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A deductive, descriptive, quanitative study was undertaken at Nyangabgwe Hospital, Francistown, Botswana, situated in the north east of the country. Its focus was on the use of partogram by midwives. The population consisted of 395 obstetric records for the period of one month. A sample of 303 obstetrics records was drawn. Data were collected through auditing the bed letters of delivered mothers and interviews with and observation of midwives using the partogram in practice. The Statistical Package for Social Sciences (SPSS) program was used to analyse the data. The findings indicate that there are problems regarding, and factors that can have a negative influence on the use of the partogram by midwives. It is suggested that a supportive teaching programme for the midwives should be designed, that will support the system of supervision in the labour ward that already exists, in the use of the partogram throughout the labour process. / Health Studies / M.A. (Advanced Nursing Sciences)

<p>The high prevalence of diabetes mellitus among the Sudanese population is linked to obesity, poor glycaemic control and a high rate of complications. This study investigated 1/ Leptin hormone and its correlations with different biochemical characteristics in Sudanese diabetic subjects, 2/ The impact of glycaemic control on pregnancy outcome in pregnancies with diabetes, 3/ The glycaemic response to Sudanese traditional carbohydrate foods, 4/ The influence of glucose self-monitoring on the glycaemic control among this population, 5/ The health related quality of life in Sudanese subjects with diabetes-related lower limb amputation. </p><p>Leptin was significantly lower in diabetic subjects compared with controls of same BMI in both females (P =0.0001) and males (P =0.019). In diabetic subjects, serum leptin correlated positively with the homeostatic assessment (HOMA) of both beta-cell function (P =0.018) and insulin resistance (P =.038). In controls, leptin correlated only with insulin resistance. Pregnancy complications were higher among diabetic compared with control women (P<0.0001) and varied with the type of diabetes. Infants of diabetic mothers had a higher incidence of neonatal complications than those of non-diabetic women (P<0.0001). In six Sudanese traditional carbohydrate meals over all differences in incremental AUCs were significant for both plasma glucose (P = 0.0092) and insulin (P = 0.0001). Millet porridge and wheat pancakes displayed significantly lower post-prandial glucose and insulin responses, whereas maize porridge induced a higher post-prandial glucose and insulin response. In type 2 diabetic subjects SMBG or SMUG was not related to glycaemic control. In type 1 diabetic subjects, SMBG was significantly associated with better glycaemic control, as assessed by HbA1c (P=0.02) and blood glucose at clinic visits (P=<0.0001), similar associations were found for SMUG respectively. Neither glycaemic control nor glucose self-monitoring was associated with education level. Diabetic subjects with LLA had significantly poorer HRQL compared to a reference diabetic group (P=<0.0001). Duration of diabetes and amputation had negative impact on HRQL in subjects with LLA (P=<0.0001) respectively. Diabetic subjects with LLA had decreased sense of coherence and high presence of symptoms. Improving health services at the primary level is important to reduce the complications and burden of disease in the Sudanese population.</p>

The high prevalence of diabetes mellitus among the Sudanese population is linked to obesity, poor glycaemic control and a high rate of complications. This study investigated 1/ Leptin hormone and its correlations with different biochemical characteristics in Sudanese diabetic subjects, 2/ The impact of glycaemic control on pregnancy outcome in pregnancies with diabetes, 3/ The glycaemic response to Sudanese traditional carbohydrate foods, 4/ The influence of glucose self-monitoring on the glycaemic control among this population, 5/ The health related quality of life in Sudanese subjects with diabetes-related lower limb amputation. Leptin was significantly lower in diabetic subjects compared with controls of same BMI in both females (P =0.0001) and males (P =0.019). In diabetic subjects, serum leptin correlated positively with the homeostatic assessment (HOMA) of both beta-cell function (P =0.018) and insulin resistance (P =.038). In controls, leptin correlated only with insulin resistance. Pregnancy complications were higher among diabetic compared with control women (P&lt;0.0001) and varied with the type of diabetes. Infants of diabetic mothers had a higher incidence of neonatal complications than those of non-diabetic women (P&lt;0.0001). In six Sudanese traditional carbohydrate meals over all differences in incremental AUCs were significant for both plasma glucose (P = 0.0092) and insulin (P = 0.0001). Millet porridge and wheat pancakes displayed significantly lower post-prandial glucose and insulin responses, whereas maize porridge induced a higher post-prandial glucose and insulin response. In type 2 diabetic subjects SMBG or SMUG was not related to glycaemic control. In type 1 diabetic subjects, SMBG was significantly associated with better glycaemic control, as assessed by HbA1c (P=0.02) and blood glucose at clinic visits (P=&lt;0.0001), similar associations were found for SMUG respectively. Neither glycaemic control nor glucose self-monitoring was associated with education level. Diabetic subjects with LLA had significantly poorer HRQL compared to a reference diabetic group (P=&lt;0.0001). Duration of diabetes and amputation had negative impact on HRQL in subjects with LLA (P=&lt;0.0001) respectively. Diabetic subjects with LLA had decreased sense of coherence and high presence of symptoms. Improving health services at the primary level is important to reduce the complications and burden of disease in the Sudanese population.

Σκοπός της παρούσας διατριβής ήταν να μελετηθεί η επίδραση του μηχανικού-ακουστικού ερεθισμού στη βιοφυσική εικόνα του εμβρύου με μια προοπτική τυχαιοποιημένη μελέτη Το υλικό της μελέτης απετέλεσαν γυναίκες με μονήρεις κυήσεις, ηλικία κύησης 30 + 0 εβδομάδες και βιοφυσική εικόνα ≤ 8/10. Οι γυναίκες με τυχαίο τρόπο κατατάσσονταν σε μια από δύο ομάδες. Στην ομάδα Α εφαρμοζόταν ακουστικός ερεθισμός διάρκειας 3 δευτερολέπτων με ένα τεχνητό λάρυγγα. Αν η βιοφυσική εικόνα παρέμενε μη φυσιολογική για 30 λεπτά, ακολουθούσε η εφαρμογή ενός δεύτερου ερεθίσματος, ίδιου με το πρώτο και εκτίμηση της βιοφυσικής εικόνας για ακόμη 30 λεπτά. Στην ομάδα Β ο χρόνος παρατήρησης παρατάθηκε για 60 λεπτά (δύο διαστήματα των 30 λεπτών) , ώστε να συμφωνεί με το χρόνο εξέτασης των γυναικών της ομάδας Α. Οι κυήσεις αντιμετωπίστηκαν με βάση την τελική βαθμολογία της βιοφυσικής εικόνας. Όσες γυναίκες γέννησαν περισσότερο από 24 ώρες από την τελευταία εξέταση δεν περιελήφθησαν στη μελέτη. Τα κριτήρια αξιολόγησης ήταν ενδομήτριος θάνατος, καισαρική τομή για εμβρυϊκή δυσπραγία, βαθμολογία Apgar < 7 στα 5 λεπτά από τον τοκετό, κεχρωσμένο αμνιακό υγρό (από μηκώνιο) και εισαγωγή στη ΜΕΘ νεογνών. Η μηδενική υπόθεση ήταν ότι η εφαρμογή του ακουστικού ερεθισμού δεν μεταβάλλει τις στατιστικές παραμέτρους της δοκιμασίας. Συνολικά 2,833 γυναίκες εισήλθαν στη μελέτη και συγκεκριμένα 1,349 στην ομάδα Α και 1,484 στην ομάδα Β. Η εφαρμογή του ακουστικού ερεθισμού μείωσε σημαντικά τον αριθμό των θετικών δοκιμασιών στην ομάδα Α σε σχέση με την ομάδα Β (4.74% vs. 6.67%, p < 0.05) και αύξησε την επίπτωση των κριτηρίων αξιολόγησης στην υποομάδα των γυναικών με θετική τελική δοκιμασία (positive likelihood ratio: 24.1-CI 95%: 11.12-52.46 vs. 7.52-CI 95%: 4.93-11.46), χωρίς να τροποποιεί το περιγεννητικό αποτέλεσμα. Επιπλέον, η ειδικότητα, η θετική προγνωστική αξία και η ακρίβεια της μεθόδου βελτιώθηκαν σημαντικά στην ομάδα Α,όπως επίσης και η αρνητική προγνωστική αξία για τους ενδομήτριους θανάτους. Συμπερασματικά, η εφαρμογή του μηχανικού-ακουστικού ερεθισμού σε περιπτώσεις που υπάρχει υποψία για εμβρυϊκή δυσπραγία, βελτιώνει την αποτελεσματικότητα της μεθόδου (βιοφυσικής εικόνας), μειώνοντας τις ψευδώς θετικές δοκιμασίες και βελτιώνοντας την ακρίβεια της μεθόδου. Θα πρέπει δε να θεωρείται ως μέσο μιας πιο ενδελεχούς εμβρυϊκής εκτίμησης σε αυτές τις περιπτώσεις. / OBJECTIVES: To verify the effect of vibroacoustic stimulation on biophysical profile score, with a prospective randomised study. STUDY DESIGN: All women with singleton pregnancy, gestational age ≥ 30 weeks, intact membranes and biophysical profile score ≤ 8/10 entered the study, after giving written consent, and were randomised to two groups. In group A, a 3-second stimulus with an artificial larynx was applied; if biophysical profile remained abnormal for 30 minutes, a second stimulus was applied, and it was assessed again. In group B the observation time was extended for 60 minutes to match the time periods of group A. Pregnancies were managed by final test score and patients delivering more than 24 hours apart from last examination were disregarded from the study. Outcome criteria were intrauterine deaths, caesarean sections for fetal distress, Apgar score < 7 at 5 minutes postpartum, meconium-stained amniotic fluid and neonatal intensive care unit admissions. Our null hypothesis was that application of vibroacoustic stimulation does not alter test’s statistical parameters. RESULTS: 1,349 patients were randomised in group A, and 1,484 in group B (2,833 in total). When comparing group A to B, application of vibroacoustic stimulation significantly decreased the number of positive tests (4.74% vs. 6.67%, p < 0.05) and increased the prevalence of outcome criteria in this subgroup (positive likelihood ratio: 24.1-CI 95%: 11.12-52.46 vs. 7.52-CI 95%: 4.93-11.46), without altering perinatal outcome. Furthermore, specificity, positive predictive value and test accuracy were significantly improved, as well as negative predictive value for intrauterine death. CONCLUSION: Vibroacoustic stimulation improves the efficiency of biophysical profile score by decreasing false positive tests and improving test accuracy and should be considered as a means of a more thorough fetal evaluation when fetal compromise is suspected.

A deductive, descriptive, quanitative study was undertaken at Nyangabgwe Hospital, Francistown, Botswana, situated in the north east of the country. Its focus was on the use of partogram by midwives. The population consisted of 395 obstetric records for the period of one month. A sample of 303 obstetrics records was drawn. Data were collected through auditing the bed letters of delivered mothers and interviews with and observation of midwives using the partogram in practice. The Statistical Package for Social Sciences (SPSS) program was used to analyse the data. The findings indicate that there are problems regarding, and factors that can have a negative influence on the use of the partogram by midwives. It is suggested that a supportive teaching programme for the midwives should be designed, that will support the system of supervision in the labour ward that already exists, in the use of the partogram throughout the labour process. / Health Studies / M.A. (Advanced Nursing Sciences)

This study investigated the impact of a sensory-motor stimulation programme, namely the SEMOSTI Programme, on the gross motor proficiency of four-to-six-year-old children. A field experiment was conducted using a quasi-experimental comparison group pretest-posttest design as three teachers implemented the SEMOSTI Programme over a 30-week period. Data collection took place at two schools’ grade R classes in Gauteng province of South Africa. Due to a limited sample of 73 participants, the results are context-bound and specific to Afrikaans-speaking, white, grade R children and selected gross motor skills. Data was collected using subtests of the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2), a scale and measuring tape as well as several questionnaires. The variables, physical activity, body mass index (BMI), gender, age, and perinatal morbidity could possibly influence the results and were taken into account. Data was statistically analysed using the General Linear Model (GLM) procedure and Dunnett’s t-test analysis. Findings indicated that the SEMOSTI Programme had a significant impact on the dependent variable, gross motor proficiency. The SEMOSTI Programme positively impacted on all five motor skills tested (bilateral coordination, balance, running speed and agility, upper-limb coordination and strength), but only the impact on running speed and agility and strength were statistically significant. Findings from the questionnaires indicated that the teachers who presented the SEMOSTI Programme perceived it as user-friendly, well-structured and effective in choice of equipment and activities. They identified the timeframe for the evaluation of developmental milestones and the structure of the plan-of-action section as weaknesses. Findings suggest that the SEMOSTI Programme is promising in improving gross motor proficiency in four-to-six-year-old children. Through participation in the programme, the experimental group significantly improved total gross motor proficiency, running speed and agility, and strength. This study offers support for the future use of the SEMOSTI Programme as a stimulation programme in grade R after further development and validation. / Dissertation (MOccTher)--University of Pretoria, 2012. / Occupational Therapy / unrestricted

Objectifs : Évaluer l’incidence de la macrosomie fœtale en fonction des différentes définitions (poids de naissance >4000g, >4500g, ≥90ième percentile de Kramer) en vigueur et comparer la prévalence de la morbidité maternelle et périnatale associée à la macrosomie entre les populations Cris et les populations du Québec. Des courbes postnatales spécifiques aux Cris de l’Est de la Baie-James seront proposées. Devis : Comparaison de deux cohortes prospectives Cris et Québec. La cohorte des populations Cris de l’Est de la Baie-James, comporte 2546 femmes recrutées de 2000-2010, au cours de l’étude sur la macrosomie fœtale chez les Cris de l’Est de la Baie James. La cohorte du Québec est composée de 97475 femmes et provient de l’essai clinique randomisé multicentrique QUARISMA, 2008-2010, cette étude promulguant la réduction du taux d’accouchement par  césarienne. Méthodes : Les risques de macrosomie fœtale et de la morbidité maternelle et périnatale sont évalués par des modèles de régression logistique d’équations d'estimation généralisées (EEG) ajustés et comparés selon l’ethnicité, Cris et Québec. GEE. Le groupe de référence étant les femmes du Québec. Les courbes de croissance spécifiques aux Cris sont construites par régression quantile. Résultats : Plus du tiers, soit 36,76%, des Cris et 9,329% des nouveau-nés du Québec, ont un poids de naissance >4000g. Les résultats attestent montrent que 10,92% des Cris de l’Est de la Baie-James ont un poids de naissance de plus de 4500g, ce taux est de 1,23% au Québec. La définition de la macrosomie fœtale, par un poids néonatal ≥90ième percentile de Kramer, identifie 40,02% des bébés Cris, pour 8,83% des nourrissons du  Québec, comme macrosomes. Les Cris sont plus à risque de macrosomie fœtale, comparativement à la population générale du Québec, ces associations sont statistiquement significatives : RC=5,22; 95% IC (4,66-6,05,98), pour un poids de naissance >4000g, RC=8,10; 95% IC (6,22-10,77), pour un poids de naissance >4500g et RC=6,22; 95% IC (5,77-6,72), pour un poids de naissance ≥90ième percentile de Kramer. Le risque de la morbidité périnatale majeure, de la macrosomie fœtale, est généralement moins important pour les Cris que pour la population générale du Québec : 0,76; 95% IC 0,62-0,94. La macrosomie fœtale devrait être décrite par un poids de naissance≥95ième percentile de Kramer, pour les Cris, mais préférablement au 90ième percentile des courbes postnatales spécifiques aux Cris de l’Est de la Baie-James. Les poids de naissance diagnostique spécifiques aux Cris de l’Est de la Baie-James, au 90ième percentile de la 40ième semaine d’aménorrhée, sont de 4 417g pour les filles et 4 488g pour les garçons. Conclusions : Les courbes de Kramer diagnostiquent systématiquement plus de macrosomes chez les Cris que dans la population du Québec. Par contre, le risque de morbidité périnatale majeure est inférieur pour ces communautés autochtones, aux différents seuils décrivant la macrosomie fœtale, ce qui suggère l’utilisation de courbes spécifiques aux Cris et permettrait de diminuer les interventions obstétricales non nécessaires chez les gros bébés Cris, donc non-macrosomes. / Objective: Assess the impact of fetal macrosomia based on definitions (birth weight> 4000 g,> 4500g, ≥90ième percentile Kramer) currently used in Quebec and compare the prevalence of maternal and perinatal morbidity associated with macrosomia between the Cree populations of Eastern James Bay and the general population of Quebec. Specific postnatal curves for the Cree will be constructed. Design: Comparison of two prospective cohort Cree and Quebec. Cohort of Cree populations of eastern James Bay, has recruited 2546 women from 2000 to 2010, during the study of fetal macrosomia in the Cree of eastern James Bay. Quebec cohort consisted of 97,475 women and comes from the multicenter randomized clinical trial QUARISMA 2008-2010, this study promulgates the reduction of caesarean delivery rate. Methods: The risk of fetal macrosomia, maternal and perinatal morbidity, by ethnicity, Cree and Quebec, are evaluated by generalized estimating equations models (GEE). GEE models were adjusted to control for potentially confounding factors. The reference group is Quebec women. The specific growth curves of the Cree are built by quantile regression. Results: More than a third, 36.8%, of Cree populations of Eastern James Bay and 9.3% of newborns in Quebec have a birth weight> 4000g. For a birth weight> 4500g, the results show that 10.9% of the Cree, have a birth weight of more than 4500g, the rate is 1.2% in Quebec. The definition of fetal macrosomia by neonatal birth weight≥90th percentile of Kramer identifies 40.02% Cree’s for 8.8% of infants of Quebec as macrosomic. The Cree population are more at risk of fetal macrosomia, compared to the general population of Quebec, these associations were statistically significant: OR = 5.2; 95% CI (4.6 to 6.0) for birth weight> 4000g, OR = 8.1; 95% CI (6.2 to 10.7) for birth weight> 4500g and OR = 6.2; 95% CI (5.7 to 6.7) for birth weight percentile ≥90th Kramer. The risk of major perinatal morbidity associated with fetal macrosomia, is generally less important for the Cree than for the general population of Quebec: 0.76; 95% CI 0.62-0.94. Fetal macrosomia should be described by birth weight ≥95th percentile of Kramer, for the Cree, but preferably at the 90th percentile of the specific postnatal curves of Cree populations of Eastern James Bay. The specific Cree birth weight thresholds for diagnosing fetal macrosomia, at the 90th percentile of the 40th week of gestation, are 4 417g for the girls and 4 488g for the boys. Conclusion: Kramer’s curves diagnose systematically too much macrosomic Cree babies compare to the general population of Quebec. Futhermore, the risk of major maternal and perinatal morbidity is lower for these indigenous communities, at the different definitions of fetal macrosomia, suggesting the use of specific curves for the Cree, to reduce obstetrics interventions not required in large, but non macrosomic, Cree babies.