Literature provides evidence for disparities and inequities in health and birth outcomes based on geographical location, which highlight differential mother characteristics. These differences influence behaviors associated with adverse birth outcomes such as premature birth and low birth weight (LBW), the leading causes of infant morbidity and mortality. Consistent with the Healthy People 2020 and Millennium Development goal, to reduce infant morbidity and mortality rates, we sought to compare maternal characteristics and behaviors and the occurrence of adverse birth outcomes in Northeast (NETN) region, as defined by the Tennessee Department of Health, compared to the rest of Tennessee (TN). TN vital statistics birth record data for the years 2009 - 2014 were used in this analysis; n = 20,786 and 482,681 live births for NETN and TN respectively. Bivariate analyses were performed to deduce the demographic and birth characteristics and their proportions across the years. Logistic regression was used to calculate crude odds ratios for pre-pregnancy smokers, with the dependent variables of preterm birth and LBW. We followed with adjusted odds ratios, which controlled for mother’s demographic variables; age, education years and reported household income and mother’s behavioral characteristics; pre-pregnancy cigarette smoking, prenatal care by first trimester and previous preterm birth. From 2009 through 2014, the percentage of teenage mothers decreased for both TN groups, with a larger proportion in NETN (%:13.8,12.2,12.5, 11.9,9.6,9.4) compared to TN (%:12.8,11.8,10.8,10.0,9.0,8.4). A larger percentage of TN mothers did not have a high school degree or completed GED compared to NETN. A larger proportion of NETN mothers were married at the time of birth of the infant (%:60.3,60.5,59.3,58.6,57.6,57.8) compared to TN mothers (%:55.5,55.9,55.9,55.8,56.0,56.0). Over the period, 34% of NETN women smoked during the 3 months prior to pregnancy versus 21% for TN mothers. Through the third trimester 24% of NETN mothers reported cigarette smoking compared to 13% of TN mothers. Throughout, more adverse birth outcomes were observed in NETN. Compared to non-smokers, for six consecutive years and overall, the odds of a LBW among pre-pregnancy smoking mothers were higher in NETN (odds ratio (OR):2.16,1.73,2.56,2.03, 2.02,1.83,2.05) than in TN (OR:1.51,1.53,1.56,1.56,1.56,1.52,1.54), p-values

Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent, yet controversial diagnosis affecting children and young people. This study aims to inform educational practice and challenge the negative outcomes associated with ADHD by exploring the lived experience of young people and their teachers. I use Interpretative Phenomenological Analysis (IPA) making use of a paired design to explore how student-teacher dyads within a mainstream secondary school conceptualise and experience ADHD. Findings suggest participants’ conceptualisations of ADHD and associated treatment (e.g. medication) were widely varied and influenced by their personal experiences. Consequently, I advocate a bio-psycho-social understanding of the condition as beneficial for both students and teachers. Students experienced stigma and isolation but benefitted from positive relationships with teachers. Teachers found it difficult to assess the need for a different approach when teaching students with ADHD, but also recognised positive relationships as factors to enable student’s success. This study offers a unique contribution to the substantive topic, and original application of a multi-perspective IPA design. Implications for professional practice are discussed and I invite further research to build upon the current findings by addressing the experience of female students with ADHD, wider samples of secondary school teachers, and further multi-perspective designs.

Det är påfrestande att bli förälder och det medför därför en risk att parrelationen blir sämre. Enligt tidigare forskning har föräldrarnas parrelation en betydelsefull inverkan på barnets hälsa. Sjuksköterskans förebyggande arbete inom barnhälsovården är att främja den fysiska, psykiska och sociala hälsan för hela familjen. Eftersom sjuksköterskan på barnavårdscentralen nästan träffar alla föräldrar till barn mellan 0-6 år ger det en unik möjlighet att stödja och stärka föräldrarna i sin parrelation och därmed förebygga ohälsa. Det finns inga nationella riktlinjer att sjuksköterskan skall ge stöd i parrelationen, men det finns förslag att ge stöd och råd vid vissa besök. Det gör att stödet idag ser olika ut beroende på var familjen bor. Syftet är att beskriva föräldrars erfarenheter av stöd i parrelationen inom barnhälsovården. Sex intervjuer genomfördes med föräldrar som levde i en parrelation och hade barn mellan 4-5 år. Intervjuerna analyserades med hjälp av en kvalitativ innehållsanalys. Föräldrarnas erfarenhet är att barnhälsovåden fokuserar på mamma och barn och att ämnet parrelation sällan tas upp. När ämnet parrelation tas upp är det vid hembesök och i föräldragrupper. Föräldrarna önskar att få stöd vid rätt tidpunkt i livet och att sjuksköterskan tar initiativ till samtal om parrelationens betydelse för familjen. Studien avslutas med slutsatser utifrån framkommet resultat till nytta för barnhälsovårdens utveckling. / Program: Specialistsjuksköterskeutbildning med inriktning mot distriktssköterska

Introdução - O uso de bicos artificiais é um hábito cultural com alta prevalência em diversos países. Profissionais e mães acreditam que o uso desses utensílios seja inofensivo, ou mesmo necessário, para o desenvolvimento da criança, tendo atitude indiferente ou permissiva frente ao seu uso indiscriminado. Há mais de 30 anos, consenso científico internacional reconhece bicos artificiais e leites industriais como responsáveis por parte dos índices de morbimortalidade infantil e alterações na saúde da criança. Objetivo - Analisar a influência de fatores socioeconômicos, biológicos e da atuação dos serviços de saúde sobre o uso de bicos artificiais (chupetas e mamadeiras) entre crianças menores de um ano nas capitais brasileiras e Distrito Federal(DF). Métodos- Estudo com delineamento transversal realizado a partir do banco de dados da II Pesquisa de Prevalência de Aleitamento Materno nas Capitais e DF em 2008 na segunda fase da Campanha Nacional de Multivacinação. Foi utilizada amostra por conglomerados, com sorteio em dois estágios. O questionário era composto por questões fechadas incluindo perguntas sobre o uso de chupeta e mamadeira no dia anterior à pesquisa. Foram analisados os fatores associados ao uso de bicos artificiais considerando três desfechos: 1)Uso exclusivo da chupeta; 2)Uso exclusivo da mamadeira; e 3)Uso de bicos artificiais (chupeta e mamadeira). As razões de prevalência e os intervalos de confiança foram obtidos por meio da regressão de Poisson seguindo modelo hierárquico. Resultados Participaram 34.366 crianças menores de um ano. Identificou-se como fatores associados ao uso exclusivo de chupeta mãe trabalhar fora do lar (RP=1,18), primiparidade (RP=1,28), não ter mamado na 1ªhora (RP=1,15) e uso de chá no1ºdia em casa (RP=1,37). Para o uso exclusivo de mamadeira, identificou-se: mãe trabalhar fora do lar (RP=1,39), primiparidade (RP=1,28), baixo peso ao nascer (RP=1,21) não ter mamado na 1ªhora (RP=1,08), uso de leite artificial (RP=1,82) e do chá (RP=1,96) no 1ºdia em casa. O uso de bicos artificiais associou-se ao trabalho materno fora do lar (RP=1,43), primiparidade (RP=1,21), parto cesáreo (RP=1,06), bebês do sexo masculino (RP=1,07), baixo peso ao nascer (RP=1,11), ter nascido em hospital não credenciado como Amigo da Criança (RP=1,12), realizar acompanhamento de saúde na UBS/SUS (RP=0,91), ter ingerido leite artificial (RP=2,06), água (RP=1,18) e chá (RP=1,38) no 1ºdia em casa. Conclusão Caracterizaram-se diferentes perfis de usuários de bicos artificiais, chupetas e mamadeiras. Observaram-se semelhanças e diferenças para cada desfecho. As semelhanças indicam os fatores comuns aos quais profissionais da saúde devem estar atentos. Já as diferenças sugerem que a utilização de chupeta e/ou mamadeira envolve diversas dimensões da vida da mulher/criança/família, perpassando aspectos biopsicossociais e culturais. / Introduction - The use of artificial nipples is a cultural habit with a high prevalence in many different countries. Professionals and mothers believe that the use of those tools is harmless or even necessary for the child\'s development therefore they do not discriminate their use having a permissive approach towards them. For over 30 years, international scientific consensus recognizes artificial nipples and industrialized milk as responsible for part of the morbidity and mortality rates and changes in child\'s health. Objective - To analyze the influence of socioeconomic, biological factors and the health services on the use of pacifier and baby\'s bottle among children under one year old in Brazilian Capitals and Federal District (FD). Methods Cross-sectional study conducted from the database of the Second Research Prevalence of Breastfeeding in all the Brazilian Capitals and FD performed in 2008 in the second phase of the National Vaccination Campaign. Cluster sampling was used, with a draw in two-stages. The questionnaire consisted of closed questions including questions about the use of pacifier and baby\'s bottle on the day preceding the survey. We analyzed the factors associated with the use of artificial nipples considering three possible outcomes: 1)Exclusive use of a pacifier, 2)Exclusive use of the baby\'s bottle, and 3)Use of artificial nipples (pacifiers and baby\'s bottle). Prevalence ratios (PR) and confidence intervals were obtained using Poisson regression following a hierarchical model. Results Sample included 34 366 children under one year old. It was identified as factors associated with exclusive use of a pacifier mother working outside the home (PR = 1.18), primiparity (PR = 1.28), not having breastfed within first hour (PR = 1.15) and use of tea on first day at home (PR = 1.37). For the exclusive use of a bottle, were identified: mother working outside the home (PR = 1.39), primiparity (PR = 1.28), low birth weight (PR = 1.21) had not suckled within first hour (PR = 1.08), use of artificial milk (PR = 1.82) and tea (PR = 1.96) on first day at home. The use of artificial teats was associated with maternal employment outside the home (OR = 1.43), primiparity (PR = 1.21), Cesarean section (PR = 1.06), male infants (PR = 1, 07), low birth weight (PR = 1.11), was born in a hospital is not accredited as \"Baby Friendly\" (PR = 1.12), perform health monitoring in the UBS / SUS (PR = 0.91) , having drunk formula (PR = 2.06), water (PR = 1.18) and tea (PR = 1.38) on first day at home. Conclusion - It was found various user profiles of of pacifier and/or baby\'s bottle. It was observed similarities and differences for each outcome. The similarities indicate common factors to which health professionals should be aware. And the differences suggest that the use of artificial nipples, pacifier or baby\'s bottle involves several dimensions of women\'s lives, biopsychosocial and cultural aspects.

My research takes a social work perspective to investigate the concept of the child with ‘additional needs'. This concept arose out of the Labour Government's programme ‘Every Child Matters' (HM Government, 2003) which proposed that children's needs for support should be picked up at an earlier point by an integrated Children's Services consisting of social care, health and education. This would stop them from ‘falling through the net' of services. A focus on ‘additional needs' should mean that children in distress are helped at an early stage before problems became critical, improving the ‘well-being' of children and their families. The research has traced the cases of twelve children with ‘additional needs' through their contacts with Children's Services, using an interactionist methodology to interrogate the meaning-making between respondents. Further, following Hacking (2004), a Foucauldian approach to discourse allowed me investigate the discourses which shape formal diagnosis and categorization. Focusing on the ways that the child is positioned and perceived has allowed me to address the question of whose ‘need' is prioritized when the child enters the professional gaze. In doing so it has examined the role of formal and informal labels in constructing the child, the emotional content that goes into creating the ‘meaning-labels' of the child, and the ways that failures in knowing about the child affect the ways that a child becomes pictured. It concludes that in the shifting practices that make up Children's Services, the child with additional needs can become lost in the complex interaction between adult needs and emotions. The informal ‘meaning-labels' which arise out of this complexity often identify the child as carrying a ‘spoiled identity'. This can be carried through into practice with the child, including the processes of formal diagnosis and categorization. Adult emotions need to be managed better if children are to get fitting and timely help to allow them to thrive.

Researchers have linked physical activity (PA) with positive health outcomes. Unfortunately, PA in young people continues to be reported as a concern with many not achieving the recommended guidelines. Further, participation in childhood and adolescence is positively associated with PA into adulthood, highlighting the importance of PA habits in young people for lifelong participation. Gender, socio- economic status (SES), and motivation have all been shown to be important factors that influence participation, and as such are a focus of this thesis. Mixed methods research was adopted to ‘investigate the nature of PA in young people within a Scottish context' including quantitative (study one) and qualitative (studies two and three) methodologies. The initial motivation for study one emerged through my personal interest in understanding the nature of young people's participation in structured club activities and the role SES, gender and motivation play in a Scottish context. Sport is often used as a proxy for PA and as such, young people's participation is frequently reported on sports club based activities. On reflection, this focus on ‘weekly club activity sessions,' rather than a more broad, valid, and reliable measure of PA, limited the application of the findings. Nevertheless, the findings and reflection on the methods used in study one informed the direction of the thesis moving forward. More specifically, SES was found to be the strongest predictor of club activity participation, with those from higher SES taking part in more club activity sessions than those from lower SES. No significant gender differences in participation were found. While SES was the sole predictor of school club activities, perceived competence and intrinsic motivation were also important predictors of participation in out-of-school club activities. The regression models predicted between 5% and 27% of the variance in club participation, highlighting the multi-factorial nature of the influencers of participation. In order to understand the nature of PA more broadly in young people from lower SES within a Scottish context and to investigate the complexity of participation influencers, a qualitative methodology was used. Study two investigated low SES Scottish youths' PA experiences across key development stages (i.e., childhood, adolescence and newly identified early adulthood, study two). Results suggested that young people from low SES participate in a high variety of unstructured PA throughout their lives, which is under reported in the literature. Participation in structured sport based activities in childhood, particularly those in which a young person forms a sport ‘identity,' influences future adherence, but also engagement and enjoyment of school physical education (PE). For many young people, particularly those from less affluent backgrounds, school PE may be the only opportunity for them to participate in structured PA. While some young people embraced school PE, others perceived PE a threatening, so leading them to avoid or drop out altogether. Findings showed that in addition to previous experience, the nature of the PE climate also influenced participation as young people entered early adulthood. As well as shedding light on the broad nature of young people's PA from low SES backgrounds, the findings from study two highlighted the role that schools (e.g., through PE) have in influencing young people's PA and associated attitudes. Study three aimed to investigate young people's PA, motivational influences, and the role of schools from the perspective of qualified Scottish PE teachers, knowledgeable on policy issues and active in the development of future teachers. The main findings from study three showed that family influences (mostly parents) and SES were key towards the formation of young people's attitudes and behaviours towards PA, particularly in sports. Those young people with parents not showing any interest in PA were more likely to be inactive compared to those youngsters with active parents. Young people from lower SES backgrounds were less likely to participate in sports activities, thus preventing them from gaining the necessary experiences (and competencies) needed to successfully take part in many school PE activities. Also, this study found that secondary school PE is perceived by many pupils as threatening which subsequently led many to avoid PE altogether. Many young people are not achieving the curriculum expected health and well-being benefits through school PE. The results also highlighted the huge challenge and role conflict that is apparent for PE teachers in schools, which is a barrier to effective promotion of PA and positive attitudes in a range of young people. This thesis supports the contention that SES is an important factor in young people's PA. While those from lower SES were shown to participate in less structured sport club activity than those from higher SES, evidence emerged suggesting that young people from lower SES participate in a variety of unstructured PA which is underreported in the literature. The complexities of PA participation were also apparent where previous experience, parents and school PE were found to have important roles, which either facilitated or debilitated motivation, and participation. This thesis also highlighted that there are serious challenges in delivering an effective PE experience to pupils with a wide range of ability and backgrounds. These challenges were exacerbated by the vagueness of policy guidance (e.g., within Scotland's curriculum for excellence), the pressures of certification, and the mostly sport dominated culture of PE. Implications for policy and practice in relation to the motivational climate of PEemerged. Recommendations for future research and practice in this area are discussed.

Volume I is divided into two papers. The first is a literature review that explored the emotional experience of professionals who work with victims of domestic violence. Twelve papers are evaluated and the evidence of negative and positive effects is presented. The second is a qualitative study with young people, their mothers and their grandmothers which explored resilience after domestic violence. Data was analysed using Interpretative Phenomenological Analysis. Four themes regarding the memories of domestic violence, newfound stability, acceptance and strength and continued and re-scripted attachments were found. Volume II consists of five reports. The first describes the assessment of a 13-year-old boy with low self-esteem. His needs and strengths are formulated from two approaches: cognitive-behavioural and systemic. The next discusses a behavioural intervention and single case experimental design for a 15-year-old male presenting with challenging behaviours. The third paper outlines a Person Centred Care training program for staff working with older adults. The fourth is a case study of two siblings in local authority care. To consider care-plans, a formulation is informed by the complex trauma literature. The final report was an oral presentation of an admission assessment of a young woman in a high secure hospital.

PURPOSE: Pregnancy is a physically impactful process in a woman’s life. During this time, a woman will gain weight and research has shown that many women will retain some extra weight after delivery. Because of this, recovery in the postpartum period is pivotal to avoiding the implications of weight retention. The postpartum period is vastly understudied in both the research and medical communities and this gap between pregnancy and postpartum research needs to be bridged. Therefore, the purpose of this study was to investigate metabolic changes from pregnancy to postpartum and to study how factors such as sleep and breastfeeding can impact metabolic values in the postpartum period. METHODS: Women participated in a pregnancy study visit at 32-34 weeks of gestation (n = 25) and attended two subsequent visits at 4-6 months (n = 25) and 12-13 months postpartum (n = 16). At these visits, the women had a baseline blood draw and baseline metabolic measurements taken via indirect calorimetry. At the pregnancy visit, participants completed a demographic survey and a dietary questionnaire (DHQ-II). At the postpartum visits, they completed the same surveys, along with validated sleep and breastfeeding surveys. RESULTS: Absolute resting metabolic rate (RMR) was significantly higher during pregnancy than at 4-6 months postpartum and 12-13 months postpartum (p < 0.001 and p = 0.001, respectively). Accounting for body weight, relative RMR was significantly higher during pregnancy than at 4-6 months postpartum. With regard to sleep, women deemed to be “good sleepers” had a significantly higher relative RMR than those who were deemed “poor sleepers” (23.6 ± 2.5 vs 20.8 ± 2.3, p = 0.009). With regard to breastfeeding, women who breastfed had a relative RMR than the women who did not breastfeed (22.8 ± 2.6 vs 20.4 ± 2.3, p = 0.046). CONCLUSIONS: There are hypermetabolic changes that take place during pregnancy. These values seem to decrease into the postpartum period. Women who demonstrate an improved sleep quality and who opt to breastfeed tend to have improved metabolic responses. This could help combat the struggle with postpartum weight retention that some women face.

A Health Promoting School (HPS) approach is now widely accepted internationally, with a focus on children’s health, the school curriculum, and whole school environment. In Thailand, the health and well-being of children is a fundamental value. HPS programmes have been implemented in schools as a strategy to focus on young people’s health. A number of barriers to successful HPS have been identified. While there is international evidence to show the steps and the key factors in creating successful HPS, little is known about successful HPS in the Thai context, in particular, in Northeastern Thailand which has been classified the poorest region. Ethnographic methods were used to examine what understanding of the meaning of HPS is necessary for a successful school, and how all those involved acted from the adoption of the HPS programmes by the local school until it achieved HPS status. A rural school which was successful in a HPS programme was selected, in Mahasarakham province, Northeastern Thailand. The data were obtained through participant observation, ethnographic interviews, and ethnographic records, and data analysis took place simultaneously with data collection. In this study, Lofland’s strategy for the analysis of the structure of human interaction was used. A variety of techniques for improving and documenting the credibility of the study such as prolonged engagement, persistent observation, and triangulation were used. This research revealed that the informants’ views reflected diverse understandings of the meaning of HPS. Those views were based on their experiences of HPS which differed according to the degree of participation, different levels of knowledge about HPS, and in the roles they played in the implementation of HPS in the school. Thai culture and school ethos influenced the success of HPS. Community participation was also crucial in supporting the school’s achievement. Key factors that underpinned success are identified. Implications of the findings for the HPS programme, health professionals, the school and community are discussed.

This study presents an analysis of policies addressing child mortality in Pakistan focusing on problem structuring, using a comparison with Bangladesh. Pakistan's progress in addressing child mortality rate has been much slower than that of Bangladesh despite the fact that Pakistan has excelled in economic growth, and the two countries have comparable populations and share political history. This study analyzes and provides an explanation for differential outcomes in terms of problem structuring in the two countries. A comparative analysis of policy documents reviewed for the two countries illustrates the fact that Bangladesh, in formulating its child health policy, has emphasized the input factors such as nutrition and environmental aspects, besides health services. Pakistan, on the other hand, maintains a general problem formulation strategy focusing mainly on health service and ignoring the social, environmental, and other factors causing morbidity and mortality in children. Another comparison between policy formulation in each country and the extensive literature available on child mortality suggest that neither country pays as much attention to structural factors as the literature does. The analysis provides some insight into differentials in policy formulation associated with child mortality in the two countries, but more importantly, it provides an understanding of the underlying elements for inadequate policy outcomes in case of Pakistan.