Master of Public Health - MPH / Women of child-bearing age sometimes fail to plan for pregnancies. Often they discover that they are pregnant and are not prepared or cannot afford to raise the child. Before 1996 there was no choice for women as regards pregnancies, all pregnancies must be carried to term and delivered except on health grounds and with stringent conditions. However after the TOP act was enacted in 1996, women were allowed a choice of TOP up to and including 20 weeks of pregnancy. Regardless of the availability of choice of TOP, some pregnant women still present late (after 12 weeks) for TOP when the risks of complications and costs are higher. Women who present late for TOP usually have to be admitted to a district or regional hospital and managed. The costs at such institutions are high. TOPs before 12 weeks (early TOP) are done in a primary health care (PHC) facility (TOP center) and no admission is required hence less cost. Complications of early TOP are also very mild and rare. In Lejweleputswa district there is only one TOP Center (Kopano TOP Clinic) and this serves both Lejweleputswa and the Northern Free State districts. Early TOPs (less than 12 weeks) are done and completed at this center. Late TOPs (above 12 weeks but not more than 20 weeks) are initiated at this TOP center and referred to district or regional hospitals nearest to the patient’s home, in both districts for completion.Problems - An increasing number of women are seeking TOP service at late stages of pregnancies and the incidence of severe complications like severe bleeding, retained placenta, infection, amniotic fluid embolism, death etc, are increasing. The hospital’s bed space and budget are stretched to the limit due to the influx of late term TOP to the hospitals. Lack of manpower, especially doctors, in these hospitals also create some problems, as the few doctors available have to attend to other ill patients as well. Sometimes bleeding TOP patients are transfused with blood and placed on a waiting list for theatre and this often increases the risk of complications. The emotional effect of late TOP on hospital staff (doctors and nurses) are enormous as the expelled fetus are much more developed than in early TOP where no fetus is seen at evacuation with simple Manual Vacuum Aspiration (MVA). / South Africa

Master of Public Health - MPH / This study focused on perceptions and experiences of pregnant women who opted in against those who opted out of voluntary antenatal HIV counseling and testing. The pregnant women's perceptions and experiences were assessed in order to gain insight into their views towards voluntary antenatal counseling and testing. / South Africa

The effects of repeated mild concussive head injury on professional rugby players were examined. Data were collected for rugby players (n=26) and cricket player controls (n=21) using a comprehensive neuropsychological test battery comprising five modalities (Verbal Memory, Visual Memory, Verbal Fluency, Visuoperccptual Tracking and Hand Motor Dexterity) and a self-report Postconcussive Symptomology Questionnaire. Group statistical comparisons of the percentage of individuals with deficit were carried out for (i) rugby versus cricket; (ii) rugby forwards versus rugby backs; and (iii) rugby forwards versus cricket. Rugby players performed significantly poorer than controls on SA W AIS Digit Symbol Substitution subtest and on the Trail Making Test. On Digits Forward and Digit Symbol Incidental Recall, the results approached significance with the rugby players showing a tendency toward impairment on these tests. Rugby players exhibited impairment in areas of visuoperceptual tracking, speed of information processing and attention, and there are tendencies of impairment in verbal and/or visual memory. Results obtained on the self-report questionnaire strongly reinforced cognitive test results and a significant proportion of rugby players reported difficulties with sustained attention, memory and lowered frustration tolerance as well as symptoms of anxiety and depression. It was consistently noted that players in the more full contact positions (rugby forwards) were most susceptible to impairment, confirming that these players, who are exposed to repeated mild head injuries, are at greater risk of exhibiting postconcussive sequelae / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

No description available.

This project set out to derive a prediction rule based on preoperative clinical variables to identify patients with high risk of developing atrial fibrillation following cardiac surgery. Methods: Prospectively collected data from a perioperative database was corroborated with chart review to identify eligible patients who had non-emergent surgery in 2010. Details on 28 preoperative variables were collected and significant predictors (p<0.2) were inserted into multivariable logistic regression and recursive partitioning. Results: 305 (30.5%) of 999 patients developed new onset postoperative atrial fibrillation. Eleven variables were significantly associated with atrial fibrillation, however, both final models included only three: left atrial dilatation, mitral valve disease and age. Bootstrapping with 5000 samples confirmed that both final models provide consistent predictions. Coefficients from the logistic regression model were converted into a simple seven point predictive score. Conclusions: This simple risk score can identify patients at higher risk of developing atrial fibrillation after cardiac surgery.

The purpose of this investigation was twofold. First, to investigate the attitudes and feelings of a group of normal women expecting their first child. Second, to evaluate the effectiveness of a family centred maternity programme in promoting a positive feeling towards the infant and in terms of preparing the mothers for their new role. The subjects were 94 married women who attended prenatal classes with their husbands. They were white, Caucasian, with a mean age of 27 years and a mean level of education of 14 and one half years. The women were raised in North America or the British Commonwealth. All women delivered a single full term infant and experienced no major medical complications of either themselves or their infant during pregnancy, delivery or the postpartum period. Each woman completed a series of questionnaires relating to attitude towards pregnancy, labour and delivery, childbirth, the new baby and the hospital experience. These measures were completed at four points in time; in the ninth month of pregnancy, while in hospital and after one and five weeks at home. In addition, she completed the Depression Adjective Checklists, the Beck Depression Index and the Pleasant Events Schedule in the ninth month of pregnancy and in the sixth week after delivery of her child. The Depression Adjective Checklist was also completed each day that the woman was in hospital. Major comparisons were (a) type of maternity hospital programme experienced — a family centred maternity programme versus a more traditional maternity programme and (b) type of delivery — whether vaginal or caesarian. Multivariate analyses conducted on the set of variables at each time period revealed a significant difference between the two groups of women depending upon which hospital programme they experienced, both while in hospital and after they had been home for one week. Univariate analyses revealed significant difference between the two groups on their responses to the following variables: The women in the family centred maternity programme had a more positive attitude towards their babies while in hospital; considered that they received more experience in how to care for their babies in hospital and perceived that they obtained more help from the hospital in preparing them for their mothering role. There was no difference in attitude towards the baby once the women had been home for one week caring for and interacting with their babies. A repeated measures analysis of variance indicated that there were no differences in the level of depressive affect between the women in the two types of programme over the time periods involved. Multivariate, analyses of the sets of variables at each time period indicated a significant difference between those who had a vaginal delivery and those who had a caesarian section. Those women who had a caesarian section had a less positive attitude towards their labour and delivery. There was no difference between these two groups of women in either their attitude towards their infant or their feelings of self-confidence. A repeated measures analysis of variance revealed that those women who had caesarians were more depressed after the birth of their baby than those women who delivered their baby vaginally. Although the women in the present study were not clinically depressed there were significant correlations between levels of depressive affect and other variables. For example, in the ninth month of pregnancy depressive affect was related to a less positive attitude towards pregnancy; in hospital depressive affect was related to a less positive attitude towards labour and delivery and towards the baby; at six weeks postpartum depressive affect was related to a less positive attitude towards the baby. The discussion centred around the implication of the findings for hospital programmes and prenatal class curricula, current behavioural theories of depression and the myth of maternal instinct. / Arts, Faculty of / Psychology, Department of / Graduate

Orientador: Emílio Carlos Elias Baracat / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T04:26:21Z (GMT). No. of bitstreams: 1 Amorim_PollyanaGarcia_M.pdf: 16755241 bytes, checksum: 0957977c7fadfa2ed8d659009f766145 (MD5) Previous issue date: 2013 / Resumo: Objetivos: identificar os fatores sócio-econômicos e clínicos associados à evolução para complicação em crianças internadas com pneumonia adquirida na comunidade (PAC) complicada e não complicada. Métodos: estudo observacional, analítico, prospectivo e longitudinal em crianças entre um e quatro anos e 11 meses de idade internadas em enfermaria geral de pediatria, com diagnóstico de PAC com e sem complicações. Excluídos os diagnósticos de fibrose cística, cardiopatia, má-formação pulmonar, neuropatias e doenças genéticas. Diagnóstico de pneumonia foi definido por características clínicas e radiológicas. Os dados foram coletados dos prontuários médicos e por um questionário semiestruturado, e comparados nas variáveis sócio-econômicas e clínicas. Os dados foram processados com o software SPSS 16.0., utilizando os testes de Qui-quadrado, Exato de Fisher e Regressão Logística, com nível de significância de 5%. Resultados: Sessenta e três crianças foram incluídas no estudo, vinte e nove sem complicações e trinta e quatro com complicações. Não foi observada diferença estatisticamente significante entre os grupos quanto à idade cronólogica à admissão, idade gestacional, peso ao nascer, gênero e variáveis sócio-econômicas. A comparação entre os grupos mostrou diferença estatística nas variáveis pneumonia anterior (p=0,03), antibioticoterapia prévia (p=0,004), tempo de início da doença (p=0,01), duração da febre antes da internação (p<0,001), duração da antibioticoterapia (p<0,001) e tempo de internação (p<0,001). Na análise multivariada, permaneceu no modelo a variável duração da febre antes da internação com OR = 1,97 [IC95%: 1,36-2,84] (p<0,001). Conclusões: Variáveis biológicas tiveram associação com a evolução para complicação em crianças com PAC, com destaque para o tempo de febre anterior à internação / Abstract: Objectives: To identify the socio-economic factors and clinical progression to complications in children hospitalized with community-acquired pneumonia (CAP), complicated and uncomplicated. Methods: A observational analytical prospective longitudinal study in children between one and four years and 11 months old admitted to the pediatric general ward with a diagnosis of CAP with and without complications. Children with the diagnosis of cystic fibrosis, heart disease, pulmonary malformations, neurological disorders and genetic diseases were excluded. Diagnosis of pneumonia was defined by clinical and radiological features. Data were collected from medical records and a structured questionnaire, and compared with the socio-economic and clinical variables. Data were processed with the SPSS 16.0 software, using the chi-square and Fisher's Exact Logistic Regression, with a significance level of 5%. Results: Sixty-three children were included in the study, twenty-nine uncomplicated and thirty-four with complications. There was no statistically significant difference between groups in chronological age at admission, gestational age, birth weight, gender and socioeconomic variables. The comparison between groups showed statistical differences in the variables previous pneumonia (p = 0.03), previous antibiotic therapy (p = 0.004), time of onset (p = 0.01), duration of fever before admission (p <0.001), duration of antibiotic therapy (p <0.001) and hospital stay (p <0.001). In multivariate analysis, remained in the model the variable duration of fever before admission, OR = 1.97 [95% CI: 1.36 to 2.84] (p <0.001). Conclusions: Biological variables were associated with progression to complications in children with CAP, especially the time of fever prior to admission / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

Orientadores: Desanka Dragosavac, Luciana Castilho de Figueiredo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T10:18:25Z (GMT). No. of bitstreams: 1 Rodrigues_CristianeDelgadoAlves_D.pdf: 6776527 bytes, checksum: 911dcad00f3a4026901b992e7babcae5 (MD5) Previous issue date: 2015 / Resumo: OBJETIVO: Estudo de coorte retrospectivo realizado com o objetivo de verificar a presença de Disfunção Transitória da Troca Gasosa (DTTG) no pós-operatório de cirurgia cardíaca e determinar se esse transtorno está relacionado a eventos cardiorrespiratórios. MÉTODOS: Foram incluídos 942 pacientes consecutivos submetidos à cirurgia cardíaca e procedimentos cardíacos, encaminhados para a UTI, entre junho de 2007 e novembro de 2011. RESULTADOS: A Síndrome do Desconforto Respiratório Agudo (SDRA) foi observada em 15 pacientes (2%), apresentaram Disfunção Transitória da Troca Gasosa (DTTG) leve 199 (27.75%) pacientes, DTTG moderada em 402 (56.1%) pacientes e DTTG grave em 39 (5.4%) pacientes. A presença de hipertensão arterial e choque cardiogênico foram associadas ao surgimento de DTTG moderada no período pós-operatório (p=0.02 e p=0.019, respectivamente) e foram considerados fatores de risco para esta disfunção (p=0.0023 e p=0.0017, respectivamente). A presença de diabetes mellitus também foi considerada um fator de risco para DTTG (p=0.03). Houve correlação entre a presença de pneumonia e a presença de DTTG moderada em 8.9% dos casos (p = 0.001). A presença de DTTG grave foi associada a pacientes que necessitaram de terapia de substituição renal (p=0.0005), hemoterapia (p=0.0001), nutrição enteral (p=0.0012), ou arritmia cardíaca (0.0451). CONCLUSÕES: A presença de hipertensão pré-operatória e choque cardiogênico foram associados com a ocorrência de DTTG pós-operatória. Os fatores de risco pré-operatórios foram hipertensão, choque cardiogênico e diabetes. No pós-operatório, a pneumonia, pneumonia associada à ventilação (PAV), terapia de substituição renal, hemoterapia e arritmia cardíaca foram associados com o aparecimento de certo grau de DTTG, que foi fator de risco para reintubação, pneumonia, PAV e terapia de substituição renal no pós-operatório de cirurgia cardíaca e procedimentos cardíacos / Abstract: OBJECTIVE: A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange (TDGE) in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. METHODS: We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the ICU between June 2007 and November 2011. RESULTS: Fifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild TDGE, 402 (56.1%) had moderate TDGE, and 39 (5.4%) had severe TDGE. Hypertension and cardiogenic shock were associated with the emergence of moderate TDGE postoperatively (p = 0.02 and p = 0.019, respectively) and were risk factors for this dysfunction (p = 0.0023 and p = 0.0017, respectively). Diabetes mellitus was also a risk factor for TDGE (p = 0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate TDGE (p = 0.001). Severe TDGE was associated with patients who had had renal replacement therapy (p = 0.0005), hemotherapy (p = 0.0001), enteral nutrition (p = 0.0012), or cardiac arrhythmia (0.0451). CONCLUSIONS: Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative TDGE. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, VAP, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of TDGE, which was a risk factor for reintubation, pneumonia, VAP, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures / Doutorado / Fisiopatologia Cirúrgica / Doutora em Ciências

No description available.

Thesis (MPH.) -- University of Limpopo, 2020 / The purpose of this study was to determine the prevalence of gestational diabetes mellitus (GDM) and the associated risk factors in the Greater Giyani Area, Mopani District. Quantitative cross-sectional descriptive study was conducted to determine the prevalence rate and risk factors of GDM. Data was collected using questionnaire and data entry form. One hundred and one (101) pregnant women who were attending antenatal clinic visits at Nkhensani Hospital, Nkhensani Gateway Clinic and Giyani Healthcare Centre participated in the study. The SPSS programme was used and p-value of <0.05 was considered significant. The study found that the prevalence of GDM in the area was 1.9%. Pregnant women above 30 years with secondary education, employed, obese and at gestational age of 31-35 weeks were more likely to present with GDM. A family history of diabetes was significantly associated with development of GDM. In conclusion, the universal screening approach for GDM needs to be adopted by all health institutions.