京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20613号 / 医博第4262号 / 新制||医||1023(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 小川 修, 教授 篠原 隆司, 教授 近藤 玄 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

No description available.

No description available.

Thesis (MPH.) -- University of Limpopo, 2021 / Pregnancy and childbearing are most of the crucial milestones in women’s lives as they look forward to becoming mothers. During this time, they have positive expectations while pregnant, however, the physical, hormonal, neurotransmitters and psychosocial changes that occur can make pregnancy to be stressful and overwhelming. The disability associated with depression and its impact on maternal and child health has important implications for public health policy. While the prevalence of postnatal depression is high, there are no prevalence data and associated risk factors on antenatal depression in Helen Franz Hospital of Limpopo Province, South Africa. The purpose of this study was to determine the prevalence and factors associated with depression amongst pregnant women at Helene Franz Hospital. Methodology: A quantitative retrospective design was used in the study and a sample size of 336 was required which was calculated based on the 95% confidence interval, 5% sampling error and 38.5% prevalence of depression amongst pregnant women in KZN. A self-administered questionnaire with close-ended questions which was adopted from the Edinburgh postnatal depression scale was given to the participants to complete. The scoring of the questionnaire was that the maximum score was 30 and the persons who scored 10 or greater were considered depressed according to the Edinburg scale for assessing depression. Data were analysed using SPSS V.21.0 and a p-value of less than 0.05 was considered statistically significant. Results: The participants ranged from 18 to 47 years with the mean age of 27.8±6.9 years. The majority of the pregnant women were in the age groups 20-24 years and 25-29 years. The mean depression score for pregnant women was 7.87±5.2 and ranged from 0 to 23. The prevalence rate of depression symptoms was 31%. Maternal age was not significantly associated with depression and a significantly higher proportion of married pregnant women were depressed as compared to unmarried women at p=0.017. Pregnant women who smoke were significantly more likely to be depressed than those who do not smoke at p=0.002. Pregnant women without financial support from partnerwere significantly likely to be depressed than those who receive financial support at p-=0.002. A significantly greater proportion of pregnant women with partner violent were likely to be depressed than those with non-violent partner at p <0.001. Pregnant women in relationships with unemployed spouses were significantly likely to experience depression than the employed spouse at p=0.035. lastly, pregnant women in relationship with a spouse with lower educational level were significantly likely to be depressed than the other groups at p-.006. Conclusion: The prevalence of depression among pregnant women was high and the main risk factors involved in the onset of antenatal depression have highlighted a complex multifactorial aetiology. These are related to different sources of chronic diseases, psychosocial, environmental, obstetric and pregnancy- related risk factors have been highlighted. Correctly identifying women at risk of suffering from depression would provide an opportunity to target those women who would benefit from preventive and supportive interventions. Therefore, a psychosocial assessment, in the sense of a comprehensive and multidimensional evaluation of a woman's psychosocial circumstances should be common practice for all women during the antenatal period. Key concepts Antenatal care; Pregnancy; Childbearing; Depression; Psychosocial

The association between television exposure and infants’ toy play was examined. Specifically, differences in the amount of program content and coviewing in the home were expected to predict different patterns of play when children were away from television. This thesis also sought to extend Pempek’s (2007) findings indicating that the more parents coviewed certain baby videos (i.e., Sesame Beginnings) in the home with their children, the more likely these parents actively engaged with their children in the laboratory. Consequently, the current thesis examined whether or not this active engagement resulted in something meaningful for children’s play behaviors. Parents of infants who were either 12- to 15- months or 18- to 21- months were given a TV viewing diary to record their children’s TV exposure at home over a two-week period. In addition, parent-infant dyads were randomly assigned to view either Baby Einstein or Sesame Beginnings videos in the home. A control group was not assigned to watch any videos. All dyads visited the laboratory after the exposure period for a videotaped 30-min free-time session (no TV). Each observation was coded for the amount of time children spent in play, mean play episode length, and total number of play episodes as well as the level of parent engagement. Results indicated that the amount of television exposure in the home did not influence infants’ toy play even when program content and coviewing were considered. Moreover, the increase in active parental engagement found in Pempek’s study did not result in an increase in children’s play behaviors. These results suggest that television does not have a distal influence on children’s play behaviors, regardless of content, coviewing, and level of parent engagement.

Magister Artium - MA / Introduction A high burden of Human Immunodeficiency Virus (HIV) constitutes a key global public health concern. In South Africa, it is estimated that 260 000 children aged 0-14 years had HIV infection and only 63% of them were reported to have received HIV treatment in 2018. Without antiretroviral therapy (ART), HIV infection during infancy is associated with rapid disease progression where more than half of all infected children are expected to die before two years of age. Early infant diagnosis (EID) of HIV is therefore essential for accessing timely HIV treatment. However, preanalytical errors within the EID diagnostic cascade prevent optimal access to HIV polymerase chain reaction (PCR) results. The aim of this study was to describe the prevalence and contributing factors of preanalytical errors resulting in missed diagnostic opportunities for HIV among children below 18 months of age in Thabo Mofutsanyana (TM) district. Methodology The study was conducted using a descriptive cross-sectional study design and data was collected in two phases. Phase 1 involved obtaining the routine HIV PCR testing data set from the National Health Laboratory Services (NHLS) for all samples collected at TM public health facilities in 2018 and registered by NHLS. Phase 2 included a facility assessment checklist and semi structured questionnaire administered to 36 health care workers (HCWs) from 10 purposively selected health facilities. Data collected in phase 2 was analyzed to describe health facilities and HCW factors that might be contributing to the HIV PCR preanalytical errors. Results Phase 1. Of the 9318 samples included in the analysis, 49.6% were birth HIV PCRs whilst 42.1% and 8.3% were from 10 weeks and above 12 weeks age categories, respectively. A total of 745 (8%) samples were rejected because of the following preanalytical errors: insufficient specimen (84.3%), unsuitable sample (9.9%) and clerical error (5.8%).By age, the preanalytical errors were: birth (534), 10 weeks (170) and the above 12 weeks age category (41). Hospitals had the highest proportion of total preanalytical errors (58.1%). For PHCs the errors were: insufficient specimen (90%), unsuitable sample (5.5%) and clerical (4.8%).

The mechanical function of the uterine cervix is critical for a healthy pregnancy. During pregnancy, the cervix undergoes a significant remodeling from a mechanical barrier into a compliant structure to allow for a successful delivery. A too early or too late cervical softening will lead to spontaneous preterm births (sPTB) or dystocia. PTB is a leading cause of neonatal death, affecting 15 million newly born babies each year around the world. According to CDC, the rate of PTB increases in recent years. Dystocia increases the risk to both mother and newborn babies, leading to neonatal asphyxia, neonatal infection, uterine rupture, or other dangerous sequelae. Therefore, it is significant to have a better correlation of the mechanical properties change and the biological remodeling process of the cervix during pregnancy. This thesis will focus on (1) mechanical experiments of the human cervix, and (2) the development of a material constitutive model for cervix to characterize the complex microstructure-related mechanical property of the cervix. In this thesis, a spherical indentation test was designed and conducted on human cervical samples sliced perpendicular to the axial direction, to characterize the compressive mechanical behavior of the human cervix. A uniaxial tensile was designed and conducted on the strip samples cut along and perpendicular to the preferential fiber direction from the indentation samples, to characterize the tensile mechanical behavior of the cervix. Based on the detailed experimental investigation, a nonlinear time-dependent anisotropic microstructure-inspired constitutive model has been developed. The basic idea of the model is that the mechanical behavior of the human cervix can be decomposed into an equilibrium and a time-dependent part, and the tension and compression mechanical behaviors are caused by disparate mechanisms. Specifically, the collagen fibrous network plays a major role in the tensile mechanical response, while proteoglycans (PGs), glycosaminoglycans (PGs),, and liquid cause the compressive mechanical response. The tensile time-dependent mechanical behavior of the human cervix is mostly attributed to the interactions between the collagen fiber and other components, while the compressive time-dependent mechanical behavior is mainly attributed to the porous effect. The equilibrium and time-dependent mechanical responses have been well captured using the model, and the results reveal the connection between the ECM microstructure remodeling and mechanical properties change during pregnancy.

No description available.

USA Infant Court is a multisystem, trauma-focused approach designed to address the complex needs of infants, toddlers, and their parents involved in the child welfare system and to improve outcomes. Infant mental health values and principles as well as knowledge areas such as the impact of trauma on early brain development, attachment theory, and trauma -informed care are integrated into the practice of infant courts. The core components of evidenced informed infant and early childhood courts will be reviewed. Presenters will describe two pilot infant court projects and the expansion of infant courts statewide through legislation.