Submitted in fulfilment of the requirements for the degree Doctor of Education in the Department of Educational Psychology and Special Education of the Faculty of Education at the University of Zululand, South Africa, 2012. / This study examined the nature of educators’ experiences in dealing with teenage pregnancy. The study focused on educators in secondary schools in KwaZulu-Natal province of the Republic of South Africa. The researcher looked at teenage pregnancy as a major problem in the education system in South Africa. Educators are dealing with pregnant learners almost every day. More learners, mostly teenagers, fall pregnant while they are still at school. Educators have different experiences of such a problem. The study further examined the influence of educators’ biographical characteristics like age, gender, race, teaching experience, educational level and religious affiliation on their experiences in dealing with teenage pregnancy. The study further looked at the extent to which educators experience stress when dealing with teenage pregnancy in secondary schools.

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A safety study was then carried out in VIVO III normal pregnant mice. The most commonly used single herb, Largehead Atractylodes Rhizome, at relevant clinical doses was administered orally to the pregnant animals at different or throughout gestational periods, beneficial and adverse effects on both mothers and offspring were studied. At higher clinical dosage, significant decreased maternal weight, fetal/neonatal growth and weight; and significant increased incidences of fetal resorption, congenital caudal regression and hip dysplasia were recorded . Bone CT examination and skeleton staining confirmed congenital skeleton abnormality, including shoulder joint dislocation, congenital absence of ulna and distal digits, oligodactyly, long bone shortening, congenital hip dislocation and caudal regression In vitro whole embryo culture confirmed that Largehead Atractylodes Rhizome induced abnormal limb development during early development. Molecular study suggested the effects of Largehead Atractylodes Rhizome on Tbx suppression for early limb development. / For more than 3,000 years of history, Traditional Chinese Medicine has been used in pregnant women. Nowadays, it is principally applied in Mainland China but has become more and more widely used worldwide to promote both mothers ' and fetuses ' health and treat common pregnancy disorders. / Over 3,000 publications were identified and selected to assess Chinese medicines for pregnancy, including their indications, contraindications, formulae , individual medicines, regimes, effectiveness , efficacy, safety, adverse effects and toxicity. Amongst all clinical applications, threatened miscarriage was the most common clinical indication. Shou Tai Pill, containing 4 major herbal medicines Chinese Dodder Seed, Chinese Taxillus Twig, Donkey-hide Glue, and Himalayan Teasel Root, was the most commonly used formula in preventing miscarriage and promoting pregnancy. The top 10 most frequently prescribed single herbal medicines in wide variety of formulas were identified. The average clinical dose for each medicine ranged from 6g to 28g daily, however the dosage of Chinese medicines was not significantly correlated with its overall efficacy. Randomized controlled trials evaluating the effectiveness of the medicines were selected for meta-analysis. The results showed Chinese medicines in combination with other pharmaceuticals were more effective to improve the clinical outcomes of threatened miscarriages than other pharmaceuticals. No specific safety problem was reported, but potential adverse and toxic effects on reproductive system by certain medicines were identified from other publications. / To date, no data are available to provide an overview of Chinese medicines in pregnancy. In the first part of this study, the clinical applications, and therapeutic effects and safety of Chinese medicines for pregnancy were reviewed and studied. In the second part of this study, the safety of most commonly used Chinese medicine during pregnancy was studied in pregnancy animal models, in vivo and in vitro. / Li, Lu. / Adviser: Wang Chi Chiu. / Source: Dissertation Abstracts International, Volume: 73-04, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 299-330). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

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Michael Scott Rogers. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (p. 265-314). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

nÃo hà / O estudo objetivou buscar e avaliar evidÃncias disponÃveis na literatura sobre os DiagnÃsticos de Enfermagem em gestantes. Para tanto, desenvolveu-se revisÃo integrativa da literatura, seguindo as etapas preconizadas por Whittemore e Knafl (2005). A busca e seleÃÃo dos estudos foram realizadas nas bases de dados LILACS, CINAHL, MEDLINE e SCOPUS. A amostra foi de 14 estudos nÃo experimentais, com nÃvel de evidÃncia VI. Os estudos foram avaliados e distribuÃdos em trÃs categorias temÃticas: diagnÃsticos de enfermagem em gestantes saudÃveis; diagnÃsticos de enfermagem em gestantes enfermas; e diagnÃsticos de enfermagem especÃficos. Em relaÃÃo aos resultados, os estudos foram publicados entre 1999 e 2010, eram brasileiros, tinham como idioma o portuguÃs, com autores vinculados à enfermagem. A primeira categoria foi composta por cinco estudos, dos quais foram relacionados 15 diagnÃsticos mais frequentes, relacionados a alteraÃÃes fisiolÃgicas da gestaÃÃo. Destacaram-se os diagnÃsticos Conhecimento deficiente, PadrÃo de sono prejudicado, NÃusea e Risco de infecÃÃo. A segunda categoria foi composta por sete estudos que investigaram a presenÃa de diagnÃsticos de enfermagem em gestantes com patologias, como a SÃndrome Hipertensiva da GestaÃÃo, a Amniorrexe prematura, o Trabalho de Parto Prematuro, a SÃndrome da ImunodeficÃncia adquirida, a Anemia Ferropriva, ou seja, gestantes de alto risco. Nesta categoria, os diagnÃsticos tenderam aparecer isoladamente em cada estudo, correlacionados com a patologia que a cometia as gestantes que estavam sendo investigadas. Foram destacados 33 diagnÃsticos mais frequentes, com Ãnfase para os diagnÃsticos: Conhecimento deficiente, Risco de infecÃÃo, Dor aguda, ManutenÃÃo do lar prejudicada, Ansiedade, Medo e ManutenÃÃo ineficaz da saÃde. A terceira e Ãltima categoria foi composta por dois estudos que investigaram como os DE Fadiga, PrivaÃÃo de sono e PadrÃo de sono prejudicado aconteciam na gravidez. Os diagnÃsticos retratados na revisÃo se relacionaram a aspectos biolÃgicos, psicolÃgicos, sociais e familiares das gestantes, o que vai ao encontro da necessidade de se investigar a gestante de forma integral, bem como de se prestar cuidado holÃstico a esta populaÃÃo e famÃlia. A presente revisÃo integrativa seguiu o rigor metodolÃgico adequado e identificou e avaliou os DE em gestantes. Ademais, permitiu aprofundamento teÃrico sobre a prÃtica baseada em evidÃncias, os mÃtodos de revisÃo integrativa, os diagnÃsticos de enfermagem e o processo de enfermagem relacionado à gravidez. Identificou-se a necessidade de se desenvolverem estudos quase experimentais ou experimentais, envolvendo a temÃtica dos diagnÃsticos de enfermagem em gestantes, visto que os estudos desta revisÃo foram classificados com nÃvel de evidÃncia VI. Entendendo-se com isto que à necessÃrio empreender esforÃos para o desenvolvimento de pesquisas com delineamentos que produzam evidÃncias fortes relacionadas ao tema, elevando, assim, o poder de generalizaÃÃo dos achados. Pretende-se com esta revisÃo estimular enfermeiros a consumirem resultados de pesquisa, bem como a produzirem pesquisas que resultem em uma prÃtica clÃnica de qualidade, contribuindo para promoÃÃo da saÃde de gestantes, seus conceptos e familiares. E, sobretudo, para a Enfermagem Baseada em EvidÃncias. / This study aimed to search and assess the available evidences in the literature on the Nursing Diagnoses in pregnant women. For this purpose, we performed integrative literature review, following the steps proposed by Whittemore and Knafl (2005). The search and selection of studies were conducted in the LILACS, CINAHL, MEDLINE and SCOPUS databases. The sample consisted of 14 non-experimental studies with evidence level VI. The studies were assessed and divided into three thematic categories: nursing diagnoses in healthy pregnant women; nursing diagnoses in sick pregnant women; and specific nursing diagnoses. Regarding the results, the studies were published between 1999 and 2010, were Brazilians, in Portuguese language, with authors associated to nursing. The first category consisted of five studies, of which the 15 most frequent diagnoses were reported; related to physiological changes of pregnancy. With special reference to the diagnoses Knowledge, deficient; Sleep pattern disturbance; Nausea; and Risk for infection. The second category consisted of seven studies that investigated the presence of nursing diagnoses in patients with diseases such as Hypertension Syndrome of Pregnancy, Premature Rupture of Membranes, Preterm Labor, Acquired Immunodeficiency Syndrome, Iron-deficiency Anemia, i.e. high-risk pregnancies. In this category, diagnoses tended to appear separately in each study, correlated with the pathology that affected the pregnant women who were being investigated. The 33 most frequent diagnoses were highlighted, with emphasis on the diagnoses: Knowledge, deficient; Risk for infection; Acute pain; Impaired home maintenance; Anxiety; Fear; and Ineffective health maintenance. The third and final category consisted of two studies that investigated how the nursing diagnoses Fatigue; Sleep deprivation; and Sleep pattern disturbance occur in pregnancy. The diagnoses portrayed in the review were related to biological, psychological, social and family aspects of the pregnant women, which meets the need to investigate the pregnant woman integrally, as well as to provide holistic care to this population and family. This integrative review followed the appropriate methodological rigor and identified and assessed the nursing diagnoses in pregnant women. Moreover, it allowed the theoretical deepening on the evidence-based practice, the integrative review methods, the nursing diagnoses and the nursing process related to pregnancy. We identified the need to develop experimental or quasi-experimental studies involving the topics of nursing diagnoses in pregnant women, since studies in this review were classified as evidence level VI. Understanding that efforts are needed to develop researches with designs that produce strong evidence related to the issue, thus, raising the generalization of findings. With this review, we aimed to encourage nurses to consume search results, as well as to produce researches that result in a quality clinical practice, helping the health promotion of pregnant women, their fetuses and family. And, above all, for the Evidence-Based Nursing.

Nausea and vomiting of pregnancy (NVP) is the most common medical condition in pregnancy, and, unfortunately, variability exists among pregnant women in the therapeutic effect of anti-emetics as well as in factors that can exacerbate NVP. Identifying and managing these sources of variability will result in significant improvements in the quality of life of pregnant woman. This dissertation addressed clinical pharmacology strategies in managing NVP by focusing on three predominant areas of variability. The first challenge addressed in this dissertation was women with pre-existing gastrointestinal (GI) conditions and adherence and tolerability to prenatal multivitamin supplementation. To identify the role of iron in reducing adherence and increasing NVP and GI symptoms, two separate studies were conducted. In the first study, women randomized to a prenatal multivitamin supplementation with higher iron content experienced more adverse GI effects and increased severity of NVP symptoms. In the second study, after discontinuing iron-containing prenatal multivitamins, two-thirds of women in a prospective cohort reported improvement in their NVP symptoms which was corroborated with validated scales to quantify NVP severity. The second challenge addressed in this dissertation was the effect of heartburn and acid reflux on the severity of NVP. In a controlled, prospective study, women experiencing heartburn and acid reflux experienced greater severity of NVP compared to women with no GI symptoms. Furthermore, treatment of heartburn and acid reflux with acid-reducing pharmacotherapy with associated with a reduction in GI symptoms and NVP severity. Therefore, histamine 2 blockers or proton pump inhibitors, which do not appear to be associated with increased fetal risks, should be administered when required. The third clinical pharmacology challenge addressed in this dissertation was to determine the pharmacokinetic variability of the active ingredients of Diclectin®, first-line pharmacotherapy for the treatment of NVP. Large variability was observed in the area under the curve for both active metabolites: a 6.5-fold difference for pyridoxal-5’-phosphate and a 2.1-fold difference for doxylamine. Whether these pharmacokinetic differences contribute to suboptimal efficacy remains to be determined. In conclusion, based on the results presented in this dissertation, several improvements in clinical pharmacology strategies can be made to enhance management of NVP.

Nausea and vomiting of pregnancy (NVP) is the most common medical condition in pregnancy, and, unfortunately, variability exists among pregnant women in the therapeutic effect of anti-emetics as well as in factors that can exacerbate NVP. Identifying and managing these sources of variability will result in significant improvements in the quality of life of pregnant woman. This dissertation addressed clinical pharmacology strategies in managing NVP by focusing on three predominant areas of variability. The first challenge addressed in this dissertation was women with pre-existing gastrointestinal (GI) conditions and adherence and tolerability to prenatal multivitamin supplementation. To identify the role of iron in reducing adherence and increasing NVP and GI symptoms, two separate studies were conducted. In the first study, women randomized to a prenatal multivitamin supplementation with higher iron content experienced more adverse GI effects and increased severity of NVP symptoms. In the second study, after discontinuing iron-containing prenatal multivitamins, two-thirds of women in a prospective cohort reported improvement in their NVP symptoms which was corroborated with validated scales to quantify NVP severity. The second challenge addressed in this dissertation was the effect of heartburn and acid reflux on the severity of NVP. In a controlled, prospective study, women experiencing heartburn and acid reflux experienced greater severity of NVP compared to women with no GI symptoms. Furthermore, treatment of heartburn and acid reflux with acid-reducing pharmacotherapy with associated with a reduction in GI symptoms and NVP severity. Therefore, histamine 2 blockers or proton pump inhibitors, which do not appear to be associated with increased fetal risks, should be administered when required. The third clinical pharmacology challenge addressed in this dissertation was to determine the pharmacokinetic variability of the active ingredients of Diclectin®, first-line pharmacotherapy for the treatment of NVP. Large variability was observed in the area under the curve for both active metabolites: a 6.5-fold difference for pyridoxal-5’-phosphate and a 2.1-fold difference for doxylamine. Whether these pharmacokinetic differences contribute to suboptimal efficacy remains to be determined. In conclusion, based on the results presented in this dissertation, several improvements in clinical pharmacology strategies can be made to enhance management of NVP.