Thesis (M.P.H.)--University of Michigan, 1947.

Thesis (M.P.H.)--University of Michigan, 1947.

Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1993. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (p. 311-338).

Thesis (M.S.)--University of Wisconsin-Madison, 1993. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 42-47).

Philosophiae Doctor - PhD / Pregnancy-related poor maternal health and maternal death remain major problems in most Nigerian states including Cross River State. The acute impact of these problems is borne more heavily by rural communities where the majority of births take place at home unassisted or assisted by unskilled persons. These problems are due to a mixture of problem recognition and decision-making during obstetric emergencies leading to delayed actions. Every pregnancy faces risk, and prenatal screening cannot detect which pregnancy will develop complications. If the goal of reducing maternal morbidity/mortality is to be achieved, increasing the number of women receiving care from a skilled provider (doctor/nurse/midwife) during pregnancy, delivery, and post-delivery and prompt adequate care for obstetric complications has been identified as the single most important intervention. One of the strategies identified in many countries is engaging and working with individuals, families, and communities as partners to improve the quality of maternal healthcare. This strategy is thought to remove the barriers that dissuade women from using the services that are available, empowering the community members to increase their influence and control of maternal health, promote ownership and sustenance, as well as increase access to skilled care. The aim of the study: The overall aim of this PhD study was to develop a model of community engagement to facilitate the prevention of maternal health complications in the rural areas of Cross River State, Nigeria. To develop this model, the study specifically sought to: 1. Understand the current situation in Cross River State by exploring the knowledge gap of women of child-bearing age (pregnant and new mothers) regarding obstetric danger signs, birth preparedness and complication readiness, delivery practices of women, the action of family/community members, and the role of community-based maternal health initiatives, if any, in emergencies, as well as explore participants’ opinions on actions to be taken by the community to promote the utilisation of orthodox healthcare facilities by rural women of Cross River State (Phase 1). 2. Engage community members through a participatory approach (Photovoice) to highlight problems regarding pregnancy and birth practices, identify possible solutions, and make recommendations on communities’ roles in the prevention of maternal health complications (Phase 2). The older women of the study communities were also engaged to verify and validate the findings from phases 1 & 2 analyses. 3. Develop a model of community engagement to improve maternal health literacy by increasing knowledge on early detection of obstetric complications, birth preparedness, complication readiness, and improved access to skilled birth attendance (Phase 3). Methods: The study was conducted using a qualitative descriptive research approach that combined qualitative semi-structured interviews and focus group discussions within the Photovoice participatory approach. Purposive sampling was employed to select 20 participants, 10 each from the Idundu (Community A) and Anyanganse (Community B) rural communities of Akpabuyo Local Government Area of Cross River State, Nigeria. The participants comprised pregnant women and new mothers (babies aged 12 months and younger) who met the eligibility criteria. Data collection was by means of semi-structured interviews (Phase1), focused group discussions and Photovoice (Phase 2). Trustworthiness of the data was ensured by means of applying Guba’s model of credibility, transferability, and authenticity. The ethical principles of respect for human dignity, beneficence, confidentiality, and justice were applied throughout the study. The Citizenship Healthcare and Socio-Ecological Logic models were used to direct the study. Permission was obtained from participants for all the phases of the study while approval for the study was obtained from the Senate Higher Degrees Committee of the University of the Western Cape and the Cross River State Ministry of Health Ethical Committee. Data was analysed using Tesch’s method of content analysis. Based on the findings of Phases 1 & 2 of the study, themes emerged that were then validated by the older women in the study communities. The model was then developed by means of the four steps of the theory generation process. Step one was concept development that consisted of the identification, definition, validation, classification, and verification of the main and related concepts. Step two was model development consisting of the sub-steps, namely model guidelines and definitions. The communities’ stakeholders were engaged at this phase to verify and validate the concepts, as well as contribute to the drafting of the model guidelines and the definitions. Step three was a model description whereby the structure, definition, relation statements, and the process of the model were described. A visual application of the model that depicts the main concepts, the process, and the context was shown. Step four dealt with the development of guidelines for the operation of the model. A critical reflection of the model was done using Chinn and Kramer’s five criteria for model evaluation. Results: The study revealed that Idundu and Anyanganse’s rural women have limited knowledge of obstetric danger signs and very few of them acknowledged the importance of hospital delivery. They also exhibited poor understanding of what birth preparedness and complication readiness entailed. There was a high preference for traditional birth attendant care during pregnancy and delivery with their reasons being belief and trust in traditional birth attendants, a long standing tradition to deliver with them, assumptions that orthodox healthcare is expensive, poor attitude of healthcare providers towards women, unavailability of 24-hour services in healthcare facilities, fear of hospital procedures and operations, communal living in traditional birth attendant’s homes, spirituality in traditional birth attendant services, and the consideration of proximity to service points. These factors exacerbated the delays in seeking care and in referrals for skilled care in phases of emergency. The study also revealed that in the study communities, heavy household chores carried out by pregnant women is culturally accepted and seen as exercise to ease labour, there is lack of proper information regarding maternal and child health issues, men are sole decision-makers, they are ignorant of availability of free treatment in health centres, there is an ignorance regarding care of the new-born, and a lack of community structures to support women’s health. Based on the above findings, the women made the following suggestions towards finding a solution: improving maternal health literacy, increasing spirituality in service delivery, involving of husbands in antenatal care for proper information on maternal health issues, accessing community support through the use of community structures (town announcers, women groups, churches, etc.) with the purpose of emphasising facility delivery, constitution of influential groups to monitor the activities of pregnant women to ensure utilisation of skilled attendants, access to healthcare through free services and availability of providers, trust of health services, and traditional birth attendant training/traditional birth attendant facility collaboration. A total of eight concepts were identified from the concluding statements of steps 1 & 2, and used to develop the Maternal Health-Community Engagement Model (MH-CEM). These were: maternal health literacy, spirituality in healthcare, integrated traditional birth attendants’ role (value, training, and traditional birth attendants/hospital collaboration), trust in health services (by addressing previous experiences, attitude, and fear), improving access to healthcare, culturally acceptable care, husbands’ involvement in women’s health issues, and community support. These concepts formed the core components for the Maternal Health-Community Engagement Model which was developed as the main recommendation to address the core concepts. Central to this Model was the Community Engagement Group (CEG) which was established during the process of engaging the community stakeholders in validating the concepts and drawing up of the guidelines for the Model development. Conclusions and Recommendations: It is believed that the activities of the Community Engagement Group may bring about improved maternal health literacy, a process for working with traditional birth attendants through training and re-orienting them to be promoters of facility delivery when appropriate, and a model for involving husbands, and indeed the entire community, in maternal health issues. Limitations were identified and recommendations for nursing practice, education, and research concluded the study.

Stress is associated with a range of unhealthy eating habits. However, no previous studies have used experimental design to take an intergenerational perspective in the examination of how stress may influence parental feeding behavior, nor have they examined potential protective factors. The current study tests the effects of stress on maternal feeding behaviors and explores the potential protective role of maternal executive functioning (EF). We manipulated maternal stress with the Trier Social Stress Task (TSST) in a community sample mothers (N = 61, Mage = 33.45 years). We measured maternal EF with a series of computerized tasks. Maternal feeding behavior was observationally coded using standardized procedures. Results indicate a main effect of stress on controlling feeding styles. Furthermore, this effect of stress on controlling feeding behaviors is ameliorated among mothers with higher levels of EF. Results suggest potential factors to be considered in the treatment and prevention of diet-related illnesses.

O presente estudo avaliou (1) a memória espacial de ratas Wistar expostas a diferentes formas de experiência maternal [primiparidade (PRIM), sensibilização maternal pela exposição a filhotes adotivos (SENS) e primiparidade com privação de contato com os filhotes por 6 horas diárias (PRIV), em comparação com a nuliparidade (NUL)] em tarefas espaciais de memórias de referência e operacional no labirinto aquático de Morris. Os resultados revelaram ausência de diferenças quando os animais são avaliados após o desmame dos filhotes, enquanto que o período de contato com os mesmos resultou em comportamentos relacionados à ansiedade em ratas SENS. Adicionalmente, ratas PRIV exibiram melhor desempenho no teste de memória operacional, possivelmente devido a um efeito de enriquecimento ambiental pela exposição intermitente e contínua aos filhotes durante o período de lactação. Ainda, comparou- se (2) o desempenho de ratas PRIM e NUL das linhagens Wistar (W) e Sprague-Dawley (SDW) nas mesmas tarefas comportamentais no labirinto aquático. As ratas PRIM-SDW exibiram melhores desempenhos em relação às NUL-SDW e também em relação às PRIM-W no teste de memória de referência, enquanto que no teste de memória operacional, as ratas PRIM-SWD exibiram um desempenho superior em relação às PRIM-W. Adicionalmente, ratas SWD, independentemente da experiência maternal, exibiram estratégias de busca mais eficientes para cumprir a tarefa. Por fim, (3) avaliou-se o desempenho de ratas PRIM e NUL da linhagem SWD expostas a um ambiente enriquecido (AE) em comparação com ratas PRIM e NUL mantidas em gaiolas comuns de laboratório (STD) em tarefas de localização e reconhecimento de objetos, bem como as taxas de neurogênese hipocampal desses animais. Os resultados mostraram que as ratas PRIM-AE foram mais sensíveis à alteração na disposição espacial de um objeto familiar em comparação com as NUL-AE. Adicionalmente, as ratas NUL e STD exibiram mais comportamentos relacionados com ansiedade e estresse. Os resultados anatômicos mostraram que a experiência maternal e a exposição ao AE por 45 dias não geraram alterações na neurogênese hipocampal em ratas SWD. Estes resultados mostram que diferentes formas de experiência maternal exercem alterações distintas sobre o comportamento de ratas, de forma dependente do momento em que os animais são avaliados e da linhagem de ratas utilizadas. Adicionalmente, mostram que o AE gera alterações de memória espacial e produz efeitos ansiolíticos, particularmente em ratas PRIM. / Maternal experience in rats induces changes in brain and behavior. This study compared (1) spatial memory performances of primiparous (PRIM), pup-induced maternal behaviors (SENS), 6h/daily pup-deprived primiparous (DEP) and nuliparous (NUL) Wistar rats in the reference and working memory versions of the Morris water maze task. No differences were found when the animals were tested after pup\'s weaning/exposure. On the other hand, lactation/pup exposure period induced anxiety-like behaviors in SENS rats when tested during this period. In addition, DEP rats showed better performances in the working memory task, which may be an \"environmental enrichment effect\" due the intermittent exposure to the offspring during lactation. We also compared (2) spatial performances of PRIM and NUL rats from 2 different strains, e, Wistar (W) and Sprague-Dawley (SDW) in the same tasks described in the first experiment. The results showed better performances of PRIM-SDW groups relative to both NUL-SWD and PRIM-W in the reference memory task, while PRIM-SWD outperformed PRIM-W rats in the working memory task. Additionally, SWD rats, regardless their reproductive status, showed better performance in relation to their search strategies to find the hidden platform. Lastly, we (3) evaluated performances of PRIM and NUL Sprague-Dawley rats exposed to an enriched environment (EE) compared to NUL and PRIM rats housed in standard laboratory cages (STD) in an object placement and object recognition task. All groups were injected with BrdU in order to assess hippocampal cell proliferation, differentiation/migration, and cell survival in these animals. In the place object task, PRIM-AE rats exhibited better performances compared to NUL-AE rats. In addition, NUL and STD rats showed more anxiety and stress-related behaviors. The anatomical data showed no differences among all groups, indicating that enriched environment in a regimen of 45 days exposure or maternal experience had no influence on the hippocampal neurogenesis in Sprague-Dawley rats. Taken together, these data show that different forms of maternal experience in rats induce different effects on behavior, in a time and strain-dependent manner. Also, the results showed that exposure to an enriched environment induced spatial memory alterations and anxyolitic effects, mainly in PRIM rats.

Background: The number of women considered overweight (OW) and obese (OB) in Canada has steadily increased over the past thirty years. In addition, there has also been a rise in the amount of weight women gain during pregnancy. Many adverse pregnancy outcomes are associated with maternal overweight, obesity and/or excessive gestational weight gain (GWG), which have been widely studied and reported. In 2009, the Institute of Medicine (IOM) developed healthy GWG guidelines, based on trial and observational evidence, that provide BMI-related weight gain targets. This evidence has shown that weight gain within the guidelines results in better health outcomes for the mother and baby, during pregnancy, as well as postpartum. Objectives: (1) To address diet quality and patterns using data collected from the Maternal Obesity Management (MOM) Intervention Trial, and (2) Develop and validate a comprehensive web-based questionnaire that can be used in a future study to examine women’s knowledge of the IOM GWG guidelines, dietary recommendations, physical activity (PA) practices, as well as other lifestyle habits. Methods: (1) Exploratory pooled analysis of dietary data from Maternal Obesity Management (MOM) trial - To identify diet quality of women who exceeded (EX) versus did not exceed (NEX) the 2009 IOM pregnancy weight gain targets. Participants (n=50) completed 7-day food records at 3 points during pregnancy (baseline (V1: 12-20 weeks), between 26-28 weeks (V2) and between, 36-40 weeks (V3). Data were analyzed in ESHA Food Processor Program and SPSS (version 13) to see if there was any difference found in diet between EX and NEX women. (2) Development and validation of a comprehensive maternal health questionnaire aimed to establish gaps in women’s behaviours and perceptions of the IOM GWG guidelines - An expert panel was consulted in the development of questionnaire constructs and items to gain content validity of the questionnaire. After multiple phases of questionnaire development and revisions, a 14-day test re-test validation pilot study was conducted to establish test re-test validity. Results: (1) In the EX and NEX analysis, significant decreases were found in total energy intake, including fat and protein, across pregnancy in the NEX GWG group. Significant group-by-time interaction was also found for energy intake and protein. (2) Most constructs included in the electronic maternal (EMat) Health questionnaire all proved to have sufficient test re-test validity via correlation analysis. Conclusion: In order to address the knowledge gaps regarding excess weight and changes in dietary habits during pregnancy, it is beneficial to explore pregnant women's knowledge and behaviours regarding these issues and collect information on what women report as barriers and facilitators to gestational weight management. The conclusions drawn from both of these studies may inform future interventions, as well as indicate where further education strategies are needed.

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