[pt] Esta pesquisa interdisciplinar aborda os avanços tecnológicos obtidos no desenvolvimento da técnica de conversão de exames de imagens médicas em modelos virtuais e físicos, na área de medicina fetal. A técnica tem por objetivo melhorar a visualização e contribuir com as tomadas de decisão clínica através do desenvolvimento de modelos tridimensionais que simulam com acurácia as formas anatômicas do paciente. Ao longo de dez anos, diversos avanços foram criados e incorporados, ampliando significativamente as formas de visualização e interatividade. A relação interdisciplinar entre o design e a medicina, possibilitou a constante atualização da técnica, atestado pela vasta produção cientifica nacional e internacional produzida. Um procedimento complexo na área de neurologia foi escolhido como estudo de caso de forma a exemplificar a gama de modelos e simulações que permitiram observar como o design contribui em todo o processo. / [en] This interdisciplinary research approaches the technological advances obtained in the development of the technique of converting medical image images into virtual and physical models, in the area of fetal medicine. The technique aims to improve visuality and contribute to clinical decision making through the development of threedimensional models that accurately simulate the patient s anatomical shapes. Over ten years, several advances were created and incorporated, significantly expanding the ways of visualization and interactivity. The interdisciplinary relationship between design and medicine enabled the constant updating of the technique, attested by the vast national and international scientific production. A complex procedure in the field of neurology was chosen as a case study in order to exemplify the range of models and simulations that allowed us to observe how design contributes to the entire process.

The type and duration of observation and monitoring of mother and fetus after abdominal trauma are dependent on gestational age and severity of trauma. Fetal monitoring is usually not required when the fetus is not viable; the primary consideration is the safety of the mother. When the fetus is viable, 24-hour inpatient fetal monitoring is indicated in cases of major trauma, even when no symptoms of injury are obvious.

Fragestellung/Hintergrund: In den letzten Jahren hat die Wassergeburt eine weite Verbreitung gefunden. Die Geburt eines Kindes ist als 'life-event' (Kentenich) im Leben werdender Eltern zunehmend ins Bewusstsein gerückt. So soll nach den Forderungen der Eltern in möglichst häuslicher Umgebung mit Freiraum für eigene Gestaltung das Spektrum medizinisch-technischer Möglichkeiten im Bedarfsfall verfügbar sein. Um Zufriedenheit mit dem Geburtserlebnis zu erreichen, müssen die an eine Geburtsklinik gestellten Erwartungen erfüllt werden. So ist es unser Anliegen, eine Geburtshilfe anzubieten, welche auch als psychosomatisch verstandene Geburtshilfe die Zufriedenheit der Eltern zum Ziel hat. Methode: Die vorliegende Untersuchung ist eine Fall-Kontrollstudie, in der die Geburtsmodi Wassergeburt und Bettgeburt auf drei Aspekte hin untersucht wurden: Daten des Fetal Outcome, mütterliche geburtshilfliche Parameter sowie Daten zum Geburtserlebnis, der Geburtsvorbereitung, der Assoziation zum Thema Wassergeburt und soziodemographische Variablen. Anhand des letzten Aspektes wurde untersucht, ob ein Zusammenhang besteht zwischen dem Geburtsmodus und der Zufriedenheit mit dem Geburtserlebnis. Weiterhin wurde die mikrobiologische Kontamination des Badewassers untersucht. Ergebnisse: Die Kollektive unterschieden sich nicht hinsichtlich Parität, Schwangerschaftswoche und mütterlichem Alter. Bezüglich der mütterlichen geburtshilflichen Parameter und des Fetal Outcome ergaben sich keine signifikanten Unterschiede. Der Entschluss zur Wassergeburt wird von den meisten Frauen (59%) spontan im Kreißsaal getroffen. Das Geburtserlebnis wird von den Frauen der Fallgruppe signifikant besser beurteilt. Es traten keine Neugeboreneninfektionen auf, die durch Keime des Badewassers verursacht wurden. Schlussfolgerung: Die Wassergeburt ist unter Berücksichtigung von Ausschlusskriterien ein sicherer Geburtsmodus für Mutter und Neugeborenes. Die Möglichkeit für die Gebärende, sich spontan für diesen Geburtsmodus zu entscheiden, geht mit einer positiven Bewertung des Geburtserlebnisses einher. Somit ist die Wassergeburt ein sinnvolles Angebot an die Gebärende vor dem Hintergrund der an die Geburtshilfe gestellten Erwartungen. / Objectives: In recent years water birth has obtained much acceptance. Childbirth has more and more taken on the quality of a life event (Kentenich) in the consciousness of expectant parents. While parents want it to take place in a personal and homely atmosphere they whish at the same time to have the security of medical facilities. Parents will be satisfied with the experience of childbirth if their expectations towards obstetrics are fulfilled. Methodology: This study is based on a case-control trial in which water birth and conventional birth in bed have been compared in respect of the following data: fetal outcome, maternal obstetrical parameters, birth event, pre-birth preparation, association regarding the subject of water birth and sociodemographical variables. It has been examined whether there is a correlation between the mode of birth and the satisfaction with the birth event. Furthermore microbiological contamination of bath water after water birth was examined. Results: The two collectives are equal concerning parity, gestational age and maternal age. They have shown no significant differences concerning maternal obstetrical parameters and fetal outcome. The majority of women (59%) make decision for water birth spontaneously in the delivery room. Women in case group have shown a significantly greater satisfaction with birth event. There were no infections in neonates by germs from bath water. Conclusion: With the exclusion of risk-groups water birth is a safe mode of delivery. The possibility for the birth attendants to opt for a mode of birth spontaneously correlates with a positive assessment of birth event. In our opinion water birth is a commendable alternative fulfilling expectations of parents towards modern obstetrics.

For many decades the Boston University School of Medicine Department of Anatomy and Neurobiology has housed an unprovenienced collection of fetal specimens. At least ten percent of the 137 fetal specimens were lost due to drying out and other damage. The specimens were stored for many decades in individual fluid filled containers. There is no reliable information regarding the medical or curation histories of the human fetal specimens. Furthermore, there is concern that the fixative may have led some internal structures to shrink more than others. At issue was to determine whether the specimens had maintained or lost their relationships, and size amongst internal structures. In normal fetal development the cerebellum, the femur, and the foot all follow mostly positive linear growth with age. Therefore, the purpose of the present study was to assess whether these specimens demonstrate anatomical correlations that one might find within in utero fetuses. This prospective correlation study used MRI images of the cerebellum and femur as well as anthropometric measurements of each foot and mass to seek to answer this question. A blind, random sample of twenty-five specimens was selected from forty-eight specimens roughly grouped by size. The Boston University Institutional Review Board was notified and, assigned waiver status to the application because the specimens were unprovenienced fixed tissue. All specimens were magnetic resonance scanned at the Center for Biomedical Imaging at the Boston University School of Medicine using a 3.0T whole body scanner (Achieva, Philips Healthcare, Best, The Netherlands). All scans were acquired using the 8-channel high-resolution head coil made by Invivo for the Achieva 3T scanner. This study found that the measurements taken from the images, and the feet had good intra-rater reliability because paired t-tests did not show significant differences between the measurements (alpha (α) < 0.05, all p-values were > 0.17, t-values were less than t-critical, and R2 < 0.02). Pearson's correlation coefficient testing revealed strong positive correlation between all the mean measures comparing these three structures: transverse cerebellar diameter (TCD), femur length, and foot length (α < 0.05, r - values were > 0.91, p < 0.001, and R2 > 0.82). Leading us to conclude that the dimensions of the soft tissues - TCD; and bone tissues - femur and foot of the lower extremities were unlikely to have changed significantly in decades of storage.

Objectif : Établir le profil psychosocial des femmes enceintes de l'Estrie et évaluer de façon préliminaire si ce profil diffère parmi les grossesses avec issues défavorables. Méthode. Cohorte prospective de 120 femmes enceintes, rencontrées à deux reprises (10-20 et 25-30 semaines), entre août 2004 et mars 2006. Il s'agit d'un questionnaire auto-administré des données démographiques, anthropométriques, des facteurs de risques biomédicaux, ainsi qu'un profil psychosocial comportant 6 dimensions: stress psychologique perçu, ennuis quotidiens, détresse psychologique, locus de contrôle, soutien social, traumatismes dans l'enfance. Les paramètres psychosociaux sont présentés en moyennes ou pourcentages. Le profil psychosocial est comparé entre les grossesses normales et anormales avec les tests t de Student ou le test de Mann Whitney, lorsque approprié. Résultats. Trente trois grossesses (27,5%) ont présenté des issues défavorables (prématurité, restriction de croissance intra-utérine, hypertension gestationnelle, diabète gestationnel). L'analyse du profil psychosocial révèle un score de stress psychologique perçu plus élevé entre 10-20 semaines chez les femmes avec issues défavorables de grossesse (score : 34,2 « 12,3 ; P < 0,01) et chez les femmes avec prématurité (score : 36,1 « 11,2 ; P < 0,02) comparativement à celui des femmes avec grossesses normales (score : 28,6 « 9,6). Par ailleurs, les 5 autres dimensions ne semblaient pas différentes selon les issues de grossesse. Conclusion. Ces résultats préliminaires suggèrent une piste possible reliant la perception de stress maternel durant la grossesse et certaines issues défavorables de grossesse, dont l'accouchement prématuré.

Thesis (MMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background - Preeclampsia is a multi-system disease characterized by hypertension and proteinuria in pregnant women at greater than 20 weeks of gestational age. It remains one of the leading causes of maternal and foetal mortality and morbidity. While the cause of preeclampsia is essentially unknown, the important theories strongly implicate disturbed placental function in early pregnancy. Additionally, some researchers have investigated the possibility of a seasonal relationship with the incidence of preeclampsia. Differences in incidences of preeclampsia, examined exclusively on the basis of delivery timing, have also been noted to have seasonal variation, but results have been inconsistent. Objective - Our primary objective was to investigate the seasonal variation in preeclampsia in relation to the timing of conception and the timing of presentation with clinical disease over the period of one year. Methods - We performed a retrospective descriptive study of all women with preeclampsia who delivered at Tygerberg Hospital in 2010. Preeclampsia was diagnosed as hypertension associated with proteinuria after the 20th week of gestation. Names of patients were identified from labour ward records and data was collected and recorded on a data-sheet. Data were primarily analysed in relation to the season of delivery and also the season of the last menstruation. Summer was diagnosed as lasting from summer solstice to autumn equinox, autumn as lasting from autumn equinox until winter solstice, winter as lasting from winter solstice until spring equinox and spring as lasting from spring equinox until summer solstice. The data was analysed using the SPSS software (Statistical Package for Social Science). Discrete data was compared by calculating relative risks with 95% confidence limits, as well as the chi2 test. Fisher‘s exact test was used to compare ratios where the expected value in any cell of a two-by-two table is less than five. The means of normally distributed continuous data was compared by analysis of variance, while the medians of continuous data which are not distributed normally, where calculated using the non-parametric Mann Whitney u test. A p-value of < 0.05 was considered to be statistically significant, where applicable. Results - The peak incidence of preeclampsia was during winter with 32.2% of all cases occurring during this season. This was significantly higher than during the summer when only 169 (17.17%) cases of preeclampsia were delivered. When we analysed the data looking at the timing of menstruation (and therefore conception), we found that 292 (29.7%) patients that developed preeclampsia had their last menstrual period in the spring, with November the month of peak incidence. The lowest incidence was found in winter, with only 218 (22.2%) patients. Conclusion - We have confirmed a previous finding of a seasonal variation in the occurence of preeclampsia in Tygerberg Hospital. We have also confirmed that this seasonal variation is not only influenced by the timing of delivery, but also by the timing of conception. / AFRIKAANSE OPSOMMING: Agtergrond - Preeklampsie is ‘n multi-sisteem siekte wat gekenmerk word deur hipertensie en proteinurie. Dit word slegs gedurende swangerskap aangetref - gewoonlik na 20 weke. Dit is steeds een van die voorste oorsake van moederlike en fetale morbiditeit en mortaliteit. Terwyl die oorsaak van preeklampsie steeds onbekend is, dui die belangrikste teorië op versteurde plasentale ontwikkeling en funksionering vroeg in swangerskap. Sekere navorsers het ook die moontlikheid van ‘n seisonale patroon in die voorkoms van preeklampsie ondersoek. ‘n Seisonale patroon is wel identifiseer, maar dit is slegs gebasseer op die datum van verlossing en die resultate tussen studies wissel. Doel - Ons primêre doel was om die seisonale patroon in die insidensie van preeklampsie te ondersoek oor ‘n tydperk van een jaar en dan die datum van bevrugting te vergelyk met die datum van diagnose en verlossing. Metodiek - Ons het ‘n retrospektiewe beskrywende studie gedoen oor al die pasiënte met preeklampsie wat tydens 2010 by Tygerberg Hospitaal verlos is. Preeklampsie is gediagnoseer as hipertensie met geassosieerde proteinurie met aankoms na 20 weke. Die name van die pasiënte is verkry uit die kraamsaal-registers en data is versamel en op ‘n datastel aangebring. Data is primer geanaliseer in terme van die seisoen van verlossing en die seisoen waartydens die laaste maandstonde plaasgevind het. Die seisoene is as volg geklassifiseer : somer vanaf die summer solstice to autumn equinox, autumn as lasting from autumn equinox until winter solstice, winter as lasting from winter solstice until spring equinox and spring as lasting from spring equinox until summer solstice. Die data is geanaliseer met die SPSS sagteware (Statistical Package for Social Science). Diskrete data is vergelyk deur die relatiewe risiko’s te bereken met vertrouensintervalle van 95%, sowel as die chi2 toets. Fisher se eksakte toets is gebruik om ratios te vergelyk waar die verwagte waarde van enige sel in ‘n 2-by-2 tabel minder as 5 is. Die gemiddeldes van normaal-verspreide aaneenlopende data is vergelyk deur die analise van variance. Die mediane van aaneenlopende data wat nie normaal versprei was nie, is bereken met die non-parametriese Mann-Whitney-U-toets. ‘n P-warde van <0,05 is beskou as statisties betekenisvol, waar van toepassing. Resultate - Die piek –insidensie van preeklampsie was gedurende die wintermaande, met 32.2% van alle gevalle. Dit was betekenisvol hoër as die gedurende die somer, waar slegs 169 (17.17%) van gevalle verlos is. Toe ons die data analiseer na gelang van die datum van laaste menstruasie (en gevolglik bevrugting), het ons gevind dat 292 (29.7%) van die pasiënte wat preeklampsie ontwikkel het, het hul laaste maandstonde gedurende die lente ervaar. Die piek-insidensie was gedurende November. Daarteenoor is die laagste insidensie gevind in pasiënte met ‘n laaste menstruasie in die winter, met slegs 218 (22.2%) pasiënte. Gevolgtrekking - Ons het die vorige bevinding by Tygerberg Hospitaal van ‘n seisonale patroon in die ontwikkeling van preeklampsie bevestig. Ons het ook bevestig dat dit nie die datum van diagnose en verlossing is wat’n rol speel nie, maar wel die datum van laaste maandstonde en bevrugting.

Thesis (M Social Work)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Fetal alcohol syndrome (FAS) is a condition which occurs when women drink alcohol during pregnancy. The use of alcohol during pregnancy has permanent and serious consquences which manifests in developmental delays and causes harmful effects to the central nervous system. FAS is seen as completely preventable and irreversable which lasts into adulthood. The prevalence rate of FAS in the Western Cape is the highest in the world. FAS is not just a health problem but also a social welfare problem, since the care for adolescents with FAS brings about exceptional demands for the carer. For this reason it became vital to explore the educational roles of the carers of adolescents with FAS. This research study firstly describes the characteristics of FAS within the physical, cognitive and social development of the adolescents with FAS. Secondly, the study describes and explores the educational roles of the carers of adolescents with FAS. The study combines both quantitative and qualitative research. The exploratory and descriptive research designs were used and a purposive sampling method was used. The participants were interviewed individually with the help of a semi-structured questionnaire. The findings of the empirical investigation show that the carers of FAS adolescents according to their perceptions and experiences know what is expected of them within their respective educational roles and they do make an effort to fulfil this role to the best of their ability. Further findings show that due to aspects like poverty and illiteracy of the participants, the carers need the support of the social worker in order for them to fulfil their educational roles. Recommendations resulting from the empirical investigation indicated that social workers need to support the carers of adolescents with FAS in parenting programmes which is simple and practical for the carers to understand and to implement. Further recommendations focus on awareness programmes and actions where the carers also take part in educating the community in terms of FAS. Through these actions the carers of adolescents with FAS can build a support system for themselves whithin the community. Therefore the community can be utilized by the carers of adolescents with FAS as a valuable resource in the fulfilment of their educational roles. / AFRIKAANSE OPSOMMING: Fetale-alkoholsindroom (FAS) is ‘n toestand wat veroorsaak word wanneer vroue alkohol drink tydens swangerskap. Alkoholgebruik tydens swangerskap het blywende en ernstige nagevolge wat manifesteer in ontwikkelingsagterstande en skade in die senuweestelsel. FAS word dus beskou as heeltemal voorkombaar, maar is onomkeerbaar en duur voort tot in volwassenheid. Die voorkomsyfer van FAS is wêreldwyd die hoogste in veral die Wes-Kaap. FAS is nie net ‘n gesondheidsprobleem nie, maar ook ‘n maatskaplike probleem aangesien die versorging van adolessente met FAS besondere eise aan versorgers stel. Om hierdie rede is dit noodsaaklik om die opvoedingsrolle waaroor versorgers van FAS-adolessente moet oor beskik te ondersoek. Hierdie navorsingstudie beskryf eerstens die kenmerke van FAS binne die fisiese-, kognitiewe- en sosiale ontwikkeling van die adolessent met FAS. Tweedens beskryf studie die opvoedingsrolle waaroor versorgers van FAS-adolessente moet oor beskik. Die studie kombineer beide kwalitatiewe en kwantitatiewe navorsing. Die verkennende en beskrywende navorsingsontwerp is gebruik en daar is ‘n doelbewuste steekproef gedoen. Individuele onderhoude is met die deelnemers gevoer met behulp van gestruktureerde vraelyste. Die bevindinge van die empiriese ondersoek toon dat die versorgers van FAS-adolessente volgens hulle persepsie en belewenisse, weet wat van hulle verwag word in die verskillende opvoedingsrolle en dat hulle wel pogings aanwend om hierdie rolle te probeer vervul. Verdere bevindings toon dat as gevolg van aspekte soos armoede en ongeletterdheid van die deelnemers die maatskaplike werker ondersteuning sal moet bied aan die versorgers van FAS-adolessente in die vervulling van hul opvoedingsrolle. Aanbevelings vanuit die empiriese ondersoek dui daarop dat die versorgers van FASadolessente deur veral die maatskaplike werker ondersteun moet word deur ouerleidingsprogramme wat eenvoudig en prakties aangebied behoort te word sodat die versorgers die inhoud maklik kan verstaan en kan toepas. Verdere aanbevelings fokus op bewusmakingsprogramme en -aksies waarin die versorgers ‘n rol kan speel om sodoende die gemeenskap ook op te voed ten opsigte van FAS. Hierdeur kan die versorgers van FASadolessente vir hulleself ‘n ondersteuningsnet binne die gemeenskap bou en die gemeenskap as ‘n waardevolle hulpbron benut in die vervulling van hul opvoedingsrolle.

Thesis (M Social Work)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Non-biological caregivers often take children into their care when their own biological caregivers have failed to provide them with a safe and loving home. These children are often also affected with Fetal Alcohol Spectrum Disorders (FASD). Learning of a child’s disability can be a big shock to non-biological caregivers especially if it is misunderstood, available professional help is scarce and intervention resources are not readily available. These non-biological caregivers are often not prepared for the financial, emotional and physical investment that is required to fully support the children and their development. This can cause various emotional reactions and implications that are challenging for the caregivers. It is critical to recognise parenting experiences and challenges as a means of developing and promoting intervention strategies and support that will respond to the needs of the children with FASD and their non-biological caregivers especially from a South African perspective. There is a need for social workers to take on responsibility for addressing FASD as they have the professional capacity to help families living with FASD to develop and maintain stable and nurturing households. One way in which this can be achieved is through the initiation and facilitation of support groups. The goal of the study was to gain an understanding on the experiences of non-biological caregivers of children with FASD and of the utilisation of support groups to help them cope better. The researcher made use of a combination of an exploratory and descriptive research design. By using both a quantitative and qualitative approach in a complimentary manner, the researcher was able to gain an in depth insight into the lives of the non-biological caregivers and how they experience this disability and support groups that are utilised as a means of helping them cope. Permission to conduct the study was granted by the committee for Human Research at the University of Stellenbosch. The literature study firstly investigated the implication of FASD on affected children. Secondly, the extents to which non-biological caregivers are affected by the consequences of this disability were discussed. After this the utilisation of support groups as a method of supporting non-biological caregivers, with the emphasis on a mutual-aid and educational approach as theoretical underpinning was described. The empirical study was completed with 16 participants through face-to-face, semi-structured interviews. An interview schedule based on the findings of the literature study was utilised. The criteria for inclusion were that participants had to have attended at least 5 support group sessions and had to be a non-biological caregiver of FASD children who had attended the support groups specifically related to this disorder. The results of this study mostly confirmed the findings from the literature study which showed that support groups play a vital role in providing necessary support to non-biological caregivers who are often unprepared for the realities of caring for a FASD child. Recommendations are aimed at the social work profession in South Africa who need to align itself in providing necessary support to non-biological caregivers through the use of support groups and various other methods of service rendering. Suggestions for future research are also made in line with how non-biological caregivers can be supported in their unique caregiver responsibilities. / AFRIKAANSE OPSOMMING: Nie-biologiese versorgers neem dikwels kinders in hul sorg wanneer kinders se biologiese ouers versuim om vir hulle ‘n veilige en liefdevolle huis en omgewing te skep. Hierdie kinders kan ook ly aan of geaffekteer word deur Fetale Alkohol Spektrum Versteuring (FASV). Dit kan ‘n groot skok wees wanneer versorgers uitvind dat die kind geaffekteer is daardeur, veral as hierdie versteuring misverstaan word. Professionele hulp is skaars, en intervensies en hulpbronne is nie vryelik beskikbaar nie. Versorgers is dikwels nie voorbereid op die finansiële, emosionele en fisiese eise wat nodig is om ten volle die kind se ontwikkeling te ondersteun nie. Dit kan dit lei tot verskillende emosionele reaksies met verskeie gevolge wat opsigself ook verskeie uitdagings vir die nie- biologiese versorgers veroorsaak. Dit is van kritieke belang om die ervarings en uitdagings van ouerskap te verken in die bevordering en ontwikkeling van intervensiestrategieë ter ondersteuning van die behoeftes van die kinders met FASV en hul versorgers, veral vanuit ‘n Suid-Afrikaanse perspektief. Daar word vereis van maatskaplike werkers om verantwoordelikheid te neem vir die aanspreek van FASV, aangesien hulle die professionele kapasiteit het om families wat geaffekteer is te help, en om hulle by te staan sodat ‘n stabiele en koesterende huishouding ontwikkel en volgehou kan word. Een manier waarop dit bereik kan word, is deur die vestiging en fasilitering van ondersteuningsgroepe. Die doel van hierdie studie was om ‘n begrip te ontwikkel oor die ervarings van nie-biologiese versorgers van kinders met FASV se benutting van ondersteuningsgroepe. Die navorser het gebruik gemaak van ‘n kombinasie van ‘n verkennende en beskrywende navorsing. Deur die gebruik van beide ʼn kwantitatiewe en kwalitatiewe benadering, is die navorser in staat gestel om ‘n indiepte insig in die lewens van die versorgers te bekom, en ondersoek in te stel oor hul ervarings van die versteuring/gestremdheid deur ondersteuningsgroepe wat as intervensie aangewend is. Toestemming om die studie te doen is deur die Etiese Komitee vir Menslike Navorsing aan die Universiteit van Stellenbosch bekom. Eerstens is die literatuurstudie voltooi waarin die navorser ondersoek ingestel het oor die implikasies van FASV op geaffekteerde kinders. Tweedens is daar bespreek hoe nie-biologiese versorgers geraak word deur die gevolge van hierdie versteuring/gestremdheid. Daarna is ondersteuningsgroepe as ‘n metode van ondersteuning aan versorgers ondersoek, en klem is gelê op ‘n wedersydse hulpbenadering en ‘n opvoedkundige benadering as teoretiese grondslag. Die empiriese studie is voltooi met 16 deelnemers deur middel van individuele, een-tot-een, semi-gestruktureerde onderhoude. ‘n Onderhoudskedule, wat gebaseer is op die bevindinge van die literatuurstudie, is gebruik. Die kriteria vir deelname aan die studie en groep het ingesluit dat deelnemers ten minste vyf sessies van ‘n ondersteuningsgroep moes bywoon en ook ‘n pleegouer wees van ‘n FASV kind. Die resultate van hierdie studie het meestal die bevindinge uit die literatuurstudie bevestig en het getoon dat ondersteuningsgroepe ‘n belangrike rol speel in ondersteuning aan nie-biologiese versorgers, wat dikwels onvoorbereid is op die werklike problematiek van die versorging van ‘n kind met FASV. Aanbevelings word gerig aan die maatskaplikewerk-professie in Suid-Afrika, ten einde ondersteuningsgroepe en ander metodes van dienslewering te bied, ter ondersteuning aan die versorgers van FASV kinders. Voorstelle vir verdere navorsing word ook gemaak sodat daar ‘n ondersteuningsnetwerk opgebou kan word vir die versorgers van ‘n FASV kind ten einde aan hulle unieke versorgingsbehoeftes te voorsien.

Dissertation (PhD)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: Introduction: Fetal alcohol syndrome (FAS) consists of multi-system abnormalities and is caused by the excessive intake of alcohol during pregnancy. The teratogenic effect of alcohol on the human fetus has now been established beyond reasonable doubt and FAS is the most important human teratogenic condition known today. The syndrome, first described by Lemoine in1968 in the French literature and in the English literature by Jones and Smith in 1973, has since been corroborated by numerous animal and human studies. This study has grown out of several epidemiological, prenatal and infant studies in areas of the Western Cape that are currently being undertaken by the Foundation for Alcohol Related Research (FARR). Preliminary data from studies in Wellington have confirmed that a significant proportion of school-entry children have FAS. The prevalence ofF AS in this community exceeds that for Down syndrome by a factor of30 times. The frequency ofFAS in high-risk populations of the Western Cape is the highest reported anywhere in the world. With this background, and the paucity of FAS literature related to dentistry, the aim of this study was to determine the craniofacial and oral manifestations ofF AS in a sample of school-going children in the Western Cape. Methodology: This study is a descriptive, case-control, cross-sectional study using a random cluster sampling method. On the day of examination, children were weighed, and their height and head circumference were measured. They then had photographs and radiographs taken, followed by an oral examination. For each child, the following information was recorded on the data capture sheet: date of birth, gender, head circumference, weight and height, enamel opacities, dental fluorosis, plaque index, gingival bleeding index, dentition status, oral mucosal lesions and dentofacial anomalies. Results: The total sample of90 children with diagnosed FAS and 90 controls, were matched for age, gender and social class. There were no significant age differences between the two groups (p=0.3363) and the mean ages were 8.9 and 9.1 for the FAS and control groups respectively. Head circumference (HC) differed significantly between the two groups (p<O.OOO 1) and the three photographic diagnostic measurements were all influenced by head circumference. The prevalence of enamel opacities between FAS and controls was not significantly different and averaged around 15% for both groups. The opacities were found largely in the maxillary central incisor and lower first molar teeth. More than three quarters of both the cases and the controls demonstrated the presence of plaque and almost two thirds demonstrated gingival bleeding on probing. FAS patients had statistically significantly (p<O.OO 1) more dentofacial anomalies than the controls. The mean dmft score for the FAS sample was slightly higher, though not significantly different from that of the controls and the decayed component (d) made up the largest part of the index in both groups. None of the FAS children had any missing or filled teeth, and in the case of the controls these were also rarely found. Thirty nine children (21.67%) of the total sample were caries-free. Discussion: This study represents one of the largest sample sizes documenting the craniofacial and oral and dental manifestations of the FAS to date. Forty two per cent of the FAS sample manifested growth retardation and this was statistically significant (p<O.OOOl) when compared to their controls. Analysis of the face using anthropometry supports many of the previous clinical descriptions of the effects of neonatal alcohol exposure and offers some new perspectives on the FAS facial phenotype. The characteristic dysmorphic facial features found included ptosis of the upper eyelids, epicanthic folds, short upturned nose, thin vermillion border of the upper lip and a smooth philtrum. Overall the analysis of the caries data for this study in respect of differences between cases and controls was found to be unremarkable. The lack of difference in the primary and permanent dentitions between the cases and controls could have been anticipated in this population due to the high prevalence of dental caries among children from the Western Cape. The FAS children showed significantly lower dental ages when compared to the controls. Dental maturation has previously been shown to be mildly, but consistently, delayed in children with delayed development and therefore this is a not surprising finding for the FAS children in this study. Differences between skeletal age and chronological age were noted for both boys and girls, but as a whole, in the present study groups (FAS and controls) showed little variation in skeletal development. Measurements related to the face height and mandibular size appear to be the most important in distinguishing the FAS children from the controls. Most (5 out of8) of the discriminating linear measurements studied lie in the front of the skull area. Most of the discriminating measurements are vertical measurements and only two of the measurements are lines between soft tissue points. When comparing the photographic analyses of the facial features versus the cephalometric assessments; the four facial features most typical of aF AS child had a Positive Predictive Value (PPV) of92% and a Negative Predictive Value (NPV) of90% and the eight linear measurements from the cephalometric analyses had a PPV of 92% and a NPV of 95%. One can therefore conclude that the external facial features are probably more reliable in discriminating between the two groups than the cephalometric measures. For further analyses, other models where a single angular measurement explains a combination of linear measurements need to be investigated. This might further improve the discriminating abilities of the cephalometric measurements as a whole. Conclusions: This study has shown the importance of the oral and craniofacial features ofFAS. FAS can no longer be viewed as just a rare and peculiar childhood disorder. Awareness and recognition of children with FAS is important so that they can be correctly diagnosed and referred appropriately. Prevention of the secondary disabilities and most importantly, the prevention of FAS in subsequent programmes can be planned. The dentist who treats children with FAS must recognise that such patients might be emotionally and mentally handicapped and may make treatment difficult and there may be a need for the child to be treated with behaviour modification and/or premedication before restorative treatment. The dentist should also be aware of the need for an accurate medical history, and possible medical consultations, before treatment can be undertaken safely. / AFRIKAANSE OPSOMMING: Fetale alkoholsindroom (FAS) bestaan uit multisisteem abnormaliteite en word veroorsaak deur oormatige inname van alkohol tydens swangerskap. Die teratogeniese uitwerking van alkoholop die menslike fetus word nie meer betwyfel nie en FAS is die belangrikste menslike teratogeniese toestand tans bekend. Die sindroom, soos aanvanklik deur Jones en Smith in 1973 beskryf, is sedertdien deur vele studies op mens en dier bevestig. Hierdie studie het gegroei uit vele epidemiologiese-, prenatale- en kleuterstudies in dele van die Weskaap wat tans onderneem word deur die Stigting vir Alkoholverwante Navorsing. Voorlopige data van die studies in Wellington bevestig dat 'n betekenisvolle deel van skoolbeginners FAS het. Die prevalensie van FAS in hierdie gemeenskap oortref dié van Down se sindroom met 'n faktor van 30. Die frekwensie van FAS in die Weskaap is die hoogste wat in die wêreld gerapporteer is. Met hierdie agtergrond, en die skaarste aan FAS literatuur wat op tandheelkunde betrekking het, was die doel van hierdie studie om die kraniofasiale en mondmanifestasies van fetale alkoholsindroom in 'n monster van skoolkinders in die Weskaap te ondersoek. Metodologie: Hierdie studie was 'n beskrywende, gevallebeheerde deursneestudie waarin 'n lukrake gebondelde monstermetode gebruik is. Op die dag van die ondersoek is die kinders geweeg en hulle lengte en kopomtrek bepaal. Hierna is foto's en x-straalopnames geneem, gevolg deur 'n mondondersoek. Die volgende inligting is vir elke kind aangeteken: geboortedatum, geslag, kopomtrek, massa en lengte, glasuur-opasiteite, tandfluorose, plaakindeks, gingivale bloedingsindeks, gebitstatus, mukosale letsels en dentofasiale anomalieë. Resultate: Die totale monster, bestaande uit 90 kinders met gediagnoseerde fetale alkoholsindroom en 90 bypassende kontroles, is vergelyk ten opsigte van ouderdom, geslag en sosiale klas. Daar was geen betekenisvolle ouderdomsverskille tussen die twee groepe nie (p- =0.3363). Kopomtrek het betekenisvol tussen die twee groepe verskil (p<0.0001), en die drie fotografiese diagnostiese afmetings is almal beïnvloed deur kopomtrek. Die prevalensie van glasuur-opasiteite tussen die FAS- en kontrolegroep was nie betekenisvol nie en het rondom 15% vir beide gewissel. Die opasiteite is hoofsaaklik gesien in maksillêre sentrale snytande en mandibulêre eerste molare. Meer as driekwart van beide groepe het plaak getoon, en byna tweederdes het gingivale bloeding met sondering gehad. Die gevallegroep het statisties betekenisvol meer (p<O.OO1) dentofasiale anomalieë getoon. Die gemiddelde dmft telling vir die FAS groep was effens hoër, alhoewel nie betekenisvol nie, as die kontrolegroep, en die "delayed" (vertraagde erupsie) komponent (d) het die grootste deel van die indeks uitgemaak in beide groepe. Geen van die FAS kinders het enige afwesige tande (m) of hers telde tande (f) gehad nie, soos ook gevind in die kontrolegroep. Nege-en-dertig kinders (21.67%) van die totale monster was kariesvry. Bespreking: Hierdie studie verteenwoordig een van die grootste monstergroottes tot op datum waarin ondersoek ingestel is na die kraniofasiale en mond- en tandmanifestasies van die fetale alkoholsindroom. Twee-en-veertig persent van die FAS monster het vertraagde groei getoon en dit was statisties-betekenisvol (p<O.OOOl)vergeleke met die kontrolegroep. Antropometriese analise van die gesig steun die vele kliniese beskrywings van neonatale blootstelling aan alkohol, en bied ook nuwe perspektiewe op die FAS gesigsfenotipe. Die kenmerkende dismorfiese gesigseienskappe wat gevind word, sluit ptose van die boonste ooglede, epikantusvoue, kort opgedraaide neus, dun vermiljoen rand van die bolip en 'n gladde filtrum in. In die geheel was die analise van die karies data ten opsigte van verskille tussen gevalle en kontroles onopvallend. Die afwesigheid van 'n verskil in die primêre en sekondêre gebitte in die gevalle en kontroles kon in hierdie bevolking verwag gewees het as gevolg van die hoë voorkoms van tandkaries onder kinders in die Weskaap. Die FAS kinders het betekenisvol-laer gebitouderdomme gehad as die kontrolegroep. Gebitmaturasie is in geringe maar deurlopende mate vertraag in kinders met vertraagde ontwikkelings, soos voorheen al getoon, en is daarom nie verbasend vir die FAS kinders in hierdie studie nie. Verskille tussen skeletale ouderdom en chronologiese ouderdom is gevind in beide seuns en dogters, maar in die geheel het dié huidige groepe (FAS en kontroles) min variasie in skeletale ontwikkeling getoon. Dit wil voorkom of afmetings wat verband hou met die gesigshoogte en grootte van die mandibula die belangrikste is om FAS kinders van die kontrolegroep te onderskei. Meeste (5 uit 8) van die diskriminerende lineêre afmetings wat bestudeer is, lê op die voorkant van die skedel. Die meeste is vertikale afmetings, terwyl slegs twee lyne tussen sagte weefsel punte. Waneer die fotografiese analises van die gesigseienskappe vergelyk word met die sefalometriese waarnemings, word gevind dat die vier gesigseienskappe tipies van 'n FAS kind 'n Positiewe Voorspelbare Waarde (PVW) van 92% en 'n Negatiewe Voorspelbare Waarde (NVW) van 90% het, en die agt lineêre afmetings vanaf die sefalometriese analise 'n PVW van 92% en 'n NPV van 95% het. Daar kan dus afgelei word dat die eksterne gesigseienskappe waarskynlik meer betroubaar is om te onderskei tussen die twee groepe. Vir verdere analise behoort ander modelle waar 'n enkel hoekige afmeting 'n kombinasie van lineêre afmetings verduidelik, ondersoek te word. Dit mag die diskriminerende vermoëns van sefalometriese afmetings in die geheel verder bevorder. Gevolgtrekking: Hierdie studie het die belang van orale en kraniofasiale eienskappe van FAS getoon. Die toestand kan nie langer as 'n seldsame en eienaardige aandoening van kinders beskou word nie, en bewustheid en herkenning van fetale alkoholsindroom pasiënte is belangrik sodat hulle korrek gediagnoseer en op gepaste wyse verwys kan word. Die tandarts wat FAS pasiënte behandel, moet besef dat sulke pasiënte emosioneel en geestelik belemmer mag wees en dus hantering en behandeling bemoeilik. Daar mag 'n behoefte ontstaan vir gedragsmodifikasie enlofpremedikasie voor herstellende behandeling. Verder moet die tandarts bewus wees van die behoefte aan 'n akkurate mediese geskiedenis, en moontlik konsultasie met 'n geneesheer, voor behandeling veilig ingestel kan word.

Existing commonly used maternal-fetal attachment instruments have not been thoroughly tested for reliability and validity; criticism can be levelled for a variety of problems ranging from lack of reliability due to an inadequate underpinning framework to facilitate objective interpretation to limited generalizability due to the sample. The aim of this study is to acknowledge the centrality of the mother, to use the experiences of pregnant women to generate a definition of maternalfetal attachment and ultimately create a tool that will act as a reliable, valid and simple measurement. A mixed method framework utilising a sequential exploratory strategy has allowed qualitative exploration of the phenomenon under investigation followed by quantitative testing of the emerging theory on a much larger and different sample. Phase 1 involved face to face open structured interviews on an opportunity sample of 10 (5 primigravid; 5 multiparous) women in the final trimester of pregnancy followed by 3 focus groups targeting specific groups – primigravid women (6 participants); multiparous women (7 participants) and teenagers (4 participants). Data analysis was through constant comparative methodology. A multidimensional, psycho-biological definition of attachment was generated from the women’s own perception of their attachment to their fetus. This was used as a framework to design a questionnaire for the measurement of maternal-fetal attachment. Phase 2 involved the validation of the questionnaire and further testing of the definition. Cohort 1 tested for reliability with 200 participants within their second or third trimester of pregnancy. Following modification of the questionnaire, Cohort 2 a sample of 150 women within the final trimester of pregnancy tested the tool for internal reliability and validity. The generated Maternal-Fetal Attachment Tool (MFAT) following rigorous testing proved both reliable and valid. Maternal fetal attachment is founded in psycho-biological theory and is a complex multi-dimensional construct. Central to the definition is the woman’s need to protect her fetus, attachment develops as the fetus becomes more tangible, it is facilitated through the woman’s intergenerational experience of attachment and through appropriate social support. Maternal-fetal attachment facilitates behavioural change to ensure a favourable intra-uterine environment.