A partir dos dados coletados pelo Programa de Defesa da Vida dos Lactentes da Secretaria de Higiene e Saúde do Município de Bauru no período de 11 de maio de 1986 a 10 de novembro de 1987, avaliou-se a capacidade de elementos clínicos e sociais, de fácil obtenção no momento do parto, predizer a mortalidade e internação de crianças entre O e 6 meses. O critério diagnóstico com maior sensibilidade para discriminar um grupo de crianças que devem receber uma atenção especial nos períodos de O a 6 dias e de 7 dias a 6 meses foram: - O a 6 dias: peso do recém nascido abaixo de 2500 gr, mãe menor de 18 anos e malformação congênita. - 7 dias a 6 meses: peso ao nascer abaixo de 2750 gr, renda familiar per capita abaixo de 0.75 salário mínimo, e malformação congênita. Outros critérios diagnósticos são apresentados e comparados com estes, entre os quais o do Programa de Defesa da Vida dos Lactentes, calculando-se as respectivas sensibilidades, especificidades e percentual de crianças classificadas como de risco. O mesmo critério diagnóstico proposto para prevenir a mortalidade entre 7 dias e 6 meses foi utilizado para calcular a sensibilidade quando o desfecho e a internação. / According to the data of the \"Infant Life Defense Program\" of the Public Health Office of the \"Municipallity of Bauru during the period of may 11, 1986 to november 10, 1987, we tried to evaluate the capacity of clinical and social characteristics which are obtained at the moment of birth for predicting mortality and hospitalization of children until 6 monthes of life. The diagnostic criterion with more sensitivity to choose a percentage of children to require special care between the first 7 days and betwen 7 days to 6 months of life: - O to 6 days: birth weight less than 2500 g., adolescent pregnancy and congenital malformations. - 7 d. to 6 m.: birth weight less than 2750 g., family revenue less than $27 per capita in a month and congenital malformations. Other diagnostic criteria have been shown and compared by the sensitivity and specificity to the proposals above in which the \"Infant Life Defense Program\" was included. The same diagnostic criteria was used to evaluate the sensitivity for hospitalization.

Introdução: Evidências sugerem uma associação entre nascer pequeno para idade gestacional (PIG) e o risco aumentado de desenvolver problemas de comportamento. Além disso, indivíduos que relatam ter recebido menor cuidado materno apresentam mais sintomas de depressão e de ansiedade, e, de modo geral, cuidam com menos eficiência de seus filhos. Portanto, uma interação entre nascer PIG e a percepção da mãe de baixo cuidado materno recebido nos seus primeiros dezesseis anos de vida poderia estar associada a prejuízos na função cognitiva e risco aumentado para psicopatologias ao longo da vida. O objetivo deste trabalho foi avaliar a interação entre nascer PIG e o cuidado parental percebido pela mãe sobre o comportamento infantil aos 18 meses de vida. Métodos: Estudo transversal aninhado a uma coorte prospectiva canadense de nascimentos – MAVAN (Maternal Adversity, Vulnerability and Neurodevelopment) – realizada entre os anos de 2003 e 2010. Os dados analisados são provenientes de 3 questionários (Parental Bonding Instrument, PBI, Early Chidhood Behavior Questionnaire, ECBQ e Infant-Toddler Social and Emotional Assessment, ITSEA) respondidos pelas mães de 305 crianças. Para análise utilizamos Multivariate Analysis of Variance (MANOVA) com análise de interação para detecção das diferenças entre os grupos. Resultados: Observou-se uma interação entre o cuidado materno percebido pela mãe e o peso ao nascimento na habilidade atencional de crianças aos 18 meses de vida em ambos os instrumentos ECBQ e ITSEA. Crianças nascidas PIG e de mães que relataram ter recebido baixo cuidado materno alcançaram menores escores de atenção relatados nos dois questionários analisados - ECBQ (p=0,002) e ITSEA (p=0,05). Efeitos principais das variáveis preditoras peso ao nascimento sobre os domínios aconchego (p=0,011), assim como do cuidado materno sobre os domínios prazer de baixa intensidade (p=0,016) e transferência de atenção (p=0,004) do ECBQ também foram encontrados. Conclusão: Os achados reforçam a importância de uma visão sistêmica do desenvolvimento que contemple aspectos do ambiente precoce e de cuidados parentais nos primeiros anos de vida. Além disso, o comprometimento da atenção encontrado já aos 18 meses nessas crianças tem implicâncias clínicas, visto que pode servir como sinal de alerta, sugerindo a necessidade de um acompanhamento precoce para esses sujeitos. / Introduction: Evidence suggests an association between being born small for gestational age (SGA) and the increased risk for behavioral problems. Besides that, individuals who report have received lower quality of maternal care show increased prevalence of depression and anxiety, as well as in general are poorer caregivers of their offspring. Therefore, an interaction between the birth weight status and the quality of maternal care perceived by the mother could affect the cognitive functioning later in life. This study aimed to evaluate the interaction between being born SGA and the parental bonding perceived by the mother on the children’s behavior at 18 months of age. Methodology: a nested cross-sectional evaluation of a prospective Canadian birth cohort (MAVAN, Maternal Adversity, Vulnerability and Neurodevelopment), developed between the years of 2003 and 2010. Data from 305 children evaluated at 18 months of age and that had all three questionnaires completed (Parental Bonding Intrument - PBI, Early Chidhood Behavior Questionnaire - ECBQ and Infant-Toddler Social and Emotional Assessment – ITSEA) were used. Multivariate ANOVA accounting for parental interactions was used for the analysis. Results: Children born SGA from mothers reporting low maternal care had lower scores in the attentional set shifting trait (ECBQ, p=0.002) and attention construct (ITSEA, p=0.05) at 18 months of age. We also found isolated effects of SGA decreasing cuddliness (p=0.011) and high maternal care per se increased ECBQ low intensity pleasure (p=0.016) and attentional shifting (p=0.004). Conclusion: The findings reinforce the importance of a systemic developmental vision that integrates early environmental aspects and parental care in the first years of life. Besides, the effects on attention found already at 18 months have clinical relevance as it may serve as a warning sign for this population.

Orientadores: Maria Francisca Colella dos Santos, Maria de Lurdes Zanolli / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T19:15:34Z (GMT). No. of bitstreams: 1 Ravanini_SolangeGagheggi_D.pdf: 4014610 bytes, checksum: 77c3a41ed1d7c30c350441a7c524a29b (MD5) Previous issue date: 2012 / Resumo: Objetivos: Analisar o desenvolvimento visual de lactentes, por meio da identificação dos comportamentos visuais mais freqüentes nos três primeiros meses de vida e identificar qual o mês mais favorável para realização da triagem visual. Método: Estudo analítico, seccional, realizado no CEPRE/FCM/UNICAMP, com lactentes saudáveis, nos três primeiros meses de vida. O instrumento utilizado foi o Método de Avaliação da Conduta Visual de Lactentes. A análise estatística foi realizada pelo modelo loglinear para associações entre o sexo, faixa etária e as respostas dos lactentes em cada prova. Resultados: A amostra do estudo foi de 1073 lactentes (50,1% meninos e 49,9% meninas), sendo no primeiro mês 688 lactentes, no segundo mês 229 e no terceiro mês 156. Verificou-se diferença significante entre a freqüência das respostas dos lactentes e a faixa etária nas provas P3 (sorriso social), P5 (seguimento visual vertical), P7 (exploração visual da mão), P8 (movimentos dos membros ao visualizar objeto) e P9 (estender o braço na direção do objeto visualizado). Na P5 verificou-se freqüência de respostas positivas acima de 95% a partir do segundo mês. Não houve diferença significante nas provas P1-contato de olho, P2- fixação visual, P4- seguimento visual horizontal e P6- observação visual do ambiente. Estas provas apresentaram freqüência superior a 99% já no primeiro mês. A P9 foi significante quando comparada ao sexo. A comparação do sucesso das respostas dos lactentes na aplicação do instrumento de triagem com os meses foi significante entre o primeiro e segundo e entre primeiro e terceiro meses. Conclusão: A triagem do comportamento visual de lactentes deve ser realizada entre o segundo e terceiro meses de vida, pelas provas: P1, P2, P4, P5 e P6, como ação de promoção da saúde ocular e detecção precoce de alterações visuais / Abstract: Objectives: To analyze the visual development of infants, by identifying the most frequent visual behaviors in the first three months and to identify the most favorable month for carrying out visual screening. Method: Sectional analytic study, carried out at CEPRE/FCM/UNICAMP, with healthy infants, during their first trimester. The instrument used was the Assessment Method of Infant Visual Behavior. Statistical analysis was carried out using the log-linear model of association between sex, age and infant responses to each test. Results: The study sample was made up of 1073 infants(of which 50,1% were boys and 49,9% girls), with 688 first month infants, 229 second month infants and 156 third month infants. The results showed a significant difference among frequency of infant responses and age for the following tests: T3 (social smile), T5 (vertical visual tracking), T7 (visual exploration of hands), T8 (arm and leg movements when looking at object) and T9 (arm extension towards the object being visualized). For T5, the frequency of positive answers was more than 95% after the second month. There was no significant difference for tests T1 - eye contact, T2 - visual fixation, T4 - horizontal visual tracking and T6 - visual observation of environment. These tests presented frequency higher than 99% already at the first month. T9 was significant when compared to sex. Comparison of the success of newborn infants for the application of the screening instrument monthly was significant between the first and second months and between the first and third months. Conclusion: Screening of visual behavior of infants should be carried out between the second and third months of life using the tests: T1, T2, T4, T5 and T6, as an action for ocular health promotion and early detection of visual alterations / Doutorado / Saude da Criança e do Adolescente / Doutor em Saude da Criança e do Adolescente

Magister Scientiae (Physiotherapy) - MSc(Physio) / Maternal and child-health and health education are three major concerns of public health organisations and researchers throughout the world. Health education for mothers is a strategy many countries have adopted to improve maternal and child-health. The present study was carried out in Uganda with the objective of exploring the factors influencing the utilisation of postnatal services at Mulago and Mengo hospitals, a government and private hospital. Both hospitals are located in Kampala district in Uganda. The survey, was completed by 330 women who responded to a structured questionnaire that was given to them six to eight weeks after delivery. Questions that were asked generated demographic information about the mothers; mothers’ knowledge about postnatal services; mothers’ socio-economic status and barriers to utilisation of the postnatal services. The participants included all women who delivered in Mulago and Mengo hospitals in November 2003 except for those who had had a neonatal death. The data was analysed using descriptive and inferential statistics. Some of the key findings of the study were that most women lacked awareness about postnatal services and those who knew about these services only knew about immunisation and family planning services. The majority of the mothers did not know about other services, such as physiotherapy, counselling, growth monitoring, and physical examination. Lack of money for transport or service costs, distance from the health care facility, not being aware of the services, lack of somebody to take care of the child at home were some of the main barriers to utilisation of postnatal services. Others included, lack of education, lack of employment, lack of decision-making powers, and lack of time to go back for the service. The ministry of health should educate women and communities about the importance of postnatal care, its availability, and the importance of women having decision-making power over their own health. The health service organization should improve on the quality of care by ensuring that services are provided at convenient hours with privacy, confidentiality and respect and it should evaluate the services periodically from the users perspective to maintain the quality of service. / South Africa

In this study, children s ideas about childcare were investigated cross-culturally, considering gender differences as well as developmental and cultural factors. Children between 4 and 8 years of age were interviewed. A rural Nso sample representing a prototypical interdependent context (N=72) and a German middle-class sample representing a prototypical independent context (N=64) were selected. Through the help of picture cards that showed children caring for babies, the children were asked to answer what aspects of care (e.g. primary care, body contact, or object stimulation) are most important and why they are important. Furthermore, the children were asked to elaborate on what they would like to teach a baby and how to react in certain situations, such as infant crying. It was assumed that the children s ideas reflect the characteristic model of childrearing of the respective cultural community. Older children were expected to express more elaborated ideas, but gender differences in the knowledge about infant care were not expected. Results indicate that the Nso and German children apply different caregiving models. The Nso model is characterized by multiple caregivers, co-occurring care, high sensitivity to negative infant signals, and a focus on body contact. The German model, on the other hand, was based on exclusive attention by the mother and distal parenting, such as object stimulation, face-to-face interaction, and vocal interaction. The German children s unexpected focus on primary care and motor development is discussed with respect to different practical caregiving experiences of the German and Nso children and varying sense of responsibility for infant care. Concerning age and gender differences, the hypotheses were predominantly confirmed. Finally, methodological challenges of cross-cultural research and of interviews with children are discussed, and perspectives for future research are presented.

Research emphasises the importance of the mother-infant relationship for infants’ well-being. To benefit interventions, the current research, using a critical realist lens, investigates an area that research has neglected, which is the subjective experience of the mother-infant relationship, including experiences of moments of connection. Bourdieu’s ‘thinking tools’ enables exploration of mechanisms that may affect the mother-infant relationship. How the study’s results can inform health visiting practice is considered. Six mothers were interviewed, four of whom participated in a video of their mother-infant interaction. Two focus groups, each with six health visitors, discussed their practice in the context of supporting the mother-infant relationship. Interpretative phenomenological analysis and thematic analysis were employed. This research indicated a high arousal state, referred to as Vigilantia, was experienced by mothers and infants. Vigilantia appeared to support mothers’ drive to make sense of their young infants but also seemed associated with mothers’ reliance on a discourse of the ‘traditional baby’, which stressed instrumental care and omitted the relational infant. The mothers found it difficult to make sense of the “bizarre” relational connection they felt for their infants. Health visitors described obstacles to supporting the mother-infant relationship associated with their service’s design and their role. Health visitors also seemed to identify with some mothers and in doing so could overlook the infants. Neoliberal values discount the relational and these values affect the experience of the mother-infant relationship. Ideas for improving practice are suggested, as well as acknowledgment of the need for social structural changes.

Maternal and child-health and health education are three major concerns of public health organisations and researchers throughout the world. Health education for mothers is a strategy many countries have adopted to improve maternal and child-health. The present study was carried out in Uganda with the objective of exploring the factors influencing the utilisation of postnatal services at Mulago and Mengo hospitals, a government and private hospital. Both hospitals are located in Kampala district in Uganda. The survey, was completed by 330 women who responded to a structured questionnaire that was given to them six to eight weeks after delivery. Questions that were asked generated demographic information about the mothers / mothers&rsquo / knowledge about postnatal services / mothers&rsquo / socio-economic status and barriers to utilisation of the postnatal services. The participants included all women who delivered in Mulago and Mengo hospitals in November 2003 except for those who had had a neonatal death. The data was analysed using descriptive and inferential statistics. Some of the key findings of the study were that most women lacked awareness about postnatal services and those who knew about these services only knew about immunisation and family planning services. The majority of the mothers did not know about other services, such as physiotherapy, counselling, growth monitoring, and physical examination. Lack of money for transport or service costs, distance from the health care facility, not being aware of the services, lack of somebody to take care of the child at home were some of the main barriers to utilisation of postnatal services. Others included, lack of education, lack of employment, lack of decision-making powers, and lack of time to go back for the service. The ministry of health should educate women and communities about the importance of postnatal care, its availability, and the importance of women having decision-making power over their own health. The health service organization should improve on the quality of care by ensuring that services are provided at convenient hours with privacy, confidentiality and respect and it should evaluate the services periodically from the users perspective to maintain the quality of service.

Lee Chor To. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 102-112). / Abstracts in English and Chinese. / List of appendices --- p.xi / List of tables --- p.xii / List of figures --- p.xii / Chapter CHAPTER 1. --- INTRODUCTION --- p.1 / Chapter CHAPTER 2. --- LITERATURE REVIEW / Introduction --- p.3 / Prematurity --- p.3 / Parental feelings of a preterm birth --- p.5 / Transition from hospital to home care --- p.11 / Maternal information need --- p.13 / Discharge education --- p.15 / Use of video education --- p.18 / Summary --- p.21 / Chapter CHAPTER 3. --- OBJECTIVES AND METHODOLOGY / Aims and Objectives --- p.22 / Operational definitions --- p.23 / Research design --- p.23 / Sample --- p.24 / Inclusion criteria --- p.24 / Sample size --- p.25 / Sampling procedure --- p.26 / Educational program of infant care --- p.27 / Usual care --- p.27 / Educational video --- p.27 / Data collection methods --- p.30 / Phase I: / Instruments --- p.31 / Chinese version State Scale of the State-Trait Anxiety Inventory for Adults --- p.31 / The Chinese version of the Maternal Confidence Questionnaire --- p.31 / Knowledge Test Infant Care --- p.33 / Social Support Questionnaire --- p.35 / Demographic information --- p.35 / Satisfaction Questionnaire of the Video Education --- p.36 / Date Collection procedure in Phase I --- p.37 / Phase II: / Instrument --- p.39 / Interview guide --- p.39 / Data collection procedure in Phase II --- p.39 / Data analysis --- p.40 / Phase I of the quantitative data --- p.40 / Phase II of the qualitative data --- p.41 / Pilot study --- p.42 / Ethical considerations --- p.42 / Chapter CHAPTER 4. --- FINDINGS / Introduction --- p.44 / Phase I / Sample --- p.45 / Sociodemographic and other characteristics of participating women --- p.45 / Demographic characteristics of infants --- p.46 / Comparison of sociodemographic data between groups --- p.47 / "Maternal outcomes of knowledge, confidence and anxiety about infant care" --- p.52 / Knowledge of infant care --- p.52 / Confidence in infant care --- p.53 / Anxiety concerning infant care --- p.55 / Correlation between outcome measures and sociodemographic data --- p.56 / Video group women perceived satisfaction of the study video --- p.58 / Summary of major findings in Phase I --- p.61 / Phase II / Characteristics of informants --- p.62 / Six categories emerged from the content analysis --- p.63 / Feelings about infant care at home --- p.64 / Concerns about the infant --- p.65 / Perceptions of the discharge process --- p.67 / Sources of support --- p.69 / Help-seeking activities --- p.70 / Perceptions of the usefulness of video education --- p.74 / Differences and similarities in the perceptions of the video group and non-video group women about the experience of caring for their infants at home --- p.77 / Summary of major findings in Phase II --- p.78 / Chapter CHAPTER 5. --- DISCUSSION / Introduction --- p.80 / Sociodemographic characteristics of participants --- p.80 / Effects of video education on knowledge of infant care --- p.83 / Effects of video education on confidence about infant care --- p.85 / Effects of video education on anxiety about infant care --- p.88 / Women's feelings about caring for infants at home and their information need --- p.90 / Preferred methods of learning about infant care --- p.92 / Contributions of the study video --- p.93 / Chapter CHAPTER 6. --- CONCLUSION / Limitations --- p.96 / Implications for nursing practice --- p.98 / Recommendations for farther research --- p.100 / Conclusion --- p.101 / REFERENCES --- p.102 / APPENDICES / Appendix 1a State Scale of State-Trait Anxiety Inventory for Adults (English) --- p.113 / Appendix 1b State Scale of State-Trait Anxiety Inventory for Adults (Chinese) --- p.114 / Appendix 2a Maternal Confidence Questionnaire (English) --- p.115 / Appendix 2b Maternal Confidence Questionnaire (Chinese) --- p.116 / Appendix 3a Knowledge Test of Infant Care (English) --- p.117 / Appendix 3b Knowledge Test of Infant Care (Chinese) --- p.120 / Appendix 4a Social Support Questionnaire (English) --- p.123 / Appendix 4b Social Support Questionnaire (Chinese) --- p.125 / Appendix 5 Demographic information --- p.127 / Appendix 6a Satisfaction Questionnaire of the Video Questionnaire (English) --- p.128 / Appendix 6b Satisfaction Questionnaire of the Video Questionnaire (Chinese) --- p.129 / Appendix 7a Interview guide (English) --- p.130 / Appendix 7b Interview guide (Chinese) --- p.131 / Appendix 8a Ethics approval 2001 --- p.132 / Appendix 8b Ethics approval 2004 --- p.133 / Appendix 9 Permission from Prince of Wales Hospital --- p.134 / Appendix 10 Consent form --- p.135 / Appendix 11 Comments about the video provided by video group women --- p.136 / Appendix 12 Other topics of interest provided by video group women --- p.137

<p>By the late nineteenth century childbirth was firmly established in the domestic sphere. However, in the early years of the twentieth century different forms of maternity clinics were established where normal, as well as complicated, deliveries could take place. The aim of this dissertation is to analyse the institutionalisation of maternity care in a local urban context, the role of women in confinement in this process, and its impact on infant mortality. The geographical setting of the thesis is Sundsvall, a town in northern Sweden. The study concentrates on the period spanning from 1900 to 1930, when local communities, rather than federal agencies, were charged with creating and implementing community standards for maternity care.</p><p>In order to lower the mortality rate of illegitimate infants, and to improve delivery conditions for unmarried women, a maternity home was opened in Sundsvall in 1913. Moreover, a maternity ward was established at the local hospital in 1920. In this study it is clear, that when institutional maternity care became available, the transition was rapid and unhesitating. When analysing the local practices it is possible to highlight the central role women played as part of this process. Initially indigent women and women bearing children out of wedlock accepted the institutional alternative, but shortly thereafter married women of means turned to the newly created wards. As a result of this early acceptance, these institutions were soon filled to capacity. </p><p>During the period in question a significant reduction in infant mortality rates can be noticed in the Swedish towns. A reasonable assumption is that the institutionalisation of maternity care improved infants chances of survival. In the study it is suggested that the institutionalised maternity care made an impact on neonatal mortality, as well as on post-neonatal mortality. The study shows that local practices of care played a key role in infant survival.</p><p>This dissertation reveals the value of examining local practices in order to understand the rapid changes of maternity care. Childbirth changed from being a private matter, taking place in one’s home, to be a public concern, taking place in the institutional setting. At the 1937 Parliament (Riksdag) the responsibility for institutionalised maternity care became a public and a State concern, and maternity care became a part of the Swedish welfare system.</p>

By the late nineteenth century childbirth was firmly established in the domestic sphere. However, in the early years of the twentieth century different forms of maternity clinics were established where normal, as well as complicated, deliveries could take place. The aim of this dissertation is to analyse the institutionalisation of maternity care in a local urban context, the role of women in confinement in this process, and its impact on infant mortality. The geographical setting of the thesis is Sundsvall, a town in northern Sweden. The study concentrates on the period spanning from 1900 to 1930, when local communities, rather than federal agencies, were charged with creating and implementing community standards for maternity care. In order to lower the mortality rate of illegitimate infants, and to improve delivery conditions for unmarried women, a maternity home was opened in Sundsvall in 1913. Moreover, a maternity ward was established at the local hospital in 1920. In this study it is clear, that when institutional maternity care became available, the transition was rapid and unhesitating. When analysing the local practices it is possible to highlight the central role women played as part of this process. Initially indigent women and women bearing children out of wedlock accepted the institutional alternative, but shortly thereafter married women of means turned to the newly created wards. As a result of this early acceptance, these institutions were soon filled to capacity. During the period in question a significant reduction in infant mortality rates can be noticed in the Swedish towns. A reasonable assumption is that the institutionalisation of maternity care improved infants chances of survival. In the study it is suggested that the institutionalised maternity care made an impact on neonatal mortality, as well as on post-neonatal mortality. The study shows that local practices of care played a key role in infant survival. This dissertation reveals the value of examining local practices in order to understand the rapid changes of maternity care. Childbirth changed from being a private matter, taking place in one’s home, to be a public concern, taking place in the institutional setting. At the 1937 Parliament (Riksdag) the responsibility for institutionalised maternity care became a public and a State concern, and maternity care became a part of the Swedish welfare system.