Thesis--Copenhagen. / Summary in Danish. Includes bibliographical references (p. 175-191).

Thesis--Copenhagen. / Summary in Danish. Bibliography: p. 175-191.

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (leaves 137-143).

Even though it has been managed to concentrate deliveries of premature infants to the perinatal centres thanks to the ?in utero? (before-delivery) transports in recent years, there are still a certain number of newborn infants who are born outside the centres and, thus, it is required to transport them to the specialized departments. The transport of a newborn infant is characterized with special therapeutic procedures and it requires different equipment for providing intensive or resuscitation care and it is provided by transport service for newborn infants that is an integral part of the regional system of the differentiated care of newborn infants. The objective of the diploma thesis is: Objective 1: To characterize current provision of neonatal transport services. Objective 2: To map the role of nursing staff when providing neonatal transport service. Objective 3: To find out if nurses deliver care by nursing process when providing neonatal transport service. A hypothesis and research questions were defined on the basis of these results. Hypothesis 1: Presence of a nurse when providing neonatal transport service is important. Research question 1: What is the role of a nurse when providing neonatal transport service? Research question 2: How is the nursing process applied when providing neonatal transport service? The investigation proved the hypothesis and the research questions were answered. The goal of the thesis was met. The standard ?Nursing Care of Newborn Infants during Transport? is the result of the diploma thesis.

Thesis (M. A. (Nursing Science)) -- University of Limpopo, 2016. / Perinatal morbidity is a public health indicator of the level of equality in a country. Its prevention has major medical, social and economic costs. The aim of this study was to describe factors contributing to high perinatal morbidity rates in Mankweng-Polokwane Complex of the Capricorn district, Limpopo Province, South Africa. A quantitative, descriptive cross-sectional research method was used to describe factors contributing to high perinatal morbidity. The study population comprised 80 registered midwives. Simple random sampling was used to select the 66 respondents. Data were collected using a self-developed questionnaire. Questionnaires were completed and returned, and only one questionnaire was not returned, and two were spoiled as they were incomplete, then 63 questionnaires were analysed. Ethical clearance was obtained from Medunsa Research and Ethics Committee, Limpopo Province Department of Health Ethics Committee and Hospital management. The Statistical Package for Social Sciences (SPSS, version 22) was used for data analysis. Descriptive statistics were used to analyse and describe and summarise data whereby the findings were presented in the form of distribution tables and graphs. Inferential statistics were used based on probability and allowed judgement to be made about the variables. The study revealed that shortage of staff, absenteeism, resignation, bad staff-patient ratio and overcrowding of patients, long waiting periods for caesarean sections, long waiting period for babies operation, work overload of staff, lack of equipment and supplies, congenital anomalies, perinatal asphyxia, prematurity and neonatal sepsis were contributory factors to high perinatal morbidity rates. The study recommended that all staff should be able to resuscitate newborn babies, be able to use Partograph effectively, further research on factors contributing to high perinatal morbidity and education training on speciality qualifications. Key-words: Factors, High, Perinatal, Morbidity rates

Background: Statistical and machine learning techniques are now being incorporated into high-dimensional mixture research to overcome issues with traditional methods. Though some methods perform well on specific tasks, no method consistently outperforms all others in complex mixture analyses, largely because different methods were developed to answer different research questions. The research presented here concentrates on answering a single mixtures question: Are there exposure patterns within a mixture corresponding with sources or behaviors that give rise to exposure? Objective: This dissertation details work to design, adapt, and apply pattern recognition methods to environmental mixtures and introduces two methods adapted to specific challenges of environmental health data, (1) Principal Component Pursuit (PCP) and (2) Bayesian non-parametric non-negative matrix factorization (BN²MF). We build on this work to characterize the relationship between identified patterns of in utero endocrine disrupting chemical (EDC) exposure and child neurodevelopment. Methods: PCP---a dimensionality reduction technique in computer vision---decomposes the exposure mixture into a low-rank matrix of consistent patterns and a sparse matrix of unique or extreme exposure events. We incorporated two existing PCP extensions that suit environmental data, (1) a non-convex rank penalty, and (2) a formulation that removes the need for parameter tuning. We further adapted PCP to accommodate environmental mixtures by including (1) a non-negativity constraint, (2) a modified algorithm to allow for missing values, and (3) a separate penalty for measurements below the limit of detection (PCP-LOD). BN²MF decomposes the exposure mixture into three parts, (1) a matrix of chemical loadings on identified patterns, (2) a matrix of individual scores on identified patterns, and (3) and diagonal matrix of pattern weights. It places non-negative continuous priors on pattern loadings, weights, and individual scores and uses a non-parametric sparse prior on the pattern weights to estimate the optimal number. We extended BN²MF to explicitly account for uncertainty in identified patterns by estimating the full distribution of scores and loadings. To test both methods, we simulated data to represent environmental mixtures with various structures, altering the level of complexity in the patterns, the noise level, the number of patterns, the size of the mixture, and the sample size. We evaluated PCP-LOD's performance against principal component analysis (PCA), and we evaluated BN²MF's performance against PCA, factor analysis, and frequentist nonnegative matrix factorization (NMF). For all methods, we compared their solutions with true simulated values to measure performance. We further assessed BN²MF's coverage of true simulated scores. We applied PCP-LOD to an exposure mixture of 21 persistent organic pollutants (POPs) measured in 1,000 U.S. adults from the 2001--2002 National Health and Nutrition Examination Survey (NHANES). We applied BN²MF to an exposure mixture of 17 EDCs measured in 343 pregnant women in the Columbia Center for Children’s Environmental Health's Mothers and Newborns Cohort. Finally, we designed a two-stage Bayesian hierarchical model to estimate health effects of environmental exposure patterns while incorporating the uncertainty of pattern identification. In the first stage, we identified EDC exposure patterns using BN²MF. In the second stage, we included individual pattern scores and their distributions as exposures of interest in a hierarchical regression model, with child IQ as the outcome, adjusting for potential confounders. We present sex-specific results. Results: PCP-LOD recovered the true number of patterns through cross-validation for all simulations; based on an a priori specified criterion, PCA recovered the true number of patterns in 32% of simulations. PCP-LOD achieved lower relative predictive error than PCA for all simulated datasets with up to 50% of the data < LOD. When 75% of values were < LOD, PCP-LOD outperformed PCA only when noise was low. In the POP mixture, PCP-LOD identified a rank three underlying structure. One pattern represented comprehensive exposure to all POPs. The other two patterns grouped chemicals based on known properties such as structure and toxicity. PCP-LOD also separated 6% of values as extreme events. Most participants had no extreme exposures (44%) or only extremely low exposures (18%). BN²MF estimated the true number of patterns for 99% of simulated datasets. BN²MF's variational confidence intervals achieved 95% coverage across all levels of structural complexity with up to 40% added noise. BN²MF performed comparably with frequentist methods in terms of overall prediction and estimation of underlying loadings and scores. We identified two patterns of EDC exposure in pregnant women, corresponding with diet and personal care product use as potentially separate sources or behaviors leading to exposure. The diet pattern expressed exposure to phthalates and BPA. One standard deviation increase in this pattern was associated with a decrease of 3.5 IQ points (95% credible interval: -6.7, -0.3), on average, in female children but not in males. The personal care product pattern represented exposure to phenols, including parabens, and diethyl phthalate. We found no associations between this pattern and child cognition. Conclusion: PCP-LOD and BN^2MF address limitations of existing pattern recognition methods employed in this field such as user-specified pattern number, lack of interpretability of patterns in terms of human understanding, influence of outlying values, and lack of uncertainty quantification. Both methods identified patterns that grouped chemicals based on known sources (e.g., diet), behaviors (e.g., personal care product use), or properties (e.g., structure and toxicity). Phthalates and BPA found in food packaging and can linings formed a BN²MF-identified pattern of EDC exposure negatively associated with female child intelligence in the Mothers and Newborns cohort. Results may be used to inform interventions designed to target modifiable behavior or regulations to act on dietary exposure sources.

Reducing health disparities and achieving health equity in maternal and infant health is a critical concern for social work and public health stakeholders more generally. This three-paper dissertation is dedicated to exploring program or policy modifiable social determinants of maternal and infant health with a particular focus on vulnerable populations. Paper one explores the influence of household members on women’s sexual and reproductive behaviors. Paper two studies the impact of smoke-free regulations on birth outcomes in Latin America. Lastly, paper three looks at the effects of police use of force, and racialized police use of force, on maternal and infant health. The findings of these papers provide important information to inform programs and policies aimed at improving reproductive health and well-being in the U.S. and Latin America.

Thesis (MPH.) -- University of Limpopo, 2022 / Background: Stillbirth rates are a health problem and they cause distractions in the families. There are more than 5 million perinatal deaths occurring each year, ending preventable stillbirths and neonatal deaths continues to form a significant part of the international public health agenda beyond 2015. There are several risk factors which are associated with stillbirths and this could be classified as maternal, foetal and external risk factors. Therefore, the focus of the study was on the prevalence and determinants of stillbirths in Dilokong Hospital of the Limpopo Province. Methods: A retrospective descriptive study was conducted which followed a quantitative approach. This study used secondary data from patient clinical records from the maternity ward in Dilokong Hospital. Comparison between groups for continuous and categorical variables was performed using student t-test, and chisquare test, respectively. P-value less than 0.05 at 95% confidence level was regarded as significant. Findings: The prevalence of stillbirth amongst women who delivered at Dilokong hospital between period 2016 and 2019 was 13.5 % (CI: 0.12 – 15.2). The prevalence of stillbirth is stratified by year and it shows that highest prevalence was in 2018 at 42.5% followed by 2017, 2019 and 2016 at 23.2%, 19.7% and 14.6 respectively. The prevalence of stillbirth increased with increasing maternal age from 0.4% in the age group ≤14 years to 26.2% then decreased to 21.5% in the age group 30 – 34 years. The prevalence of macerated stillbirth between period 2016 and 2019 was 11.0%, for fresh stillbirth was 2.6 %. There was significant association of age, marital status of pregnant women, level of education, parity, gravidity, syphilis and HIV status. Older women at age 18 years and above were 1.4 times more likely to have stillbirth and 1.9 times more likely to have fresh stillbirth at p<0.05. Single women were 3.3 times more likely to have stillbirth and 3 times more likely to have macerated stillbirth as compared to married women. Fresh stillbirth was not significantly associated with marital status of pregnant women. Educational level was significantly associated with both stillbirth and macerated stillbirth as those women with no education or having primary educational level were 12.3 times more likely to have stillbirth and 14 times more likely to have macerated stillbirth as compared to women with tertiary educational level. vi Women who had pregnancies that have each resulted in the birth of an infant capable of survival (parity) for four or more times were 2.4 times more likely to have stillbirth and women who were in their fifth or more pregnancies (gravida) were 1.8 times more likely to have stillbirth and 3 times more likely to have fresh stillbirth. Lastly, women who had tested positive for syphilis were 4.1 times more likely to have stillbirth and 3.7 times more likely to have macerated stillbirth and women who were HIV positive were 3.1 times more likely to have stillbirth and 2.3 times more likely to have macerated stillbirth. CONCLUSION: The prevalence of stillbirth was very high in the current study and there is a need for studies on stillbirth and related factors in rural areas of Limpopo Province. This study showed that maternal age, low educational level, marital status of pregnant women, high parity, gravidity, syphilis and HIV status were statistically associated with stillbirth. The factors associated with stillbirth in the current study are preventable if quality focused antenatal care, intrapartum care is provided. Therefore, identification of pregnancy complications and facilitation of proper method of delivery is key to improve quality of care. Efforts to reduce unacceptably high stillbirth in the current study are needed. This study recommends that pregnant mothers need to be educated about the dangers in pregnancy and importance of antenatal visits.

A lesão nasal decorrente do uso da ventilação não invasiva (VNI) é um evento adverso cada vez mais comum nas unidades de terapia intensiva neonatais (UTIN) e apresenta consequências a curto e longo prazo. Esta lesão pode resultar em sequelas tanto de ordem estética quanto funcional, limitar o uso da VNI em RN que necessita desse suporte ventilatório, causar desconforto e septicemia; podendo aumentar, desta forma, o tempo de internamento na UTIN. Esta pesquisa tem por objetivo avaliar tecnológica e clinicamente os protetores nasais empregados na VNI de RN internados na UTIN. A metodologia consistiu primeiramente em levantar as possíveis causas da lesão nasal e avaliar os fatores de risco associados ao seu desenvolvimento. Em seguida, foi realizado um ensaio clínico randomizado para comparar os efeitos de três tipos de proteção nasal e das prongas novas e esterilizadas sobre a gravidade da lesão nasal. E por fim, foi realizada a caracterização térmica e estrutural dos protetores nasais após serem envelhecidas com temperatura e umidade no interior da incubadora neonatal. As principais causas da lesão foram relacionadas às características do material, a problemas no equipamento, a fatores assistenciais, neonatais e profissionais. Neste estudo, foram constatados como fatores de risco: a idade gestacional, a massa ao nascer, o tempo total de permanência na VNI, a reutilização deste suporte, o tempo da primeira utilização e da reutilização da VNI, bem como o tempo de internação na UTIN. Não foram observadas diferenças significativas na gravidade da lesão quando comparadas as três proteções estudadas, nem quando utilizadas prongas novas e esterilizadas. Quanto à análise dos materiais, foi constatado que a exposição à temperatura e à umidade alterou a percentagem de cristalinidade e a rugosidade das proteções nasais estudadas. / The nasal injury resulting from the use of non-invasive ventilation (NIV) is an adverse event increasingly common in the newborn intensive care unit (NICU) and shows the short and long term consequences. This lesion can result both aesthetic and functional sequelae, limit the use of NIV in newborns who need this ventilatory support, cause discomfort and septicemia, may thereby increase the length of stay in NICU. This research aims to evaluate technological and clinically nasal protectors used with NIV of newborns admitted to the NICU. The methodology consisted primarily in raising the possible causes of nasal injury and assess the risk factors associated with its development. Then, it was conducted a randomized clinical trial to compare the effects of three kind of nasal protector and new and sterilized prongs on the severity of nasal lesions. And finally, it was performed the thermal and structural characterization of nasal protection after being aged with temperature and humidity inside the neonatal incubator. The main causes of injury were related to characteristics of the material, equipment problems, assistive, neonatal and professional factors. In this study, it was found as risk factors: gestational age, weight at birth, the total time stay in the NIV, the reuse of this support, the time of first use and reuse of NIV and the length of stay in the NICU. They were not observed significant differences in lesion severity when compared the three protectors studied, nor when used new and sterilized prongs. The materials analysis indicated that exposure to temperature and humidity changed the percentage of crystallinity and the roughness of the nasal protections studied.

A lesão nasal decorrente do uso da ventilação não invasiva (VNI) é um evento adverso cada vez mais comum nas unidades de terapia intensiva neonatais (UTIN) e apresenta consequências a curto e longo prazo. Esta lesão pode resultar em sequelas tanto de ordem estética quanto funcional, limitar o uso da VNI em RN que necessita desse suporte ventilatório, causar desconforto e septicemia; podendo aumentar, desta forma, o tempo de internamento na UTIN. Esta pesquisa tem por objetivo avaliar tecnológica e clinicamente os protetores nasais empregados na VNI de RN internados na UTIN. A metodologia consistiu primeiramente em levantar as possíveis causas da lesão nasal e avaliar os fatores de risco associados ao seu desenvolvimento. Em seguida, foi realizado um ensaio clínico randomizado para comparar os efeitos de três tipos de proteção nasal e das prongas novas e esterilizadas sobre a gravidade da lesão nasal. E por fim, foi realizada a caracterização térmica e estrutural dos protetores nasais após serem envelhecidas com temperatura e umidade no interior da incubadora neonatal. As principais causas da lesão foram relacionadas às características do material, a problemas no equipamento, a fatores assistenciais, neonatais e profissionais. Neste estudo, foram constatados como fatores de risco: a idade gestacional, a massa ao nascer, o tempo total de permanência na VNI, a reutilização deste suporte, o tempo da primeira utilização e da reutilização da VNI, bem como o tempo de internação na UTIN. Não foram observadas diferenças significativas na gravidade da lesão quando comparadas as três proteções estudadas, nem quando utilizadas prongas novas e esterilizadas. Quanto à análise dos materiais, foi constatado que a exposição à temperatura e à umidade alterou a percentagem de cristalinidade e a rugosidade das proteções nasais estudadas. / The nasal injury resulting from the use of non-invasive ventilation (NIV) is an adverse event increasingly common in the newborn intensive care unit (NICU) and shows the short and long term consequences. This lesion can result both aesthetic and functional sequelae, limit the use of NIV in newborns who need this ventilatory support, cause discomfort and septicemia, may thereby increase the length of stay in NICU. This research aims to evaluate technological and clinically nasal protectors used with NIV of newborns admitted to the NICU. The methodology consisted primarily in raising the possible causes of nasal injury and assess the risk factors associated with its development. Then, it was conducted a randomized clinical trial to compare the effects of three kind of nasal protector and new and sterilized prongs on the severity of nasal lesions. And finally, it was performed the thermal and structural characterization of nasal protection after being aged with temperature and humidity inside the neonatal incubator. The main causes of injury were related to characteristics of the material, equipment problems, assistive, neonatal and professional factors. In this study, it was found as risk factors: gestational age, weight at birth, the total time stay in the NIV, the reuse of this support, the time of first use and reuse of NIV and the length of stay in the NICU. They were not observed significant differences in lesion severity when compared the three protectors studied, nor when used new and sterilized prongs. The materials analysis indicated that exposure to temperature and humidity changed the percentage of crystallinity and the roughness of the nasal protections studied.