MMed(Obstetrics and Gynaecology) / Introduction Against the high background rate of HIV among our antenatal clinic attendees, 30.3% in Gauteng in 2007, and the importance of cancer of the cervix as a health issue; this study was undertaken to determine the rate of abnormality found in cervical smears performed on HIV positive women attending the postnatal clinic at Johannesburg Hospital. The degree of abnormality and where possible its management, was reviewed. Secondly it was determined whether the immune status, namely the WHO clinical stage, CD4 cell count and viral load, correlated with the Pap smear results. Lastly patients were also analyzed according to the treatment received for HIV and their Pap smear results. Patients and Methods The study is a retrospective record review. All the patients who attended the postnatal clinic (PNC) between October 2005 and the end of July 2006, who had a Pap smear, were included. Follow-up test results were collected to the end of June 2007. A total of 324 patients attended the clinic in the study time period, of which 248 (76.5%) had a Pap smear done and 76 (23.5%) did not. iv Results The main results of interest were as follows – 131 patients (52.8%) had normal Pap smears, 64(25.8%) had LGSIL, 32 (12.9%) had HGSIL, 10 (4.0%) had ASCUS and 11 (4.4%) had Pap smears that could not be classified. In total 47.2% of the Pap smears were abnormal. There was one case of malignancy developing after an abnormal Pap smear. Patients with abnormal Pap smears tended to have a lower mean CD4 cell count while the viral load and WHO Stage did not appear to have an impact on the final analysis of the Pap smears. Conclusion The rates of cervical abnormality in HIV sero-positive patients attending the Johannesburg Hospital postnatal clinic are much higher (47.2%) than would be expected in the general population (10%), with a significant portion requiring follow-up investigation and management. It is however preferable to deal with cervical cytological abnormalities comprehensively during the screening phase rather than trying to manage a potential increase in cervical cancer cases.

ABSTRACT Naturalistic Inquiry was used to explore, describe and discover the experiences and perceptions of men whose partners have been admitted to an Intensive Care Unit (ICU) immediately after childbirth. The sixteen men's experiences were explored using semi-structured open-ended questions. Data were analysed using thematic content analysis. The research questions driving this study were: • What are men's experiences and perceptions of the incidence and impact of their partners being admitted to ICU following the complications of childbirth? • What is the nature of the relationships and interactions that men have with healthcare professionals before, during and after their partner's ICU admission following the complications of childbirth? • What impact did the experience of their partners being admitted to ICU, following the complications of childbirth, have on the men's relationships with their partners, newborn child, and other children? • What impact did the experiences of their partners being admitted to ICU following the complications of childbirth have on their future life plans? During the time of their partners' obstetric crisis the men, in this study, were left isolated, alone and struggling. The current healthcare policy and practice for men with their partners in life-threatening situations intrapartum and immediately postpartum failed 16 families.

Background: Adults benefit from participating in physical activity (PA) for chronic disease prevention and treatment. Postnatal women are encouraged to commence a gradual return to PA 4-6 weeks after giving birth, with participation in line with PA guidelines. The potential benefits of postnatal PA include weight management, improvements in cardiovascular fitness and psychological wellbeing. There has been limited high-quality information about the efficacy, feasibility and acceptability of PA interventions in postnatal women and few studies in the UK. Behavioural counselling interventions informed by behaviour change theory have been shown to successfully increase PA in low-active adults. Physical activity consultations (PACs) use structured and individualised behavioural counselling to enhance individuals’ motivation for change, and improve self-management skills. This approach may support adoption of PA in low-active postnatal women with research demonstrating that modifiable socio-cognitive factors influence PA behaviour. This thesis reports on the efficacy of a postnatal PA intervention, the More Active MuMs in Stirling (MAMMiS) study on change in PA behaviour. Efficacy of the intervention was tested in a randomised controlled trial. The effect on secondary health and wellbeing outcomes and PA cognitions targeted by the intervention and feasibility results are also reported. Methods: The intervention comprised a face-to-face PAC of around 35-45 minutes and 10-week group pramwalking programme. Non-attenders to the pramwalking group received a support telephone call. A follow-up PAC (15-20 minutes) was delivered after three month assessments. The first PAC involved raising awareness about benefits of PA, developing self-efficacy for change, setting goals and action planning PA, developing strategies for overcoming barriers, encouraging self-monitoring, prompting social support and selecting/changing the environment to support PA. The second PAC involved feedback about changes and preventing a return to sedentary habits. The pramwalking group met weekly for 6 walks of 30-55 minutes at a brisk pace, providing opportunities to demonstrate moderate-intensity walking and to encourage and support PA behaviour change. The control group received an NHS leaflet, which encouraged PA after childbirth. Postnatal women (six weeks to 12 months after childbirth) were identified through a variety of NHS-based and community-based strategies plus local advertisements and word-of-mouth. The primary outcome measure was evaluation of PA behaviour change using the Actigraph GT3X/GT3X+ accelerometer, an objective measure of PA behaviour; self-reported moderate-vigorous physical activity (MVPA) was measured using a recall questionnaire (Seven-Day Physical Activity Recall) and cardiovascular fitness using a submaximal step-test (Chester step-test). Secondary health and wellbeing measures were; anthropometric (i.e. weight and body mass index (BMI)) and body composition (measured using a bioelectrical impedance), psychological wellbeing (measured using the Adapted General Wellbeing Index) and fatigue (measured on a 100-point visual analogue scale). PA cognitions were measured via a questionnaire with constructs adapted from previous studies. All were taken at baseline (prior to randomisation), three and six months follow-up from baseline. Process measures were used to investigate intervention fidelity and feasibility. Acceptability was investigated in a post-trial interviews, conducted by a researcher not involved in the trial. RESULTS: Sixty-five postnatal women (average 33 years old with an infant 24 weeks old) were recruited (77% of those eligible). There was a 91% rate of retention at six months; participants who missed a follow-up assessment were younger (30 versus 34 years old) and had younger infants (21 versus 34 weeks old). Participants were less deprived and older compared with postnatal women in Scotland. Objectively measured PA behaviour did not change in response to the intervention. There was no between-groups difference in change in mean counts/minute from baseline to three months (p=0.35, 95% CI -73.50, 26.17, d=0.22) or three to six months (p=0.57, 95% CI -39.46, 71.18, d=0.13). There was no change in MVPA 7 minutes/day in either group from baseline to three (intervention =-0.70, IQR -9.86, 8.36; control =1.65, IQR -4.79, 8.21) or three to six months (intervention =0, IQR -1.13, 1.10; control =0, IQR -9.86, 8.23), with no between-groups difference baseline to three (p=0.43; r=0.10) or three to six months (p=0.75, r=0.09). Results for relative MVPA were similar. Median steps/day from baseline to three months did not change in the intervention group (0, IQR –1619.44, 1047.94) and increased by 195.95 (IQR -1519.55, 1691.03) among controls. The between-groups difference was non-significant (p=0.37, r=0.18). From three to six month follow-up steps/day increased in the intervention group and not in controls (0, IQR -1147.50, 1303.52), this between-groups difference was also non-significant (p=0.35, r=0.16). From baseline to three months self-reported MVPA declined in the intervention group (15 minutes/week; IQR -111, 15) and increased in the control group (30 minutes/week; IQR –68, 75): a non-significant between-groups difference, with a small effect size (p=0.71, r=0.22). From three to six months a decline in self-reported MVPA was found in controls (53 minutes/week; IQR -41,-101) and no change among the intervention group (0, IQ range -26, 71); a significant between-groups difference with a small effect size (p=0.04, r=0.26). There were no differences between the groups for the change in aerobic capacity from baseline to three months or three to six months with no evidence for change over time in aerobic capacity or fitness category in either group. Change in secondary outcomes did not differ between the groups from baseline to three or three to six months (although fatigue did improve in the intervention group relative to controls from baseline to three months). Considering PA cognitions, outcome expectancies declined in both groups from baseline to three months and continued to decline only in the intervention group from three to six months, a between-groups difference with a small effect size (p=0.03, r=0.26). Self-efficacy increased in the intervention group from baseline to three months and declined in the control group with a small effect size for the between-groups difference (p=0.03, r=-0.27). An increase in action 8 planning was seen among the intervention group but not controls from baseline to three months (p<0.01, r=-0.34). Both groups showed an increase in coping planning and action control; the change was larger among the intervention group relative to controls (i.e. p<0.01, r=0.44, r=0.43, respectively). Increased self-efficacy and action control were maintained from three to six months in the intervention group. Coping planning increased relative to controls (p<0.01, r=0.41) and action planning increased among controls from three to six months (p<0.01, r=0.39). Intervention fidelity and feasibility was good. All intervention participants received the initial PAC and adoption of self-management strategies was high for ‘thinking about the benefits of PA’, ‘action planning’ and ‘self-monitoring’, between baseline and three months. Most participants attended at least one walk (61% attended five or more), 89% of planned walks were conducted with no evidence of poor attendance due to season. Walks were conducted at a brisk pace and met moderate-intensity thresholds. DISCUSSION: MAMMiS aimed to recruit low-active healthy postnatal women to test the efficacy of a PAC and group pramwalking intervention. There was no evidence for an intervention effect on PA or on secondary health and wellbeing outcomes.