Thesis (MPhil (Sociology and Social Anthropology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The study examines the implementation of an intervention aimed at stopping alcohol consumption during pregnancy in order to decrease Foetal Alcohol Spectrum Disorder (FASD) and how this affected changes in alcohol consumption. FASD is a growing concern in South Africa where the prevalence rate is almost 12/100 at some schools in the Western Cape; the highest reported FASD rate in the world. FASD is caused by alcohol consumption during pregnancy and it is an irreversible mental and physical disability in children. FASD is preventable through abstinence from alcohol consumption during pregnancy. The intervention study (referred to as the Ceres Intervention Study), utilised a cluster-randomised trial design, with a control and intervention group, where the control arm of the study received basic screening and information on FASD, while the intervention arm of the study received a more comprehensive intervention, consisting of a variety of screening and counselling techniques. The study took place during 2007/2008 in the Witzenberg sub-district in Ceres in the Western Cape Province of South Africa. The Study used research techniques combined with therapeutic methods and techniques to mediate behaviour change in pregnant women. From the Ceres Intervention Study it was found that 60% of pregnant women changed their drinking behaviour, which led to questions around how this behaviour change took place. The main aim of this study therefore is to examine how pregnant women changed their drinking behaviour during this intervention and also what facilitated the change that was observed. In order to examine the behaviour change, data from the intervention arm and control arm of the study was analysed and a profile of the women was developed. A focus on the intervention arm of the study resulted in distinguishing further between two sub-groups within the intervention arm, namely, the change and no-change groups. Mainly quantitative data was obtained with the use of various tools, however from the comments and experiences of participants, qualitative data could be used as complementary to quantitative data to provide more clarity as to how behaviour change was facilitated in the study. Results from the study suggest that there is a dialectical interplay between client and counsellor which facilitate generative mechanisms that may lead to behaviour change. / AFRIKAANSE OPSOMMING: Hierdie studie lig die implementering van 'n intervensie toe met die doel om die gebruik van alkohol gedurende swangerskap te stop teneinde Fetale Alkohol Spektrum Afwyking (FASD) te verminder en die gepaardgaande gedragsverandering by swanger vroue te ondersoek. FASD is 'n groeiende probleem in Suid-Afrika waar die voorkoms van FASD by 12/100 kinders by sommige skole in die Weskaap gerapporteer is. FASD word veroorsaak deur alkohol-gebruik tydens swangerskap en kan permanente verstandelike en fisiese gestremdheid by kinders veroorsaak. FASD kan voorkom word deur geen alkohol tydens swangerskap te gebruik nie. Die intervensie (of die Ceres Intervensie-studie) maak gebruik van 'n kliniese ontwerp met 'n kontrole en 'n intervensie groep, waar die kontrole arm van die studie basiese assessering asook inligting oor FASD ontvang het, terwyl die intervensie arm 'n meer omvattende intervensie bestaande uit 'n verskeidenheid assesserings sessies en beradingstegnieke ontvang het. Die studie is gedurende 2007/2008 in die Witzenberg sub-distrik in Ceres in die Weskaap, Suid-Afrika, geïmplementeer. Die studie maak gebruik van navorsingstegnieke gekombineer met wetenskaplik gebaseerde intervensie metodes en tegnieke om gedragsverandering by swanger vroue te onderhandel. In die Ceres Intervensie-studie is bevind dat 60% van die swanger vroue hul alkohol-gebruik gedrag verander het. Dit het aanleiding gegee tot vrae rondom hoe hierdie gedragsverandering plaasgevind het. Die hoofdoel van hierdie studie is dus om te kyk na hoe swanger vroue hul alkohol-gebruik verander het gedurende die intervensie asook wat hierdie verandering in gedrag moontlik gemaak het. Om hierdie gedragsverandering te ondersoek is data van die intervensie arm en kontrole arm ontleed en is 'n profiel van die vroue saamgestel. Die fokus op die intervensie arm van die studie het aanleiding gegee tot die verdere onderskeiding tussen twee sub-groepe binne die intervensie arm, naamlik, die groep wat verander het en die groep wat nie verander het nie. Kwantitatiewe data is hoofsaaklik ingesamel, alhoewel kwalitatiewe data wat verkry is uit opmerkings en ondervindings van deelnemers as aanvullende inligting tot die kwantitatiewe data gebruik is teneinde die gedragsverandering wat plaasgevind het toe te lig. Bevindinge uit die studie dui op 'n dialektiese verhouding tussen klient en berader wat skeppende meganismes teweeg bring en sodoende moontlike gedragsverandering bevorder.

Estimation of the fetal heart rate (FHR) has gained interest in the last century; low heart rate variability has been studied to identify intrauterine growth restricted fetuses (prepartum), and abnormal FHR patterns have been associated with fetal distress during delivery (intrapartum). Several monitoring techniques have been proposed for FHR estimation, including auscultation and Doppler ultrasound. This thesis focuses on the extraction of the non-invasive fetal electrocardiogram (NI-FECG) recorded from a limited set of abdominal sensors. The main challenge with NI-FECG extraction techniques is the low signal-to-noise ratio of the FECG signal on the abdominal mixture signal which consists of a dominant maternal ECG component, FECG and noise. However the NI-FECG offers many advantages over the alternative fetal monitoring techniques, the most important one being the opportunity to enable morphological analysis of the FECG which is vital for determining whether an observed FHR event is normal or pathological. In order to advance the field of NI-FECG signal processing, the development of standardised public databases and benchmarking of a number of published and novel algorithms was necessary. Databases were created depending on the application: FHR estimation with or without maternal chest lead reference or directed toward FECG morphology analysis. Moreover, a FECG simulator was developed in order to account for pathological cases or rare events which are often under-represented (or completely missing) in the existing databases. This simulator also serves as a tool for studying NI-FECG signal processing algorithms aimed at morphological analysis (which require underlying ground truth annotations). An accurate technique for the automatic estimation of the signal quality level was also developed, optimised and thoroughly tested on pathological cases. Such a technique is mandatory for any clinical applications of FECG analysis as an external confidence index of both the input signals and the analysis outputs. Finally, a Bayesian filtering approach was implemented in order to address the NI-FECG morphology analysis problem. It was shown, for the first time, that the NI-FECG can allow accurate estimation of the fetal QT interval, which opens the way for new clinical studies on the development of the fetus during the pregnancy.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

The aim of this thesis was to analyse possible effects of prenatal arsenic exposure on foetal and infant health. The setting is Bangladesh, where two cohorts were studied, both part of a health and demographic surveillance system in Matlab. A historical cohort 1991-2000 included 29,134 pregnant women with information on drinking water sources and arsenic testing of tube well water. A prospective cohort study included pregnant women 2002 - 2003 where urinary arsenic concentrations were assessed twice during pregnancy; 2,924 women and their pregnancy outcomes were evaluated for foetal loss, perinatal and infant mortality; 1,578 mother-infant pairs were analysed for size at birth; and 1,552 were analysed for morbidity during infancy. Women exposed to arsenic levels ≥ 50 µg/L in water had an increased risk of foetal loss and infant death in comparison with women exposed to arsenic levels < 50 µg/L. These findings were confirmed in the prospective cohort study. Women with urine arsenic concentrations at the 5th quintile had 62% increased risk of spontaneous abortion (OR 1.62, 95% CI 1.04 - 2.55) in comparison with women who had arsenic concentrations at the 1st quintile level. Increased risks of perinatal morality (RR 3.01, 95% CI 1.07 - 8.45) and infant mortality (RR 5.01; 95% CI: 1.41 - 17.84) were also observed at the 5th quintile of exposure. Significant negative dose-effect associations were found between arsenic exposure and birth weight, head and chest circumferences at a relatively low level of exposure (<100 µg/L in urine). In this range of exposure birth weight decreased by 1.68 g (SE 0.62) for each 1 µg/L increase of arsenic in urine. In comparison with exposure at the 1st quintile level the risk of lower respiratory tract infection was significantly increased (RR 1.68, 95% CI 1.35-2.07) for women who had urinary arsenic concentrations at the 5th quintile level. The risk was also increased for diarrhoeal diseases. The study findings highlight the negative effects of arsenic exposures on pregnancy outcomes and infant health. Mitigation programs need to be strengthened and women of reproductive ages should be prioritized in arsenic affected regions worldwide.

The overall aim of this thesis is to evaluate the risk for increased morbidity and mortality due to long-term arsenic exposure via drinking water by use of epidemiological and spatial approaches in studies performed in Matlab, Bangladesh. A total of 166,934 individuals aged 4 years and above were screened for skin lesions in 2002-2003. Another sample of 115,903 adults aged 15 years or more and a third sample of 26,972 pregnancies in 1991-2000 were considered in a historical cohort and an ecological study, respectively, where risk of adult mortality and spatial clusters of foetal loss and infant death were analysed in relation to arsenic exposure. More than 70% of the tube-wells in the study area exceeded the threshold for arsenic contamination according to the WHO guideline (10 µg/L). The prevalence of arsenic-induced skin lesions was 3/1000 and men had significantly higher prevalence of skin lesions (SMR 158, 95% CI: 133-188) compared to women. There was an increased risk for death in adulthood due to all non-accidental causes (hazards ratio = 1.16, [95% CI 1.06-1.26]) even at a low level of arsenic contamination (10-49 µg/L). Slightly lower risks were observed for death in cancers (1.44 [1.06-1.95]) and infectious diseases (1.30 [1.13-1.49]) at 50-149 µg/L, but for cardiovascular diseases, it was evident (1.23 [1.01-1.51]) from the level 150-299 µg/L. A dose-response relationship was observed for each of these causes. We identified high and low risk clusters of foetal loss and infant death that coincided with identified high and low clusters of arsenic exposure. Water arsenic concentration of the reported main water source was significantly correlated with arsenic concentration in urine, which reflects current arsenic intake from all sources (R2=0.41, ρ< 0.0001), and the influence of neighbouring water sources was minimal. The study findings underlines that the ongoing arsenic exposure has resulted in a series of severe public health consequences in Bangladesh that call for reinforcement in the mitigation efforts. Knowledge about the spatial distribution of exposure and health effects may be of value in that process.

No description available.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Improved perinatal care during the last few years has led to higher survival rates for preterm infants. However, with higher survival rates, the number of children demonstrating long-term health disorders that result in a poorer quality of life is increasing. The most common complications in those preterm children include motion disorders, vision and hearing impairment, mental disorders, and chronic lung disease. Intrauterine infection may cause foetal infection and inflammation thus inducing the inflammatory response in foetus, defined by foetal inflammatory response syndrome (FIRS). FIRS may cause a heavy damage in foetus and newborns as well as later disorders in the infant organism, such as cerebral palsy and chronic lung disease. Speaking about researches proving relation of the perinatal inflammatory response and psychomotor development in a preterm newborn, these are few. The foetal inflammatory response syndrome is a problem that has not been examined yet in Lithuania. Researches of cytokines in umbilical cord blood to make prognoses on the health and psychomotor development in a premature infant has not been performed either. Hopefully, the study results will allow a more detail explanation of the reasons for preterm delivery, better understanding of health disorders in premature infants and prognosis of the process of a child development. The aim of the study was to evaluate the importance of FIRS for the early and later adaptation of premature infants and for... [to full text] / Dėl pagerėjusios perinatalinės priežiūros per pastaruosius metus neišnešiotų naujagimių išgyvenamumas labai pagerėjo. Tačiau, kai neišnešiotų naujagimių išgyvena vis daugiau, daugėja ir vaikų, kuriems augant, išryškėja ilgalaikiai sveikatos sutrikimai, pabloginantys jų gyvenimo kokybę. Nurodoma, kad dažniausia neišnešioto naujagimio gimimo priežastis yra intrauterinė infekcija, kuri progresuodama gali inicijuoti vaisiaus uždegiminio atsako sindromą, kurio metu vaisiuje suintensyvėja uždegiminių citokinų IL-1, IL-6, IL-8, TNF-α, augimo veiksnių gamyba. Šio sindromo pasekmė - sunkūs vaisiaus ir naujagimio pažeidimai bei vėlesni liekamieji kūdikio sveikatos sutrikimai, tokie kaip cerebrinis paralyžius ir lėtinė plaučių liga. Tyrimų, kurie rodytų perinatalinio uždegimo ir neišnešioto naujagimio psichomotorinės raidos sąsajas nėra daug. Ryšys tarp vaisiaus uždegimo ir neišnešiotų naujagimių retinopatijos atrastas neseniai, tad tyrimų šia kryptimi atlikta taip pat nedaug. Ryšys tarp perinatalinio uždegimo ir grėsmingų naujagimystės komplikacijų leidžia daryti prielaidą, kad neišnešioto naujagimio ankstyvas sveikatos vertinimas ir gyvenimo kokybės prognozė yra labai svarbūs, norint kuo anksčiau pradėti tikslinį gydymą bei ankstyvą vaiko raidos korekciją. Šio darbo tikslas buvo įvertinti vaisiaus uždegiminio atsako sindromo įtaką neišnešioto naujagimio sveikatai ir psichomotorinei raidai iki 1 metų koreguoto amžiaus. Tyrimo objektą sudarė virkštelės kraujo citokinų IL-6, bTNF-α... [toliau žr. visą tekstą]

Dėl pagerėjusios perinatalinės priežiūros per pastaruosius metus neišnešiotų naujagimių išgyvenamumas labai pagerėjo. Tačiau, kai neišnešiotų naujagimių išgyvena vis daugiau, daugėja ir vaikų, kuriems augant, išryškėja ilgalaikiai sveikatos sutrikimai, pabloginantys jų gyvenimo kokybę. Nurodoma, kad dažniausia neišnešioto naujagimio gimimo priežastis yra intrauterinė infekcija, kuri progresuodama gali inicijuoti vaisiaus uždegiminio atsako sindromą, kurio metu vaisiuje suintensyvėja uždegiminių citokinų IL-1, IL-6, IL-8, TNF-α, augimo veiksnių gamyba. Šio sindromo pasekmė - sunkūs vaisiaus ir naujagimio pažeidimai bei vėlesni liekamieji kūdikio sveikatos sutrikimai, tokie kaip cerebrinis paralyžius ir lėtinė plaučių liga. Tyrimų, kurie rodytų perinatalinio uždegimo ir neišnešioto naujagimio psichomotorinės raidos sąsajas nėra daug. Ryšys tarp vaisiaus uždegimo ir neišnešiotų naujagimių retinopatijos atrastas neseniai, tad tyrimų šia kryptimi atlikta taip pat nedaug. Ryšys tarp perinatalinio uždegimo ir grėsmingų naujagimystės komplikacijų leidžia daryti prielaidą, kad neišnešioto naujagimio ankstyvas sveikatos vertinimas ir gyvenimo kokybės prognozė yra labai svarbūs, norint kuo anksčiau pradėti tikslinį gydymą bei ankstyvą vaiko raidos korekciją. Šio darbo tikslas buvo įvertinti vaisiaus uždegiminio atsako sindromo įtaką neišnešioto naujagimio sveikatai ir psichomotorinei raidai iki 1 metų koreguoto amžiaus. Tyrimo objektą sudarė virkštelės kraujo citokinų IL-6, bTNF-α... [toliau žr. visą tekstą] / Improved perinatal care during the last few years has led to higher survival rates for preterm infants. However, with higher survival rates, the number of children demonstrating long-term health disorders that result in a poorer quality of life is increasing. The most common complications in those preterm children include motion disorders, vision and hearing impairment, mental disorders, and chronic lung disease. Intrauterine infection may cause foetal infection and inflammation thus inducing the inflammatory response in foetus, defined by foetal inflammatory response syndrome (FIRS). FIRS may cause a heavy damage in foetus and newborns as well as later disorders in the infant organism, such as cerebral palsy and chronic lung disease. Speaking about researches proving relation of the perinatal inflammatory response and psychomotor development in a preterm newborn, these are few. The foetal inflammatory response syndrome is a problem that has not been examined yet in Lithuania. Researches of cytokines in umbilical cord blood to make prognoses on the health and psychomotor development in a premature infant has not been performed either. Hopefully, the study results will allow a more detail explanation of the reasons for preterm delivery, better understanding of health disorders in premature infants and prognosis of the process of a child development. The aim of the study was to evaluate the importance of FIRS for the early and later adaptation of premature infants and for... [to full text]

The upward trend in the prevalence of childhood mental disorders observed in the UK over the previous two decades, together with UK’s poor performance in recent international comparisons of child well-being, has brought childhood social and emotional well-being (SEW) to the forefront of policy. Key to tackling this issue is to understand what causes SEW in childhood, what interventions are successful in improving it, and what are its late-life consequences. This thesis furthers the literature in each of these areas. Firstly, we examine whether foetal (or in-utero) exposure to influenza hampers the development of childhood SEW. To do so, we examine the use of an instrumental variables approach, whereby the severity of the 1957 Asian Flu epidemic in the local authority of birth is used as an instrument for whether mothers self-report contracting influenza during pregnancy. We establish that exposure has little effect on childhood SEW, but that it results in a 60% increase in the risk of being stillborn, suggesting an increasing focus on influenza vaccination during pregnancy is needed. Secondly, we investigate the long-term effectiveness of school-based interventions to improve SEW. In order to overcome the absence of long follow-up in trial datasets, we develop a new modelling approach which involves the matching of trial participants to individuals in birth cohort datasets. An application of this method found that a Promoting Alternative Thinking Strategies (PATHS) intervention implemented in Greater Manchester schools led to a statistically significant improvement in childhood SEW, and had a positive, although statistically insignificant, effect on health across the life-course. Finally, we address the paucity of studies examining the effects of childhood SEW on late-life health and labour market outcomes. To do so, we develop a method for generating predictions of the effects of childhood characteristics beyond the currently available follow-up periods in birth cohort datasets, adapting an existing mediation analysis framework. Applying this method, we establish that a one-standard deviation improvement in childhood SEW leads to an increase of up to 0.18 accumulated quality-adjusted-life-years in late-life, and an increase in pre-tax labour income in late-life of up to £23,850. Both of these effects are primarily driven by large positive effects of childhood SEW on educational attainment, employment, income and health in mid-life. Childhood SEW is a predictor of important outcomes throughout the lifecourse. More research is needed to identify its causes and interventions to successfully improve it.