Dairy cattle characteristically exhibit decreased milk yield and reproductive performance, as well as increased uterine infection rates during periods of high stress. Chromium supplementation has demonstrated efficacy as a feed additive capable of reducing the detrimental effects of stress. As such, its application in dairy production may help to alleviate economic losses associated with seasonal heat stress and the stress experienced during the early postpartum period. Therefore, the objective of the work described in this thesis was to evaluate the potential benefits of short-duration, high-dose chromium (Cr) supplementation in early postpartum dairy cows during the summer months. Multiparous, early postpartum cows (20.95 ± 0.21 DIM, 658.29 ± 13.61 kg) were assigned to one of two treatment groups: 1) normal TMR (Con; n=10) and 2) normal TMR + Cr propionate supplementation (CrPro; 12 mg/h/d Cr; n=12). Body weight (BW), milk yield, and feed intake were measured each day of the experiment. Ambient temperature and humidity were monitored, and the temperature-humidity index (THI) was calculated for the duration of the study as an indicator of the severity of the heat stress experienced by the cows. Transrectal ultrasonography was performed every three days to assess ovarian follicular and luteal dynamics. Respiration rates (RR), rectal temperatures (RT), and blood glucose were recorded concurrently with ovarian ultrasonography. Plasma was collected and used for analysis of progesterone concentrations. Every six days in conjunction with ultrasonography, endometrial cytology samples were collected via cytobrush from each cow to determine the incidences of subclinical endometritis (SCE), as determined by polymorphonuclear leukocyte (PMNL) %. There were no treatment-based differences in RR, RT, blood glucose, feed intake, milk yield, or BW. However, the supplementation strategy did improve reproductive parameters. Within the Con group, there was an increase in PMNL % between samples five and six. Furthermore, at cytology sample six, the Con group had a greater percentage of PMNL than the CrPro group (P=0.01). Chromium consumption did not affect the counts or sizes of most follicles, with the exception being the 6-9 mm category where the CrPro group had a greater average diameter and tended to have more follicles in this category. While CL numbers or size did not differ between treatments, the ratio of progesterone (P4) to corpus luteum (CL) volume was greater in the CrPro group compared to the Con group (P=0.03). The results from this study indicate that the proposed supplementation strategy does not influence DMI or milk yield in cows experiencing stress. Nonetheless, short-duration, high-dose Cr supplementation strategy could benefit reproductive performance and thereby limit economic losses experienced by dairy producers during periods of stress. / Master of Science / Dairy producers continue to experience monetary losses due to the decrease in production performance by dairy cows resulting from physiological changes in response to stress. Elevated ambient temperature and humidity conditions can lead to heat stress, which has been found to decrease both milk and reproductive performance on dairy operations. The period after calving, known as the postpartum period, can also lead to metabolic changes in a cow due to the stress of giving birth and beginning to produce milk. Chromium is an essential trace mineral that can be supplemented with cattle feed to improve the impacts of such stressful periods on production parameters. This study evaluated the effect of a short-duration, high-dose chromium supplementation strategy on reproduction and lactation of early postpartum dairy cattle during summer months. Twenty-two cows were assigned to two treatment groups: control (standard feed only) and chromium supplement (standard feed plus chromium propionate supplementation). Cows receiving the chromium supplement did not experience any changes in respiration rate, rectal temperature, blood glucose levels, feed intake, milk yield, or body weight. Reproductive analyses determined that cows receiving the chromium supplementation had a lower number of immune cells present in the uterus by the end of the experiment, which may be indicative of a healthier uterine environment. Chromium supplemented cows also had a greater level of progesterone concentration to corpus luteum volume compared to cows in the control group. These results indicate that the short-duration, high-dose chromium supplementation strategy could benefit reproductive performance and limit losses experienced by dairy cows under stress conditions.

One of the most common complications for mothers after childbirth is postpartum depression (PPD). This illness can occur in women who have given birth, who have miscarried or who have had a stillbirth. The American College of Obstetricians and Gynecologists (2010) indicate that PPD affects 1 in 8 women. These statistics are disturbing especially when 51 % of women may not be willing to seek treatment for PPD (Beck & Gable, 2001 ). Therefore, the number of women who are experiencing PPD is of national concern. The literature reveals that there is not a standard or protocol for the assessment of PPD symptoms, education delivery, or referral and treatment. With an absence of a standard or protocol, this devastating disorder will continue to go undiagnosed in thousands of women affecting not only their wellbeing but the wellbeing of their families. Nurses are in an optimal position to help prevent and identify women suffering from PPD. Establishing the nurse's role in assessing, educating and referring women and families suffering from PPD will assist in reducing the prevalence of this illness and identifying afflicted women for early intervention. Implementing a standard of practice in PPD assessment, education, and referral will assist healthcare providers in achieving the Healthy People 2010 objective of reducing mental illness and complications due to pregnancy.

Sammanfattning                                 Bakgrund:Tiden efter förlossning benämns som den mest kritiska men också mest försummade perioden i en nybliven moders liv. Det är barnmorskans uppgift att bl. a. handlägga postnatal period samt bedöma behov av uppföljning. Det har framkommit att det finns brister och behov av utveckling i eftervården. Det finns få eller inga studier som visar styrkorna som finns i eftervården i Sverige. Syfte:Att undersöka hur mödrar och barnmorskor erfar eftervården.  Metod:Kvalitativa intervjuer med induktiv ansats har utförts. Analysen av insamlat datamaterial är genomförd med kvalitativ innehållsanalys. Fyra nyförlösta mödrar och fyra barnmorskor i en region i södra Sverige har intervjuats.  Resultat:Mödrarna var överlag nöjda med eftervården men det fanns en önskan om tidigare uppföljning och bättre amningsstöd. Barnmorskorna beskrev hur de flesta mödrar är välmående och att de inte anser att det finns några större brister i dagens eftervård. De har dock önskemål om tidigare uppföljning för möjligheten att kunna utforma en individuell plan för varje familj, mer utbildning och bättre samarbete mellan olika instanser. Konklusion: Eftervården har länge sett likadan ut och är i dagsläget icke flexibel med begränsade resurser. Det finns behov av förbättring och utveckling samt en önskan om en mer individanpassad vård. / Background:The time after childbirth is known as the most critical but also the most neglected time in every new mothers life. It is part of the midwifes’ task to care for the mother during the postnatal period and assess the need for follow-up. It has been shown that there are shortcomings and a need for development in the postpartum care. There are few or no studies which examines the strengths of the Swedish postpartum care. Purpose:To examine the experiences of postpartum care among midwifes and mothers. Method:Qualitative interviews with an inductive approach, which were analyzed with a qualitative content analysis. Four new mothers and four midwifes in a region in the south of Sweden were interviewed. Results:The mothers were mostly satisfied with the postpartum care but there was a wish for an earlier follow-up after birth and better breastfeeding support. The midwifes described that most mothers are feeling well and that there are no serious shortcomings with the postpartum care today. They do however wish for an earlier follow-up after birth in order to establish an individual plan of care for every family, more education and a better cooperation between different instances. Conclusion:The postpartum care has been designed in the same way for a long time and is inflexible with few resources. There is a need for improvement and development as well as a wish for more individualized care.

<p> </p><p><strong>Background:</strong> The birth of an infant can represent additional, financial and emotional stress. Lack of social support negatively impacts these women’s ability to cope with already difficult circumstances after childbirth. Poorer health care for the postpartum women may be the consequence of deficient understanding. It is thus interesting to know how stress and lack of social support affects the health status among postpartum women.</p><p><strong>Aim:</strong> The aim was to describe stress, social support and health status among postpartum women, and also to compare the situations between women in an urban and a rural area of Thailand.</p><p><strong>Method:</strong> A descriptive comparative cross sectional study with a quantitative method was used. 160 women from Bangkok and Ayutthaya, Thailand answered a questionnaire, which was divided into four parts; background, postpartum stress, health status and social support.</p><p><strong>Result:</strong> The perceived stress was in general low. They had a large amount of social support; the most important support was received by partners and parents. They perceived a good postpartum health status. No significant difference was shown between the two areas regarding the total score of stress, social support and health status.</p><p><strong>Conclusion: </strong>In total the Thai postpartum women were exposed to a low amount of stressors. They had a good postpartum wellbeing and received a high level of social support.</p><p><strong>Clinical Implications:</strong> To enable care in a more holistic approach, improvement in detecting postpartum stressors and to encourage social support in the postpartum period, will reduce postpartum stress and  prevent a better health status.</p><p> </p> / <p> </p><p><strong>Bakgrund:</strong> Ett nyfött barn kan innebära en ekonomisk och emotionell stress. Bristande socialt stöd har en negativ påverkan på dessa kvinnors möjlighet att hantera redan svåra omständigheter efter barnafödandet. En bristande förståelse från sjukvårdspersonal kan orsaka en sämre hälso- och sjukvård för postpartum kvinnor. Det är därför intressant att veta hur stress och bristande socialt stöd påverkar hälsan bland kvinnor postpartum.</p><p><strong>Syfte:</strong> Syftet var att beskriva stress, socialt stöd och hälsa bland kvinnor  postpartum, samt att jämföra situationen mellan kvinnor i ett urbant och ett ruralt område i Thailand.</p><p><strong>Metod:</strong> En kvantitativ jämförande tvärsnitts metod användes. 160 deltagare fyllde i frågeformular, som var indelade i fyra delar; bakgrund, postpartum stress, hälso status och social stöd.</p><p><strong>Resultat:</strong> Den upplevda stressen var genrellt sett låg. De hade ett stort socialt stöd, det viktigaste stödet gavs fran partners och föräldrar. De upplevde en god postpartum hälsa. Ingen signifikant skillnad visades mellan det två områdena vad det gäller den totala rankningen av stress, hälso status och social stöd.</p><p><strong>Slutsats: </strong>Totalt sett verkade thai postpartum kvinnorna uppleva lite stress. De hade en god hälsa och upplevde i hög usträckning ett bra socialt stöd.</p><p><strong>Kliniska implikationer:</strong> För att möjliggöra ett mer holistisk vårdperspektiv, kommer förbättringar i att upptäcka postpartusmstressorer samt uppmuntran till socialt stöd tiden postpartum, leda till en  minskad postpartum stress och förebygga en bättre hälsa.</p><p> </p>

Background: The birth of an infant can represent additional, financial and emotional stress. Lack of social support negatively impacts these women’s ability to cope with already difficult circumstances after childbirth. Poorer health care for the postpartum women may be the consequence of deficient understanding. It is thus interesting to know how stress and lack of social support affects the health status among postpartum women. Aim: The aim was to describe stress, social support and health status among postpartum women, and also to compare the situations between women in an urban and a rural area of Thailand. Method: A descriptive comparative cross sectional study with a quantitative method was used. 160 women from Bangkok and Ayutthaya, Thailand answered a questionnaire, which was divided into four parts; background, postpartum stress, health status and social support. Result: The perceived stress was in general low. They had a large amount of social support; the most important support was received by partners and parents. They perceived a good postpartum health status. No significant difference was shown between the two areas regarding the total score of stress, social support and health status. Conclusion: In total the Thai postpartum women were exposed to a low amount of stressors. They had a good postpartum wellbeing and received a high level of social support. Clinical Implications: To enable care in a more holistic approach, improvement in detecting postpartum stressors and to encourage social support in the postpartum period, will reduce postpartum stress and  prevent a better health status. / Bakgrund: Ett nyfött barn kan innebära en ekonomisk och emotionell stress. Bristande socialt stöd har en negativ påverkan på dessa kvinnors möjlighet att hantera redan svåra omständigheter efter barnafödandet. En bristande förståelse från sjukvårdspersonal kan orsaka en sämre hälso- och sjukvård för postpartum kvinnor. Det är därför intressant att veta hur stress och bristande socialt stöd påverkar hälsan bland kvinnor postpartum. Syfte: Syftet var att beskriva stress, socialt stöd och hälsa bland kvinnor  postpartum, samt att jämföra situationen mellan kvinnor i ett urbant och ett ruralt område i Thailand. Metod: En kvantitativ jämförande tvärsnitts metod användes. 160 deltagare fyllde i frågeformular, som var indelade i fyra delar; bakgrund, postpartum stress, hälso status och social stöd. Resultat: Den upplevda stressen var genrellt sett låg. De hade ett stort socialt stöd, det viktigaste stödet gavs fran partners och föräldrar. De upplevde en god postpartum hälsa. Ingen signifikant skillnad visades mellan det två områdena vad det gäller den totala rankningen av stress, hälso status och social stöd. Slutsats: Totalt sett verkade thai postpartum kvinnorna uppleva lite stress. De hade en god hälsa och upplevde i hög usträckning ett bra socialt stöd. Kliniska implikationer: För att möjliggöra ett mer holistisk vårdperspektiv, kommer förbättringar i att upptäcka postpartusmstressorer samt uppmuntran till socialt stöd tiden postpartum, leda till en  minskad postpartum stress och förebygga en bättre hälsa.

Bakgrund: Postpartum depression har länge förknippats med moderskap, men drygt 10 % av papporna drabbas också av depression efter barnets födelse. Syfte. Belysa begreppet postpartum depression hos fäder. Metod: Systematisk litteraturstudie som bearbetat och analyserat kvantitativ samt kvalitativ forskning genom en innehållsanalys. Resultat: Orsakerna till postpartum depression hos fäder var främst psykologiska och sociala faktorer där mammans eventuella depression, pappans arbetslöshet och en ansträngd ekonomi samt pappans upplevelse av bristande socialt stöd utgjorde de viktigaste orsakerna. Depressionen påverkade pappans anknytning till barnet, hela familjen och föräldraskapet samt barnets emotionella, kognitiva och sociala utveckling negativt. Slutsats: Postpartum depression hos pappan orsakas av sociodemografiska, psykiska och sociala faktorer. Depressionen påverkar familjen, parrelationen, föräldraskapet samt barnets kognitiva och sociala utveckling negativt. Den kunskap litteraturstudien bidrar till ger ökade möjligheter att uppmärksamma postpartum depression hos pappan, stödja familjen samt bidra till en fördelaktig utveckling för barnet. Framtida forskning bör ske med syfte att hitta lämpliga metoder och bedömningsinstrument utformade för att identifiera pappor med risk att utveckla en depression. / Background: Postpartum depression have for a long time been associated with motherhood, but more than 10 % of fathers also get a depression after their child's birth. Aim: Elucidate the concept of paternal postpartum depression. Method: A systematic literature study who processed both quantitative and qualitative research, analyzed with a content analysis. Results: The causes of paternal postpartum depression where mostly psychological and social factors were the mother´s depression, the father’s unemployment and a strained economy together with the father´s experience of lack of social support seemed to be the most important risk factors. Paternal postpartum depression affected the father’s attachment to his child, family, parenthood and the child's emotional, cognitive and social development negatively. Conclusion: Paternal postpartum depressions are caused of socio-demographic, psychological and social factors. The depression affects the whole family, partners, parenting and the child's cognitive and social development negatively. The literature study increases the knowledge and opportunities to identify postpartum depression in fathers, support the family and to contribute to a favorable development for the child. Future research should be done in order to find appropriate methods and assessment instruments designed to find the fathers at risk for developing depression.

University of Macau / Faculty of Social Sciences and Humanities / Department of Psychology

Project (Ed.S.)--James Madison University, 2009. / Includes bibliographical references.

OBJETIVO: Esta dissertação tem por objetivo apresentar o estudo da associação entre transtornos psiquiátricos pós-parto e fatores demográficos, psicossociais e relacionados à gestação e parto em uma amostra de base populacional de um bairro de Porto Alegre. MÉTODO: O estudo envolveu todas as mães de crianças nascidas em hospital público no bairro Vila Jardim, em Porto Alegre, de novembro de 1998 a dezembro de 1999. As famílias foram estudadas quando os bebês completaram quatro meses de idade. A saúde mental das mães e pais foi avaliada pelo Self Report Questionnaire (SRQ) e por entrevistas semi-estruturadas individuais e do casal. A Escala Avaliação Global do Funcionamento Relacional (GARF) do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV) foi usada para aferir a qualidade do relacionamento do casal, do relacionamento materno com sua família de origem, com a família paterna e com a rede social. Para os outros fatores foram feitas perguntas diretas à mãe e ao pai da criança. RESULTADOS: Segundo a escala SRQ 34,45% das 148 mulheres entrevistadas apresentaram suspeita de transtorno psiquiátrico, sendo que a avaliação clínica feita por dois profissionais de saude mental que avaliavam independentemente utilizando os critérios diagnósticos do DSM-IV indicou um percentual de 54%. Sessenta e dois por cento das mulheres coabitavam com companheiro, sendo que estes também foram entrevistados. Dos 118 pais, 25,4% apresentaram suspeita de transtorno psiquiátrico, segundo a escala SRQ. Nesta população, o fato de coabitar ou não com companheiro não esteve associado com transtorno mental. Nesta pesquisa, na análise de regressão logística estudando a totalidade do grupo de mulheres os fatores que se mostraram relacionados com o desfecho (SRQ igual ou superior a sete ) foram a baixa renda familiar (p=0,017) e a presença de transtorno psiquiátrico materno no passado (p=0,043). Na regressão logística feita exclusivamente com as mulheres que viviam com companheiro, apenas a má qualidade da relação do casal (notas de 1 a 3 pela escala GARF) esteve associada à presença de transtornos psiquiátricos quatro meses após o parto (OR=7,34, p=0,001). CONCLUSÃO: Este estudo reforça a necessidade de verificar a presença de transtornos psiquiátricos da mãe nas consultas de puericultura, introduz dados sobre o pai e, especialmente, sobre a importância de avaliar rotineiramente a relação conjugal. / OBJECTIVE: To study the association between suspicion of psychiatric disorder and demographic, psychosocial factors, as well as those related to pregnancy and delivery, in a population-based sample of women from a circumscribed neighborhood in Porto Alegre. METHOD: This study included the mothers of all the children born in public hospitals in Vila Jardim, a district of Porto Alegre, Brazil, from November 1998 through December 1999. Families were assessed when infants were 4 months of age. Parents’ mental health was assessed using the Self-Report Questionnaire (SRQ) and individual and couple semi-structured interviews. The DSM-IV Global Assessment of Relational Functioning Scale was used to measure quality of couple relationship, of maternal relationship with the mother's family of origin, with paternal family and with social network. As to other factors, direct questions were asked to the child’s parents. RESULTS: According to the SRQ scale, 34.45% of all 148 interviewed women had suspicion of psychiatric disorder. The clinical assessment by two mental health professionals independently using DSM-IV criteria revealed a percentage of 54%. Sixty-two percent of women lived with partners, who were also interviewed. Of the 118 fathers, 25.4% had suspicion of psychiatric disorder, according to the SRQ scale. In this population, the fact of living or not with a partner was not associated with mental disorder. Analysis by logistic regression of the total group of women showed that factors associated with the main outcome (SRQ equal or higher than 7) were low family income (p = 0.017) and presence of previous maternal psychiatric disorder (p = 0.043). Logistic regression including only women living with a partner showed that poor marital relationship was associated with presence of psychiatric disorder, 4 months after delivery (OR = 7.34 p = 0.001). CONCLUSION: This study reinforces the need of investigating presence of maternal psychiatric disorder during childcare, introduces data on the father and especially on the importance of a routine assessment of the marital relationship.

OBJETIVO: Esta dissertação tem por objetivo apresentar o estudo da associação entre transtornos psiquiátricos pós-parto e fatores demográficos, psicossociais e relacionados à gestação e parto em uma amostra de base populacional de um bairro de Porto Alegre. MÉTODO: O estudo envolveu todas as mães de crianças nascidas em hospital público no bairro Vila Jardim, em Porto Alegre, de novembro de 1998 a dezembro de 1999. As famílias foram estudadas quando os bebês completaram quatro meses de idade. A saúde mental das mães e pais foi avaliada pelo Self Report Questionnaire (SRQ) e por entrevistas semi-estruturadas individuais e do casal. A Escala Avaliação Global do Funcionamento Relacional (GARF) do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV) foi usada para aferir a qualidade do relacionamento do casal, do relacionamento materno com sua família de origem, com a família paterna e com a rede social. Para os outros fatores foram feitas perguntas diretas à mãe e ao pai da criança. RESULTADOS: Segundo a escala SRQ 34,45% das 148 mulheres entrevistadas apresentaram suspeita de transtorno psiquiátrico, sendo que a avaliação clínica feita por dois profissionais de saude mental que avaliavam independentemente utilizando os critérios diagnósticos do DSM-IV indicou um percentual de 54%. Sessenta e dois por cento das mulheres coabitavam com companheiro, sendo que estes também foram entrevistados. Dos 118 pais, 25,4% apresentaram suspeita de transtorno psiquiátrico, segundo a escala SRQ. Nesta população, o fato de coabitar ou não com companheiro não esteve associado com transtorno mental. Nesta pesquisa, na análise de regressão logística estudando a totalidade do grupo de mulheres os fatores que se mostraram relacionados com o desfecho (SRQ igual ou superior a sete ) foram a baixa renda familiar (p=0,017) e a presença de transtorno psiquiátrico materno no passado (p=0,043). Na regressão logística feita exclusivamente com as mulheres que viviam com companheiro, apenas a má qualidade da relação do casal (notas de 1 a 3 pela escala GARF) esteve associada à presença de transtornos psiquiátricos quatro meses após o parto (OR=7,34, p=0,001). CONCLUSÃO: Este estudo reforça a necessidade de verificar a presença de transtornos psiquiátricos da mãe nas consultas de puericultura, introduz dados sobre o pai e, especialmente, sobre a importância de avaliar rotineiramente a relação conjugal. / OBJECTIVE: To study the association between suspicion of psychiatric disorder and demographic, psychosocial factors, as well as those related to pregnancy and delivery, in a population-based sample of women from a circumscribed neighborhood in Porto Alegre. METHOD: This study included the mothers of all the children born in public hospitals in Vila Jardim, a district of Porto Alegre, Brazil, from November 1998 through December 1999. Families were assessed when infants were 4 months of age. Parents’ mental health was assessed using the Self-Report Questionnaire (SRQ) and individual and couple semi-structured interviews. The DSM-IV Global Assessment of Relational Functioning Scale was used to measure quality of couple relationship, of maternal relationship with the mother's family of origin, with paternal family and with social network. As to other factors, direct questions were asked to the child’s parents. RESULTS: According to the SRQ scale, 34.45% of all 148 interviewed women had suspicion of psychiatric disorder. The clinical assessment by two mental health professionals independently using DSM-IV criteria revealed a percentage of 54%. Sixty-two percent of women lived with partners, who were also interviewed. Of the 118 fathers, 25.4% had suspicion of psychiatric disorder, according to the SRQ scale. In this population, the fact of living or not with a partner was not associated with mental disorder. Analysis by logistic regression of the total group of women showed that factors associated with the main outcome (SRQ equal or higher than 7) were low family income (p = 0.017) and presence of previous maternal psychiatric disorder (p = 0.043). Logistic regression including only women living with a partner showed that poor marital relationship was associated with presence of psychiatric disorder, 4 months after delivery (OR = 7.34 p = 0.001). CONCLUSION: This study reinforces the need of investigating presence of maternal psychiatric disorder during childcare, introduces data on the father and especially on the importance of a routine assessment of the marital relationship.