Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Michigan, 1994. / Includes bibliographical references.

Thesis (M.A.)--Denver Conservative Baptist Seminary, 1994. / This is an electronic reproduction of TREN, #090-0059. Includes bibliographical references (leaves 125-130).

Thesis (M.A.)--Denver Conservative Baptist Seminary, 1994. / Includes bibliographical references (leaves 125-130).

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Introduction : The health status of women in peri-urban areas has been influence by the South African political transition. Despite some progress, maternal and child mortality rates are still unacceptably high. A mother’s nutritional status is one of the most important determinants of maternal and birth outcomes. The Institute of Medicine’s pre-pregnancy Body Mass Index (BMI) method is not always appropriate to use in a peri-urban setting as many women attend their first antenatal clinic later on in their pregnancy. Two alternative methods, the gestational BMI (GBMI) and the gestational risk score (GRS), have been used elsewhere to screen for at risk pregnancies, but have not been used in a South African peri-urban setting. Furthermore, examining socio-economic variables (SEV) aids in the explanation of the impact of social structures on an individual. Risk factors can then be established and pregnant women in these higher risk groups can be identified and given additional antenatal clinic appointments and priority during labour. Aim: The first aim was to investigate the strength of the GBMI and GRS methods for predicting birth outcomes and maternal morbidities. The second aim was to investigate the relationships between SEV, GBMI and maternal morbidities. Methods: This was a sub-study of the Philani Mentor Mothers Study. A sample of 103 and 205 were selected for investigating the prediction methods and SEV respectively. Maternal anthropometry, gestational weeks and SEV were obtained during interviews before birth. Information obtained was used to calculate GBMI and GRS and to assess the SEV. Birth outcomes were obtained from the infant’s clinic cards and maternal morbidities were obtained from interviews two days after the birth. Results No significant association was found between GBMI and birth outcomes and maternal morbidities. A significant positive association was found between GRS and birth head circumference percentile (r=0.22, p<0.05). The higher the GRS, the higher the risk of an infant spending longer time in the hospital (Kruskal Wallis X2 = 4, p<0.05). A significant positive association was found between GBMI and the following SEV factors; age (r=0.33, p<0.05), height (r=0.15, p<0.05), parity (r=0.23, p<0.05), income (r=0.2, p<0.05), marital status (X2 = 9.35, p<0.05), employment (U=2.9, p<0.05) and HIV status (U=2.54, p<0.05). No statistically significant relationships were found between gestational hypertension and gestational diabetes mellitus and SEV. Conclusion: From the findings of this sub-study there were some promising results, however it is still unclear as to which method is the most appropriate to predict adverse birth outcomes and maternal morbidity. It is recommended that the GBMI and GRS once-off methods be repeated in a larger population to see if there are more parameters that could be predicted. Women who were older, shorter, married, had more pregnancies, HIV negative and had a higher socioeconomic status tended to have a greater GBMI. This can lead to adverse birth outcomes and increases the risk of women developing maternal morbidities and other chronic diseases later in their life. Optimal nutrition and health promotion strategies targeting women before conception should be implemented. / AFRIKAANSE OPSOMMING: Inleiding: Die gesondheidstatus van vroue in semi-stedelike areas is beïnvloed deur die Suid-Afrikaanse politiese oorgang. Ten spyte van ’n mate van vooruitgang is die sterftesyfers vir moeders en kinders steeds onaanvaarbaar hoog. ‘n Moeder se voedingstatus is een van die mees belangrike bepalende faktore van moeder- en geboorteuitkomste. Die Instituut van Geneeskunde se voorswangerskap Liggaamsmassa Indeks (LMI) metode is nie altyd toepaslik om te gebruik in ‘n semi-stedelike opset nie aangesien baie vroue hul eerste voorgeboorte-kliniek eers later in hul swangerskap bywoon. Twee alternatiewe metodes, die swangerskap LMI (SLMI) en die swangerskap risiko telling (SRT) is al elders gebruik as sifting vir hoë risiko swangerskappe, maar is nog nie gebruik in ‘n Suid-Afrikaanse semi-stedelike opset nie. Vervolgens kan ‘n ondersoek na sosio-ekonomiese veranderlikes (SEV) help om die impak van maatskaplike strukture op ‘n individu te verduidelik. Risiko faktore kan dan vasgestel word en swanger vroue wat in hierdie hoër risiko groepe val kan geïdentifiseer word. Dié vroue kan addisionele voorgeboorte-kliniek afsprake ontvang asook voorkeurbehandeling tydens die geboorteproses. Doelstellings: Die eerste doelstelling was om die sterkte van die SLMI en SRT metodes te ondersoek as voorspellers van geboorte uitkomste en moeder-morbiditeite. Die tweede doelstelling was om die verhoudings tussen SEV, SLMI en moeder-morbiditeite te ondersoek. Metodes: Hierdie projek was ‘n sub-studie van die Philani Mentor Moeders Studie. ‘n Steekproefgrootte van 103 en 205 was geselekteer om onderskeidelik die voorspeller metodes en SEV te ondersoek. Die moeder se antropometrie, swangerskap weke en SEV was verkry gedurende onderhoude voor geboorte. Informasie ingewin was gebruik om die SLMI en SRT te bereken en om die SEV te ondersoek. Geboorteuitkomste was verkry vanaf die babas se kliniekkaarte en moeder-morbiditeite was verkry tydens onderhoude twee dae na die geboorte. Resultate: Geen betekenisvolle assosiasie was gevind tussen SLMI, geboorteuitkomste en moeder-morbiditeite nie. ‘n Betekenisvolle positiewe assosiasie was gevind tussen SRT en die geboorte kopomtrek persentiel (r=0.22, p<0.05). Hoe hoër die SRT, hoe hoër die risiko dat ‘n baba langer in die hospitaal sou bly (Kruskal Wallis X2=4, p<0.05). ‘n Betekenisvolle positiewe assosiasie was gevind tussen SLMI en die volgende SEV faktore: ouderdom (r=0.33, p<0.05), lengte (r=0.15, p<0.05), pariteit (r=0.23, p<0.05), inkomste (r=0.2, p<0.05), huwelikstatus (X2=9.35, p<0.05), besit van ‘n identiteitsdokument (U=1.75, p<0.05), werkstatus (U=2.9, p<0.05) en MIV status (U=2.54, p<0.05). Geen statisties beduidende verhoudings was gevind tussen swangerskap hipertensie, swangerskap diabetes mellitus en SEV nie. Gevolgtrekking Sommige bevindinge van hierdie sub-studie dui op belowende resultate, alhoewel dit steeds nie duidelik is watter metode die mees toepaslike is om ongewenste geboorteuitkomste en moeder-morbiditeit te voorspel nie. Dit word aanbeveel dat die SLMI en SRT eenmalige metodes herhaal word in ‘n groter populasie om te sien of daar meer parameters is wat voorspel kan word. Vroue wat ouer, korter, getroud, meer swangerskappe, MIV negatief en ‘n hoër sosio-ekonomiese status gehad het was geneig om ‘n hoër SLMI te hê. Dit kan lei tot ongewenste geboorteuitkomste en verhoogde risiko om moeder-morbiditeite en ander chroniese siektes later in hul lewe te ontwikkel. Optimale voeding en gesondheidsbevordering strategieë wat vroue teiken voor bevrugting behoort geïmplementeer te word.

Submitted by JULIANA MARQUES PAIVA null (julianna_paiva@hotmail.com) on 2017-12-19T13:42:17Z No. of bitstreams: 1 Mestrado_final_Juliana.pdf: 1467462 bytes, checksum: 67a627b6e7e6238acf2c02f1debf086b (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2017-12-19T16:37:24Z (GMT) No. of bitstreams: 1 paiva_jm_me_int.pdf: 1467462 bytes, checksum: 67a627b6e7e6238acf2c02f1debf086b (MD5) / Made available in DSpace on 2017-12-19T16:37:24Z (GMT). No. of bitstreams: 1 paiva_jm_me_int.pdf: 1467462 bytes, checksum: 67a627b6e7e6238acf2c02f1debf086b (MD5) Previous issue date: 2017-11-23 / Objetivo: Avaliar o grau de satisfação dos acompanhantes durante o trabalho de parto, parto e puerpério na Maternidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu (M-HC-FMB). Sujeitos e métodos: Foi realizado estudo descritivo após aplicação de questionário constituído de 61 questões, em 108 acompanhantes de parturientes que tiveram partos na (M-HC-FMB), no período de seis meses. Foram excluídos do estudo partos emergenciais e gestantes com diagnóstico prévio ou após o parto de malformações fetais. Para todas as comparações estatísticas foi considerado nível de significância de 95% (p<0,05). Resultados: Analisando as respostas obtidas, pelo questionário apresentado aos acompanhantes, observamos a necessidade de melhorias quanto às informações fornecidas aos mesmos sobre os diversos períodos fisiológicos do parto e necessidade de maiores cuidados com a infraestrutura da maternidade. Obtivemos elevado grau de satisfação quanto à qualidade do atendimento prestado, à equipe de saúde e às situações de interação com o recém-nascido, além da sensação positiva em ser membro ativo e importante no auxilio à parturiente durante o trabalho de parto, parto e pós-parto. Conclusão: O presente estudo, de uma população de acompanhantes de parturientes, permite concluir que, o grau de satisfação dos acompanhantes de parturientes, durante a assistência ao seu trabalho de parto, parto e puerpério imediato, foi positivo em relação aos resultados obtidos para a paciente e recém-nascido, a infraestrutura da maternidade e à equipe de saúde envolvida. Palavras-chave: acompanhante, parto, trabalho de parto, parturiente, grau de satisfação. / Abstract Objective: The purpose of this study was to evaluate the degree of satisfaction of companion in childbirth care provided by the Maternity Service of the Hospital das Clinicas, Faculdade de Medicina de Botucatu (M-HC-FMB). Material and methods: A descriptive study was carried out on companions who were present in childbirth care. One questionnaire contained 61 questions were applied in 108 companions referring to expectation, experience and satisfaction, applied in the postpartum, 12 hours after the birth. Were excluded from the study emergency deliveries and diagnosis before or after delivery of fetal malformations. For all statistical comparisons was considered level of significance 95% (p <0,05). Results: Analyzing the answers obtained by the questionnaire presented to the companying, we observed the need for improvements in more information provided to de companions before de childbirth and improvements in hospital´s infrastructure. We obtained a high degree of satisfaction in quality of care provided, health team and situations with the newbornn and the positive feeling being an active and important member assisting the parturient during labor, delivery and postpartum. Conclusion: The present study, allows to conclude that the level of satisfaction during the childbith was positive in all questions submitted (health team, infrastructure and issues related to the newborn).

Pesquisa piloto de intervenção com dados prospectivos, grupo único de intervenção, cujo desfecho é a medida da dor de mulheres em trabalho de parto. Apresenta como objetivo discutir os efeitos da crioterapia no alívio da dor das parturientes. Como referencial teórico este trabalho apresentou o descrito por Soares e Low, onde se encontra que os mecanismos de ação do gelo para alívio da dor propiciam o decréscimo da transmissão das fibras de dor, a diminuição da excitabilidade nas terminações livres, a redução no metabolismo tecidual aumentando o limiar das fibras de dor e a liberação de endorfinas. Baseou-se ainda nos princípios da desmedicalização e do emprego de tecnologias não-invasivas de cuidado de enfermagem obstétrica conforme descritos por Vargens e Progianti. A pesquisa foi realizada no Centro Obstétrico do Hospital Municipal Maternidade Carmela Dutra, no Rio de Janeiro de abril a agosto de 2011. O gelo foi aplicado, utilizando-se para tal uma bolsa-cinta ajustável à região tóraco-lombar de 36 gestantes. A bolsa/cinta é descartável, de tecido TNT, com abertura na parte superior para introdução de gelo picado envolto em plástico. As aplicações se deram aos cinco centímetros de dilatação do colo uterino; e/ou aos sete centímetros de dilatação do colo uterino; e/ou aos nove centímetros de dilatação uterina, totalizando ao final das três aplicações um tempo de 60 minutos, que corresponde ao somatório de 20 minutos para cada uma. O gelo foi produzido em fôrma exclusiva para o projeto, em freezer da unidade. Os dados referentes à avaliação da dor foram coletados através de entrevista estruturada guiada por formulário previamente elaborado. Os resultados evidenciaram que a crioterapia produziu extinção ou alívio da dor quando aplicada na região tóraco-lombar das parturientes aos cinco, sete ou nove centímetros de dilatação do colo uterino, dando-lhes maiores condições de vivenciar o seu trabalho de parto; produziu um relaxamento geral e local (na região lombar) das parturientes; não interferiu na dinâmica uterina e, não causou dano ao binômio mãe-filho. Concluiu-se que a crioterapia, na forma como descrita no presente estudo, pode ser considerada uma tecnologia não-invasiva de cuidado de enfermagem obstétrica para alivio da dor no trabalho de parto. / This pilot intervention study, with prospective data and a single intervention group, the outcome of which was the pain measured in women in labour, was designed to discuss the pain relief effects of cryotherapy in childbirth. The theoretical framework for this study was as described by Soares & Low, in which the mechanisms of the pain-relief action of ice foster decreased pain fibre transmission, reduced free nerve ending excitability, reduced tissue metabolism, increased pain fibre threshold and release of endorphins. It also drew on the principles of de-medicalisation and non-invasive obstetric nursing techniques as described by Vargens & Progianti. The study was conducted at the Obstetrics Centre of the Carmela Dutra Municipal Maternity Hospital, in Rio de Janeiro, from April to August 2011. Ice was applied using an adjustable belt-bag to the lumbar/thoracic region of 36 expectant mothers. The disposable TNT fabric belt-bag has an opening at the top for introducing plastic-wrapped ground ice. Applications were given at five centimetres cervical dilation; and/or at seven centimetres cervical dilation; and/or at nine centimetres cervical dilation: to a total of three applications over a 60-minute timespan, corresponding to the sum of 20 minutes each. The ice was produced exclusively for the project in the units freezer. Pain assessment data were collected by structured interview guided by a previously prepared script. The results provided evidence that cryotherapy produced extinction or relief of pain when applied to the lumbar-thoracic region of women in labour at five, seven or nine centimetres cervical dilation, affording them better conditions in which to experience their labour; it produced relaxation (both overall and locally, in the lumbar-thoracic region) in the women in labour; and it neither interfered in the dynamics of the uterus nor caused harm to the mother and child. It was concluded that cryotherapy, as described in this study, can be considered a non-invasive obstetric nursing technology for pain relief in labour.

Orientador: Vera Therezinha Medeiros Borges / Resumo: Objetivo: Avaliar a eficácia da aplicação da estimulação elétrica nervosa transcutânea (TENS) no controle da dor durante o período da dilatação do trabalho de parto. Método: Foi realizado um ensaio clínico, paralelo e randomizado. Sessenta e oito parturientes com gestação única, de baixo risco, no termo, com dilatação cervical ≥ 4 cm e ≤ 7 cm e sem uso de medicação analgésica prévia. Foram randomizadas em dois grupos: TENS (n=34) e placebo (n=34) e avaliados os desfechos primários (intensidade da dor após a intervenção, grau de desconforto e grau de satisfação materna) e secundários (uso de outros métodos não farmacológicos para alívio da dor, fármacos no parto vaginal, taxa de cesárea e duração do trabalho de parto). A TENS foi aplicada por 30 minutos, entre T10 – L1 e S2 – S4. A intensidade da dor e o grau de desconforto foram avaliados por meio da escala visual analógica (EVA) e o grau de satisfação materna por nota de 0 a 10. Considerando a diferença de 34% entre os grupos para detectar efetividade do tratamento e assumindo a margem de erro de 10% e confiabilidade de 95%, o tamanho amostral calculado foi de 34 parturientes por grupo. Os resultados foram analisados estatisticamente para comparação entre os grupos estudados, adotando-se o limite mínimo de significância de 95% (p<0,05) Resultados: No grupo TENS houve maior número de parturientes classificando a dor como leve/moderada (RR= 2,4; IC95%: 1,6-3,7), melhora do grau de desconforto (RR= 4,1; IC95%: 2,1-8,1), maior n... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) in the control of pain during the period of labor. Method: A clinical, parallel and randomized trial was performed. Sixty-eight parturients with single, low-risk pregnancies at term, with cervical dilatation ≥ 4 cm and ≤ 7 cm and without previous analgesic medication. They were randomized into two groups: TENS (n = 34) and placebo (n = 34) and primary outcomes (pain intensity after intervention, degree of discomfort and degree of maternal satisfaction) and secondary outcomes (use of other non-pharmacological methods for pain relief, vaginal delivery drugs, cesarean section rate and duration of labor). The TENS was applied for 30 minutes between T10 - L1 and S2 - S4. The intensity of the pain and the degree of discomfort were evaluated through the visual analogue scale (VAS) and the degree of maternal satisfaction by grade from 0 to 10. Considering the difference of 34% between the groups to detect treatment effectiveness and assuming the margin of error of 10% and reliability of 95%, the sample size calculated was 34 parturients per group. The results were statistically analyzed for comparison between the groups studied, adopting the minimum significance level of 95% (p <0.05). Results: In the TENS group, there was a higher number of parturients classifying pain as mild / moderate (RR = 2.4, 95% CI: 1.6-3.7), improvement in the degree of discomfort (RR = 4.1, 95% CI, (RR = 2.8, 95% CI: 1... (Complete abstract click electronic access below) / Mestre

Bakgrund: Förr i tiden var barnafödande enbart kvinnans område, men idag ses det som en självklarhet att även inkludera fäderna i förlossningsrummet. Det är barnmorskans uppgift att ta hand om barnafadern, likväl som den födande kvinnan. Syfte: Att beskriva nyblivna fäders upplevelser i samband med barnafödande.  Metod: Studien genomfördes med en kvalitativ ansats, där semistrukturerade intervjuer användes för att få fram resultatet. Åtta nyblivna fäder rekryterades under sin vistelse på BB. Den insamlade datan analyserades med hjälp av kvalitativ innehållsanalys.  Resultat: De flesta fäder förberedde sig inför barnafödandet genom att delta i föräldrautbildning och genom att söka information om förlossningen på internet. Fädernas känslor pendlade mellan negativa och positiva beroende på var i förlossningsarbetet dem befann sig. Fädernas främsta uppgift var att stötta kvinnan i den mån de kunde genom närvaro och peppande ord. Om barnmorskan inkluderade fäderna och stöttade dem, upplevde fäderna det lättare att behålla lugnet och att de i sin tur kunde stötta sin födande partner. Att bli positivt bemött av barnmorskan upplevdes som en viktig faktor som genomsyrade hela upplevelsen av barnafödandet.  Slutsats: Överlag upplevde fäderna barnafödandet som positivt, men de gav uttryck för att de saknade någon form av uppföljning bara för dem som nyblivna fäder. / Background: In late history the childbirth was the area of women alone, but today it´s more of an expectation that giving birth also includes that the fathers are present. It´s the midwife´s duty to focus on both the woman who is giving birth and the father to be.  The aim: To bescribe recent become fathers experiences of childbirth.  Method: The study was conducted with a qualitative approach, in which semistructured interviews were used. Eight recent become fathers were recruited to the study during there stay at the postnatal care ward. The collected data was analyzed using qualitative content analysis.  Results: Most fathers prepared themselves through parental education and by seeking information about childbirth on the internet. The feelings of the fathers varied between negative and positive, depending on where they were in the birth process. The fathers primary task was to support their woman through presence and uplifting words. If the midwife included the fathers and supported them, the fathers felt it easier to keep calm and in that way easier to support their partner during the birth process. Being positively treated by the midwife was an important factor that stayed throughout the entire experience of childbirth. Conclusion: Overall the fathers experienced the childbirth as positive, but they expressed a lack of follow-up just for them as recent become fathers.