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Bakgrund: Postpartum Depression (PPD) drabbar mellan 10-15 % av alla kvinnor som föder barn och karakteriseras av depressiva symtom. PPD kan orsakas av flera faktorer, såsom tidigare erfarenhet av psykisk ohälsa och psykisk ohälsa under graviditeten. Syfte: Syftet är att beskriva kvinnors upplevelser med postpartum depression. Metod: Studien är en kvalitativ litteraturöversikt baserad på tio vetenskapliga artiklar som belyser kvinnors perspektiv. Resultat: Kvinnor upplevde bristande anknytning till sina barn och bar på en överväldigande känsla av ansvar gentemot dem. Dessutom kände de sig otillräckliga inför de förväntningar som samhället hade på dem. Det framkom även att många kvinnor fann det svårt att prata om sina känslor på grund av rädsla att bli dömda som "dåliga mammor". Stigmatiseringen kring PPD försvårade ytterligare att prata öppet om sina upplevelser. Konklusion: Studien visade att majoriteten av kvinnorna hade svårt att prata om sina upplevelser. De betonade vikten av hälso- och sjukvårdspersonal, var medvetna om detta och visade empati, förståelse för att underlätta för dem i deras svåra situation. Det framgick även att kvinnor kände sig mindre isolerade om de kunde dela sina erfarenheter med sina närstående eller andra kvinnor i liknande situationer. / Background: Postpartum Depression (PPD) affects between 10-15% of all women who give birth and is characterized by depressive symptoms. PPD can be caused by several factors, such as previous experiences with mental health issues and mental health issues during pregnancy. Aim: The aim of this study is to describe women's experiences with postpartum depression. Method: The study is a qualitative literature review based on ten scientific articles that describe women's perspectives. Findings: Women experienced a lack of attachment to their children and carried an overwhelming sense of responsibility towards them. In addition, they felt inadequate to society's expectations of them. Many women found it difficult to talk about their feelings due to fear of being judged as 'bad mothers'. The stigma surrounding PPD made it evenmore difficult to open up about their experiences. Conclusion: The study showed that the majority of women had difficulty talking about their experiences. It's important that healthcare professionals were aware of this and showed empathy, understanding to faciliate in their difficult situation. It also appeared that women felt less isolated if they could share their experiences with their relatives or other women in similar situations.

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The purpose of this research was to develop, validate, and test an instrument to evaluate motivations to eat in low-income women during the early postpartum period. The instrument was also used in a sample of young college women to further validate the measure and explore determinants of eating in this population. In study 1, the Eating Stimulus Index was validated in 179 low-income women in early postpartum. Validity and reliability were determined via principal components analysis, internal consistency reliability, and test-retest reliability using a subgroup of 31 low-income new mothers. The factor analysis produced an eight factor structure with reliability coefficients ranging from 0.54-0.89. Convenience eating (r=-0.25, P<0.01), emotional eating (r=-0.17, P<0.05), and dietary restraint (r=-0.21, P<0.01) were significantly related to weight status. In study 2, the relationship between eating motivations and diet quality, determined via the Dietary Guidelines Adherence Index, was established in 115 low-income women in early postpartum. High diet quality was related to fruit and vegetable availability (r=0.25, P<0.01), convenience eating resistance (r=-0.36, P<0.001), and vegetable taste preference (r=0.23, P<0.05). Motivations to eat differed between overweight and obese women with the primary motivation being convenience eating and taste, respectively. In study 3, determinants of weight loss were examined in 58 low-income women in early postpartum participating in an 8-week weight loss intervention. Participants were evaluated at pre- and post-study for all measures. Factors related to weight loss included increases in dietary restraint, weight management skills, and weight loss self-efficacy and decreases in fruit juice servings, total energy, and discretionary energy intakes. After hierarchical regression analysis, improvement in weight loss self-efficacy was the most significant determinant (β=0.263, P<0.05) followed by decreases in discretionary energy intake (β=-0.241, P<0.05). In study 4, determinants of diet quality were assessed in a sample of 88 young college women using the Eating Stimulus Index. Low diet quality was associated with poor fruit and vegetable availability, convenience eating resistance, vegetable taste preference, and weight management self-efficacy, while high diet quality was related to increased frequency of meals prepared at home and decreased frequency of meals consumed at fast food restaurants. / text

Les objectifs de cette étude ont été de : (1) déterminer s’il existe une association entre la présence intra-utérine d'Escherichia coli dans la 1 ère semaine postpartum et le développement de la métrite postpartum, (2) déterminer s’il y a une association entre les gènes de virulence d'E. coli et la métrite postpartum, et (3) d'évaluer si les analyses bactériologiques (bactéries et gènes de virulence d'E. coli) pourraient prédire la métrite postpartum chez la vache laitière. Des écouvillons utérins ont été prélevés dans la première semaine postpartum sur 486 vaches de race Holstein et soumis au laboratoire pour détection de E. coli. Les gènes de virulence d'E. coli ont été identifiés par la technique d'hybridation des sondes radioactives. Un total de 252 vaches (52%) ont été positives à E. coli et 67 vaches positives à la métrite postpartum (13,7%). Les vaches positives à E. coli intra-utérin dès la première semaine postpartum avaient un risque 2,6 fois plus élevé de développer la métrite postpartum que les vaches sans E. coli. La plupart des E. coli possédaient un ou plusieurs gènes des E. coli d'origine extra-intestinale (ExPEC) dont fimH (89%), HlyE (87%) et iss (70%). Parmi les autres gènes ExPEC, on a retrouvé sitA (23%), fepC (20%) hra1 (20%) malX (14%) tsh (11%) et bien d'autres. Les gènes de virulence kpsMTII et hra1 ont été associés à la métrite postpartum avec un rapport de cote de 4,3 chacun. La présence d'E. coli dans l'utérus avait une valeur prédictive positive de 18% tandis que la présence des gènes kpsMTII et hra1 avait une valeur prédictive positive de 36% et 31% respectivement. La détection de certains gènes de virulence d'E. coli dans les prélèvements utérins pourrait renseigner sur le risque de développement de la métrite postpartum chez la vache laitière. Les études ultérieures pourraient tester encore plus de gènes et viser à développer des tests de dépistage simple, facilement et rapidement applicable à la ferme. / The objectives of this study were to (1) determine whether there is an association between the presence of intra-uterine Escherichia coli in the first week postpartum and the occurrence of postpartum metritis in the subsequent weeks, (2) determine whether there is an association between E. coli virulence genes and postpartum metritis, and (3) to assess whether the presence of these E. coli virulence genes could predict the occurrence of postpartum metritis in dairy cows. Uterine swabs were collected in the first week postpartum from 486 Holstein cows and submitted to the laboratory for detection of E. coli. Virulence genes of E. coli were identified using the radioactive probe hybridization method. A total of 252 cows (52%) were positive for intra-uterine E. coli and 67 cows (13.7%) were positive for postpartum metritis. Cows positive for intra-uterine E. coli in the first week postpartum had 2.6 times the odds of developing postpartum metritis compared to negative cows. Most intra-uterine E. coli possessed one or more ExPEC genes, among which FimH (89%), hlyE (87%), and iss (70%). Other ExPEC genes such as sitA (23%), fePC (20%) hra1 (20%) malX (14%) tsh (11%) and others were found with low prevalence. The presence of the virulence genes kpsMTII and hra1 was associated with 4.3 times each the odds of developing postpartum metritis compared to negative cows. The presence of E. coli in the uterus had a positive predictive value of 18%, while the presence of the genes kpsMTII and hra1 had a positive predictive value of 36% and 31% respectively. The detection of certain virulence genes of E. coli in uterine swabs could inform about the risk of developing postpartum metritis in dairy cattle. Further studies could test more virulence genes and aim at developing molecular tests that would be simple, quickly and easily applicable on farm.

Le facteur VIII (FVIII) joue un rôle essentiel dans la coagulation sanguine. Lorsque le FVIII fait génétiquement défaut, une pathologie hémorragique grave survient: l'hémophilie A (HA) congénitale. La complication majeure de la prise en charge de ces patients est l'apparition d'allo-anticorps (alloAcs) dirigés contre le FVIII thérapeutique administré. Dès lors, la seule thérapeutique efficace est l'induction de tolérance immune (ITI) qui vise à les éradiquer. Cependant, ce traitement échoue dans 30% des cas, sans qu'aucun facteur ne permette actuellement de prédire l'échec de ce traitement contraignant et coûteux. des facteurs immunologiques prédictifs de l'efficacité de l'ITI ont été recherchés chez 25 patients par analyse du répertoire épitopique et isotypique des Acs anti-FVIII à l'aide de la technologie x-MAP. Des biomarqueurs individuels (Acs anti-A2 et -A1 du FVIII), et des combinaisons originales ont été identifiés (0,841 < AUC < 0,946). Des manifestations hémorragiques peuvent apparaitre chez des patients non hémophiles, dues à des autoAcs anti-FVIII (HA acquise). Dans certains cas, les autoAcs se développent au moment du postpartum. peu de données sont disponibles sur cette réponse immune. Dans une seconde étude portant sur 73 cas, nous avons découvert un profil immunologique (autoAcs anti-A1) différenciant les HA du postpartum et les autres HA acquises. Les profils d'IgG anti-FVIII que nous avons établis s'avèrent prometteurs pour prédire l'efficacité de l'ITI et engendrer une cartographie précise de la réponse autoimmune chez les patients atteints d'HA acquise. / Factor VIII (FVIII) plays a critical role in blood coagulation. When FVIII s genetically defective, a serious hemorrhagic disease occurs: congenital hemophilia A (HA). The main complication of the management of these patients is the appearance of alloantibodies (alloAbs) directed against administred therapeutic FVIII. therefore, the only effective treatment is the immune tolerance induction (ITI), which aims to eradicate these alloAbs. However, this treatment fails in up to 30% of cases, without any factor currently able to predict the failure of this constraining and expensive treatment. Immunological factors predictive to the efficacy of ITI were investigated in 25 patients by analysis of epitopic and isotypic IgG profile of anti-FVIII Abs using x-MAP technology. Individual biomarkers (anti-FVIII A1 and -A2 Abs), and original combinations were identified (0,841 < AUC < 0,946). Hemorrhagic manifestations can occur in non-hemophiliac patients, due to anti-FVIII autoAbs (acquired HA). In some patients, the autoAbs appear in postpartum period but few data are available on the immune response due to the rarity of the disease. In a second study of 73 cases, we found a different immunological profile between patients with postpartum HA and the other acuired HA patients. IgG profiles of anti-FVIII we have established are promising for predicting the effectiveness of ITI and generate an accurate mapping of autoimmune response in patients with acquired HA.

Exclusive breastfeeding for at least 6 months provides numerous infant and maternal benefits. Yet mothers with risk factors, such as lower education, lower socioeconomic status, younger maternal age, planned cesarean birth, and anxiety and depression, are more likely to stop breastfeeding in the early postpartum period. Few studies have focused on perinatal depression as a risk factor for breastfeeding cessation. To tailor effective interventions, nurses must first understand the lived experience of breastfeeding for mothers at risk for perinatal depression. A descriptive phenomenological study was conducted to elucidate the experience of breastfeeding for mothers with perinatal depression. The study was grounded in Swanson’s middle-range theory of caring. After university Institutional Review Board approval, a purposive sample of 10 women was recruited from various organizations. Participants completed a demographic questionnaire and the Edinburgh Postnatal Depression Scale, and semistructured, audiorecorded face-to-face or telephonic interviews were conducted. The researcher transcribed the data which was transformed into constituents of the mothers’ lived experience by utilizing Giorgi’s descriptive phenomenological method. Five constituents emerged: choosing selflessness, harboring inadequacy, deliberate persevering, discerning meaning, and cherishing intimacy. The constituents embodied the essence of the mothers’ thoughts and feelings connected to breastfeeding. By daily choosing selflessness, mothers consciously decided to breastfeed despite physical or psychological struggles. They often were harboring inadequacy due to ongoing struggles which led to incessant thoughts of maternal incompetence. Yet they successfully breastfed for at least 2 weeks after birth by deliberate persevering. Through breastfeeding, they were discerning meaning to realize their value as mothers. Finally, they reveled in purposeful moments of togetherness with their babies through cherishing intimacy. The study findings inform recommendations for nursing education, practice, research, and policy. Nursing education must include basic breastfeeding and perinatal mental health knowledge in prelicensure curricula and up-to-date lactation management techniques and perinatal mental health awareness training in continuing education. Practicing maternal-child nurses must provide education and support to mothers about advantages and difficulties of breastfeeding throughout the perinatal period. Future research includes determination of support needs for women with perinatal depression with subsequent development and evaluation of therapeutic actions to promote breastfeeding success. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

INTRODUÇÃO: A sexualidade, aspecto central do ser humano, influencia o bem estar global do individuo. Neste estudo foi avaliado como a violência por parceiro íntimo associa-se a dificuldades na esfera sexual, em puérperas, entre 6 e 18 meses após o parto. METODOLOGIA: Estudo transversal com 700 mulheres que realizaram o pré-natal em Unidade Básica de Saúde, na zona oeste de São Paulo, entre janeiro 2006 à março de 2007. Foram avaliadas dificuldades na esfera sexual, por meio de questionário e violência por parceiro íntimo, perpetrada somente antes do parto ou no puerpério, por meio de questionário estruturado para este fim. Depressão pós-parto foi avaliada por meio do instrumento SRQ 20, com ponto de corte de 7/8, sendo considerada variável mediadora. Para calcular os coeficientes de associação das vias diretas e indiretas na análise de mediação, foi utilizada análise estrutural (path analysis). RESULTADOS: As prevalências de dificuldades na esfera sexual, violência por parceiro íntimo e depressão pós parto encontradas foram de 30%, 42,8% e 27,8%, respectivamente. A violência ocorrida exclusivamente antes do parto não mostrou associação com dificuldades na esfera sexual pela via direta, nem tampouco pela via indireta por meio da depressão. DISCUSSÃO: Dificuldades na esfera sexual, violência por parceiro íntimo e depressão pós-parto foram muito prevalentes, portanto, a inclusão de questionamentos sobre sexualidade, violência e depressão puerperal no seguimento durante a gravidez e no puerpério é importante para atenção integral à saúde global da mulher. Futuras investigações sobre a relação entre violência, sexualidade e depressão no puerpério são recomendadas. Estudos longitudinais que incluam outros mediadores podem ser realizados para melhor entendimento da cadeia causal e elucidação das variáveis que influenciam, direta e/ou indiretamente, as questões da sexualidade no pós-parto / INTRODUCTION: Sexuality is one of the central aspect of human being and influences several aspects of physical and emotional well-being of the individual. In this study, we evaluated how intimate partner violence is associated with difficulties in the sexual field, in women in postpartum period, between 6 and 18 months after childbirth. METHODOLOGY: A cross-sectional study with 700 women who received prenatal care in a basic health unit in the western area of São Paulo, between January 2006 and March 2007. Difficulties in the sexual field were evaluated through questionnaire and intimate partner violence, perpetrated just before childbirth or also / exclusively in the postpartum period, with a questionnaire structured for that purpose. postpartum depression was evaluated using the SRQ 20 instrument, with a cut-off point of 7/8, being considered as mediating variable. Path analysis was performed to know the different pathways: the direct association between outcome and exposure, and the indirect pathways through the mediator. RESULTS: Prevalence of difficulties in the sexual field, intimate partner violence and postpartum depression were 30%; 42.8%; 27.8%, respectively. Violence occurred exclusively prior to delivery showed no association whit difficulties in the sexual field in the direct path, neither they occur indirectly through postpartum depression. DISCUSSION: Considering that difficulties in the sexual field, intimate partner violence and postpartum depression were prevalent in this study, the inclusion of questions about sexuality, violence and depression is an important step towards integral attention to the global health of the women, given that these are topics usually relegated to a secondary level, at the follow-up of women, during pregnancy and in the puerperium. Longitudinal studies that include other mediators can be performed to better understand the causal chain and elucidation of the variables that influence, directly and / or indirectly, postpartum sexuality issues

Background: This study examined the bidirectional nature of mother-infant positive and negative emotional displays during social interactions across multiple tasks among postpartum women accounting for childhood maltreatment severity. Additionally, effects of maternal postpartum psychopathology on maternal affect and effects of task and emotional valence on dyadic emotional displays were evaluated. Sampling and Methods: A total of 192 mother-infant dyads (51% male infants) were videotaped during free play and the Still-Face paradigm at 6 months postpartum. Mothers reported on trauma history and postpartum depression and posttraumatic stress disorder (PTSD) symptoms. Reliable, masked coders scored maternal and infant positive and negative affect from the videotaped interactions. Results: Three path models evaluated whether dyadic affective displays were primarily mother driven, infant driven, or bidirectional in nature, adjusting for mothers' maltreatment severity and postpartum psychopathology. The bidirectional model had the best fit. Child maltreatment severity predicted depression and PTSD symptoms, and maternal symptoms predicted affective displays (both positive and negative), but the pattern differed for depressive symptoms compared to PTSD symptoms. Emotional valence and task altered the nature of bidirectional affective displays. Conclusions: The results add to our understanding of dyadic affective exchanges in the context of maternal risk (childhood maltreatment history, postpartum symptoms of depression and PTSD). Findings highlight postpartum depression symptoms as one mechanism of risk transmission from maternal maltreatment history to impacted parent-child interactions. Limitations include reliance on self-reported psychological symptoms and that the sample size prohibited testing of moderation analyses. Developmental and clinical implications are discussed.