A three-day food intake was recorded for 100 elderly patients who were subsequently interviewed to determine the relationship of income level, educational level completed, and sex of the person with the nutrient intakes of these patients. Three-day caloric and nutrient intakes were recorded and compared to the 1974 Recommended Daily Allowances (RDA). Mean intake for a three-day period of seven nutrients showed patient averages met at least 100 percent of the RDA for all nutrients except calcium. The females had a mean intake of ninety-six percent of the RDA for calcium. The patients with the lower incomes had dietary patterns that were less adequate than the patterns for those with higher incomes, and these patients ate more carbohydrate and less protein than did the patients with higher income. Nutrient intake was increased for the patients as their level of education increased. There were no significant differences in the nutrient intakes between sexes. The males had a higher nutrient intake and had a higher percentage of protein in their diets than did the females, however, the differences were slight. It was concluded from the above results that certain beneficial changes in the study menu could be made. Especially important areas such as calcium and fat intake may need modification at some time in the future as more light is shed on these areas. / Master of Science

Prenatal maternal inflammation (PNMI) is associated with neuropsychiatric outcomes in offspring, including depression and schizophrenia. Despite high levels of comorbidity between these disorders, and overlap in symptomatology, longitudinal examinations of PNMI and its relationship to symptom-level, behavioral outcomes in adulthood have yet to be examined. In both cross-sectional and longitudinal studies conducted within the postnatal period, inflammation is associated with emergence of “sickness behavior,” a cluster of symptoms including dysregulation of appetite, sleep, energy, and motivation. The present studies examined the relationship between maternal levels of specific inflammatory biomarkers during the first and second trimesters of pregnancy, and dimensions of depressive symptomatology, subtypes of anhedonia, and subjective sleep quality/duration, in offspring from the Child Health and Development Studies (CHDS) at mid-life (ages 57-61). The roles of fetal sex and timing of exposure also were explored. First trimester IL-6 was associated with poorer subjective sleep quality in offspring. In sex-stratified analyses, results seem to diverge by sex. Higher first trimester levels of inflammation in mothers pregnant with in male offspring were associated with greater consummatory pleasure and poorer subjective sleep quality. Alternatively, higher second trimester levels of inflammation in mothers pregnant with female offspring were associated with lower anticipatory pleasure, only prior to post hoc correction. These studies expand the developmental scope of examinations of the relationship between PNMI and symptom-level outcomes to mid-life and provide meaningful insight into areas for prevention and intervention across the lifespan. / Psychology

The purpose of this study was to find the difference, if any, between the weight gain patterns during pregnancy of women attending public health clinics in Northern Virginia who were enrolled in the NIC program and women not enrolled in the NIC program. Women on the NIC program during pregnancy were identified from NIC files. The control group was chosen from among women who were shown to be both nutritionally at risk and eligible for NIC based on income, but who were not receiving NIC benefits during pregnancy. The sample consisted of M8 subjects in each group who met certain other selection criteria. With the exception of income, there was no statistically significant difference when selected maternal and infant variables were compared. There was no significant difference (p>.O5) between total weight gain of the two groups, although the NIC mothers gained slightly more during pregnancy than the non-NIC mothers. A series of t-tests, performed between the means of the weekly weight gains, showed no significant difference in the weekly weight gain of the two samples at any week of pregnancy. Both samples had increased weekly weight gains near the end of pregnancy - the mean of the non-WIC group was higher and occurred slightly later than did that of the WIC group. These higher means near the end of pregnancy for the non-WIC group resulted in statistically significant differences in the two groups when comparing the last part of pregnancy and suggest that the non-WIC group is gaining a larger amount of weight very late in pregnancy. / Master of Science

Yes / There is a marked increase in the number of General Practitioner (GP) organisations across Europe providing out of hours (OOH) emergency primary care services whereby GPs and/or Nurse Practitioners (NPs), provide telephone consultations to patients (Giesen et al., 2007a, McKinstry et al., 2009, Derkx et al., 2009). This has been an important development to manage the rising demand for health care with increasingly scarce resources (Blank et al., 2012, Purc-Stephenson and Thrasher, 2010) and also reduces unnecessary attendance at accident and emergency departments or home visits by GPs (Bunn et al., 2005, Roberts et al., 2008)... In this study we describe the characteristics of telephone consultation calls made by pregnant women to an OOH service run by a GP co-operative and also to compare and contrast the differences between the way the calls were handled by GPs and Nurse Practitioners (NPs). The NPs were qualified and registered nurses experienced in primary care or emergency care settings and none were practicing.

No

The purpose of the study was to explore and describe factors influencing termination of pregnancy and describe measures that can be implemented to reduce the high rate of Termination of pregnancy (TOP). A qualitative, exploratory, descriptive and contextual research design was followed, in order to explore and describe factors influencing termination of pregnancy in Mafikeng North West Province. Purposive sampling was utilized to identify participants who met inclusion criteria for the study. The sample size was determined by data saturation, which was reached after twenty five in-depth individual interviews with women requesting TOP was done. In-depth individual interviews were utilized to gather data after written approval from the Human research Ethics committee as well as the Research Ethics Committee of the North West University (Mafikeng Campus), North West Provincial Department of Health, Operational manager of Montshioa Stadt Health Centre, and Hospital Manager of Mafikeng Provincial Hospital where data was collected, and consent was also obtained from women who requested TOP. The findings of this study indicated that factors influencing termination of pregnancy were economic factors, the need for self development, health factors and social factors. From the results, women requesting termination of Pregnancy think that effective use of contraceptives and correct use of condom can reduce the high rate of termination of pregnancy. Conclusion reached were that, non-use of contraceptives and incorrect use of condoms influenced TOP, as it was their common problem, hence the researcher suggested that health education on different methods of contraceptives should be given to teenage girls and other older women by health care providers. Recommendations in the field of nursing practice, nursing education, as well as nursing research were made. / Thesis (M.Cur) North-West University, Mafikeng Campus, 2012

Background Overweight and obesity are global health problems with several adverse health effects that threaten public health. In Sweden, almost four of ten pregnant women are overweight or obese, conditions that are associated with adverse pregnancy outcomes, including gestational diabetes mellitus (GDM), a metabolic disorder that complicates pregnancy. Globally, physical inactivity is the fourth leading risk factor for mortality. The recommendation for physical activity (i.e., ≥150 minutes/week) issued by the Professional Associations for Physical Activity and the Swedish National Board of Health and Welfare is in line with the recommendations by the WHO. Physical activity during pregnancy is generally safe and beneficial for both the pregnant woman and her fetus and can maintain or improve fitness and may further improve pregnancy outcomes. However, pregnant women tend to lower their physical activity when entering pregnancy. Midwives working in antenatal care (ANC) in Sweden play a prominent role in promoting a healthy lifestyle through counselling pregnant women on lifestyle, including physical activity during pregnancy. Individual counselling on physical activity encourages pregnant women to maintain their pre-pregnant leisure time physical activity throughout their pregnancy. Aims This thesis has three main aims. First, this thesis investigated guidelines for screening of GDM, risk factors, and pregnancy outcomes in relation to GDM. Second, it investigated physical activity during pregnancy and pregnancy outcomes. Third, it explored midwives’ and pregnant women’s experiences with counselling that addressed physical activity during pregnancy. Methods Study I and III are cross-sectional studies using data from the Maternal Health Care Register and the Salut Register. A total of 184,183 pregnant women were included in Study I (2011-2012) and 3,868 in Study III (2011-2012). Several statistical analyses were used: two-independent samples t-test, Pearson’s Chi-Square test, and univariate and multivariate logistic regression analyses. Study II and IV are qualitative studies applying qualitative content analysis. Study II included 41 midwives who were interviewed in eight focus group discussions (FGD). Study IV included 14 pregnant women who participated in individual in-depth interviews. Main findings There was no consensus in Sweden regarding clinical guidelines for screening regimes or 2-hour cut-off value for diagnosis of GDM from 2011 through 2012. Four screening regimes were applied in Sweden during this time period: A) universal screening with a 2-hour cut-off value of 10.0 mmol/L; B) selective screening with a 2-hour cut-off value of
8.9 mmol/L; C) selective screening with a 2-hour cut-off value of 10.0 mmol/L; and D) selective screening with
a 2-hour cut-off value of 12.2 mmol/L. The highest prevalence of GDM was found where selective screening was applied with a 2-hour cut-off value of 8.9 mmol/L. Unemployment, low educational level, and non-Nordic origin were all risk factors for GDM, and a BMI ≥30 kg/m2 almost four-doubled the risk for GDM compared to pregnant women with BMI <30 kg/m2. Increasing OGTT-values were associated with increasing risk of adverse pregnancy outcomes (Paper I). Midwives in antenatal care perceived counselling as both challenging and as an opportunity to promote a healthy lifestyle for pregnant women. As the theme “An on-going individual adjustment” revealed, the midwives tried to adjust their counselling to each pregnant woman’s individual needs. Counselling pregnant women on physical activity was seen as complex and ambiguous with a risk of being rejected by the women if the advice was delivered too straightforward. Instead, the midwives were “tiptoeing” around the sensitive topics (Paper II). Almost half of pregnant women reported that they achieved the recommended level of physical activity during pregnancy (i.e., ≥150 minutes/week). These pregnant women were characterized by lower BMI, higher educational level, and very good or good self-rated health (SRH) compared to the pregnant women who did not achieve the recommended level (Paper III). Pregnant women reported a desire for individual counselling on physical activity during pregnancy. The theme that emerged was “Longing for fulfilment of individual needs and expectations”, which reflected the wish that midwives’ counselling on physical activity should be based on pregnant women’s individual needs instead of merely providing general advice. Some participants reported receiving encouragement and support, but others believed they were provided insufficient counselling on physical activity and that the midwife had her own agenda focusing mostly on medical surveillance (Paper IV). Conclusions No consensus regarding clinical guidelines and diagnostic criterion for GDM existed in Sweden during 2011 to 2012. Obesity was a strong risk factor for development of GDM, and low socio-economic status and non-Nordic origin were also demonstrated as significant risk factors. Positively, almost half of the pregnant women reached the recommended level of physical activity during pregnancy. Participants fulfilling the recommendation were characterized by lower BMI, higher education, and very good or good self-rated health. Midwives strived to adjust and individualize their counselling on physical activity; however, some of the pregnant women could experience the counselling on physical activity being too general. Clearly, healthcare professionals should encourage fertile and pregnant women to be physically active, especially overweight and obese pregnant women who report low levels of physical activity, in order to improve overall health in this population. / Bakgrund Övervikt och fetma är ett stort hälsoproblem globalt med flera negativa hälsoeffekter som utgör ett hot mot folkhälsan. Nästan 40% av de gravida i Sverige har övervikt eller fetma vilket är associerat med flera negativa graviditetsutfall där graviditetsdiabetes (GDM) är en metabolisk sjukdom som komplicerar graviditeten. Fysisk inaktivitet är den fjärde ledande riskfaktorn för dödlighet i ett globalt perspektiv. Att vara fysiskt aktiv förbättrar välbefinnandet och livskvaliteten, främjar stabil vikt, insulinkänslighet och normalt blodtryck. Vidare sänker fysisk aktivitet risken för diabetes mellitus typ 2, fetma och hjärt-och kärlsjukdomar. Fysisk aktivitet under en okomplicerad graviditet är generellt att betrakta som utan risk och ökar välbefinnandet för både kvinnan och fostret. Fysisk aktivitet bidrar till att bibehålla eller förbättra fysisk kondition och kan förbättra graviditetsutfall. Trots dessa fördelar tenderar gravida att sänka sin fysiska aktivitet under graviditeten. De svenska rekommendationerna följer de internationella riktlinjerna som innebär ≥150 minuter/vecka av måttlig fysisk aktivitet alternativt 75 minuter/vecka av intensiv fysisk aktivitet eller en kombination av dessa. Svenska barnmorskor som arbetar inom mödrahälsovården i Sverige har en central, rådgivande roll gentemot gravida kvinnor när det gäller att verka för en hälsosam livsstil inkluderande fysisk aktivitet. Individuell rådgivning i fysisk aktivitet kan uppmuntra och stödja gravida kvinnor att fortsätta vara fysiskt aktiva under hela graviditeten. Syfte Att kartlägga riktlinjer för graviditetsdiabetes i Sverige samt riskfaktorer och graviditetsutfall i relation till GDM. Vidare att undersöka fysisk aktivitet under graviditeten samt associationer till graviditetsutfall och slutligen att utforska barnmorskor och gravida kvinnors upplevelser av rådgivning i fysisk aktivitet. Metod Studie I och III var tvärsnittsstudier där data från Mödrahälsovårds-registret och Salutregistret nyttjades. Totalt 184,183 gravida kvinnor inkluderades i Studie I och 3,868 inkluderades i Studie III (tidsperiod 2011-2012). Statistiska analyser som genomfördes var t-test, Pearson’s Chi-2-test och univariat samt multivariat logistisk regressionsanalys. Studie II och IV var kvalitativa studier där intervjuerna analyserades med manifest och latent kvalitativ innehållsanalys. Studie II inkluderade 41 barnmorskor i åtta fokusgrupper och 14 gravida omföderskor djupintervjuades individuellt i Studie IV. Resultat Under perioden 2011-2012 förelåg inte någon enighet gällande riktlinjer för screening och gränsvärde för diagnosen GDM i Sveriges 43 mödrahälsovårdsområden. Fyra olika screeningregimer identifierades; A) generell screening och 2-timmar gränsvärde på 10,0 mmol/L i plasmaglukos, B) selektiv screening och 2-timmar gränsvärde på 8,9 mmol/L i plasmaglukos, C) selektiv screening och 2-timmar gränsvärde på 10,0 mmol/L i plasmaglukos och D) selektiv screening och 2-timmar gränsvärde på 12,2 mmol/L i plasmaglukos. Den högsta prevalensen av GDM återfanns i det område som hade 8,9 mmol/L som gränsvärde och den lägsta där 12,2 mmol/L var gränsvärdet för GDM. Arbetslöshet, låg utbildningsnivå och ett utom-nordiskt ursprung utgjorde alla riskfaktorer för utveckling av GDM. Fetma, BMI ≥30 kg/m2, utgjorde den riskfaktor med högst risk för att utveckla GDM under graviditet med en nästan fyrdubblad risk jämfört med en kvinna med BMI <30kg/m2. Ökande 2-timmarsvärden av blodglukos var associerat med ökande negativa graviditetsutfall såsom kejsarsnitt och instrumentell vaginal förlossning (Artikel I). Barnmorskorna i mödrahälsovården upplevde rådgivningen i fysisk aktivitet som å ena sidan utmanande men å andra sidan som en möjlighet att verka för en hälsosam livsstil hos de gravida kvinnorna. Temat ”En ständigt pågående anpassning” visar barnmorskornas försök att anpassa sin rådgivning efter varje enskild gravid kvinnas behov och situation. Rådgivningen i fysisk aktivitet till gravida upplevdes som komplex och mångfacetterad. Det uttrycktes en oro för att bli avvisad av den gravida kvinnan om de givna råden förmedlades för uppriktigt. Detta ledde ibland till att barnmorskorna ”trippade på tå” och försiktigt närmade sig känsliga ämnen såsom övervikt och råd om fysisk aktivitet. Barnmorskorna försökte även finna individuella lösningar och anpassa råden utifrån varje enskild gravid kvinnas möjligheter. Detta var särskilt tydligt i mötet med kvinnor som immigrerat till Sverige, där barnmorskorna upplevde att en del av rådgivningen bestod i att slå hål på myter om fysisk aktivitet såsom något riskfyllt samt att informera om de positiva hälsoeffekterna med fysisk aktivitet under graviditeten (Artikel II). Nästan hälften av de gravida kvinnorna uppnådde Socialstyrelsens rekommendationer avseende fysisk aktivitet under graviditet och dessa kvinnor karakteriserades av lägre BMI, högre utbildningsnivå samt mycket bra/bra självskattad hälsa jämfört med de gravida som inte uppnådde rekommendationerna Artikel III). Temat som framkom i Artikel IV var ”Längtan efter tillfredsställelse av individuella behov och förväntningar” och speglar de gravidas önskan att erhålla en individuellt anpassad rådgivning i fysisk aktivitet av barnmorskorna istället för en generell rådgivning avsedd för alla. Några gravida hade erfarenheter av barnmorskan som stöttande och uppmuntrande i sin rådgivning i fysisk aktivitet. Andra kunde uppleva rådgivningen som otillräcklig, att barnmorskan exempelvis inte hade tillräckligt med kunskap i fysisk aktivitet samt att barnmorskan hade en egen agenda för deras möten som i huvudsak fokuserade på den medicinska övervakningen av graviditeten. Slutsats Under perioden 2011-2012 förelåg ingen consensus angående de nationella riktlinjerna och diagnostiska värdet för GDM i Sverige. Fetma var den riskfaktor med högst risk för utvecklande av GDM och låg socio-ekonomi, maternell ålder >35 år samt utom-nordiskt ursprung utgjorde även riskfaktorer för GDM. Positivt var att nästan hälften av de gravida uppnådde Socialstyrelsens rekommendationer för fysisk aktivitet under graviditeten och dessa karakteriserades av signifikant lägre BMI, högre utbildningsnivå samt mycket god/god självskattad hälsa. Trots att barnmorskorna beskrev hur de strävade efter att anpassa rådgivningen i fysisk aktivitet till varje enskild kvinna, kunde de gravida kvinnorna uppleva att rådgivningen var otillräcklig, för generell och främst fokuserad på den medicinska övervakningen. Det är av största vikt att hälso- och sjukvårdspersonal som möter fertila och gravida kvinnor verkar för en hälsosam livsstil, särskilt avseende kvinnor med en inaktiv livsstil och de som har övervikt eller fetma för att på så sätt förbättra hälsan hos denna del av befolkningen. För att uppnå detta krävs resurser gällande personal, tidsutrymme samt fortbildning inom hälsa och rådgivning för barnmorskor och annan hälso- och sjukvårdspersonal som möter dessa kvinnor. Slutligen, för att möjliggöra rådgivning som avser att stödja fysisk aktivitet för de kvinnor som immigrerat till Sverige behövs mer kunskap och utbildning i mötet med dessa kvinnor.

Thesis (MPhil)--Stellenbosch University 2005 / ENGLISH ABSTRACT: The aim of the current study was to undertake a phenomenological investigation on teenage motherhood and to learn how this experience forms part of the teenage mother's life. Using the snowball sampling method, five women aged between 26 and 35 years were selected to participate in the study. All the five women became mothers during their teenage years. Indepth interviews were conducted in Northern Sotho and Tshivenda depending on the language preference and fluency of the participant. The interviews were audio-taped, and later transcribed and translated. A phenomenological method of analysis was used to transform the original data into natural meaning units (NMUs) which were further interrogated so as to distil central sociological themes that were associated with the experience of teenage motherhood. Apart from the finding that the participants got pregnant when they were aged between 16 and 18, five sociological themes associated with teenage motherhood were identified. These are: • Lack of knowledge about sexual relationships contributes to teenage pregnancy and motherhood. • Early childbearing has a negative impact on the teenage mother's social relationships. • Teenage mothers tend to experience emotional problems after delivery of their babies. • Teenage motherhood has a long term disruptive effect on the teenage mother's educational and occupational opportunities. • Teenage motherhood leads to significant lifestyle changes for those who have been through the experience. In view of the above themes, sexual education both at school and at home, is suggested here as a more viable option to help minimise the risk of teenage motherhood in society. Whilst other options like abortion and the newly introduced child support grant are also available to the teenage mother, these are not considered favourable. / AFRIKAANSE OPSOMMING: Die doel van die huidige studie was om 'n fenomenologiese ondersoek oor tienermoederskap te doen en uit te vind hoe hierdie belewenis deel uitmaak van die tienermoeder se bestaan. Deur die sneeubaltoetsingsmetode is vyf vroue tussen die ouderdomme van 26 en 35 jaar gekies om deel te neem aan die studie. AI vyf vroue het tydens hulle tienerjare moeders geword. Diepteonderhoude is in Noord-Sotho en Venda gevoer, afhangende van die taalvoorkeur en -vlotheid van die deelnemer. Klankopnames is van die onderhoude gemaak wat later getranskribeer en vertaal is. 'n Fenomenologiese analisemetode is gebruik om die oorspronklike data na natuurlike betekeniseenhede (NMUs - natural meaning units) te herlei wat verder ondersoek is om sentrale sosiologiese temas geassosieer met die belewing van tienermoederskap te identifiseer. Behalwe vir die bevinding dat die deelnemers swanger geraak het toe hulle tussen die ouderdom van 16 en 18 jaar was, is vyf sosiologiese temas geassosieer met tienermoederskap geïdentifiseer. Hierdie temas is: • 'n Gebrek aan kennis oor seksuele verhoudings dra by tot die voorkoms van tienerswangerskappe en -moederskap. • Vroeë kinderbaring het 'n negatiewe impak op die tienermoeder se sosiale verhoudings. • Tienermoeders is geneig daartoe om emosionele probleme te ondervind na die geboortes van hulle babas. • Tienermoederskap het 'n langtermyn ontwrigtende effek op die tienermoeder se opvoedings- en werksgeleenthede. • Tienermoederskap lei tot betekenisvolle veranderinge in lewenstyl vir diegene wat die ondervinding deurgemaak het. Met inagneming van bogenoemde temas word hier voorgestel dat seksuele opvoeding beide op skool en by die huis 'n meer lewensvatbare opsie is om die risiko van tienermoederskap in die samelewing te verminder. Alhoewel ander opsies soos aborsies en die nuutingestelde toekennings van kinderonderhoud ook vir die tienermoeder beskikbaar is, word hierdie opsies nie as bevorderlik beskou nie.

Pregnancy in unmarried teenaged girls in America today is a growing concern to health care workers, educators, government officials and parents. Pregnancy during adolescence is not an issue because births to teenagers are increasing but because teenage pregnancy is no longer a societal option. This paper describes adolescent pregnancy from within the context of the subculture of adolescence and from the perspective of 16 pregnant, teenaged girls. The findings revealed a description of the life experiences of pregnant teenagers and introduced health-care issues that were not previously disclosed in other research studies of pregnant teens. The anthropological concepts of liminality, the double-bind, social labeling, and schizmogenesis served to guide the research. The concepts also helped to explain many behaviors and observations that were made of the informants throughout the research. An ethnographic approach using participant observation and ethnographic interviews was used to collect data from 16 pregnant, unmarried, teenaged girls in a large Southwestern, urban area. The informants ranged in age from 14 through 19 years and represented various backgrounds. Nine informants resided in a home for unwed, pregnant teenagers with the remainder residing in diverse locations. Data analyses occurred concurrently with data collection as part of an ongoing process. Data were ordered and transcribed within a framework designed to enhance thematic analysis. Transcribed interview and observational data were transferred onto the Ethnograph, a data-management software program. Data were coded using substantive and conceptual codes. Codes were linked according to patterns of association and frequency of occurrence which in turn led to the revealing of recurrent thematic patterns. In all, eight themes were revealed: (1) pregnancy is bad; (2) loneliness; (3) waiting it out; (4) dependency; (5) looking bad; (6) giving up baby; (7) losing what was; and (8) losing control. Thematic content also disclosed many inconsistencies and double-binds between the larger Western macroculture and adolescent subculture. Ethnographic themes and expressions of these themes provided new information for constructing health-related interventions with pregnant teens.

No description available.