More than 85% of American adults do not consume recommended amounts of fruits or vegetables. Preterm birth and hypertensive disorders of pregnancy are common adverse conditions affecting pregnancy and are leading causes of maternal and fetal morbidity and mortality. Preterm birth affects nearly 10% of all births in the United States and is on the rise, as are hypertensive disorders, which have increased by 25% over the last two decades. Pregnancy is a state of controlled inflammation, and dysregulation has been linked to preterm birth and other adverse gestational outcomes. A healthy diet is recommended in pregnancy, but little is known about the effect fruit and vegetable intake on perinatal outcomes. Omega-3 (n-3) fatty acids are essential dietary components and are known to affect inflammatory state, but little is known about how they affect inflammation in pregnancy. As current evidence is lacking, further research is needed to investigate the relationships between maternal nutrition in pregnancy, inflammation and birth outcomes. The purposes of this dissertation were to: 1) to review and evaluate the current evidence on the relationship between n-3 fatty acids and inflammation in pregnancy; 2) to evaluate the current state of the science on the impact of maternal dietary consumption of fruits and vegetables on preterm birth, gestational diabetes, preeclampsia, small for gestational age, gestational weight gain and measures of inflammation or oxidative stress in pregnancy; and 3) to examine relationships between maternal dietary intake of fruits and vegetables, cytokine expression in early and mid-pregnancy, preterm birth and gestational hypertension. A critical review of literature examining the relationship between inflammation and n-3 intake during pregnancy found that multiple inflammatory cytokines in maternal and fetal tissues were lower in women who received n-3 supplements. A second review of literature review supported an inverse relationship between fruit and vegetables and risk of preeclampsia and suboptimal fetal growth. The available evidence was insufficient to establish relationships between fruit and vegetable intake and gestational diabetes, preterm birth or inflammation. A study evaluating the relationships between maternal fruit and vegetable intake, inflammation and birth outcomes was conducted. This study provided evidence supporting a relationship between first and second trimester cytokine expression and maternal dietary intake of fruits and vegetables. Those who met recommended vegetable intake in the first trimester had higher first trimester serum CRP, IL1-α, IL-6 and TNF-α and lower first trimester cervicovaginal IL-6 levels. Those who met recommendations for first trimester fruit intake had 56% lower risk for preterm birth. Those who met second trimester vegetable intake recommendations had more than twice the risk of developing gestational hypertension. The results of this dissertation provide support for the beneficial effects of omega-3 fatty acids and fruit and vegetable intake in pregnancy. Maternal intake of these dietary components may promote optimal immune status during pregnancy. Supplementation of maternal omega-3 fatty acids may help regulate inflammation via the anti-inflammatory effects their bioactive eicosanoids exert. Fruit and vegetables have antioxidant and anti-inflammatory effects that may also help balance the inflammatory state during pregnancy. These dietary components may help promote favorable immune status during pregnancy and reduce risk of adverse perinatal outcomes such as poor fetal growth, hypertensive disorders of pregnancy and preterm birth.

Bakgrund: Stöd i föräldraskapet är ett av barnhälsovårdens grundläggande uppdrag. Barnhälsovårdssjuksköterskor ska ha goda kunskaper om barns utveckling, hälsofrämjande åtgärder och anknytning mellan barn och föräldrar. Stöd och bekräftelse till pappor i deras föräldraroll är betydelsefullt då deras engagemang i barns uppväxt har positiva hälsoeffekter för barnen. Sveriges arbete för ett jämställt föräldraskap är på rätt väg men det är fortfarande flest mammor som deltar i barnhälsovården. Genom förtroendefulla relationer till barnhälsovårdssjuksköterskor kan pappors involvering i barnhälsovården öka. Syfte: Studiens syfte var att beskriva barnhälsovårdsjuksköterskors erfarenheter av att involvera pappor i barnhälsovården. Metod: Kvalitativ metod har genomförts med induktiv ansats. Semistrukturerade intervjuer gjordes med tio barnhälsovårdssjuksköterskor i södra Bohuslän och Fyrbodal. Dataanalyserades utifrån innehållsanalys. Resultat: I resultatet framkom två kategorier, Att se hela familjen och Organisatoriska förutsättningar. Den första kategorin innehåller tre subkategorier; BHV-sjuksköterskors förhållningssätt vilken belyser hur barnhälsovårdssjuksköterskor med sitt förhållningssätt påverkar hur pappor involveras i barnhälsovården, Familjen som ett team belyser hur viktigt det är att se familjen som en helhet och Stärka pappans föräldraroll. Den andra kategorin har två subkategorier; Enskilda föräldrasamtal visade sig betydelsefulla och förmodas påverka den fortsatta vårdrelationen och Anpassa arbetet efter pappans behov var angeläget för att möjliggöra för pappan att delta. Slutsats: Slutsatsen är att barnhälsovårdssjuksköterskors förhållningssätt är avgörande för relationen till pappor. Betydelsen att se familjen som en helhet, uppmärksamma pappors behov av stöd i sin föräldraroll och enskilda föräldrasamtal ökar pappors involvering och stärker vårdrelationen. Mer insatser från samhället och organisatoriska förutsättningar i barnhälsovården behövs / Background: Support in parenting is one of the fundamental tasks of child health care. Child health nurses should have a good knowledge of children's development, health promotion and attachment between children and parents. Support and affirmation to fathers in their parental role is important as their involvement in children's upbringing has positive health effects for children. Sweden's work on equal parenting is on the right track but there are still mostly mothers who participate in the child health care. Through trusting relationships with child health nurses, fathers' involvement in child health care can increase. Aim: The aim of the study was to describe the experiences of child health nurses in involving fathers in child health care. Method: Qualitative method has been implemented with an inductive approach. Semistructured interviews were conducted with ten child health nurses in southern Bohuslän and Fyrbodal. Data was analyzed based on content analysis. Results: Two categories emerged in the result, Seeing the whole family and Organizational prerequisites. The first category contains three subcategories; Child health nurses' approach highlights how child health nurses with their approach affect how fathers are involved in child health care, The family as a team highlights how important it is to see the family as a whole and Strengthen the father's parent role. The second category has two subcategories; Individual parental conversations proved to be significant and are supposed to affect the continued care relationship and Adapting the work to the father's needs was important to enable the father to participate. Conclusion: The conclusion is that the approach of child health nurses is crucial for the relationship with the fathers. The importance of seeing the family as a whole, paying attention to fathers' need for support in their parenting role and individual parental conversations increases fathers' involvement and strengthens the care relationship. More efforts from society and organizational prerequisites in child health care are needed.

Bakgrund: Små barn spenderar allt mer tid framför digitala skärmar. Enligt WHO:s riktlinjer rekommenderas ingen skärmtid för barn under två år. Folkhälsomyndigheten saknar riktlinjer angående skärmtid, de anser att samtida forskning inte uppnått tillräckligt tydliga slutsatser. Barnhälsovården har som uppdrag att följa barn från födsel till skolstart. Barnhälsovården följer barns utveckling, arbetar hälsofrämjande och fungerar som stöd för familjen. Syfte: Studiens syfte var att beskriva Barnhälsovårdssjuksköterskorserfarenhet av digitala levnadsvanors påverkan på barns utveckling. Metod: En kvalitativ innehållsanalys med induktiv ansats användes. En skriftlig datainsamling gjordes genom frågeformulär med öppen karaktär. Informanterna var elva Barnhälsovårdssjuksköterskor. Resultat: Flera tydliga mönster framträdde hur skärmtid påverkade barnen ur ett utvecklingsperspektiv som bildade resultatets åtta underkategorier samt dessa fem kategorier; Skapar ett beteende som är att likna vid beroende, svårighet att föra dialog och samspela, påverkan på ordförrådet, stödjer anpassning till det digitala samhället och lär sig att hantera och sätta ord på känslor. Konklusion: Barnhälsovårdssjuksköterskornas erfarenhet beskriver att skärmtid kan ha en påverkan på barns utveckling. Barnhälsovårdssjuksköterskorna bör uppmärksamma signaler på beroende, anknytningsproblematik, språkförsening och samspelssvårigheter för att kunna ge råd om hur skärmtid disponeras för barn. / Background: Young children spend more and more time in front of digital screens. According to WHO guidelines, no screen time is recommended for children under two years of age. Folkhälsomyndigheten lacks guidelines regarding screen time, they believe that contemporary research has not reached sufficiently clear conclusions. Child health care is tasked with following children from birth to the start of school. They follow children`s development, work to promote health and act as support for the family. Aim: The aim of the study was to describe child health care nurses' experience of the impact of digital living habits on children's development. Method: A qualitative content analysis with an inductive approach was used. A written data collection was done through open-ended questionnaires. The informants were eleven child health care nurses´. Results: Several clear patterns emerged in how screen time affected children from a developmental perspective that formed the results´ eight subcategories as well as these five categories; Creates behavior that is similar to addiction, difficulty in dialogue and interaction, impact on vocabulary, supports adaptation to the digital society and learns to manage and put emotions into words. Conclusion: The child health nurses' experience describes that screen time can have an impact on childrens´ development. The child health nurses´ should pay attention to signs of addiction, attachment problems, language delay and interaction difficulties in order to be able to give advice on how screen time is allocated for children.

No description available.

Optimal maternal nutritional status is required for development of a healthy infant. Drinking during pregnancy puts mothers at risk for nutrient deficiencies, endangering the health of the fetus and increasing the risk of Fetal Alcohol Spectrum Disorder (FASD). The current body of research has focused on interventions using nutrients important to fetal brain development (choline, DHA, folate, vitamin A, zinc) to reduce FASD in animal models. Whether mothers at risk for having a baby with FASD are consuming adequate amounts of these nutrients during pregnancy is unknown, due to a lack of sufficient research data. Therefore, this study aims to identify intake of nutrients important to fetal brain development in pregnant mothers. Through community engagement and partnerships with Mount Carmel Clinic and other prenatal programs located in Point Douglas and Downtown Winnipeg, 56 pregnant women were recruited and interviewed. Findings show that intake of certain nutrients important to fetal brain development are not being consumed in recommended amounts. While most participants met the Dietary Reference Intakes for zinc and vitamin A, only 44.6% met recommendations for folate, 48.2% for choline, and 16.1% for DHA. Dietary intake was not significantly different between women with alcohol exposure during pregnancy and those without. These results are important due to the high rate (46%) of women with prenatal alcohol exposure. Study outcomes may provide future nutrition interventions to enhance the health of mothers consuming alcohol during pregnancy and their infants, potentially reducing the effects of FASD. / October 2016

MPH, Faculty of Haelth Sciences, University of the Witwatersrand, 2009 / The Integrated Management of Childhood Illness (IMCI) strategy was introduced in Zimbabwe in 1996 to integrate vertical child health care programmes. It has since expanded to cover over 300 first level health facilities out of 897 in 23 districts out of a total of 59 districts in the country. This survey was conducted to measure the quality of care delivered to sick children aged 2 months up to 5 years at first level health facilities implementing IMCI. The management of sick children was observed for 226 children aged 2 months up to 5 years who were brought to primary level health facilities. 226 interviews with child caretakers were conducted, all children included in the survey were re-examined by an experienced IMCI practitioner to ascertain the classification (diagnosis) of child’s illness and the appropriate treatment needed. Finally facilities, services and supplies were assessed in the 35 facilities visited. Seventy one percent of cases were children under 2 years old. The majority of caretakers (88%) were mothers of the sick children. All children were systematically checked for the four main symptoms, 80% of children were checked for general danger signs. About 70% of cases classified as having pneumonia received correct treatment for pneumonia. Almost 50% of cases observed received correct treatment for malaria. Half of the children observed (50%) received their 1st dose at the facility. Just less than half (48%) of the children who needed vaccines left the health facilities with all the needed vaccines. Eighty five percent of caretakers were advised on drug treatment. As a result of the advice received, almost two third (65%) of the caretakers who had been prescribed an antibiotic/antimalarial were able to correctly describe how to give the antibiotic to the iv child. The large majority of caretakers (78%) were satisfied with the health services provided. Over half (54%) of facilities visited had at least 60% of health workers trained in IMCI; 88% of children were managed by health workers who had been trained in IMCI. Drugs were available with the exception with oral rehydration salts (ORS) or sugar salt solution (SSS). Most facilities had supplies and equipment for vaccination, and most had other basic supplies and materials; IMCI chart booklets were found in 91% of facilities. Health facilities which received at least one supervisory visit that included observation of -case management in the last 6 months was only 11% indicating that supervision is not carried out on a regular basis. The management of sick children seen by providers trained in IMCI followed a systematic approach in most cases but there is room for further improvement. Drugs were used rationally. Key supportive elements of the health system were in place in the facilities visited with the exception of regular supervision. However only 38% needing urgent referral were identified and prescribed urgent referral. Weaknesses were also observed in the management of diarrhea, fever and in counseling the caretaker. Only 15% of caretakers were given or shown the mothers card as a job aid and only 23% of caretakers were told on when to return immediately. The IMCI strategy has the potential to act as a powerful channel to improve the quality of services. As the survey was unable to determine reasons for poor performance observed, further research is required to investigate the factors leading to poor health worker performance.

Thesis advisor: Ruth G. McRoy / India has the world’s highest burden of child undernutrition. Lack of income has been attributed as the primary cause of child undernutrition. However, evidence suggests that despite steady economic growth and investments in social services directed towards child welfare, undernutrition rates in India are persistent. Thus factors impacting child undernutrition are entrenched within the social fabric of a community. Previous studies indicate that countries that have higher gender inequality have poorer health outcomes for women and children. India with its dominant patriarchal structure and deep-rooted gender biases has disproportionately worse outcomes for women and children. This dissertation study was designed to do the following: 1) emphasize the importance of maternal autonomy and health related awareness as factors significantly impacting maternal health and child nutritional status and 2) use a strengths-based approach to make recommendations for child welfare policy. By applying an asset-based approach, the social capital within a community is recognized interventions can be developed using community and individual level strengths. This study fills the gap in literature on the role of maternal autonomy and health related awareness on child nutritional status, particularly in communities with high levels of gender inequality. The current study utilized data from the India National Family Health Survey Round-3 (NFHS-3) to conduct a cross sectional analysis. The study sample consisted of urban married women between ages of 15-49 years who had at least one living child between the ages of 0-5 years (N= 9,092). It utilized the UNICEF ‘model of care’ and three distinct theories (i) Ecological Systems Theory, (ii) Capability Approach, and (iii) Positive Deviance Inquiry to develop the conceptual framework. Scales measuring maternal autonomy and health related awareness were developed and validated. Ordered Logistic Regression and Kohler mediation model were utilized to examine the relationship between maternal autonomy and health related awareness and child nutritional status and the mediation effect of maternal health. Implications are provided for child welfare policy and practice, social work policy and research. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

A atenção integral à saúde da criança tem sido foco de interesse no Brasil, com vistas a contribuir para redução dos índices de morbimortalidade infantil, ao ampliar propostas de prevenção de agravos, promoção, manutenção e recuperação da saúde, buscando um cuidado de qualidade às crianças. Com a incorporação de novas tecnologias, a reorganização do sistema de saúde e o envolvimento de diversos agentes e segmentos sociais, houve possibilidades de melhoria na sobrevida das crianças, porém índices de óbitos neonatais e nascimentos prematuros ainda preocupam. No Brasil, em 2010, o índice de prematuros foi de 9,2%, com 279,3 mil partos de prematuros ao ano. Este estudo teve como objetivo analisar as experiências de enfermeiros que atuam em unidades de Estratégia Saúde da Família (ESF) quanto aos cuidados de crianças nascidas pré-termo, na perspectiva da vigilância à saúde da criança. Trata-se de estudo exploratório, com análise qualitativa dos dados baseada na análise de conteúdo do tipo temática indutiva, fundamentado nos princípios conceituais da vigilância à saúde. Foram realizadas entrevistas semiestruturadas com 21 enfermeiros atuantes na ESF em município do interior paulista. Os resultados foram agrupados em três temas: Vigilância à saúde da criança pré-termo: concepções e estratégias; A prática da vigilância à saúde da criança nascida pré-termo; Os saberes de enfermeiros na prática clínica na Atenção Primária à Saúde (APS) da criança pré-termo. Foi possível identificar as concepções desses profissionais sobre a vigilância à saúde da criança, com destaque para uma visão de vigilância como ampliação do olhar profissional, com acompanhamento contínuo, detecção precoce de problemas e agravos, com enfoque no processo de crescimento e desenvolvimento da criança e monitorização dos indicadores de saúde. Na prática da vigilância à saúde das crianças pré- termo, foi apontado o acompanhamento de perto, garantindo um adequado crescimento e desenvolvimento infantil, uma melhor qualidade de vida para as crianças, sendo fundamental a realização do pré-natal de qualidade, com captação precoce das gestantes e avaliação das condições de vulnerabilidade, compreendendo os múltiplos significados da gestação, tanto para a mulher quanto a sua família, o seu acolhimento, esclarecimento de dúvidas, identificação de enfermidades maternas que podem interferir na evolução da gravidez, acompanhamento do crescimento e vitalidade fetal, a vigilância e detecção precoce dos fatores de risco que levam às complicações gestacionais. Ressaltou-se a importância da consulta de enfermagem e da visita domiciliária como prática da vigilância à saúde da criança. Considerou-se a importância de desencadear processos de educação permanente, nas unidades de saúde da família, voltado à essa temática, sendo necessário maior investimento nos diferentes pontos de atenção e setores, bem como organização do atendimento na Rede de Atenção à Saúde, o apoio institucional, o compromisso da gestão dos enfermeiros e dos gestores. O estudo traz contribuições para repensar o protagonismo do enfermeiro, da prática orientada por conhecimentos oriundos de diversas fontes, os saberes aplicados de forma criativa e que promovam uma atenção à saúde de excelência, com segurança e qualidade, com compartilhamento entre profissionais, indivíduos, famílias e comunidade, em busca da integralidade da atenção à saúde da criança / Child healthcare has been the focus of interest in Brazil aiming at contributing to the reduction of infant mortality rates by developing complication prevention proposals, promotion, maintenance and restoration of health, seeking higher child healthcare quality. With the new technologies, the health system restructuring and several professionals\' and social groups\' involvement, there was room for improvement in the survival of children, however, neonatal death rates and premature births still worry. In Brazil, 2010, the rate of premature was 9,2% with 279,300 premature birth a year. This study aimed at analyzing the experiences of nurses working in Family Health Strategy (ESF) units regarding the preterm infants\' care in the child health monitoring perspective. This is an exploratory study with qualitative analysis based on the inductive thematic content analysis, based on the conceptual principles of health surveillance. Semi-structured interviews with 21 nurses working in the ESF units in a city in the interior of São Paulo were conducted. The results were classified in three themes: Preterm Child health surveillance: concepts and strategies; Preterm-born child health monitoring practice; Nurses\' knowledge on clinical practice in preterm child primary health care (PHC). It was possible to identify these professionals\' concepts on child health surveillance, highlighting the development of the professional\'s view, with continuous monitoring, early detection of problems and complications, focusing on the child growth and development process, in addition to the monitoring of health indicators. In the term and preterm infants\' health surveillance practice, close monitoring was determined as vital, seeking to ensure proper child growth and development as well as a better quality of life for children. Therefore, providing quality prenatal care is key, with early identification of pregnant women and assessment of vulnerable conditions, grasping the multiple meanings of pregnancy for the woman and her family as well: the woman\'s reception, clarification of doubts, identification of maternal diseases that can interfere in the evolution of pregnancy, monitoring of fetal growth and vitality, surveillance and early detection of risk factors that lead to pregnancy complications. It was emphasized the importance of nursing consultation and home visits, considered as child health surveillance practice. The importance of triggering permanent education processes was considered, in the Family Health Strategy units, aiming at surveillance, besides the need for investment in different levels of attention and sectors as measure of care organization in the Network Health Care, institutional support, the commitment of the management of nurses and managers. The study brings contributions to rethink the nurse\'s role, the practice oriented by the knowledge acquired from several sources, applied in a creative manner promoting health care excellence, with safety and quality, with sharing among professionals, individuals, families and community, in search of child healthcare

Thesis advisor: Summer S. Hawkins / Preventing poor health in childhood is a national social work and public health priority in the United States. Importantly, child health and wellbeing is explicitly linked with maternal health. Thus, maternal depression, a common mental illness, is a concern not only for the mother, but for the health of her offspring. The purpose of this three-paper dissertation was to extend the understanding of child health and wellbeing at age 9 years old in the context of maternal depression. Analyses utilized data from the Fragile Families and Child Wellbeing study and were guided by a resilience perspective, life course perspective, family systems theory, and ecological systems theory. Paper 1 examined the unique impact of maternal depression on child physical health outcomes utilizing a series of logistic regression analyses. Findings indicated that multiple individual-, maternal-, and family-level risk and protective factors influenced the association between maternal depression and child physical health. Paper 2 utilized latent profile analysis and multinomial logistic regression analyses to examine child physical health and psychosocial wellbeing in the context of maternal depression. Five distinct profiles of child health and wellbeing were identified, suggesting the traditional dichotomy of healthy versus unhealthy may fail to capture the complex nature of child health and wellbeing for those experiencing maternal depression. Results showed that maternal depression was associated with increased risk of poor health and wellbeing, yet also emphasized the ability for children to achieve resilient functioning. Paper 3 explored the impact of maternal depression on the maternal-child relationship and the protective nature of interpersonal supports and community resources. Findings indicated that interpersonal and community resources directly and indirectly supported a positive maternal-child relationship for mothers with depression. Altogether, results extend the literature base by providing a more nuanced and complete examination of child health and wellbeing in the context of maternal depression, with a focus on the potential for resilient functioning among this at-risk population. Findings provide evidence that even in the context of risk, protective factors exist that support resilient functioning. Results have important policy and practical implications, including continued screenings for maternal depression in a primary care setting. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

We explored the role that exogenous and endogenous competitors for attention play in infants’ abilities to encode and retain information over a 6‐month period. Sixty‐six children visited the laboratory at 15 months, and 32 returned for a second visit at 21 months. Children observed models of conventional‐ relation and enabling‐relation action sequences. Half the children were distracted by a “Mister Monkey” mechanical toy during the conventional‐relation sequence, while the other half was distracted during the enabling‐relation sequence. The Early Childhood Behavior Questionnaire indexed endogenous factors at both ages. Immediate postmodel production of target actions indexed encoding efficiency, and 6‐month production of target actions indexed long‐term recall. The exogenous distracter impacted encoding efficiency (i.e., immediate recall), but not long‐term recall. Endogenous factors (i.e., temperament) were primarily associated with long‐term recall. Of special interest was our finding that endogenous factors, especially surgency, moderated the effect of the exogenous distracter. It appears that when learning conventional‐relation sequences in the presence of exogenous distracters, surgency mobilizes attentional resources toward the learning objective; however, when learning enabling‐relation sequences under the same conditions, surgency either boosts the saliency of the distracters or boosts children’s susceptibility to them.