Lau, Tze Kin. / "May 1998." / Thesis (M.D.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (p. 165-178). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

No description available.

Purpose: This thesis addresses feasibility issues of conducting a descriptive study of pain and health-related quality of life (HRQOL) in women after Cesarean section (c-section). Objectives: Feasibility issues surrounding population access, chart completeness for review, and preference for online data collection were investigated. Prevalence and prediction of postoperative pain and HRQOL at six-weeks was addressed to generate hypotheses for future study. Methods: A descriptive pilot design was used, collecting a convenience sample of 41 women recruited two hours prior to a planned c-section at Kingston General Hospital. Consenting women completed preoperative questionnaires via computerized tablet or paper and pen. Preoperative data included pain, HRQOL, anxiety, depression, somatization, HCU, and demographics. Six weeks postoperatively, women completed pain, HRQOL, and HCU questionnaires through the internet, postal mail, or telephone. A chart review was used to collect health and obstetrical history, and acute postoperative pain. Results: An average of two participants per week were recruited, with a participation rate of 83.7%. Online questionnaires were preferred by 34 women (83%) preoperatively, and 15 women (48.4%) postoperatively. Almost 40% of patient charts were incomplete, missing symptoms reported in the immediate postoperative period. Twenty-four percent of the sample was lost to follow-up. Mild postoperative pain was reported by seven women (23) within 24 hours of completing the questionnaire. Bodily pain and the physical component of HRQOL were worse both pre- and post-operatively than age- and sex-matched norms. Postoperative pain at six weeks was predicted by tubal ligation, pain expectancy, and severe postoperative acute pain. Postoperative HRQOL scores were correlated with preoperative HRQOL score, depression, somatization, and preoperative pain. HRQOL physical composite score, bodily pain scores, and trait anxiety were predictive of healthcare use. Conclusion: The planned c-section population is accessible for research purposes, however timing and mode of follow-up should be carefully considered due to the demands of newborn care. A larger study evaluating the prevalence of chronic pain after c-section is needed, in which the role of depression, anxiety, somatization, and pain expectancy in pain outcomes and the impact on healthcare use is investigated. / Thesis (Master, Nursing) -- Queen's University, 2007-10-01 13:12:33.096

Increasing obesity rates in Canadian women are at an all time high with more than 50% of Canadian women falling into one of the four overweight to obese categories. Further to this 11-21% of Canadian women who are of child-bearing age are being described as overweight or obese. Along with the increasing rates of obesity is an increase in the number of operative deliveries experienced by pregnant women in Canada. Canadian women experience cesarean section (CS) approximately 21% of the time while women in Ontario experience an even higher rate of CS (26%). While currently there are several studies examining the relationship between pre-pregnancy overweight and obesity and its association with CS, there is little research examining the relationship between excess weight gain in pregnancy and operative delivery methods. Data were collected through a retrospective chart review to examine the relationship between excess weight gain in pregnancy and operative delivery methods. Mean weight gain throughout pregnancy was measured. Data analysis was conducted using t-tests, Chi-Squared analyses and Fisher’s Exact test of significance, accepting a significance level of alpha = 0.05 with a 95% Confidence Interval of difference. The analysis conducted demonstrated no significant relationship between weight gain in pregnancy and operative delivery methods. When examining maternal weight and labour type, statistical significance was reached (p = 0.04) demonstrating increased likelihood of induction with excess weight gain in pregnancy; statistical significance was also reached with maternal age greater than 35 years and increased risk for operative delivery(p = 0.04). Further analysis demonstrated statistically significant results when examining one minute Apgar scores between the group of women with recorded weights in comparison to those women whose charts did not contain weights. The lack of findings in this study may be largely attributed to the small sample size.Important practice issues were identified. It is important that pre-pregnancy or early pregnancy weight and height be recorded on all women in hospital databases as well paper charts. Consistency in recording weight units in either pounds or kilograms is imperative. Dietary consultation is an important component of prenatal care and women who enter pregnancy overweight or obese should have immediate access to nutritional counseling. / Thesis (Master, Nursing) -- Queen's University, 2010-09-22 09:00:57.695

Thesis (M. Mid.)--University of Sheffield, 2007. / "June, 2007." Issued as part of the Canadian electronic library documents collection. Includes bibliographical references (p. 45-55).

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 60-71).

published_or_final_version / Community Medicine / Master / Master of Public Health

Introdução - A taxa de cesárea no Estado de São Paulo está próxima de alcançar 60 por cento e a curva da última década mostra uma tendência de crescimento anual de 2 por cento . Objetivo Caracterizar a rede de assistência ao parto e identificar fatores de risco para o parto cesáreo. Métodos - Estudo retrospectivo, tipo corte transversal, dos nascidos vivos hospitalares de mães residentes dos DRS de Baixada Santista (BS), Grande São Paulo (GSP) e São José do Rio Preto (SJRP) ocorridos no ano de 2009. Utilizou-se os bancos de dados do SINASC e do CNES. Foram avaliadas as variáveis referentes: as mães, as gestações, os recém-nascidos, os municípios de residência das mães, e hospitais de parto. Foram utilizadas análises bivariadas, razão de prevalência e Teste Qui-quadrado; e análise multivariada, utilizando a técnica de regressão logística. Resultados - O porte dos municípios e a rede de hospitais que prestaram assistência ao nascimento diferiram consideravelmente entre os DRS. A rede SUS foi responsável por 74 por cento do nascimentos da BS, 62 por cento na GSP e 83 por cento de SJRP, portanto a rede privada teve maior participação na GSP. Os nascimentos da BS e SJRP ocorreram na sua maior parte em hospitais de médio volume de partos, enquanto na GSP a maior parte ocorreu em hospitais com grande volume de partos. A prevalência do parto cesáreo foi de 58 por cento na BS, 53 por cento na GSP e 80 por cento em SJRP. Os fatores de risco nos três DRS foram: mães em idade avançada, mães com alta escolaridade, mães primíparas; gravidez múltipla; ter feito 7 consultas ou mais de pré-natal; RN de raça/cor branca; e, nascer em hospitais não-SUS. Destes, merecem destaque as variáveis nascer em hospitais não SUS e gravidez múltiplaque apresentaram maiores valores de OR. Nos DRS da BS e GSP, também foram fatores de risco: nascer fora do município de residência e nascer em hospitais SUS não-públicos. Outras características só foram fator de risco para o DRS da GSP: nascer pré-termo; nascer com BPN e nascer em hospitais com baixo ou grande volume de partos. Conclusão - As diferenças existentes entre as redes de assistência ao nascimento dos DRS estudados refletiram nos fatores de risco associados ao parto cesáreo nestes DRS, de forma com que o conjunto de fatores de risco envolvidos no parto cesáreo fosse distinto para cada DRS. / Introduction - The Cesarean section rates in the state of São Paulo is close to achieve 60 per cent and the curve of the last decade shows a trend of annual increase of 2 per cent . Objective To characterize the network birth care and to identify cesarean risk factors. Methods- Retrospective study, in transversal cut, of hospitals live birth, which mothers lived in the DRS of the Baixada Santista (BS), Grande São Paulo (GSP) and São José do Rio Preto (SJRP), at the year of 2009. The SINASC and the CNES data bank was used. The variables related to: mothers, pregnancies, newborns, district of mother\'s residence, and birth hospitals were evaluated. bivariate analyzes, prevalence ratios and chi-square were used, as the multivariate analysis using logistic regression. Results - The districts size and the hospitals network that provided the birth assistance were considerably different among the DRS. The SUS network was responsable for 74 per cent of the BS\' births, 62 per cent of the GSP\'s births and 83 per cent of the SJRP\'s births. Therefore, the private network was more participative in the GPS. The births at the BS and at the SJRP ocurred, mostly, at Hospitals with average childbirth volume, while at the GSP the biggest part ocurred at hospitals with large volume of births. The cesarean section prevalence was 58 per cent at the BS, 53 per cent at the GSP and 80 per cent at the SJRP. Risk factors in those three DRS were: older mothers, mothers with high education, first-time mothers, multiple pregnancies, seven or more pre-natal care visits, newborn race/ caucasian, and birth at a non SUS hospitals. The variables birth at a non SUS hospital\'\' and multiple pregnancy deserve to be highlighted, since they showed the higher rates of fetal death. Being born outside the residence area or in a non SUS hospital were also risk factors at the BS and the GSP. Preterm birth, being born with low birth weight and birth in hospitals with low or high volume of deliveries were risk factors only at the GSP\'s Regional Health Department. Conclusion The diferences between the birth care networks in each DRS reflects in the risk factors associated with cesarean section. Because of that, the set of risk factors associated with cesarean section were different to each DRS.

Introdução - A taxa de cesárea no Estado de São Paulo está próxima de alcançar 60 por cento e a curva da última década mostra uma tendência de crescimento anual de 2 por cento . Objetivo Caracterizar a rede de assistência ao parto e identificar fatores de risco para o parto cesáreo. Métodos - Estudo retrospectivo, tipo corte transversal, dos nascidos vivos hospitalares de mães residentes dos DRS de Baixada Santista (BS), Grande São Paulo (GSP) e São José do Rio Preto (SJRP) ocorridos no ano de 2009. Utilizou-se os bancos de dados do SINASC e do CNES. Foram avaliadas as variáveis referentes: as mães, as gestações, os recém-nascidos, os municípios de residência das mães, e hospitais de parto. Foram utilizadas análises bivariadas, razão de prevalência e Teste Qui-quadrado; e análise multivariada, utilizando a técnica de regressão logística. Resultados - O porte dos municípios e a rede de hospitais que prestaram assistência ao nascimento diferiram consideravelmente entre os DRS. A rede SUS foi responsável por 74 por cento do nascimentos da BS, 62 por cento na GSP e 83 por cento de SJRP, portanto a rede privada teve maior participação na GSP. Os nascimentos da BS e SJRP ocorreram na sua maior parte em hospitais de médio volume de partos, enquanto na GSP a maior parte ocorreu em hospitais com grande volume de partos. A prevalência do parto cesáreo foi de 58 por cento na BS, 53 por cento na GSP e 80 por cento em SJRP. Os fatores de risco nos três DRS foram: mães em idade avançada, mães com alta escolaridade, mães primíparas; gravidez múltipla; ter feito 7 consultas ou mais de pré-natal; RN de raça/cor branca; e, nascer em hospitais não-SUS. Destes, merecem destaque as variáveis nascer em hospitais não SUS e gravidez múltiplaque apresentaram maiores valores de OR. Nos DRS da BS e GSP, também foram fatores de risco: nascer fora do município de residência e nascer em hospitais SUS não-públicos. Outras características só foram fator de risco para o DRS da GSP: nascer pré-termo; nascer com BPN e nascer em hospitais com baixo ou grande volume de partos. Conclusão - As diferenças existentes entre as redes de assistência ao nascimento dos DRS estudados refletiram nos fatores de risco associados ao parto cesáreo nestes DRS, de forma com que o conjunto de fatores de risco envolvidos no parto cesáreo fosse distinto para cada DRS. / Introduction - The Cesarean section rates in the state of São Paulo is close to achieve 60 per cent and the curve of the last decade shows a trend of annual increase of 2 per cent . Objective To characterize the network birth care and to identify cesarean risk factors. Methods- Retrospective study, in transversal cut, of hospitals live birth, which mothers lived in the DRS of the Baixada Santista (BS), Grande São Paulo (GSP) and São José do Rio Preto (SJRP), at the year of 2009. The SINASC and the CNES data bank was used. The variables related to: mothers, pregnancies, newborns, district of mother\'s residence, and birth hospitals were evaluated. bivariate analyzes, prevalence ratios and chi-square were used, as the multivariate analysis using logistic regression. Results - The districts size and the hospitals network that provided the birth assistance were considerably different among the DRS. The SUS network was responsable for 74 per cent of the BS\' births, 62 per cent of the GSP\'s births and 83 per cent of the SJRP\'s births. Therefore, the private network was more participative in the GPS. The births at the BS and at the SJRP ocurred, mostly, at Hospitals with average childbirth volume, while at the GSP the biggest part ocurred at hospitals with large volume of births. The cesarean section prevalence was 58 per cent at the BS, 53 per cent at the GSP and 80 per cent at the SJRP. Risk factors in those three DRS were: older mothers, mothers with high education, first-time mothers, multiple pregnancies, seven or more pre-natal care visits, newborn race/ caucasian, and birth at a non SUS hospitals. The variables birth at a non SUS hospital\'\' and multiple pregnancy deserve to be highlighted, since they showed the higher rates of fetal death. Being born outside the residence area or in a non SUS hospital were also risk factors at the BS and the GSP. Preterm birth, being born with low birth weight and birth in hospitals with low or high volume of deliveries were risk factors only at the GSP\'s Regional Health Department. Conclusion The diferences between the birth care networks in each DRS reflects in the risk factors associated with cesarean section. Because of that, the set of risk factors associated with cesarean section were different to each DRS.

We examined the relationship between cesarean section (C-section) and the risk of overweight and obesity in children in grade 6 (mean age, 11.92 years; standard deviation = 0.34). Data from phase I through phase III of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were used. Children with complete data from 1991 through 2004 were included in this study (n = 917). Multiple logistic regression analyses were used to adjust for potential confounding and to evaluate the association of C-section and childhood overweight and obesity. Compared to children delivered vaginally, children delivered by C-section had approximately twice the likelihood of being overweight (odds ratio (OR) = 1.86, 95 % confidence interval (CI) = 1.27–2.73) or obese (OR = 1.87, 95 % CI = 1.19–2.95). However, when examined according to sex, males delivered by C-section had an increased risk for being overweight (OR = 1.78, 95 % CI = 1.01–3.12) and obese (OR = 2.58, 95 % CI = 1.36–4.88), while females had an increased risk only for being overweight (OR = 1.99, 95 % CI = 1.17–3.39). Conclusion: C-section was associated with an increased risk of overweight and obesity in children in grade 6, but the relationship differed according to gender. Further longitudinal studies are warranted to examine the long-term effect of delivery mode on the risk of childhood overweight.