risk for fetal growth restriction. So far the early recognition of the risk population for preeclampsia has been problematic. The first hypothesis of this study was that in preeclampsia, the maternal serum proteomic profile is different from that in uncomplicated pregnancies, and this difference is detectable already in early pregnancy. The findings of this study demonstrate that in clinical preeclampsia the maternal serum proteomic profile is different from that in uncomplicated pregnancies with increased levels of placental proteins and antiangiogenic factors in pregnancies with clinical preeclampsia. Furthermore, the early pregnancy maternal serum proteomic profile in women who later develop preeclampsia revealed a distinct and different pattern compared with the profile in clinical preeclampsia. In early pregnancy, the differentially expressed proteins belong to placental proteins, vascular and/or transport proteins and matrix and/or acute phase proteins, while angiogenic and antiangiogenic proteins were not significantly expressed in early pregnancy.
Preeclampsia, placental insufficiency, fetal growth restriction and type-1 diabetes may have an impact on fetal cardiovascular hemodynamics. The second hypothesis in this thesis was that in placental insufficiency, abnormalities in fetal cardiovascular status correlate with biochemical markers of cardiac dysfunction and chronic hypoxia. In placental insufficiency, increases in fetal N-terminal pro-atrial (NT-proANP) and pro-B-type natriuretic peptide (NT-proBNP) and in fetal erythropoietin concentrations were related to increased pulsatility in the fetal umbilical artery and descending aorta. In addition, these fetuses demonstrated increased pulsatility in their systemic venous blood velocity waveforms. Thus, in placental insufficiency, biochemical markers of cardiac dysfunction and chronic hypoxia are associated with signs of increased fetal cardiac afterload and systemic venous pressure. Increased NT-proANP and NT-proBNP levels were also detected in fetuses of type-1 diabetic mothers with normal umbilical artery velocimetry. In these pregnancies, NT-proANP and NT-proBNP levels were related to poor maternal glycemic control during early pregnancy.
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Jiwa, Salima. "Maternal employment : exploring the relationship between maternal stress, child factors and daily routines." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq25943.pdf.
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Nyberg, White Maria. "Preventing maternal mortality : - Nurses’ and midwives’ experiences from Tanzanian maternal health care services." Thesis, Linköpings universitet, Avdelningen för omvårdnad, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-116479.
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Background: Half a million women died during pregnancy or childbirth in 2005. Bleeding, infections, high blood pressure, obstructed labor, unsafe abortions, malaria and HIV/Aids were the main causes. Tanzania is a highly affected country with 460 maternal deaths per 100 000 live births. Nurses and midwives play an important role in preventing maternal mortality. Purpose: The aim of this study was to explore and analyze nurses’ and midwives’ experiences of maternal mortality prevention on the Tanzanian island of Unguja. Method: Interviews with nine nurses and midwifes from four different hospitals and health care facilities were conducted with the assistance of an interpreter. A structural analysis designed by Ricoeur was undertaken. Results: The findings suggest that family planning, a more accessible health care, referral of severe cases, medical interventions, health education, community resource persons and involving fathers in maternal health care are preventive strategies that can reduce maternal mortality. Conclusion: To further improve the quality of maternal mortality prevention further knowledge aboutindividual differences in learning from health education is needed. Involvement of all fathers in maternal health care should also be considered. Training of unskilled personnel is believed to improve early identification of life-threatening complications and thereby reduce maternal mortality.Bakgrund: En halv miljon kvinnor i världen dog under graviditet eller förlossning under 2005. Huvudorsaker var blödningar, infektioner, högt blodtryck, långdragna förlossningar, osäkra aborter, malaria samt HIV/Aids. Tanzania är ett drabbat land med 460 fall av mödradödlighet per 100 000 levande födda barn. Sjuksköterskor och barnmorskor spelar en viktig roll i det preventiva arbetet mot mödradödlighet. Syfte: Syftet med studien var att utforska och analysera sjuksköterskors och barnmorskors upplevelser och erfarenhet av arbetet mot mödradödlighet på ön Unguja, Tanzania. Metod: Intervjuer med nio sjuksköterskor och barnmorskor från fyra olika sjukhus/hälsocentraler genomfördes med hjälp av en tolk. En strukturanalys utformad av Ricoeur genomfördes. Resultat: Resultatet visar att familjeplanering, en mer tillgänglig hälso- och sjukvård, remitterande av patienter med allvarliga komplikationer, medicinska interventioner, hälsoutbildning, resurspersoner i samhället och att involvera pappor i mödrahälsovården var preventiva strategier som kan minska mödradödlighet. Slutsats: För att ytterligare förbättra arbetet mot mödradödlighet tycks mer kunskap om individers förmåga att ta till sig hälsoutbildning behövas. Att i ännu större utsträckning även välkomna alla blivande pappor till mödrahälsovården föreslås också kunna fungera preventivt. Utbildning för outbildade kvinnor som hjälper till vid förlossningar (Traditional Birth Attendants) tros kunna förbättra tidig identifikation av livshotande komplikationer och därmed kunna minska mödradödligheten.
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Gray, Jeffrey W. "Assessment of perinatal complications with a maternal self report : the maternal perinatal scale." Virtual Press, 1987. http://liblink.bsu.edu/uhtbin/catkey/536300.
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The present study was an effort to empirically subtype children's learning disabilities. A review of the literature was presented with a focus on current and historical subtyping attempts. A cluster analysis was performed on 1144 school-age learning disabled children who had completed extensive neuropsychological, intellectual, and achievement measures. Four interpretable clusters emerged which were seen as (1) Verbal-Sequential-Arithmetic Deficits, (2) Motor Speed and Cognitive Flexibility Deficits, (3) Mixed Language/Perceptual Deficits, and a (4) No Deficit Subtype. Not only did these clusters indicate unique profiles for each subtype across the sample, but developmental differences were also apparent between all four clusters. The current investigation suggested the utility of an empirical-neuropsychological approach to subtyping children's learning disabilities, while also portraying the importance of neurodevelopmental considerations of subtypes. Future directions in research were discussed.Department of Educational Psychology
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Monte, Alana Santos. "Severe maternal morbidity in a intensive care unit and maternal and perinatal repercussions." Universidade Federal do CearÃ, 2016. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=18717.
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Objetivou-se avaliar as admissÃes em uma UTI materna de acordo com os critÃrios de morbidade materna grave estabelecidos e suas repercussÃes maternas e perinatais. Estudo epidemiolÃgico analÃtico, de corte transversal. A coleta de dados aconteceu no perÃodo de agosto a dezembro de 2015 na Maternidade Escola Assis Chateaubriand (MEAC). A populaÃÃo do estudo foi composta por todos os prontuÃrios das mulheres que tivessem se internado na UTI materna da MEAC entre os anos de 2010 a 2014, totalizando 882. Foram utilizados como critÃrios de exclusÃo: prontuÃrios de mulheres com mais de 42 dias pÃs-parto; prontuÃrios com dados incompletos ou nÃo encontrados; casos de complicaÃÃes ginecolÃgicas, sendo 322 prontuÃrios excluÃdos, totalizando uma amostra de 560 prontuÃrios. Os dados foram compilados e analisados por meio do programa Statistical Package for the Social Sciences (SPSS) versÃo 20.0. A maioria das mulheres que teve near miss materno (NMM) se associou à faixa etÃria entre 20 e 34 anos, nÃo trabalhava, multigesta, com histÃria de aborto anterior e com menos que seis consultas de prÃ-natal. O parto vaginal apresentou-se como fator de risco para Ãbito quando analisado isoladamente. PorÃm, na regressÃo logÃstica foi a cesÃrea que passou a apresentar maior chance. Os principais diagnÃsticos dessas mulheres foram as sÃndromes hipertensivas. No entanto foram as sÃndromes hemorrÃgicas que lideraram as causas bÃsicas da morte. O nÃmero de casos de NMM no critÃrio de Waterstone foi muito mais elevado do que nos outros critÃrios. Contudo, ao fazer a associaÃÃo com o Ãbito materno, ele foi o critÃrio que menos classificou as mulheres que evoluÃram para Ãbito, inferindo a necessidade de utilizar o CritÃrio da OMS. O baixo peso ao nascer, Apgar no 5 minuto menor que 7 e Idade Gestacional ao nascer menor que 30 semanas tiveram forte associaÃÃo com o Ãbito perinatal. As sÃndromes hipertensivas maternas e a insuficiÃncia respiratÃria foram as causas principais dos Ãbitos fetais e neonatais, respectivamente. Diante disso, recomenda-se que a morbidade materna grave seja investigada, pois permitirà uma anÃlise mais precisa dos fatores relacionados com a sua ocorrÃncia e tambÃm serà usada para auditar a qualidade do cuidado obstÃtrico do ponto de vista hospitalar e como grupo de comparaÃÃo em estudos de caso de morte materna e perinatal.The objective was to evaluate the admissions in a maternal ICU according to the established criteria of severe maternal morbidity and its maternal and perinatal repercussions. Analytical epidemiological study, cross-sectional. Data collection took place from August to December 2015 at the Maternity School Assis Chateaubriand (MEAC). The study population consisted of all the medical records of women who had been admitted to the maternal intensive care unit of MEAC from 2010 to 2014, totaling 882. Exclusion criteria were: records of women more than 42 days postpartum ; Charts with incomplete or missing data; Cases of gynecological complications, 322 of which were excluded, totaling a sample of 560 medical records. Data were compiled and analyzed using the Statistical Package for Social Sciences (SPSS) program version 20.0. The majority of women who had near miss maternal (NMM) were associated to the age group between 20 and 34 years, did not work, multigesta, with previous abortion history and with less than six prenatal consultations. Vaginal delivery was a risk factor for death when analyzed alone. However, in the logistic regression it was the cesarean section that presented a greater chance. The main diagnoses of these women were hypertensive syndromes. However, it was the hemorrhagic syndromes that led the basic causes of death. The number of NMM cases in the Waterstone criterion was much higher than in the other criteria. However, in association with maternal death, it was the criterion that less classified the women who died, inferring the need to use the WHO Criteria. Low birth weight, Apgar at 5 minutes less than 7 and Gestational Age at birth less than 30 weeks had a strong association with perinatal death. Maternal hypertensive syndromes and respiratory failure were the main causes of fetal and neonatal deaths, respectively. In view of this, it is recommended that serious maternal morbidity be investigated, as it will allow a more precise analysis of the factors related to its occurrence and will also be used to audit the quality of obstetric care from the hospital point of view and as a comparison group in studies Case of maternal and perinatal death.
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Hummel, Alexandra Carlyle. "Maternal Depressive Symptoms, Maternal Behavior, and Toddler Internalizing Outcomes: A Moderated Mediation Model." Miami University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=miami1366881153.
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Greiner, Lindsay E. B. S. "Markers of Maternal Metabolism and Maternal Glucose Responsiveness Following Supplementation with Docosahexaenoic Acid." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1321371169.
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Bennington, Linda. "THE RELATIONSHIP AMONG MATERNAL INFANT BONDING, SPIRITUALITY, AND MATERNAL PERCEPTION OF CHILDBIRTH EXPERIENCE." VCU Scholars Compass, 2010. http://scholarscompass.vcu.edu/etd/2242.
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The beginning of life is an intense experience for both mother and baby and sets the foundation for future interactions. Researchers have theorized that maternal infant bonding begins prenatally and continues on through the postnatal period. Mṻller (1996) examined that process to determine if prenatal bonding was related to postnatal bonding and discovered that there was only a modest correlation between the two. This led to speculation as to what variables, besides prenatal bonding, could influence postnatal bonding. Klaus & Kennell (1976) noted the detrimental effects of a lack of bonding in terms of abuse and attachment disorders and emphasized the urgency of understanding the process. Thus, an examination of factors that influence the initial attachment after birth is important in order to facilitate the experience for optimal outcomes. The purpose of this study was threefold: 1. Examine the relationship between a woman’s perceived birth experience and maternal infant bonding; 2. Examine the relationship between spirituality and maternal infant bonding; 3. Examine the relationship between perceived birth experience and maternal infant bonding. Women were recruited for an internet survey through various childbirth websites, nurses’ associations, and perinatal listserv communications. A total of 402 women responded to the survey, which consisted of 67 items in three instruments: Perception of Birth Scale; Spirituality; and Maternal Attachment Inventory. Of these respondents approximately 300 finished the survey completely and were used in the analyses. Slightly more than 190 left extensive comments regarding their experiences. Predictive Analytical Software (PASW 18) was used to analyze data and correlations were run on the measurements of the three instruments as well as a regression analysis. Perceived birth experience had the strongest correlation to maternal infant bonding and was found to have a stronger influence on bonding as well.
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Rosen, Benjamin. "Maternal Monitoring and Maternal Psychological Well-Being: Important Components in Treating Conduct Disorder." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/3246.
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Conduct disorder is characterized by behaviors that take a large toll on the individuals, families, and communities afflicted. Thus, improving treatment effectiveness should be a high priority. Currently, common intervention programs do not address parental depression, even though it has been linked to adolescent conduct disorder behaviors in some studies. The current study assessed whether the relation between maternal depression and adolescent conduct disorder behaviors is mediated by another factor which has been linked to conduct disorder behaviors, maternal monitoring. Results did not support the hypothesized mediated association, but did show significant individual associations for both maternal depression and maternal monitoring with adolescent conduct disorder behaviors. Secondary analyses showed that adolescent age and household income were significantly related to maternal monitoring and maternal depression, respectively. Findings also suggested that child disclosure may drive the association between maternal monitoring and adolescent conduct disorder behaviors. Implications for intervention are discussed.
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Menary, Joanne E. "Maternal anxiety and children's internalising difficulties : associations with maternal cognitions and parenting behaviour." Thesis, University of Manchester, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.525995.
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Leiferman, Jennifer Ann. "The effect of maternal depressive symptomatology on maternal behaviors associated with child health /." Digital version accessible at:, 2000. http://wwwlib.umi.com/cr/utexas/main.
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Ryder, Anna H. "Maternal responsiveness and children's early language development : the effect of maternal psychological factors." Thesis, University of Sheffield, 2013. http://etheses.whiterose.ac.uk/4767/.
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Fantaye, Arone. "Understanding Maternal Care Preferences and Perceptions to Curb Maternal Mortality in Rural Africa." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/40111.
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Background: The underutilization of formal, facility-based maternal care is a major contributor to the high maternal mortality rates among women living in rural Africa. Increasing the use of formal maternal care requires exploration of important maternal health issues affecting community members and comprehension of how they perceive the use of formal and traditional maternal care. This thesis aimed to identify the key factors, challenges, and needs of rural populations for the uptake of formal maternal care. Paper 1 explored rural women's preferred choices for sources of maternal care as well as the factors that contribute to their preferences in Africa. Paper 2 explored elders' perceptions about reasons for the underutilization of maternal healthcare and maternal death, as well as potential solutions to improve formal care use in rural Nigeria.
Methods: 1) In paper 1, a systematic search on Ovid Medline, Embase, CINAHL, and Global Health identified 40 qualitative studies that elicited women's preferences for maternal care in rural Africa. Reviewers collated the findings and reported on patterns identified across findings using the narrative synthesis method. 2) Data were
collected through 9 community conversations with 158 elders in 9 rural Nigerian communities. The data were analyzed inductively through thematic analysis.
Results: 1) A variety of preferences for formal, traditional and both formal and traditional maternal care during antepartum, intrapartum and postpartum periods were identified. The majority of the studies reported preferences for formal antenatal care or a combination of traditional and formal antenatal care. During intrapartum, rural women held a wide range of preferences, including facility-based births, traditional births in a domestic setting, as well as a combination of formal and traditional care depending on the onset of complications. The majority of the studies reported preferences for traditional postnatal care involving traditional attendants, self-care, and cultural rituals that fend off witchcraft. The factors that contributed to these preferences were related to the perceived need of formal or traditional maternal care, accessibility to formal or traditional care, and cultural and religious norms, beliefs and obligations. 2) The perceived reasons for the underuse of formal maternal care included poor qualities of care, physical and financial inaccessibility of facility-based services, and lack of knowledge and awareness. Reasons for women's maternal deaths included malaria and blood displacement, facility-based service deficiencies, uptake of traditional maternal care, and poor community awareness and negligence. Increased access to high-quality care, health promotion and education, community support and supernatural assistance were the proffered solutions.
Conclusions: The major areas that need improvement across rural Africa include human and material resources availability, technical and interpersonal quality of care in health facilities, physical accessibility, financial accessibility, sociocultural accessibility, cultural and religious sensitivity, and community knowledge and
awareness. Generally, the findings reflect the need for multifaceted interventions that engage target populations and consider local contexts, realities, and related needs in order to develop locally acceptable interventions. Such interventions will increase the likelihood of effective and long-lasting positive changes in healthcare utilization and maternal mortality.
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Klein, Marianne Orlandini. "Dieta hiperlipídica materna: influências sobre o comportamento maternal e o desenvolvimento da prole." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/42/42136/tde-10112016-163151/.
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Uma nutrição maternal rica em lipídios pode causar prejuízos no desenvolvimento e na vida adulta dos descendentes, como elevado risco de desenvolver alterações metabólicas e obesidade, e também parece alterar a sinalização central por opióides. Porém, estudos realizados a fim de investigar a influência da dieta hiperlipídica (HF) materna sobre o comportamento materno e o desenvolvimento da prole não são conclusivos. Este trabalho investigou a influência da dieta HF sobre a interação mãe-filhote, em duas gerações, e os efeitos imediatos e tardios sobre a prole, relacionando-os ao sistema opióide. As mães HF apresentaram prejuízos na ejeção do leite e maior expressão dos receptores opióides no hipotálamo. No geral, os descendentes HF apresentaram elevados níveis de colesterol, baixa leptina plasmática, maior expressão de peptídeos relacionados à ingestão alimentar, e menor peso. Portanto, o consumo materno de dieta HF causou alterações metabólicas, comportamentais e na expressão gênica na mãe e nos descendentes, mesmo que esses animais não tenham se tornado obesos.A maternal nutrition high in fat may impair offspring development and adulthood, increasing the risk to develop metabolic alterations and obesity, and may modify the opioids central signaling. However, studies investigating maternal high fat (HF) diet influences on maternal behavior and offspring development are inconclusive. This study aimed to evaluate the influences of a diet high in fat on mother-pup interaction, in two generations, and its early and late effects in the offspring, connecting them to the opioid system. HF dams show decreased milk ejections and higher expression of opioid receptors in the hypothalamus. Overall, HF offspring had higher cholesterol levels, less serum leptin, higher expression of peptides related to food intake, and were lighter. Therefore, maternal intake of HF diet promoted metabolic, behavioral and gene expression alterations in the mother and her offspring, even though these animals did not become obese.
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Nogueira, Sária Cristina. "Práticas educativas, indicadores emocionais maternos e comportamentos dos filhos : famílias nucleares e não nucleares /." Bauru, 2020. http://hdl.handle.net/11449/192205.
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Orientador: Olga Maria Piazentin Rolim RodriguesResumo: O objetivo geral deste trabalho foi descrever, comparar e correlacionar, de famílias nucleares e não nucleares, as práticas educativas parentais, a saúde emocional materna e problemas de comportamento das crianças. Quatro estudos foram realizados, a partir do relato de múltiplos informantes: 62 mães, 25 professoras e 62 crianças com faixa etária entre oito e 11 anos. Os instrumentos foram: Inventário de Estilos Parentais, Inventário de Depressão Beck, Inventário de Ansiedade Traço-Estado, Escala de Estresse Percebido, Questionário de Capacidades e Dificuldades e entrevista sobre dados sociodemográficos. O Estudo 1 analisou problemas de comportamento de crianças de famílias nucleares e não nucleares sob o ponto de vista de mães e professores. Os resultados apontaram que ambas informantes observaram comportamentos pró-sociais nas crianças, independente do grupo. Mães dos dois grupos perceberam de forma semelhante os problemas de comportamento dos filhos e, mais do que os professores e estes relataram significativamente mais problemas de comportamento das crianças do grupo não-nuclear. O Estudo 2 descreveu e comparou práticas educativas de mães de famílias não-nucleares e não nucleares associando-a a saúde emocional materna. Os resultados mostraram que a maioria das mães da amostra total foi classificada com estilo parental de risco, sem diferença significativa entre os grupos. As mães de famílias não nucleares utilizaram significativamente mais a prática de Abuso Físico. Quanto... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The general objective of this study was to describe, compare and correlate, of nuclear and non-nuclear families, parental educational practices, maternal emotional health and behavior problems of children. Four studies were conducted based on the report of multiple informants: 62 mothers, 25 teachers and 62 children aged between eight and 11 years old. The instruments were: Parental Styles Inventory, Beck Depression Inventory, Dash-State Anxiety Inventory, Perceived Stress Scale, Capabilities and Difficulties Questionnaire and interview about sociodemographic data. The search 1 analyzed child behavior problems from nuclear and non-nuclear families from the point of view of mothers and teachers. The results showed that both informants observed prosocial behaviors in the children, regardless of the group. Mothers from both groups perceived similarly the behavior problems of their children and, more than teachers and these reported significantly more behavioral problems of children in the non-nuclear group. The search 2 described and compared educational practices of mothers from nuclear and non-nuclear families associating her with maternal emotional health. The results showed that the majority of mothers in the total sample were classified as at risk parental style, without significant difference between the groups. The Mothers from non-nuclear families used the practice of Physical Abuse significantly more. Regarding maternal emotional health, it is noteworthy that stress and... (Complete abstract click electronic access below)
Doutor
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Nehemia, Elsa Jacinto José Maria. "Fatores associados a morbidade materna grave: a relação com o HIV e AIDS, Maputo, Moçambique." Instituto de Saúde Coletiva, 2014. http://repositorio.ufba.br/ri/handle/ri/16333.
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Introdução: Morbidade Materna Grave (MMG) é um quadro clínico observado em mulheres no ciclo gravídico-puerperal, composto por condições graves a extremamente graves, que ao sobreviverem são conhecidos por near miss materno; estes últimos são identificados por sinais de disfunção orgânica subsequentes a condições ameaçadoras da vida. As evidências vêm mostrando a carga da pandemia do HIV/AIDS sobre as condições clínicas de pacientes portadoras de outras doenças. Objetivos: estimar a incidência da razão de resultado materno grave e investigar os fatores associados à MMG em Maputo. Métodos: estudo caso-controle realizado na Cidade de Maputo, Moçambique, no período de Março a Novembro de 2012. As participantes elegíveis para o grupo de casos foram mulheres residentes em Maputo com MMG, segundo a definição da OMS. Os controles foram pacientes admitidas nos mesmos hospitais e no mesmo período, seguindo os mesmos critérios para a seleção dos casos, à excepção da condição clínica exigida para estes. Para o cálculo do tamanho da amostra utilizou-se o programa Epi Info, considerando-se um poder do estudo de 80%, um alfa=0,05, nível de confiança=0,95, relação caso/controle 1:2 e Odds Ratio (OR) esperada de 1,5, obtendo-se uma amostra com 485 casos e 970 controles. A exposição foi a infeção pelo HIV/AIDS, sendo utilizadas variáveis sócio-demográficas, clínico-assistenciais e comportamentais, como o uso de álcool e fumo. Os dados coletados de morbidade materna grave e near miss materno foram extrapolados para o período de doze meses por Regressão Linear Simples, utilizando-se termos quadrático e cúbico e calculados os indicadores. Para a diferença entre proporções utilizou-se o teste 2 de Pearson. A medida de associação entre HIV/AIDS e MMG (desfecho) foi a OR e seus intervalos de confiança a 95% por Regressão Logistica não condicional. Nas análises foi utilizado o pacote estatístico STATA versão 10.0. Resultados: A Razão de Resultado Materno Grave foi de 1,7/1.000 NV, Razão de NMM 0,4/1.000 NV, Razão near miss/morte materna de 28:100, Indice de Mortalidade de 78,3% e Razão de mortalidade materna de 133/100.000 NV. As principais causas de MMG foram as doenças hipertensivas (69,7%) seguidas das hemorrágicas (19,0%); entre as near miss materno foram as hemorrágicas (64,3%) e entre as mortes maternas foi a AIDS (50,0%). Foram fatores associados a um maior risco da gravidade o antecedente de aborto (OR=2,2; IC=1,4 -3,7); HIV positivo (OR=2,5; IC=1,9 – 3,3), puérpera (OR=2,7; IC=2,1 – 3,6), parto cesáreo (OR=14,9; IC=7,3 – 30,4) e tempo de trajeto entre casa e hospital superior a 30 minutos (OR=2,1; IC=1,4 – 3,2). A procura direta do hospital de referência atuou como fator protetor OR=0,6; IC=0,5 – 0,8. A associação entre a infeção por HIV e morbidade materna grave foi de OR=2,7 (IC=2,1 – 3,5). A Fração Atribuível Populacional ao HIV foi de 21,3% Conclusões: A morbidade materna grave é cerca de três vezes maior nas grávidas ou puérperas infectadas pelo vírus do HIV/AIDS do que nas não infectadas. A Razão de Resultado Materno Grave em Maputo é relativamente elevada, sendo as principais causas as doenças hemorrágicas e a infeção pelo HIV/AIDS. Os fatores associados estão relacionados sobretudo aos antecedentes reprodutivos das mulheres, orientando para uma maior atenção ao grupo de maior risco, pelo uso de normas e procedimentos padronizados.
Introduction: Severe Maternal Morbidity (SMM) is a clinical condition of women in their pregnancy and childbirth, composed of conditions ranging from severe to extreme severity, which are known when survive by maternal near miss (MNM); these cases are identified by signs of organ dysfunction subsequent to life-threatening conditions. Furthermore, surveys have shown evidence of the burden of the HIV / AIDS pandemic on the clinical condition of patients with other diseases. Objectives: To estimate the incidence of Severe Maternal Outcome Ratio (SMOR) and investigate factors associated with SMM in Maputo. Methods: case-control study conducted in Maputo, Mozambique, from March to November 2012. Eligible participants for the group of cases were resident women living with SMM, according to the WHO definition. Controls were patients admitted to the same hospitals during the same period, using the same criteria for selection of cases, with the exception of the clinical condition for these. To calculate the sample size we used the Epi Info program, considering a study power of 80%, an alpha = 0.05, confidence level = 0.95, compared case / control 1:2 and an expected odds ratio (OR) of 1.5. 485 cases and 970 controls were obtained. The exposure was the infection with HIV / AIDS; socio-demographic, clinical, healthcare and behaviour variables such as smoking e alcool utilization being used. The data for SMM and MNM were extrapolated to the period of twelve months by Simple Linear Regression with quadratic and cubic terms and calculated indicators. For the difference between proportions used the 2 test of Pearson. The measure of association between HIV / AIDS and SMM (outcome) was the OR and confidence intervals at 95% by unconditional Logistic Regression. For the analysis STATA version 10.0 was used. Results: SMOR was 1,7/1.000 LB, MNM Ratio 0,4/1.000 LB, maternal near miss/maternal death ratio of 28:100, mortality index of 78.3% and maternal mortality ratio of 133/100.000 LB. The main causes of SMM were hypertensive disorders (69,7%) followed by bleeding disorders (19.0%); among maternal near miss were bleeding (64.3%) and among maternal deaths were AIDS (50,0%). Factors associated with an increased risk of severity were history of abortion (OR = 2.2, CI = 1.4 - 3.7), HIV positive (OR = 2,5, CI = 1.9 to 3.3), pospartum period (OR = 2.7, CI = 2.1 to 3.6), caesarean delivery (OR = 14.9, CI = 7.3 to 30.4) and time between home and hospital exceeding 30 minutes (OR = 2.1, CI = 1.4 to 3.2) .The association between HIV infection and severe maternal morbidity was OR = 2.7 CI =( 2.1 to 3.5). The direct search of the reference hospital acted as a protective factor OR = 0.6; CI = 0.5 to 0.8. The Population Attributable Fraction of HIV was 21.3%. Conclusions: Severe maternal morbidity is about three times higher in pregnant or postpartum HIV / AIDS infected women than in uninfected. SMOR is high in Maputo and the main causes are bleeding disorders and infection by HIV / AIDS. Associated factors are mainly related to reproductive history of women, requiring greater attention to the high risk group, by the use of standards and standardized procedures.