Dissertations / Theses on the topic 'Neonatal and child health'
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Raeside, L. "Neonatal pain assessment : the development of a pain assessment scale for neonatal transport." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/372909/.
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The aim of this study is to develop a pain assessment scale for use during neonatal transport. Underpinned by the rights of the child to have appropriate assessment and management of pain and the important deleterious effects pain can have on the physiological stability of the neonate, this study utilises a qualitative consensus paradigm of enquiry to inform the content and structure a pain assessment scale specific to the transport setting. The study was conducted in three Phases, the first Phase consisted of a nominal group meeting with transport clinicians to ascertain their views on items to include in a pain assessment scale for transport. Phase Two utilised the Delphi technique to gain consensus from a large cohort of clinicians experienced in the field of neonatal transport on the content, structure and design of a transport pain assessment scale. Results of the first two Phases of the study were then applied to the adaptation of an existing pain assessment scale. Face validity of the newly developed Neonatal Transport Pain Assessment Scale (NTPAS) was then tested in Phase Three by semi-structured interviews with transport clinicians. Results of initial face validity testing suggested positive results in relation to feasibility and clinical utility of the scale, however further testing is strongly recommended. Currently there are no pain assessment scales developed for use in the transport setting, and little evidence on the effects of transport on pain and pain assessment. This study offers a unique approach in adding to the body of knowledge on neonatal pain assessment and facilitated the development of a scale adapted to transport. Further research is suggested to undertake psychometric testing of the scale and establish validity and reliability in the clinical setting.
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Dube, Queen. "Aetiology and outcome of neonatal sepsis and meningitis in Malawi." Thesis, University of Liverpool, 2014. http://livrepository.liverpool.ac.uk/2005539/.
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In Malawi there has been significant progress in reducing post-neonatal and under-5 deaths over the past decade but very little progress in reducing neonatal deaths. The major causes of neonatal deaths in Malawi are prematurity, infections and birth asphyxia. Neonatal sepsis has been shown to have long term complications ranging from motor deficits to cognitive impairment, epilepsy and behavioural disorders in preterm very low birth weight infants in the developed setting. Contrary to the epidemiology in the developed setting where neonatal sepsis is predominantly seen in preterm low birth weight infants, in the developing setting neonatal sepsis is also common among term babies. However, very little is known on the long term outcome of neonatal sepsis in the resource restrained setting. In this thesis the aetiology and outcome of neonatal sepsis and meningitis is investigated. METHODOLOGY This was study had 2 components; a cross sectional arm and a prospective cohort arm. The cross sectional study was looking at the aetiology, resistance pattern and in hospital outcome of severe neonatal infection cases presenting at QECH in Blantyre. The prospective cohort arm involved participants who were recruited in the cross sectional arm at QECH and were residing within Blantyre urban and infants that never had an episode of severe neonatal infection were recruited from Zingwangwa health Centre. The infants from Zingwangwa acted as controls. The participants in the prospective cohort arm were followed up to the age of 1 year where neurodevelopmental outcomes were assessed using the Bayley’s assessment tool. These participants also had detailed neurologic examination during the follow up visits at 6 and 12 months of age. A comparison between the cases and controls was made to ascertain the impact of neonatal infection outcome. RESULTS During the study a total of 412 cases were enrolled in the cross sectional arm. 75% of the cases had late onset disease. GBS was the commonest organism grown in blood culture 17/42(40%) and CSF culture 16/33(48%). 44% had abnormal serum sodium levels on admission and hypernatraemia was independently associated with an increased risk of dying in hospital (8.34[95% CI 1.95-35.7]). 51% of the gram negative organisms were multidrug resistant. In the long term outcome neonatal sepsis without overt meningitis was associated with an up to 6.6 –fold {95% CI (2.38-18.4) increased risk of developmental delay at 1 year of age. Meningitis was associated with a 17-fold {95% CI 4.89- 61.7} increased risk of developmental delay at 1 year of age. Positive blood or CSF culture and being HIV exposed were independent predictors of delay at I year of age. CONCLUSION GBS is a significant cause of neonatal infections in Malawi. The magnitude of developmental delay observed in infants who had neonatal sepsis without meningitis is worrying up to 35% of these infants were delayed. It is therefore important to employ measures that can prevent neonatal infections. Follow up is recommended in infants who had an episode of severe neonatal infection.
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Dare, Shadrach. "A multilevel mixed methods study of neonatal mortality in Ghana." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/30943/.
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Background: Reducing neonatal mortality rates [NMR] (deaths/1,000 live births within 28 days of delivery) is a key global health goal. Using comparable data from Ghana (West Africa) and Scotland, I investigated NMR, specific causes of death and risk factors in the two countries. By identifying the main causes of excess mortality in Ghana and where they occur, it is hoped more effective strategies can be developed. Methods: This thesis used a multilevel mixed methods study design. Data on live births were obtained from three Health and Demographic Surveillance Systems (HDSS) in the north, middle and south of Ghana respectively: Navrongo (2004-12; 17,016 live births, 320 deaths); Kintampo (2005-10; 11,207 live births, 140 deaths); Dodowa (2006-14; 21,647 live births, 135 deaths). Comparable Scottish data were obtained from the Information Services Division (1992 to 2015; 1,278,846 live births, 2,783 deaths). Each dataset was analysed by neonatal death (dead/alive), using univariate and multivariable logistic regression. The multivariable analyses adjusted for maternal demographic and obstetric characteristics. Missing data were analysed using multiple imputation techniques. Data analyses were complemented by a researcher-developed questionnaire survey of 71 maternity care providers in the three regions of Ghana followed by face-to-face in-depth interviews with 48 maternity care providers who had experience of prematurity, birth asphyxia, neonatal infection and neonatal death. Results: The NMRs in the three HDSS were: Navrongo: 18.8; Kintampo: 12.5; and Dodowa 6.2 and in Scotland it was 2.2; the NMR in both countries is reducing. More than 99% of the neonatal deaths in Scotland occurred in the first week compared to 74% in Ghana. The leading causes of neonatal deaths (NMR) in Ghana were infection (4.3), asphyxia (3.7) and prematurity (2.2). In Scotland, they were congenital malformations (0.6), asphyxia (0.4) and prematurity (0.3). Only 88 deaths (0.07) of neonatal deaths in Scotland were due to infection. Ninety-eight percent of babies born in Scotland were born in a health facility compared to 60% of babies born in Ghana (hospital: 38.1%; clinic: 21.1%). In Ghana, babies born in hospitals had a higher risk of neonatal mortality compared to those born at home (NMR-hospital: 15.6; clinic: 7.1; home: 11.8). Most of the neonatal deaths in Ghana occurred at home (54%); there were more deaths among babies who were born in a hospital but died at home (hosp/home) compared to those born at home but died in a hospital (home/hosp). Asphyxia was the leading cause of death among hosp/hosp, and infection was the leading cause of death among hosp/home, home/home and home/hosp. Neonatal mortality in Ghana was largely influenced by where mothers sought maternity service, or the type of personnel who provided maternity care service. Mothers and babies who were cared for in hospitals by doctors and midwives received relatively better care and proper management of birth complications. Those who were cared for in clinics received basic delivery services and management of uncomplicated asphyxia. Mothers and babies who were cared for at home by traditional birth attendants (TBA) received poor care and poor management of neonatal illnesses based on traditional approaches which increased the risk of death. Women’s maternity choices were influenced by wider societal factors including prominent cultural values, family hierarchical structures and the cost of maternity services, and individual/ family factors including place of residence and availability of transport and beliefs about the cause of disease. Conclusion: There is considerable opportunity for reducing NMR in Ghana, especially deaths due to asphyxia and infections. Most uncomplicated deliveries should be performed by midwives in community clinics. The number of community maternity clinics should gradually be increased to enable home deliveries by TBAs to be phased out. Facilities should be improved for delivery and postnatal care in hospitals and the proportion of sick babies managed by health care workers trained in their care should be increased. Regular postnatal checks in the community by trained staff should be standard.
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Wood, David L. "An Overview of Neonatal Abstinence Syndrome." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5183.
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Sato, Chisaki. "Social and behavioral aspect of mother's health behaviors and neonatal health." Scholar Commons, 2004. http://scholarcommons.usf.edu/etd/2972.
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The results of this study indicate that two groups of mothers share a relatively similar socioeconomic status, knowledge of health and hygiene, and have similar health-seeking behaviors. The mothers' lack of knowledge and their local view of illnesses seemed to embody questionable newborn care related to breastfeeding practices and oil applications to newborns. Three psychosocial factors that appeared to contribute to the mother's health-seeking behaviors were attitudinal factors (this consisted of favorable or unfavorable perceptions toward services based on the mother's prior experiences or familiarity with service), social pressures (opinions from others and the mother's competing responsibilities), and self-efficacies accessibility, availability, and affordability). In addition, the external factor of poverty in the slum settlements was also a significant factor which determined the mother's health seeking behaviors.
The implications of these findings are discussed in further detail, which are then followed by a set of recommendations for future health interventions designed to reduce the risk of sepsis neonatorum in urban communities. This study underscores the benefits of integrating the perspectives of anthropology and public health to further the understanding of the neonatal health problem. Finally, the need for future studies is addressed as it is necessary to further understand the existing local practices and beliefs in relation to the risks of sepsis neonatorum.
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Booth, Nicola. "Becoming a parent to an infant requiring neonatal intensive care." Thesis, Liverpool John Moores University, 2011. http://researchonline.ljmu.ac.uk/6095/.
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The number of babies that require care in the Neonatal Intensive Care Unit continues to rise in the UK and parents who have a baby who is born sick or prematurely find themselves adapting to this stressful and often unexpected event whilst also trying to establish their role as a new parent. With no current large British studies, this study explores the experiences of both mothers and fathers in the NICU in relation to adaptation and parental role development and how their experience changes over time. In total 76 parents were interviewed using semi structured interviews 7-10 days following the birth to capture their early experiences of the NICU and then again beyond 28 days to explore any changes in their views and feelings over time. Interviews were tape recorded, transcribed verbatim into the written word and imported into WINMAX PRO. Data analysis revealed nine major sections. These are preparation prior to birth, labour and delivery, first sight of infant, support from the partner, family, friends and other parents, support from and communication with staff, adaptation to the NICU experience, development of the parental role, changes with time and the experiences of fathers. Findings show differences in what mothers and fathers find stressful about their NICU experience, how they adapt to the birth of a sick or premature infant and in their development of the parental role. With the passage of time the events surrounding the birth became less significant as parents start to look to the future. Their role as a parent continued to develop with feelings that their baby needed and recognised them, but many parents felt that they were unable to influence what happened to their baby in the NICU. Recommendations are made for further research and for changes to NICU practice.
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Nelson, Candice Afonso. "Neonatal Mortality in the Cape Town Metro West Geographical Service Area 2014-2017." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32948.
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Background Each neonatal death counts, as recognised by the Every Newborn Action Plan (ENAP). This is an important aspect in attaining the third Sustainable Development Goal by 2030. Accurate neonatal mortality data as well as an understanding of the causality and context is essential to plan interventions to reduce neonatal deaths and attain the third Sustainable Development Goals (SDG) of a neonatal mortality rate of less than 12 per 1000 livebirths by 2035. Objectives The objectives of this study were: (i) to determine neonatal mortality occurring in and out of health facilities in the Metro West GSA using the three audit programmes; Perinatal Problem Identification Programme (PPIP), Child Healthcare Problem Identification Programme (Child PIP) and Forensic Pathology Services (ii) to ascertain the cause of death specific neonatal mortality (iii) to describe the avoidable factors in each death as coded by the three audit programmes (iv) to make recommendations for the alignment of existing audit databases to obtain accurate neonatal statistics for the Metro West GSA. Methods This was a retrospective descriptive study of neonatal deaths undertaken in the public healthcare setting in the Cape Town Metro West GSA from January 2014 till December 2017. Existing data from PPIP, Child PIP and the CDR/FPS was used. Neonatal deaths were defined as in the first 28 days of life where there had been signs of life at delivery and a birthweight greater than 500g. Neonatal deaths were excluded where birth had occurred outside of the GSA or in the private health care setting. The audit data with regards to cause of death and avoidable or modifiable factors was obtained for each death. Results From a total of 134843 live deliveries, 1243 neonatal deaths were identified: 976(78%) from PPIP, 58(5%) from Child PIP and 209 (17%) from CDR/FPS. Sixteen per cent of the deaths occurred outside of healthcare facilities. The neonatal mortality rate (NMR) for PPIP was 7.2, Child PIP 0.43 and CDR 1,6 per 1000 livebirths. When the audit systems were combined, the annual NMR over the study period varied from 8.05 to 10.1 with a mean of 9.2 per 1000 livebirths over the entire period. Seventy-eight per cent of the deaths occurred in the early neonatal period with a mean early neonatal mortality rate of 7.2 per 1000 livebirths. The mean late NMR was 2 per 1000 livebirths. Where all neonatal deaths were considered for those more than 500g, the main cause of death was immaturity related, then infection related followed by congenital disorders and then hypoxia related. Seventy-four per cent of deaths occurred in those less than 2500g at birth and 41% were less than 1000g and defined as extremely low birthweight. In the group of neonates greater than 1000g, the main cause of death was infection related deaths, closely followed by congenital disorders and then hypoxia, followed by immaturity. Most of infection related deaths were collected by the CDR and Child PIP. A third of Child PIP and PPIP deaths and half of the CDR deaths were coded as avoidable. The prevalence of deaths due to abandonment either by passive or active neonaticide contributed towards the higher proportion of preventable deaths in the CDR group. Conclusions The burden of deaths due to immaturity is high and may be attributed to the finding that 41% of neonatal deaths were in the ELBW group. Current viability criteria that aim at optimum use of resources may improve survival amongst this group. Infection related deaths were shown by this study to have a greater burden than recorded from PPIP data; most of these deaths were derived from Child PIP and CDR data. Also, where 10% of neonatal deaths were sudden unexpected deaths (SUDIs), a better understanding and definition of this group is urgently required as many of these deaths were subsequently found to be secondary to lower respiratory infections. It is further relevant that where 20% of CDR deaths or 3% of all the study deaths were due to active and passive neonaticide, this entity should be monitored and investigated. The study showed that the GSA has achieved the SDG for NMR of less than 12 per 1000 livebirth. However, a mean NMR of 9.2 per 1000 livebirths is not comparable to other upper middle-income countries. As 38% of the deaths were coded as avoidable, appropriate programmes to address these factors could reduce the NMR to 5.7 per 1000 livebirths. A strong recommendation from this study would be to use all three audit systems to calculate the NMR, understand the causes of neonatal deaths and plan programmes to improve neonatal survival in this GSA.
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Karl, Bethany C. "The Importance of Child Life Within the Neonatal Intensive Care Unit (NICU)." Ohio University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1428577797.
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Shakya, Sujeeta Buppa Sirirassamee. "Factors influencing utilization of Maternal Neonatal Child Health (MNCH) services among ethnic groups in Nepal /." Abstract, 2006. http://mulinet3.li.mahidol.ac.th/thesis/2549/cd393/4838763.pdf.
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Mitra, Jose Mari Lawrence. "Perceptions of Male Nursing Students About Working in Women’s Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/honors/389.
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This study explores the opinions and experiences of East Tennessee State University (ETSU) male nursing students after they have completed their clinical rotations in obstetrics (OB). Participants are interviewed about their preconceptions and post-experience perspectives regarding the clinical rotation. After analyzing the interviews, the students’ perceptions appeared to be grounded in their perceived level of comfort with women’s health nursing. Themes include (1) preconceptions, (2) welcoming, (3) rejecting, and (4) culture.
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Dietrich, Liesl Bertha Kay. "A descriptive retrospective audit of the obstetric conditions which occur in mothers of babies with neonatal encephalopathy at Mowbray Maternity Hospital in 2016." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31169.
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Introduction: Neonatal encephalopathy (NE) is an important condition which may result in mortality or severe and permanent morbidity placing much strain on busy under-resourced health care services, parents and families, and the greater community. There is much debate on its aetiology; whether it is caused by antepartum conditions or intrapartum obstetric complications (known as sentinel events); and the relative contribution of intrapartum hypoxia. Unlike perinatal mortality, NE rates are not routinely audited by maternity facilities. At Mowbray Maternity Hospital, a formal audit was conducted in 2008, which measured the NE rate, focussed on obstetric factors associated with NE and identified avoidable factors in the care provided. It was thought to be of clinical value to repeat this audit to identify whether there were any trends in rates and the pattern of obstetric factors. Aims and objectives: The aim was to describe the obstetric factors occurring in patients who delivered neonates at MMH, diagnosed with NE. Specifically, it was planned to determine the NE rate, to describe obstetric factors occurring in these patients and to assess the avoidable factors related to the patients, health system and clinical management. Methodology: This was a retrospective descriptive study which included patients whose neonates were diagnosed with NE and were born at MMH in 2016. The diagnosis of NE was made according to the MMH NE protocol where NE is defined as a voltage suppression in amplitude-integrated electroencephalography (aEEG) or seizures; or clinical seizures or dystonic movements; or moderate to severe clinical signs of NE as defined by Shankaran and a level of consciousness which is decreased with abnormal tone. The neonates’ names were retrieved from a NE register in the neonatal unit and the corresponding mothers’ folders retrieved. Data on relevant obstetric and clinical management factors were collected from the folders using a data collection tool developed in the Western Cape and all cardiotocographic tracings were assessed by the researcher. Ethics approval was granted by the University of Cape Town Human Research Ethics Committee (UCT HREC) prior to the commencement of the study. STATA 14 was used for the analysis. Results: In 2016, 53 neonates with NE were identified out of 9,702 live births (LB) at MMH. The NE rate was 5.5 per 1000 LB. Of the 53 neonates, 48 maternal patient files were retrieved and analysed. There were 58% who had been referred to MMH from the midwife obstetric units (MOUs), and 42% fully managed at MMH. All patients were booked for 14 antenatal care, the mean age was 27.5 years and 50% were nulliparous. The mean gestational age at delivery was 39 weeks. The majority (87.5%) experienced labour, spontaneous in 72.9% and induced in 14.6%. Antenatal complications occurred in 77.1%, the most frequent being prolonged pregnancy (25%) hypertensive disorders (18.8%), antepartum haemorrhage (8.3%) and prelabour rupture of membranes (8.3%). Obstetric problems in labour included prolonged second stage of labour (25% of patients who had a second stage of labour); multiple vaginal examinations (28.6%) and prolonged first stage of labour (17.9%). Fetal monitoring at the MOUs was done according to protocol in 70% of patients in the latent phase but only 12.5% of those in the active phase of labour. At MMH, all patients in labour had Cardiotocograph (CTG) monitoring with 90.6% of CTGs being pathological and 6.3% suspicious, as assessed by the researcher. Meconium stained liquor occurred in 40.5% of patients. The mode of delivery was normal vertex, (27.1%), Caesarean sections (58.3%) and assisted vaginal delivery (14.6%). Most CS (71.4%) were done for pathological CTGs. Sentinel events occurred in 15 (31.3%) patients; approximately two-thirds occurring intrapartum and one- third antenatal. Sentinel events included shoulder dystocia (10.4%), prolonged second stage of labour (10.4%), abruptio placenta (6.3%), cord prolapse (2.1%) and eclampsia (2.1%). Of the 37 (68.7%) without a sentinel event, 75.8% had a pathological CTG. Considering avoidable factors, there was an ambulance delay in 42.9%, and a delay in accessing theatre for 53.6% of patients requiring a CS. Poor quality CTG tracing and monitoring occurred in 20.8% of patients; and for 34.4%, the researcher identified an abnormal CTG but it was not detected by the attendant health care workers. Discussion and conclusion: The NE rate for MMH is 5.5 per 1000 LBs, this is higher than the 3.7 found in the previous 2008 MMH study, despite a higher CS rate. Possible reasons for the increase include changes in case ascertainment, increased workload with same staff component, or a shift from perinatal hypoxic mortality to morbidity, notably NE. This NE rate compares with other lower resource settings and the previous MMH audit, as does the high proportion of intrapartum obstetric sentinel events. This is in contrast to findings from high resource settings. Areas for service improvement include regular and ongoing intrapartum care training, including fetal heart monitoring, for medical and nursing staff; and addressing the health system issues identified.
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Morrison, April H. "Utilization of Evidence-Based Guidelines to Improve Health Care Provider’s Breastfeeding Knowledge and Attitudes as a Step to Increase Healthy People 2020 Goals." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7121.
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Huicho, Luis, Patricia Hernandez, Carlos A. Huayanay-Espinoza, Eddy R. Segura, de Guzman Jessica Niño, Gianfranco Flores-Cordova, Maria Rivera-Ch, Howard S. Friedman, and Peter Berman. "Understanding drivers of domestic public expenditure on reproductive, maternal, neonatal and child health in Peru at district level: an ecological study." BioMed Central Ltd, 2018. http://hdl.handle.net/10757/624717.
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Background: Peru has increased substantially its domestic public expenditure in maternal and child health. Peruvian departments are heterogeneous in contextual and geographic factors, underlining the importance of disaggregated expenditure analysis up to the district level. We aimed to assess possible district level factors influencing public expenditure on reproductive, maternal, neonatal and child health (RMNCH) in Peru. Methods: We performed an ecological study in 24 departments, with specific RMNCH expenditure indicators as outcomes, and covariates of different hierarchical dimensions as predictors. To account for the influence of variables included in the different dimensions over time and across departments, we chose a stepwise multilevel mixed-effects regression model, with department-year as the unit of analysis. Results: Public expenditure increased in all departments, particularly for maternal-neonatal and child health activities, with a different pace across departments. The multilevel analysis did not reveal consistently influential factors, except for previous year expenditure on reproductive and maternal-neonatal health. Our findings may be explained by a combination of inertial expenditure, a results-based budgeting approach to increase expenditure efficiency and effectiveness, and by a mixed-effects decentralization process. Sample size, interactions and collinearity cannot be ruled out completely. Conclusions: Public district-level RMNCH expenditure has increased remarkably in Peru. Evidence on underlying factors influencing such trends warrants further research, most likely through a combination of quantitative and qualitative approaches.This work was funded through a sub-grant from the U.S. Fund for UNICEF under the Countdown to 2015 for Maternal, Newborn and Child Survival grant from the Bill & Melinda Gates Foundation, and through a sub-grant from the Partnership for Maternal, Newborn & Child Health.
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Smithgall, Lisa M. "Perceptions of Maternal Stress and Neonatal Patient Outcomes in a Single Private Room versus Open Room Neonatal Intensive Care Unit Environment." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etd/1772.
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Limited clinical evidence exists regarding whether the single private room Neonatal Intensive Care Unit (NICU) environment of care delivery has a positive, negative, or neutral impact on health outcomes for the high risk neonate and on maternal stress as compared to the open room design. The study purpose was to examine whether a difference exists in health outcomes in the open room versus single private room NICU environment. The factors considered were weight gain, ventilator days, hospital length of stay, incidence and grade of intraventricular hemorrhage (IVH), the number of parental visits, and perceptions of maternal stress. Infants hospitalized in an open room environment (n=52) were matched by gestational age to infants in a single private room NICU (n=52). Mothers of the infants from the open room (n=26) and the single private room (n=20) groups completed the Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU) survey instrument. The t-test for independent groups demonstrated a difference for the number of parent visits (t=6.672, df=60.13, p<.001) with a significant increase in visitation frequency for infants in the single private room NICU. Maternal perceptions of stress were not different (t=.154, df=44, p=.878), and high stress scores were reported for both groups regardless of the infant's environment of hospitalization. This study demonstrates that the single private room environment promotes increased parental access to their infants. The finding of high levels of maternal perception of stress in both the open room and single private room NICU's demonstrates that the environment did not impact the perception of maternal stress. This finding supports the implication that mothers of hospitalized infants need nursing support regardless of the type of NICU environment.
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Kvale, Janice Keller. "Maternal and neonatal outcomes associated with selected intrapartum interventions." Case Western Reserve University School of Graduate Studies / OhioLINK, 1994. http://rave.ohiolink.edu/etdc/view?acc_num=case1061988693.
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Morrison, April H. "Breastfeeding: Evidence-Based Clinical Guidelines Every Health Care Provider Should Know." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7123.
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Agarwal, P., B. Bailey, J. Hall, M. Devoe, and David L. Wood. "Factors Associated with Maternal Drug Use and the Severity of Neonatal Abstinence Syndrome." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5148.
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Bernath, Susan Diane. "A comparison of childbirth class attendance and presence at delivery and father-infant acquaintance/attachment." FIU Digital Commons, 1998. http://digitalcommons.fiu.edu/etd/1629.
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The relationship between parent and child is one of the most important and most studied of all human relationships. The purpose of this descriptive study was to compare first-time fathers’ attendance at an entire series of prepared childbirth classes and presence at the delivery with father-infant acquaintance/attachment at three to four months post-birth. First-time fathers living with the infant’s mother were asked to complete the How I Feel About My Baby Now scale and a demographic survey. Two groups of fathers were compared. The first group attended classes, and the other group did not attend classes. Results of a statistical analysis utilizing descriptive statistics, t-tests, and one way ANOVA indicated that fathers who attended the classes felt significantly more angry at their babies than those who did not, and that fathers in the group under 30 years of age felt more playful toward their babies than those over thirty years.
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Torigoshi, Márcia Fujiko. "Desfecho dos encaminhamentos de recém-nascidos internados na unidade de terapia intensiva neonatal do Hospital Municipal de Diadema." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/6/6136/tde-01102009-162345/.
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Introdução: A tendência de queda da mortalidade infantil e o crescente avanço da saúde perinatal têm permitido a sobrevida de recém-nascidos em idades gestacionais cada vez mais precoces. Portanto, o acompanhamento dos recém-nascidos de risco nos primeiros anos de vida, após sua alta da unidade de terapia intensiva neonatal, reveste-se de importância para o adequado desfecho positivo de evolução quanto ao seu crescimento e desenvolvimento. Objetivo: Analisar desfechos de encaminhamentos dos recém-nascidos admitidos em Unidade Neonatal de Hospital Público. Método: estudo descritivo sobre a assistência ao recém-nascido após a alta hospitalar, visando à analise de desfechos de encaminhamentos dos 47 recémnascidos admitidos em Unidade Intensiva Neonatal do Hospital Público Municipal de Diadema., a coleta de dados foi realizada por meio de formulário de pesquisa, prontuário do recém-nascido, da mãe e inquérito domiciliar com o responsável pelo recém-nascido e o cartão de acompanhamento pediátrico.Resultado: Observou-se idade médias das mães de 25,9 anos, sendo que 53 por cento desta população se encontra em idade desfavorável da faixa reprodutiva.Constatou-se que 93,62 por cento de mães foram submetidas a assistência pré natal, desta 57,44 por cento apresentaram afecções como infecção do trato urinário e hipertensão arterial. O tipo de parto predominante foi a cesárea com 61 por cento.Observou-se nascimento de 48,93% de baixo peso ao nascer, 48 por cento considerados peso normal e 2 por cento com mais de 4000g. Em relação a idade gestacional 57, 44 por cento¨foi de menores de 37 semanas. Em relação ao Apgar no 1 º e no 5º minto observa-se que os RN que apresentavam anóxia grave no 1 º minuto evoluíram positivamente em 100 por cento . Em relação as variáveis de internação observa-se que mais de 90 por cento foram submetidos a oxigenoterapia e destes 27,66 por cento foram submetidos a intubação endotraqueal .Em relação as interconsultas realizadas durante a internação verifica-se que quase 40 por cento tiveram consultas com o cardiologista. Os exames realizados durante a internação observa-se que mais de 44 por cento foram submetidos a ultrassom de fontanela, mais de 30 por cento foram submetidos a eco cardiograma. Na alta observa-se que 82,98 por cento foram encaminhados a UBS e as principais especialidades foram: cardiologia e neurologia, com 23,40 por cento e 12,77 por cento respectivamente.Do grupo de estudo 85,11 por cento estão sendo acompanhados por pediatras em unidades básicas de saúde. Conclusão: A importância da implantação de um serviço especializado para acompanhamento da população de recém-nascidos após a alta da unidade de terapia intensiva neonatal para adequado desfecho positivo quanto ao seu crescimento e desenvolvimento.Introduction: The current trend of decrease in the child mortality rate and the increasing progress in perinatal care have allowed the survival of preterm newborn infants who were born having completed progressively less weeks of gestation. Therefore, continuous monitoring of high-risk newborn infants in their early-life years, after they leave NICU, is utterly important for proper and positive outcomes regarding their future growth and development. Objective: The main goal of this research is to analyse referrals results of newborns that were admitted at Neonatal Unit of a Public Hospital. Methodology: This study is a descriptive analysis of newborn assistance after hospital discharge, and aims to evaluate the referrals results of 47 newborn admitted at the Neonatal Intensive Care Unit of Diademas Municipal Public Hospital. Data were extracted from research forms, newborns hospital records, mothers interviews, domiciliary inquiry made with the responsible for the newborn care, and paediatric accompaniment cards. Results: Analyses corroborated that mothers average age is of 25,9 years, and 53 per cent of this sample finds itself outside proper reproductive age. They also showed that 93,62 per cent of the mothers got prenatal care, and within this group, 57,44 per cent had some type of disorder, for instance urinary tract infection and arterial hypertension. The prevailing type of labour was caesarean, with a ratio of 61 per cent . Amongst the newborn infants, 48,93 per cent had low birth weight, 48 per cent were considered to have normal birth weight and 2 per cent had a birth weight superior to 4000g. Concerning the gestational age, 57, 44 per cent were inferior to 37 weeks. Regarding the Apgar score at the first and fifth minute, newborns who had acute anoxia at the first minute progressed positively in a ratio of 100 per cent . On the topic of hospitalisation variables, more than 90 per cent of the newborn were submitted to oxigenotherapy, and within this percentage, 27,66 per cent had endotracheal intubation. During the hospitalisation period, newborn infants had appointments with doctors from other specialties (inter-appointments), being nearly 40 per cent of those with cardiologists. Regarding the exams and tests made during the hospitalisation, over 44 per cent of the newborn were submitted to ultrasounds at the fontanelle, and over 30 per cent were submitted to echocardiography. After hospital discharge, 82,98 per cent were referred to local primary health care units, and the main specialties they were referred to were cardiology and neurology, with a ratio of 23,40 per cent and 12,77 per cent respectively. Of the sample studied, 85,11 per cent are getting paediatric accompaniment at local primary health care units. Conclusion: The implementation of a specialised newborn health accompaniment after NICU discharge for proper and positive outcomes regarding their future growth and development is of utter importance.
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Susmani, Krystle Anne. "Certified child life specialists' perspectives on supporting siblings of infants in the neonatal intensive care unit." Thesis, Mills College, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1588940.
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The current study sought to examine certified child life specialists’ perspectives on supporting siblings of infants in the neonatal intensive care unit (NICU). The intent of the study was to identify the types of support available, barriers to offering support, the individuals who offers support and the effectiveness of interventions by certified child life specialists with siblings of infants in the NICU. Sixty-eight certified child life specialists were surveyed regarding their work supporting siblings of infants in the neonatal intensive care unit. Results support previous literature suggesting that there are many barriers to offering support to siblings in the hospital, including: staff availability, space constraints, funding, and visitation policies. In addition, results demonstrated that provided supports still vary widely from hospital to hospital and certified child life specialists are the individuals who are most likely to offer support when it is available. Furthermore, the certified child life specialists surveyed view their interventions with siblings of infants in the NICU as effective or very effective. In conclusion, these findings support the need to increase the presence of certified child life specialists in the NICU in order to adequately meet the psychosocial needs of siblings.
Keywords: certified child life specialists, child life interventions, siblings, neonatal intensive care unit, NICU
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Clancy, Amy Kathleen. "Impacts of Source of Health Funding on Child, Infant, Neonatal and Maternal Mortality in sub-Saharan African Countries." Thesis, Curtin University, 2020. http://hdl.handle.net/20.500.11937/82265.
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This work analyzed the impact of sources of health and child health expenditure on health outcomes by analyzing existing data in sub-Saharan African countries between 2000 and 2014. Development assistance for health (DAH) as a percentage of total health expenditure was associated with greater improvements in child health outcomes than government expenditure on health (GEH) but neither DAH or GEH improved maternal health outcomes.
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Santos, Juliana Paula Ferraz dos 1979. "Explorando o conceito de near miss em saúde perinatal = near miss neonatal = Exploring the concept of near in perinatal health: near miss neonatal." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312756.
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Orientador: José Guilherme CecattiDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-26T11:44:16Z (GMT). No. of bitstreams: 1 Santos_JulianaPaulaFerrazdos_M.pdf: 1715906 bytes, checksum: f5ae24f0025dda816672cb4f1b773f8c (MD5) Previous issue date: 2015
Resumo: Antecedentes: O conceito de near miss neonatal tem sido proposto como ferramenta para avaliação da qualidade da atenção aos recém-nascidos que sofreram alguma condição ameaçadora à vida. No entanto, não existem conceitos nem critérios internacionalmente aceitos que definam ou identifiquem esses casos de near miss. O objetivo do estudo é fazer uma revisão dos marcadores que possam identificar casos de near miss neonatal, bem como predizer a mortalidade neonatal. Métodos: Foram realizadas buscas eletrônicas nas bases de dados Pubmed, Embase e Scielo, sem restrição de período ou língua. Para isso foi utilizado o termo "neonatal near miss" isolado ou em associação com termos relativos à morbidade e mortalidade neonatais e aos escores de gravidade neonatal. A primeira etapa da seleção foi baseada no título, a segunda no resumo e a terceira no artigo completo. A seleção dos estudos e a extração de seus dados foram realizadas de forma independente por dois pesquisadores. O tipo dos dados não permitiu a realização de metanálise. Resultados: Pelos critérios de inclusão e exclusão definidos, apenas 4 artigos foram selecionados. Prematuridade e asfixia perinatal foram utilizados como marcadores de near miss em todos os estudos. Observou-se que a razão de near miss neonatal foi entre 2.6 a 8 vezes maior que a de mortalidade neonatal. Conclusões: O desenvolvimento do conceito e critérios para o near miss neonatal parece ser uma ferramenta importante na avaliação dos cuidados prestados ao recém-nascido e o primeiro passo para se criar estratégias de manejo que contribuam na redução de mortalidade e de sequelas na vida futura dessas crianças
Abstract: Background: The concept of neonatal near miss has been proposed as a tool to assess the quality of care to neonates suffering any life-threatening condition. However, there are still no internationally accepted concepts or criteria to define or identify these cases of neonatal near miss. The purpose of this study is to perform a systematic review on markers that are able to identify cases of neonatal near miss and to predict neonatal mortality. Methods: Electronic searches were performed in the databases of Pubmed, Embase and Scielo, with no restriction of time period or language. For that, the term "neonatal near miss" was used alone or in association with terms related to neonatal morbidity and mortality and to the scores of neonatal severity. The first step of selection was based on the titles of articles, the second on their abstracts and the third on the full article. Two researchers independently performed the study selection and data extraction. The characteristics of data did not allow for proceeding with a metanalysis. Results: Using the predefined inclusion and exclusion criteria, only four articles were selected. Preterm and perinatal asphyxia were used as markers of near miss in all of them. It was observed that the neonatal near miss ratio was between 2.6 to 8 times higher than the neonatal mortality. Conclusions: The development of concept and criteria for neonatal near miss neonatal seems to be an important tool for the assessment of health care provided to neonates and the first step to build management strategies to contribute for decreasing mortality and sequelae in the future life of these children
Mestrado
Saúde Materna e Perinatal
Mestra em Ciências da Saúde
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Aboobakur, Maimoona Pimonpan Isarabhakdi. "Influence of maternal and service factors on neonatal deaths and still births in the Maldives /." Abstract, 2006. http://mulinet3.li.mahidol.ac.th/thesis/2549/cd392/4838760.pdf.
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Horii, Naoko. "Postpartum breastfeeding in rural Niger : demographic analysis of a communication program for child health care." Thesis, Sorbonne Paris Cité, 2015. http://www.theses.fr/2015USPCB168.
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Introduction : Cette recherche a pour but d'évaluer les effets du programme de communication sur le changement comportemental de quels acteurs pour promouvoir l'allaitement dans la première heure qui suit l'accouchement chez les mères les plus vulnérables au Niger. Les objectifs consistent à identifier les déterminants de l'allaitement précoce et à élaborer une typologie de stratégies de communication intégrées. Les facteurs de résultat comportemental relatifs à la santé de l'enfant constituent un objet de recherche important en démographie. Toutefois, peu d'études ont abordé l'allaitement postpartum en Afrique Sub-Saharienne. Les interventions de soins de santé néonatale n'ont pas suffisamment été explorées dans la région selon des perspectives démographiques tout en mettant en évidence l'inégalité socio-économique dans la région. Cette thèse est une étude démographique qui a quantifié les pratiques de l'allaitement, qui se caractérise par les information qualitatives et non scientifique dans la plupart des études comportementales, et ce parmi le groupe des mères les plus démunies. Méthodes : L'analyse secondaire des études quantitatives transversales au Niger a été réalisée sur la base de la revue de la littérature sur des études menées en Afrique sub-saharienne. Les enquêtes transversales dont fait l'objet cette recherche sont les suivantes: l'Enquête démographique et de santé (EDS) 2006 Niger, l'EDS 2012 Niger et l'enquête d'évaluation dans les 4 régions de Niger en 2011, le dernier a pour but d'examiner l'impact du programme de communication sur la promotion de soins de santé de l'enfant au niveau familial et communautaire. Pour constituer une population d'étude pour chaque base de donnée, le même critère d'exclusion a été appliqué afin d'inclure les femmes de 15-49 ans, ayant au moins un enfant de moins de 24 mois et qui ont accouché par voie basse. Un échantillon aléatoire stratifié a été tiré pour sélectionner 2091 femmes divisées en deux strates, le groupe d'intervention et le groupe de contrôle. Les outils d'analyse de données ont été le test du chi2 et la régression logistique multivariée. Les variables indépendantes incluent les actions de communication, les statuts démographiques et économiques des mères, les recours aux soins de santé de l'enfant ainsi que les pratiques et infrastructures d'hygiène. Résultats : Le retard de l'allaitement postpartum s'est caractérisé par le niveau de vie des plus démunis au Niger. Quelque soit la vulnérabilité socio-économique, des pratiques d'hygiène ont augmenté la chance de l'initiation de l'allaitement précoce. L'enquête d'évaluation dans les 4 régions de Niger a montré que le lavage des mains et l'utilisation des latrines traditionnelles étaient fortement corrélées avec l'allaitement précoce qui a augmenté respectivement de l'OR à 2.4 (IC 95%: [76; 220]) et à 2.3 (IC 95%: [51; 248]). Les agents de santé des établissements sanitaires, les sages-femmes, ont joué un rôle clef déterminant sur l'allaitement postpartum. Le statut valorisant de sages-femmes impliquées dans le programme de communication était à l'origine d'une hausse significative de l'allaitement précoce. Toutefois, les consultation prénatale (CPN) par les sages femmes a augmenté l'allaitement initial de 52% (IC 95%: [14; 103]) par rapport à celles qui n'ont jamais effectué de CPN. L'enquête d'évaluation ne procure aucune information à savoir si le programme de communication a intégré les accoucheuses traditionnelles afin d'appliquer une approche à base communautaire. Une approche inter-sectorielle qui s'adresse aux multiples dimensions de soins de santé maternelle et infantile a augmenté à 6.9 l'OR de l'allaitement initial (95%CI: [374; 900]). Les visites à domicile par les relais communautaires se sont avérées statistiquement non significatives (IC 95%: [-10; 54]). La promotion par les pairs a réduit le risque de retard de l'initiation de l'allaitement de 100% (IC 95%: [39; 189])Introduction. This research aims to evaluate the effects of a behavior change communication program promoting early initiation of breastfeeding within the first hour of birth among the most vulnerable mothers in rural Niger. The main objectives are to identify the social determinants of initial breastfeeding and to examine the typology of integrated communication strategies for the socio-economically vulnerable group of populations. Behavioral child health outcomes have become an important research subject in Demography. However, few studies have examined breastfeeding during the postpartum period in Sub-Saharan Africa (SSA). Very few demographic approaches were applied to evaluate neonatal care by looking into socio-economic inequity in SSA. This thesis quantifies predominantly qualitative information characterizing behavioral studies in breastfeeding among the most deprived population. Methods. This is a secondary analysis of cross-sectional quantitative studies conducted in Niger at different points of time based on a literature review of previous studies conducted in Sub-Saharan Africa. The cross-sectional surveys include: the 2006 Niger Demographic Health Survey (DHS), the 2012 Niger DHS and the post-intervention survey (PIS) conducted in 2011 to evaluate a communication program promoting family and community based child health care in 4 regions of Niger. To constitute a study population for each dataset, the same exclusion criteria were applied to include women aged 15-49 years, having at least one child less than 24 months born with vaginal delivery. The PIS study population, drawn from the original survey with stratified random sampling, was divided into two strata, the intervention and control groups according to exposure to the communication program. Statistical analysis tools were the chi-square test and multivariate logistic regression. Independent variables include behavior change activities, socio-demographic and economic status of mothers, health seeking behavior and hygiene practices. Results. Postpartum breastfeeding is impaired by income poverty in Niger. Regardless of socio-economic vulnerability, hygiene practice increases the chance of early initiation of breastfeeding. Multivariate analysis with the 2011 PIS shows that hand washing and use of a traditional latrine increases by 2.4 (95%CI: 76; 220) and by 2.3 (95%CI: 51; 248) respectively the odds of early initiation of breastfeeding. Government health workers, midwives, play a key role determining mothers' postpartum breastfeeding. Antenatal care (ANC) provided by midwives increases the chance of early breastfeeding that increases by 52% (95%CI: 14, 103) compared to ANC provided by other health professionals among the most deprived group of populations. The PIS does not provide any information to evaluate the role of traditional birth attendants in neonatal care. An inter-sectorial approach addressing multiple dimensions of maternal and child health significantly increases by 6.9 odds (95%CI: 374, 900) early initiation of breastfeeding compared to those who are not reached by the whole integrated KFP promotion. Home visits by community volunteers are not significant (IC 95%: -10; 54). Involvement of mothers as a peer promoting exclusive breastfeeding significantly reduces the risk of delayed initiation of breastfeeding by 2.0 odds (IC 95%: 39; 189). However, the number of exposures to different types of communication strategies does not influence positively early breastfeeding. Conclusions. The impact of community volunteers and health workers is limited with regard to early breastfeeding among the most deprived group of mothers. The model of behavior change communication with participatory peer promotion and a multi-sectorial approach combining optimal hygiene promotion suggests a response to socio-economic disparity
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Lake, Sharon W. "Barriers to Effective Pain Management in Preterm and Critically Ill Neonates." UKnowledge, 2013. http://uknowledge.uky.edu/nursing_etds/7.
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The purpose of this dissertation is to explore potential barriers nurses experience in providing effective pain management for preterm and critically ill infants in neonatal intensive care units (NICUs). The specific aims of the study conducted are to examine (a) NICU caregivers’ knowledge about pain, (b) scales used to evaluate pain in infants, (c) NICU nurses’ documented pain practices, and (d) bias in treating pain of certain types of infants.
This dissertation is comprised of three manuscripts. The first manuscript is an integrated review of the literature describing caregiver knowledge, barriers, and bias in the management of pain in neonates. The second manuscript is a systematic review of multidimensional pain scales developed for use in preterm and critically ill infants. The final manuscript reports a descriptive exploratory study designed to examine nurses’ knowledge of pain, knowledge of intensity and appropriate management of procedural pain, bias in treating pain of certain types of infants, and documented pain management practices.
Over the past 25 years, caregiver knowledge of pain in preterm and critically ill infants has advanced from beliefs that neonates do not feel pain, to the knowledge that preterm infants experience more pain than term infants, older children, and adults. Nine multidimensional pain scales with varying levels of reliability and validity have been developed, yet a gold standard for pain assessment in preterm and critically ill neonates has not emerged. In this study, baccalaureate prepared nurses (BSN) and nurses with higher total years of nursing experience had better knowledge of pain in this population than associate degree nurses (ADN). However, pain management was inconsistent, resulting in pain that was untreated as often as 80% of the time. Nurses reported that physician practice was the primary obstacle to providing effective pain management. Additional concerns included knowledge deficits of nurses and physicians, lack of communication and teamwork, and rushed care. Nurses reported biases in managing pain and were less likely to invest time and energy treating the pain of infants experiencing neonatal abstinence syndrome.
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Evans, Lauren B., and L. Lee Glenn. "Type II Error and Evaluation of Kangaroo Care in Tertiary Neonatal Units." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/7461.
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Wood, David L., Beth Bailey, Pritibha Agarwal, Nathan Justice, and Karen Schetzina. "Factors Associated with Maternal Drug Use and the Severity of Neonatal Abstinence Syndrome." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5199.
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Background:
In East Tennessee and Middle Appalachia, the epicenter of the opioid epidemic, approximately 15% of women give birth taking buprenorphine or methadone for opioid addiction (medical assisted therapy--MAT) or using other drugs illicitly and 5% of births are diagnosed with neonatal abstinence syndrome (NAS). A better understanding is needed of factors contributing to the severity of NAS.
Objective:
To identify maternal and infant characteristics associated with length of stay among newborns with neonatal abstinence syndrome.
Design/Methods:
Participants were 150 newborns systematically sampled from births diagnosed with NAS during the past 5 years at a single medical center. Data were obtained through abstraction of maternal prenatal records, infant delivery and infant medical charts. The abstraction included maternal and child demographic and clinical characteristics. Drug and other substance use/exposure histories were based on maternal history, and urine and cord tissue drug screening.
Results:
The infants’ average length of stay was 18.6 (s.d. = 11.9), 15% were low birthweight, and had an average gestational age of 38.8 (s.d. = 1.8); 62% were male; 49% were breast-fed. The mothers mean age was 27.5 (s.d. = 5.0); mean parity was 1.6 (s.d. = 1.4); 77% were unmarried; 75% had < HS education; and 89% had exposure at some time during pregnancy to other prescription (in addition to buprenorphine or methadone) or illicit opioids. In the least squares regression, which included important potential covariates such as infant sex, birth weight and gestational age, significant predictors of infant length of stay include: maternal benzodiazepine use (8.3 day longer LOS on average; p = 0.019), and infants whose mothers had a history of mental illness (3.9 day longer LOS on average, p = 0.040 ). While infants born to mothers smoking in the final 30 days of pregnancy had a 2.7 day longer LOS on average after adjustment for other significant predictors, this association was no longer significant in regression analysis (p = 0.293).
Conclusion(s):
Maternal use of prescription or illicit opioids leading to NAS is rooted in women’s’ life histories characterized by disadvantage, relationship instability, polysubstance use and mental illness. Efforts to reduce the incidence and severity of NAS among those on MAT during pregnancy should focus on preventing poly-substance misuse and providing supports for other maternal health needs including treating mental illness.
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Noordin, Naveed, Morghan Jameson, MD Dr Darshan Shah, and PhD Dr Beth Bailey. "Can Birth Weight Influence the Development of Neonatal Abstinence Syndrome?" Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/16.
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Background:
Neonatal Abstinence Syndrome (NAS), a manifestation of the widespread opioid epidemic, has plagued our country, and particularly the region of Northeast Tennessee, for quite some time now. One question among many that seems to baffle almost everyone involved in research on the topic at hand is that why do only 35-40% of opioid exposed pregnancies result in NAS requiring medication while sparing the rest. Is there some discriminatory factor other than in utero opioid exposure involved? Thus, in light of this knowledge, we wanted to investigate whether birth weight at the time of delivery can influence the development of NAS; that is, are neonates of a low birth weight or high birth weight (with respect to gestational age thresholds) more likely to develop NAS.
Methods:
Therefore, we conducted a retrospective chart analysis of all deliveries within the Mountain States Health Alliance System over a 5 years period between July 1, 2011- June 30, 2016 at all 5 delivery sites in Northeast Tennessee and Southwest Virginia (N=18,728). Out of this sample size, we identified 2,392 at-term newborns as positive for prenatal opioid exposure, and then we stratified them into 2 categories: birth weight ≤3.5kg (proxy for low or average birth weight with respect to gestational age thresholds) and birth weight ≥3.5kg (proxy for high birth weight with respect to gestational age thresholds). Thereafter, we ran SPSS statistical analyses involving chi square, t tests, and logistic regression to assess whether one birth weight group was more likely to have a higher incidence rate of NAS compared to the other birth weight group.
Results:
We found that even after controlling for significant confounders such as marital status, race, and pregnancy smoking, benzodiazepine, and marijuana use, infants who were in the low to average birth weight group (≤3.5kg in this study) were almost twice as likely (statistically significant adjusted odds ratio of 1.95) to develop NAS compared to infants who were in the high birth weight group (≥3.5kg in this study). Our study helps shed some important light on the discriminatory factors for NAS development, with birth weight being a significantly associated clinical factor as we now know.
Discussion & Implications:
Unfortunately, the mechanism for the transport of opioids across the placenta is complicated, and poorly understood. There may be more ‘unbound or free opioids’ available in infants of low to average birth weight (with respect to gestational age thresholds) compared to infants of high birth weight (with respect to gestational age thresholds) resulting in a higher incidence of NAS in the former population. It is more of a speculation rather than a conclusion to explain the results of our study. However, being equipped with this knowledge that opioid exposed neonates of low to average birth weight (with respect to gestational age thresholds) have a higher risk of developing NAS will allow physicians to identify infants with a higher risk for NAS early, and this will subsequently lead to better outcomes and reduced severity in cases of NAS.
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Bales, Mary. "Knowledge of the Effects of Alcohol on Fetal Development Among Women of Childbearing Age." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/honors/22.
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While Fetal Alcohol Syndrome Disorder is a recognized problem with alcohol ingestion during the formation of facial features, Fetal Alcohol Spectrum Disorders are not as widely recognized. These disorders result from exposure to alcohol throughout pregnancy when the brain and nervous system are developing. The resulting disorders include attention deficit disorders, social disorders, inappropriate behaviors, learning disorders, and intellectual disability. The incidence of children with alcohol-related disorders is increasing as evidenced by children needing special services in the educational systems. It is unknown how much alcohol ingestion is safe during pregnancy or how genetic factors are involved in the development of these disorders. Women often get conflicting information from the media and other resources about safe levels of alcohol consumption during pregnancy. Abstinence of alcohol ingestion is the only known prevention of such intellectual disorders. It is hypothesized that women of childbearing age may not be knowledgeable of the relationship between drinking and the implications of alcohol exposure on fetal development.
The purpose of this research is to determine what women of childbearing age know about alcohol consumption during pregnancy and if there is a knowledge deficit that exists among women of a certain age or women that use specific resources for health information. The researcher surveyed 40 female students at East Tennessee State University by using true or false questions concerning alcohol consumption related to fetal development in order to determine if a knowledge deficit exists. Based on the findings, it may be determined if women of childbearing age need educational materials from a reliable source.
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Morrison, April H. "You are the Key to HPV Cancer Prevention – Update." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7117.
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Morrison, April H. "Sustaining Breastfeeding Success After Hospital Discharge." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7118.
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Morrison, April H. "Assessment and Solutions to Common Breastfeeding Challenges." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/7119.
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Morrison, April H. "Breastfeeding Expert Panel Member." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/7120.
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Raines, Deborah A. "An analysis of the values influencing neonatal nurses' perceptions and behaviors in selected ethical dilemmas." VCU Scholars Compass, 1992. http://scholarscompass.vcu.edu/etd/3612.
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The purpose of this research was to identify the values influencing the nurse's perception and choice of behavior in a hypothetical clinical situation. The theoretical framework was Rokeach's (1973) Theory on the Nature of Human Values and Value Systems. A descriptive study using a mailed survey was conducted on a random sample of 331 members of the National Association of Neonatal Nurses. Data on individual nurses' values, perception of information and behavioral choices were collected with an investigator developed questionnaire, consisting of a values scale (alpha =.82) and an information scale and choice alternatives related to three hypothetical vignettes: a low birthweight infant (alpha =.75), an infant with trisomy-13 (alpha =.70) and a chronically ill infant (alpha =.68).
Results of this study indicate that (1) nurses identified a hierarchy of values related to their practice; "doing right" (x = 6.1), beneficence (x = 5.4), and justice (x = 4.8), (2) information related to the infant was consistently most important; however, in uncertain situations, rules or external protocols had an increased influence on the behavioral choice process, (3) the behavioral choice option with the greatest agreement was different for each situation, and a consistently negative association between the options within each vignette indicates that nurses have clearly defined choice preferences, (4) model testing revealed a consistent relationship among the variable of justice and protocol, doing right and infant characteristics, and infant characteristics and the choice options across the three vignettes (p <.05).
The major findings include the identification of the value dimension, "doing right" and a lack of congruence between the values the nurse identifies as important and the actions the individual implements in practice. The phenomenon of "doing right" is a combination of items originally hypothesized to measure nurse autonomy, family autonomy and beneficence. The convergence of these items results in an unique dimension that represents the nurse's internally directed motivation or sense of duty to the infant/family unit. The lack of congruence between the identified values and the behaviors implemented in practice represents the sense of frustration and feeling of powerlessness experienced by nurses (n = 97) as they balance the role of professional and the role of employee.
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Isom, Morgan L. "The Impact of Inappropriate Gestational Weight Gain on Pregnancy, Delivery, and Neonatal Outcomes." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/honors/233.
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Inappropriate weight gain during pregnancy is a widespread problem associated with adverse maternal and newborn outcomes. This study’s objective was to examine the impact of gestational weight gain (GWG) above and below the Institute of Medicine (IOM) guidelines on pregnancy, delivery, and newborn outcomes in a rural population. Women were recruited at the first prenatal visit, and data was collected through research interviews and examination of prenatal and delivery medical records. Prepregnancy weight and weight at delivery were obtained, and the final sample (n=913) was restricted to women with singleton pregnancies. Participants were categorized by prepregnancy body mass index (BMI) and GWG above, within, or below IOM guidelines based on gestational length. After controlling for pregnancy smoking, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to identify significant outcomes associated with high or low weight gain, with normal GWG as the control. Of the 913 participants, 208 (22.8%) had inadequate GWG, 255 (27.9%) gained within the recommended range, and 450 (49.3%) gained more than recommended. Inadequate GWG was associated with delivery before 39 weeks, oxygen administration to the infant, admission to the neonatal intensive care unit (NICU), and a hospital stay longer than seven days. Excess GWG was associated with preeclampsia, pregnancy-induced hypertension (PIH), gestational diabetes mellitus, cesarean delivery, labor longer than 12 hours, macrosomia, and large-for-gestational-age (LGA) infants. GWG outside IOM guidelines was prevalent in the sample and associated with numerous adverse outcomes, suggesting a need for increased awareness and improved management of GWG in this population.
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Marrs, Jo-Ann. "Children’s Body Shop." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/7109.
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Nolen, Kalie, and L. Lee Glenn. "Heavy Lifting and Spontaneous Abortions." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/7492.
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Excerpt: The study by Lee and Jung (2012) recently published in Workplace Health and Safety concluded that, “A collective effort is needed on the parts of employers, employees, occupational health nurses, and the government to protect working women from lifting heavy items while pregnant” (p. 25). However, that conclusion over-reaches their data and consequently is not supported. First, inconsistencies existed in the odds ratios (ORs), indicating uncertainties in the stability of the statistical findings. Second, the study used a nonexperimental design with low internal validity, preventing conclusions about causation due to the possibility of external intervening variables.
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Latham, Leah M. "Birthing Positions: Is There a Connection Between Acutal Nursing Experience and Evidence-Based Research?" Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/honors/228.
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The objectives of this study were to determine whether there was an association between clinical nursing knowledge of four birthing positions and current evidence-based research of those same positions and also to identify possible areas where nursing knowledge of those birthing positions was inadequate. This pilot study used convenience sampling to survey registered nurses (RNs) and licensed practical nurses (LPNs) on labor and delivery units. The survey was distributed to three hospitals in the southeastern United States, and twenty-four RNs and LPNs participated. Participants’ knowledge did not reflect current clinical evidence in two key areas, (1) the best position to minimize blood loss and (2) the best position to decrease the likelihood anal sphincter tears. Respectively, only 13% and 27.3% of participants selected the correct position. Continuing education for maternity nurses regarding current evidence-based practice concerning various birthing positions remains a need, and incorporating this could include more frequent opportunities for education classes and unit inservices. Results from this study should not be generalized, and more research is needed in this area to validate these findings.
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Moser, Michele R. "Neonatal Abstinence Syndrome (NAS): Infant Victims of Tennessee’s Prescription Drug Abuse Epidemic." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/5001.
Full text
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Pertmer, Tamera Marie. "Characterization of Immune Responses Following Neonatal DNA Immunization: A Dissertation." eScholarship@UMMS, 2000. https://escholarship.umassmed.edu/gsbs_diss/84.
Full textAbstract:
Neonatal mice have immature immune systems with defects in several components of inflammatory, innate, and specific immune responses and develop a preferential T helper type 2 (Th2) response following immunization with many vaccine antigens. Although maternal antibody is the major form of protection from disease in early life when the neonatal immune system is still immature, the presence of maternal antibody also interferes with active immunization, placing infants at risk for severe bacterial and viral infection. Recent studies have suggested that immunizing with DNA plasmids encoding the vaccine antigen of interest is highly efficacious in a variety of adult animal models. However, similar extensive studies have not been conducted in infants. In this dissertation, we examine both the quantitative and qualitative differences between neonatal and adult humoral and cell-mediated immune responses in the presence or absence of maternal antibody.
First, we wished to determine if one-day-old neonatal mice immunized with plasmid DNA expressing influenza A/PR/8/34 hemagglutinin (HA) by either intramuscular (i.m.) or gene gun (g.g.) inoculation were capable of generating humoral responses comparable to those in mice immunized as adults. We found that newborn mice developed stable, long-lived, protective anti-HA-specific IgG responses similar in titer to those of adult DNA-immunized mice. However, unlike the adult i.m. and g.g. DNA immunizations, which develop polarized IgG2a and IgG1 responses, respectively, mice immunized as neonates developed a variety of IgG1-, IgG2a-, and mixed IgG1/IgG2a responses regardless of the inoculation method. Boosting increased, but did not change these antibody profiles. We also found that, in contrast to the DNA immunizations, inoculations of newborn mice with an A/PR/8/34 viral protein subunit preparation failed to elicit an antibody response. Further, temporal studies revealed that both responsiveness to protein vaccination and development of polarized patterns of T help following DNA immunization appeared by 2 weeks of age.
To determine if the disparity of polarized IgG responses between neonatal and adult DNA vaccinated mice was due to deficiencies in Th1 promoting cytokines, we addressed the ability of DNA encoding Th1 cytokines to bias the isotype of antibody raised by neonatal DNA immunization. We found that neonatal mice coimmunized with HA and either IL-12 or IFNγ-expressing DNAs developed IgG2a-biased immune responses, regardless of inoculation method, whereas these DNAs had no effect on IgG subtype patterns in adult DNA immunized mice. Consistent with the Th1-promoting effects of these cytokines, we also observed that codelivery of IL-12 or IFNγ DNAs raised T helper responses toward Th1 in mice immunized both as neonates or adults. Thus, codelivery of cytokine DNAs may be effective at tailoring immune responses depending on the required correlates of protection for a given pathogen.
Finally, we addressed the effect of maternal antibody on the elicitation of humoral and cell-mediated immune responses. We tested the ability of i.m. and g.g. immunization with DNA expressing influenza HA and/or nucleoprotein (NP) to raise protective humoral and cellular responses in the presence and absence of maternal antibody. We found that neonatal mice born to influenza-immune mothers raised full antibody responses to NP but failed to generate antibody responses to HA. In contrast, the presence of maternal antibody did not affect the generation of long-lived CD4+ and CD8+ T cell responses to both HA and NP. Thus, maternal antibody did not affect cell-mediated responses, but rather it limited humoral responses, with the ability to limit the antibody response correlating with whether the DNA-expressed immunogen was localized in the plasma membrane or within the cell. We further observed that protection from influenza virus challenge was dependent on the presence of anti-HA IgG and was independent of the presence T cell responses.
Taken together with other published studies, the data presented in this dissertation help better characterize the responses elicited by DNA vaccines at birth. This dissertation presents several novel observations including the temporal development of polarized IgG subtype responses, the ability of codelivered Th1 cytokine DNA to affect both antibody and T cell responses in the neonate, and the ability to generate humoral responses to intracellular, but not plasma membrane proteins, in the presence of maternal antibody. Furthermore, the data provides rationale for further development of DNA vaccines in the neonate.
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Nsibande, Duduzile. "Assessment of the uptake of referrals by community health workers to public health facilities in Umlazi, Kwazulu-Natal." Thesis, University of the Western Cape, 2011. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_2920_1367481376.
Full textAbstract:
Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &
Zupan, 2005). Early
detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing
countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking
behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home
visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,
community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing
community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured
questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo
home or at the study
offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.
Descriptive analysis was
conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant
associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were
enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the
highest number of which occurred within
the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking
their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.
Conclusion: This study found
high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South
African National Department of Health (SANDOH) which will involve the establishment of family health worker teams
including community health workers. A key function of these workers will
be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with
non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by
community health workers. Most of the referrals in this study were
neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal
and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater
realization of a team approach to PHC.
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Ogden, Lori. "THE IMPACT OF MATERNAL NUTRITION DURING PREGNANCY ON INFLAMMATION AND BIRTH OUTCOMES." UKnowledge, 2019. https://uknowledge.uky.edu/nursing_etds/49.
Full textAbstract:
More than 85% of American adults do not consume recommended amounts of fruits or vegetables. Preterm birth and hypertensive disorders of pregnancy are common adverse conditions affecting pregnancy and are leading causes of maternal and fetal morbidity and mortality. Preterm birth affects nearly 10% of all births in the United States and is on the rise, as are hypertensive disorders, which have increased by 25% over the last two decades. Pregnancy is a state of controlled inflammation, and dysregulation has been linked to preterm birth and other adverse gestational outcomes. A healthy diet is recommended in pregnancy, but little is known about the effect fruit and vegetable intake on perinatal outcomes. Omega-3 (n-3) fatty acids are essential dietary components and are known to affect inflammatory state, but little is known about how they affect inflammation in pregnancy. As current evidence is lacking, further research is needed to investigate the relationships between maternal nutrition in pregnancy, inflammation and birth outcomes.
The purposes of this dissertation were to: 1) to review and evaluate the current evidence on the relationship between n-3 fatty acids and inflammation in pregnancy; 2) to evaluate the current state of the science on the impact of maternal dietary consumption of fruits and vegetables on preterm birth, gestational diabetes, preeclampsia, small for gestational age, gestational weight gain and measures of inflammation or oxidative stress in pregnancy; and 3) to examine relationships between maternal dietary intake of fruits and vegetables, cytokine expression in early and mid-pregnancy, preterm birth and gestational hypertension.
A critical review of literature examining the relationship between inflammation and n-3 intake during pregnancy found that multiple inflammatory cytokines in maternal and fetal tissues were lower in women who received n-3 supplements. A second review of literature review supported an inverse relationship between fruit and vegetables and risk of preeclampsia and suboptimal fetal growth. The available evidence was insufficient to establish relationships between fruit and vegetable intake and gestational diabetes, preterm birth or inflammation. A study evaluating the relationships between maternal fruit and vegetable intake, inflammation and birth outcomes was conducted. This study
provided evidence supporting a relationship between first and second trimester cytokine expression and maternal dietary intake of fruits and vegetables. Those who met recommended vegetable intake in the first trimester had higher first trimester serum CRP, IL1-α, IL-6 and TNF-α and lower first trimester cervicovaginal IL-6 levels. Those who met recommendations for first trimester fruit intake had 56% lower risk for preterm birth. Those who met second trimester vegetable intake recommendations had more than twice the risk of developing gestational hypertension.
The results of this dissertation provide support for the beneficial effects of omega-3 fatty acids and fruit and vegetable intake in pregnancy. Maternal intake of these dietary components may promote optimal immune status during pregnancy. Supplementation of maternal omega-3 fatty acids may help regulate inflammation via the anti-inflammatory effects their bioactive eicosanoids exert. Fruit and vegetables have antioxidant and anti-inflammatory effects that may also help balance the inflammatory state during pregnancy. These dietary components may help promote favorable immune status during pregnancy and reduce risk of adverse perinatal outcomes such as poor fetal growth, hypertensive disorders of pregnancy and preterm birth.
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Shuman, Patricia, L. Lee Glenn, and Joellen B. Edwards. "Relationship Between Handling Heavy Items During Pregnancy and Spontaneous Abortion." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/7545.
Full textAbstract:
This pilot study sought to describe the patterns of health risk factors and objective physical findings in well rural Appalachian women. A retrospective chart review was conducted of the records of 50 women who received a health history, physical examination, and appropriate laboratory testing as part of a rural community wellness project. The most prevalent risk factors found were past or present smoking, history of lung disease, physical inactivity, obesity, and hypercholesterolemia. Higher numbers of risk factors per person were correlated with lower levels of education. The most prevalent physical findings were systolic blood pressure greater than 140 and diastolic greater than 90, diastolic blood pressure greater than 90 with normal systolic, total cholesterol greater than 240, low-density lipoprotein levels greater than 130, and greater than 20% over ideal weight. This sample reveals a high prevalence of risk factors for the leading causes of mortality in middle-aged women, partially accounted for by low formal education levels, poverty, and limited access to health care.
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Shoemaker, Griffin, Gloria Kwak, Gayatri B. MD Jaishankar, and Karen E. MD MPH Schetzina. "Prenatal Drug and Related Exposures in Infant Patients of a Northeast Tennessee Pediatric Primary Care Clinic." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/18.
Full textAbstract:
Introduction: The prevalence of opioid abuse has increased throughout Northeast Tennessee. Subsequently, more infants are born drug-exposed or with Neonatal Abstinence Syndrome (NAS). According to the Tennessee Department of Health, hospitalizations for deliveries with maternal substance abuse tripled in Tennessee between 1999 and 2011. During this period, the inpatient hospitalization rate for NAS increased 11-fold. In 2017, there were 163 NAS cases reported in Northeast Tennessee. Depending on intrauterine and environmental exposures, there may be differences in health, growth, behavior, and development in infants. Our goal was to assess and explore those differences to help update education and care recommendations for pediatric primary care clinics.
Methods: This cross-sectional study was set in a Northeast Tennessee pediatric clinic. 120 patients seen for a newborn visit between June 30, 2013 and July 1, 2014 were randomly selected. An additional sample of all infants with suspected drug exposure was identified for this period based on diagnosis codes. In total, 99 infants had no drug exposure and 62 were drug-exposed. An 83-item chart abstraction template was developed. Data was analyzed by SPSS. The chi-squared test and Mann-Whitney U test were used, with a critical value of p<0.05 to determine significance. The Bonferroni correction was applied to account for multiple comparisons. The research protocol was reviewed and approved by the Institutional Review Board of East Tennessee State University.
Results: Of the 120 charts initially selected, 3.33% of infants were exposed to buprenorphine, 1.67% to methadone, 0.83% to marijuana, 0.83% to cocaine, and 1.67% to tobacco, 8.33% to benzodiazepine, and 1.67% to barbiturates during gestation. In total, 18.33% of infants had any drug exposure, 10.00% to any opiate, and 3.33% had a documented diagnosis of NAS in their chart. Prenatal drug exposure was significantly associated with multiple demographic factors as well as pediatric respiratory, behavioral, gastrointestinal, infectious disease, and cardiac conditions.
Conclusions: Prenatal drug exposure was significantly associated with multiple pediatric complications. This illustrates the significance of addressing the increased incidence of prenatal drug exposure in Northeast Tennessee. Future multivariate analyses will attempt to control for potential confounders. This analysis is retrospective and exploratory, and any associations should be confirmed with a prospective study. A weakness of this study includes potential under-diagnosis of drug exposure and NAS due to lack of documentation in the EHR. Additional research will include further comparison of maternal and infant complications in drug-exposed and non-exposed infants. This will allow for a better understanding of the risks associated with maternal drug exposure. Findings from these research projects will be used to inform clinical initiatives for NAS in Northeast Tennessee.
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McCook, Judy G., Nancy E. Reame, and Samuel S. Thatcher. "Health-Related Quality of Life Issues in Women with Polycystic Ovary Syndrome." Digital Commons @ East Tennessee State University, 2005. https://dc.etsu.edu/etsu-works/7174.
Full textAbstract:
Objective: To evaluate the influence of obesity, fertility status, and androgenism scores on health-related quality of life in women with polycystic ovary syndrome (PCOS).
Design: Cross-sectional, correlational.
Setting: Private reproductive endocrinology practice in two southeast U.S. cities.
Participants: Convenience sample of 128 women with PCOS, half of whom were attempting to conceive in addition to being treated for PCOS. Most were White (97%), married (78%), with a mean age of 30.4 years (SD ± 5.5).
Main Outcome Measures: The Health-Related Quality of Life Questionnaire (PCOSQ) for women with polycystic ovary syndrome. A laboratory panel and clinical measures, including body mass index, waist-to-hip ratio, and degree of hirsutism.
Results: The most common health-related quality of life concern reported by women with PCOS was weight, followed in descending order by menstrual problems, infertility, emotions, and body hair.
Conclusions: The psychological implications of PCOS are easily underestimated and have been largely ignored. Nursing has a pivotal role in recognizing these concerns and implementing therapy to improve quality of life in women with PCOS.
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Nelson, Monica M. "NICU Culture of Care for Infants with Neonatal Abstinence Syndrome: A Focused Ethnography." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etd/2465.
Full textAbstract:
Purpose: The purpose of this ethnographic study was to describe the culture of care and nonpharmacological nursing interventions performed by NICU nurses for infants with NAS. Background: Infants with NAS are increasingly being cared for in the inpatient hospital setting by NICU nurses. Interventions used for the care of premature and sick infants in the NICU may or may not be the exact interventions that should be used for the care of the fragile infant with NAS. Research studies on the nonpharmacological nursing care of infants with NAS encompass 5 main areas of practice: environment, adequate rest and sleep, feeding, assessment and evaluation using Finnegan scoring by nurses, and nurses as caregivers. Method: Roper and Shapira’s (2000) framework for the analysis of ethnographic data was used for this research and included participant observation, individual interviews, and the examination to existing documents. Data analysis included: (a) coding for descriptive labels, (b) sorting to identify patterns, (c) identification of outliers or negative cases, (d) generalizing constructs and theories, and (e) memoing to note personal reflection and insights. Focused ethnography allows for the articulation of research questions before fieldwork while observing and describing a culture. Results: Five themes emerged from the data: learn the baby (routine care, comfort care, environment, adequate rest and sleep, feeding), core team relationships (support, interpersonal relationships), role satisfaction (nurturer or comforter, becoming an expert), grief, and making a difference (wonderful insanity, critical to them). Implications: The results of this were a description of the culture of care provided to infants with NAS by NICU nurses and provide general recommendations to the nurse caring for an infant with NAS in the areas of environment, adequate sleep and rest, feeding, and the role of the nurse. This study also has implications for future study of evidence-based research strategies to decrease withdrawal symptoms in infants with NAS. Research is needed in the areas of clinical practice guidelines to help the bedside nurse care for these infants using current research and evidence for practice. Nursing theory and nursing education both contribute to nursing research in how to better understand the culture of care provided by nurses.
47
McCook, Judy G., Stacey Williams, Beth Bailey, Sheeba Anand, and Nancy Reame. "Differential Contributions of the Reproductive and Metabolic Features of Polycystic Ovary Syndrome (PCOS) to Psychological Symptoms." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/7183.
Full textAbstract:
Objective: Although women with PCOS have elevated levels of psychological distress, findings regarding which aspects of PCOS contribute to psychological symptoms are inconsistent. The purpose of this study was to investigate the independent and differential contributions of the previously identified key PCOS manifestations (infertility, hirsutism, obesity, menstrual problems) to multiple psychological symptoms. Methods: Participants were 126 endocrinology patient volunteers diagnosed with PCOS who completed a cross-sectional study of key manifestations of PCOS (including the PCOSQ) and psychological symptoms (BSI). Results: Participants had significantly elevated scores on all nine BSI subscales of psychological symptoms. Menstrual problems were significantly associated with all symptom subscales as well as the global indicator, while hirsutism and obesity were significantly related to five or more subscales. Neither infertility status nor infertility concerns significantly predicted any of the psychological symptoms. After controlling for demographic factors, menstrual problems remained the strongest predictor of psychological symptoms. Conclusions: Findings suggest that for women with PCOS, the features of excess body hair, obesity and menstrual abnormalities are especially troubling and carry unique risks for serious adverse psychologic symptoms including depression, anxiety, somatization and interpersonal sensitivity. Specific manifestations of PCOS were differentially related to psychological symptoms suggesting that the predictive value of PCOS for depression and other mental health problems may vary according to the specific symptoms experienced. Menstrual problems may be the most salient of these features and deserve particular attention as a marker for psychological risk among women with PCOS.
48
McCook, Judy G., Stacey Williams, Beth Bailey, Sheeba Anand, Nancy Reame, and Samuel Thatcher. "Differential Contributions of the Reproductive and Metabolic Features of Polycystic Ovary Syndrome (PCOS) to Psychological Symptoms." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/7184.
Full textAbstract:
Objective: Although women with PCOS have elevated levels of psychological distress, findings regarding which aspects of PCOS contribute to psychological symptoms are inconsistent. The purpose of this study was to investigate the independent and differential contributions of the previously identified key PCOS manifestations (infertility, hirsutism, obesity, menstrual problems) to multiple psychological symptoms. Methods: Participants were 126 endocrinology patient volunteers diagnosed with PCOS who completed a cross-sectional study of key manifestations of PCOS (including the PCOSQ) and psychological symptoms (BSI). Results: Participants had significantly elevated scores on all nine BSI subscales of psychological symptoms. Menstrual problems were significantly associated with all symptom subscales as well as the global indicator, while hirsutism and obesity were significantly related to five or more subscales. Neither infertility status nor infertility concerns significantly predicted any of the psychological symptoms. After controlling for demographic factors, menstrual problems remained the strongest predictor of psychological symptoms. Conclusions: Findings suggest that for women with PCOS, the features of excess body hair, obesity and menstrual abnormalities are especially troubling and carry unique risks for serious adverse psychologic symptoms including depression, anxiety, somatization and interpersonal sensitivity. Specific manifestations of PCOS were differentially related to psychological symptoms suggesting that the predictive value of PCOS for depression and other mental health problems may vary according to the specific symptoms experienced. Menstrual problems may be the most salient of these features and deserve particular attention as a marker for psychological risk among women with PCOS.
49
Rhoads, Jacqueline, and Jo-Ann Marrs. "Disorders Usually Presenting in Infancy or Early Childhood 0-5 Years Age." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/7098.
Full textAbstract:
Book Summary: This quick reference serves as an authoritative clinical guide to diagnostic treatment and monitoring recommendations for patients with mental disorders in the primary care setting. It offers fast and efficient access to evidence-based diagnostic and therapeutic guidelines for managing psychiatric and mental health conditions. The book guides family and adult advanced practice nurses in making clinical decisions that are supported by the best available evidence, reflecting current research and expert consensus. Additionally, researchers may use this book to identify important clinical questions where more research could be conducted to improve treatment decision making.
This comprehensive text is organized by major diagnostic categories, such as anxiety disorders, with specific diagnoses organized alphabetically within each category. It supports informed practice, which increases confidence in differential diagnosis, safe and effective treatment decision making, reliable treatment monitoring and, ultimately, improved patient outcomes. Additionally, DSM-IV-TR diagnostic standard summaries and ICD-9 codes are incorporated for use in the clinical setting. It is an essential resource in everyday practice for all health care providers.
50
Baker, Sarah C., and L. Lee Glenn. "Measurement Reliability and Effect Direction for Self-Efficacy and Pain in Colorectal Cancer Patients." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/7463.
Full textAbstract:
Excerpt: The conclusions by Zhang et al. (2015) were notable, but the support for the conclusions was not particularly strong because of two issues. The first weakness is that although some studies have found correlations between self-efficacy and pain, the study did not consider the possibility that it is symptom distress that affects self-efficacy in colorectal cancer patients. Rather, it was assumed only that self-efficacy caused reduced symptom effects instead of a reverse or mutual relationship. The study did not consider the possibility that low self-efficacy in those with high symptom distress was actually caused by the distress itself, which is a plausible explanation. In fact, Chiarotto et al. (2014) found that cancer patients on pain medication have higher rates of self-efficacy, which would appear to show that distress reduces self-efficacy, rather than the other way around, as assumed in the above study.