Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-07-15T00:33:15Z No. of bitstreams: 1 Disserta??o.pdf: 1171570 bytes, checksum: b9d60d56611f65106bfe64f3ae580d37 (MD5) / Made available in DSpace on 2016-07-15T00:33:15Z (GMT). No. of bitstreams: 1 Disserta??o.pdf: 1171570 bytes, checksum: b9d60d56611f65106bfe64f3ae580d37 (MD5) Previous issue date: 2015-03-31 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Exclusive breastfeeding (EBF) during the first six months of life is essential to promote proper growth and development, and contribute to reducing child mortality. Socioeconomic, demographic, biological, behavioral, psychological among others, interfere with this practice. However, the measurement of some variables has been a challenge due to the subjectivity and limitations of self-report data, both prone to errors. The identification of similar characteristics patterns among nursing mothers and health professionals allows better understanding of the between interrelationship the various factors associated with breastfeeding, and the role of each individual in that process. To this end, theoretical models can be used by Latent Class Analysis (LCA); statistical technique that seeks to identify characteristics of individuals with similar patterns of behavior; and categorize them into their most likely class their responses. The objectives of this study were: a) identify behavior patterns towards EBF among nursing mothers and health professionals; b) evaluates the factors associated with EBF cessation within the first month of life, including variables that were not previously examined in the literature. This is a cohort study with cross-sectional analysis, which used LCA to design a model with four constructs (maternal emotional state, availability to breastfeeding, maternal attitude towards breastfeeding; and health professional?s attitude towards breastfeeding), each with two latent classes, from 15 indicators surveyed in a birth cohort composed 1.309 women interviewed in the first month after delivery. In addition, logistic regression analysis was also performed to investigate the association between EBF interruption at 1 month of life and the latent variables and other covariates. Four constructs were defined using LCA, three related to maternal characteristics: attitude, emotional state and availability to breastfeeding, and on attitude of health professionals on breastfeeding. The frequency of women with unfavorable emotional state was 36.5%; 14.7% had less availability to breastfeed; and 41.5% had a negative attitude towards breastfeeding; and 62.0% of health professionals had negative attitude towards breastfeeding. The classes unfavorable maternal emotional state (OR=1.62; IC95%: 1.28-2.05), unfavorable health professional?s attitude towards breastfeeding (OR=1.31; IC95%: 1.03-1.67) and negative maternal attitude to breastfeeding (OR=2.18; IC95%: 1.73-2.75) were associated with EBF interruption in the 1st month of life. Maternal education up to elementary school (OR=1.47; IC95%: 1.15-1.89) and family income less than one minimum wage (OR=1.41; IC95%: 1.10-1.81) also presented statistical significance for the denouement. The results for education and income were consistent with the literature. The LCA demonstrated behavior patterns of nursing mothers and health professionals on the EBF. The study found new factors associated with interruption of EBF at 1 month of life. / O aleitamento materno exclusivo (AME) nos primeiros seis meses de vida ? fundamental para promover bom crescimento e desenvolvimento, al?m de contribuir para a redu??o da morbimortalidade infantil. Fatores socioecon?micos, demogr?ficos, biol?gicos, comportamentais, psicol?gicos entre outros, interferem nesta pr?tica. Entretanto, a mensura??o de algumas vari?veis tem se mostrado um desafio devido ? subjetividade e as limita??es de dados autorrelatados, ambos propensos a erros. A identifica??o de padr?es de caracter?sticas similares entre nutrizes e profissionais de sa?de permite compreender melhor a interrela??o entre os diversos fatores associados ? pr?tica da amamenta??o, e o papel de cada indiv?duo nesse processo. Para tal, podem ser utilizados modelos te?ricos, mediante An?lise de Classes Latentes (ACL); uma t?cnica estat?stica que busca identificar caracter?sticas de indiv?duos com padr?es similares de comportamentos; e categoriz?-los em sua classe mais prov?vel, dadas as suas respostas. Os objetivos deste trabalho foram: a) identificar padr?es de comportamento relacionados ao AME entre nutrizes e profissionais de sa?de; e b) avaliar os fatores associados ? interrup??o do AME no primeiro m?s de vida, incluindo vari?veis latentes. Trata-se de um estudo de coorte com an?lise transversal, que utilizou ACL para elaborar um modelo com quatro constructos (estado emocional materno, disponibilidade para amamentar, atitudes maternas e dos profissionais de sa?de quanto ? amamenta??o), cada um com duas classes latentes a partir de 15 indicadores pesquisados em uma coorte de nascidos vivos composta por 1.309 mulheres entrevistadas no primeiro m?s p?s-parto. Ademais, foi realizada an?lise de regress?o log?stica para investigar a associa??o entre a interrup??o do AME no primeiro m?s de vida e as vari?veis latentes definidas e outras covari?veis. Foram definidos quatro constructos, utilizando ACL, tr?s relacionados ?s caracter?sticas maternas: atitude, estado emocional e disponibilidade para amamentar, e um sobre atitude dos profissionais de sa?de quanto ? amamenta??o. A frequ?ncia de mulheres com estado emocional desfavor?vel foi de 36,5%; 14,7% apresentaram menor disponibilidade para amamentar e 41,5% informaram atitudes negativas quanto ? amamenta??o; e 62,0% dos profissionais de sa?de apresentaram atitude desfavor?vel quanto ? amamenta??o. As classes estado emocional materno desfavor?vel (OR=1,62; IC95%: 1,28-2,05), atitude do profissional de sa?de desfavor?vel quanto ? amamenta??o (OR=1,31; IC95%: 1,03-1,67) e atitude materna negativa quanto ? amamenta??o (OR=2,18; IC95%: 1,73-2,75) associaram-se com a interrup??o do AME no primeiro m?s de vida. Escolaridade materna at? ensino fundamental (OR=1,47; IC95%: 1,15-1,89) e renda familiar inferior a um sal?rio m?nimo (OR=1,41; IC95%: 1,10-1,81), tamb?m foram significativamente associados ao desfecho. Os resultados encontrados para escolaridade e renda apresentaram-se concordantes com a literatura. A ACL demonstrou padr?es de comportamentos de nutrizes e profissionais de sa?de quanto ao AME. O estudo encontrou novos fatores associados ? interrup??o do AME no primeiro m?s de vida.

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This thesis deals with the implementation and application of exclusive access for the ARCOR2 system, which is used for collaborative programming of robots, using augmented reality. The goal of this thesis is an analysis of default state, proposal, and implementation of an exclusive access solution for this system. The implementation is extensive and allows for a number of work scenarios, which require the usage of exclusive access. Scenarios are revealed by the system analysis. Based on the analysis proposal of a solution is created. The problem is resolved by creating a global lock manager, which is applied. Patterns of how the manager should be used, are defined in the work. The benefits of this work are effective and easygoing collaborative programming.

Magister Public Health - MPH / World Health Organisation and UNICEF recommend exclusive breastfeeding (EBF) for the first six months and continuation of breastfeeding for two years and beyond. Despite this recommendation, EBF rates have not been optimal globally, with coverage ranging from 1% - 23% in Europe to 0.3% - 73% in sub Saharan Africa. In Zambia, despite recording an increase in EBF during the first six months of life from 61% (2007) to 73% (2014), there is a rapid decline in EBF as infants get older during the first six months, from 94% among infants aged less two (02) months to 45% among infants aged 4 to 5 months. This study explored mothers’ experiences, perceptions and attitudes towards existing Behavioural Change Communication (BCC) interventions and the possible influence thereof on the adoption of exclusive breastfeeding among mothers of infants under six months in Tazara and Chilonga areas of Mpika district.

Master of Public Health - MPH / The World Health Organisation recommendations for breastfeeding in the general population, including mothers living with HIV, emphasise breastfeeding within one hour of birth, exclusive breastfeeding (EBF) during the first six months of life, and continued breastfeeding for up to two years or beyond. However, only 34.8% of infants worldwide are exclusively breastfed for the first six months of life, and as a result, about 1.4 million infants lose their lives due to undernutrition. In South Africa, only 31.6% of infants are exclusively breastfed for the first six months. Despite the benefits of exclusive breastfeeding, many mothers living with HIV do not initiate breastfeeding or discontinue breastfeeding prematurely. It is, therefore, crucial to determine the barriers inhibiting the uptake of EBF and factors promoting mothers living with HIV to adopt exclusive breastfeeding.

Bakgrund: Världshälsoorganisationens rekommendationer är att barn ska helammasde första sex månaderna. Statistiska undersökningar visar att det knappt är 13 procentav barnen i Sverige som helammas vid sex månaders ålder, då många mödrar avslutaramningen tidigare, eller väljer att inte amma alls. Syftet med studien var att belysavad barnhälsovårdssjuksköterskor anser att en moder behöver för att etablera ochunderhålla helamning under barnets första sex månader. Metoden som användes varen kvalitativ innehållsanalys med induktiv ansats med 17 intervjuer. Resultat: Trekategorier identifierades: Information, Stöd och Egenvård. Modern behöver fåinformation om vad amning innebär, hur det fungerar och vad som är normalt när honammar. Stödet från partner och närmsta omgivningen spelar stor roll men även densyn samhället har på amning. Moderns egen motivation och egenvård är viktig för attorka att helamma. Slutsats: Barnhälsovårdssjuksköterskan har en viktig uppgift i attge information, stöd och uppmuntran till egenvård till den ammande modern.Ytterligare studier kring vad en moder behöver för att etablera och underhållahelamning behövs. Även fler studier som belyser hur utbildning av den blivande ochnyblivna modern kan utvecklas och hur BHV-sjuksköterskan ska kunna arbeta medatt ge stöd åt varje enskild moder under de månader hon ammar behövs. / Background: Exclusive breastfeeding is recommended by the World HealthOrganization during the children’s first six months. According to statistics, just under13 percent of children in Sweden are exclusively breastfed at six months of age. Manymothers quits breastfeeding earlier or choose not to breastfeed at all. Aim: The aim ofthis study was to illustrate what child health care nurses considers a mother needs toestablish and maintain exclusive breastfeeding during the child’s first six months.Method: A qualitative content analysis with an inductive approach with 17 interviews.Results: Three categories were identified: Information, Support and Self-care. Mothersneed information about breastfeeding, how it works and what is normal when shebreastfeeds. The support from both partners and the immediate environment plays a bigrole, but also the view society has of breastfeeding in general. The mother’s ownmotivation and self-care are important to be able to breastfeed. Conclusion: The childhealth care nurse has an important task in providing information, support andencouragement to the breastfeeding mother. Further studies on what a mother needs toestablish and maintain exclusive breastfeeding are needed. Suggestions for furtherstudies can be studies that shed light on how the education of the expectant and newmother can be developed and how the child health care nurse should be able to workwith providing support to each individual mother during the months she breastfeeds.

According to the World Health Organization, breastfeeding is natural and the most effective way of nourishment to feed infants and young children to ensure child health and survival. Currently, the World Health Organization, the American Academy of Pediatrics, and other health organizations recommend exclusive breastfeeding during the first 6 months of life. Although exclusive breastfeeding has been shown to reduce the occurrence of adverse health outcomes to the infant and mother, the duration of exclusive breastfeeding remains relatively low in the United States. The theory of planned behavior was used as a theoretical framework for this study. The purpose of the project was to identify the barriers to exclusive breastfeeding among mothers during the first four weeks after delivery. A descriptive research design and a convenient sampling method were used to conduct this study. A questionnaire was used to collect the data from 75 mothers who met the inclusion criteria and who attended 3 selected obstetric and gynecologic private practice physicians' offices. Data analysis was performed by using descriptive and correlational statistics. The findings showed that only 8 mothers continued exclusive breastfeeding during the first 4 weeks postpartum. The major maternal problems identified for not continuing exclusive breastfeeding were (a) insufficient breast milk, (b) sore or painful nipples, (c) return to work or school, and (d) poor latching. Findings suggested that healthcare professionals use the model of the theory of planned behavior to develop interventions that promote a positive attitude toward breastfeeding. A positive attitude toward breastfeeding will create a social change within the community to promote exclusive breastfeeding.

Att amma är karakteristiskt för alla däggdjur och ett beteende som utvecklats under miljontals år. Amning är en global folkhälsoangelägenhet, då bröstmjölken och amningen ger ett dominerande skydd för både barnets och mammans fysiska, kognitiva och mentala hälsa. Enligt Svenska Barnmorskeförbundet ingår det i barnmorskans kompetensbeskrivning attarbeta hälsofrämjande och förebyggande, det inkluderar amning. Barnmorskan ska främja amning, ge information till blivande föräldrar om amningens hälsofördelar samt främja hud mot hudkontakt postpartum. I Sverige har andelen kejsarsnitt varit relativt bestående sedan år 2004, runt 17 procent av alla födslar. År 2015 var den värdsliga siffran 20 procent, vilket innebar att var femte förlossning i världen under året 2015, rapporterades in som kejsarsnitt. Efter ett kejsarsnitt kan mor och barn separeras från varandra postpartum, vilket ökar risken för försenad amningsinitiering jämfört med en vaginal förlossning. Detta på grund av separation de första timmarna postpartum som visat sig vara en avgörande tidpunkt för att etablera amningen. Syftet med föreliggande litteraturstudie var att beskriva om, och i så fall vilka faktorer, som kan påverka exklusiv amning upp till sex månader efter kejsarsnitt hos mödrar med normal, fullgången graviditet. Metoden som användes var en litteraturstudie. Den utfördes baserat på 16 vetenskapliga artiklar, med kvalitativ och kvantitativ ansats. Inhämtat material söktes i databaserna CINAHL och PubMed, dessa analyserades genom en integrerad analys på ett strukturerat och systematiskt sätt. Resultatet presenterade femtiosex faktorer som kan påverka exklusiv amning sex månader efter ett kejsarsnitt. Faktorerna redovisas med hjälp av fyra bärande huvudkategorier; förlossningsvård, modern, barnet och amning. Därtill framkom även elva subkategorier. Resultatet visade att kejsarsnitt påverkade den omedelbara hud mot hudkontakten, som är främjande för den exklusiva amningen postpartum. Även maternella postoperativa komplikationer och livsstilsfaktorer, moderns amningsintention, barnets hälsotillstånd postpartum, amningsstöd, bröst- och amningskomplikationer samt modersmjölksersättning, sågs påverka exklusiv amning. Slutsatsen som kan dras är att föda med kejsarsnitt hotar den omedelbara hud mot hudkontakten som visat sig vara essentiell för den exklusiva amningen postpartum. Det sombland annat visade en lyckad exklusiv amning var kvinnans positiva avsikt och inställning till amning innan födseln. Mer utbildning behövs för all vårdpersonal inom vårdkedjan för kejsarsnitt. På så vis skulle möjligheten kunna öka till att samtliga yrkesgrupper strävar efter gemensamma beslut som gynnar hud mot hudkontakt mellan mamma och barn, och samvård utan separation i största möjliga mån. / Breastfeeding is characteristic of all mammals and a behavior that has evolved over millions of years. Breastfeeding is a global public health issue, as breast milk and breastfeeding provide a dominant protection for both the baby's and the mother's physical, cognitive and mental health. According to The Swedish Association of Midwives (Svenska Barnmorskeförbundet), it is included in the midwife's competence description, that midwives must work to promote health and health prevention, this includes breastfeeding. The midwife must promote breastfeeding, provide information to expectant parents about the health benefits of breastfeeding, and promote skin-to-skin contact postpartum. In Sweden, the proportion of caesareans has been relatively permanent since 2004, around 17 percent of all births. In 2015, the worldly figure was 20 percent, which meant that every fifth birth in the world in 2015 was reported as a caesarean section. After a caesarean section, mother and child can be separated from each other. That might increase the risk of delayed initiation of breastfeeding compared to a vaginal birth. This is due to separation the first hours postpartum which has been proved to be a crucial time to establish breastfeeding. The aim of this literature study was to describe, if and which factors, that could affect exclusive breastfeeding up to six months after a cesarean section, including mothers with a normal and full-term pregnancy. The method performed was a literature study. It was carried out based on 16 scientific articles, with a qualitative and quantitative approach. Collected material was searched in the databases CINAHL and PubMed, these were analyzed through an integrated analysis in a structured and systematic way. Result of the study features fifty-sixfactors that could affect exclusive breastfeeding six months after a caesarean section. The factors are presented using four main categories: maternity care, mother, baby and breastfeeding. In addition, eleven subcategories emerged. The results showed that cesarean section affected the immediate skin-to-skin contact, which is conducive to the exclusive postpartum breastfeeding. Maternal postoperative complications and lifestyle factors, the mother's breastfeeding intention, the child's health condition postpartum, breastfeeding support, breast and breastfeeding complications and breast milk replacement, were also seen to affect exclusive breastfeeding. Conclusion that can be drawn, is that a caesarean section threatens the immediate skin-to-skin contact that has been shown to be essential for the exclusive postpartum breastfeeding. However, the mother’s positive intention and attitude to breastfeeding before giving birth, lead to a successful exclusive breastfeeding. More training is needed for all healthcare staff within the chain for caesarean section. In this way, the possibility could increase, that all professional groups would strive for similar decisions that would be in favor for skin-to-skin contact between mother and child, and cohabitation without need for separation, as much as possible.

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Out of the people who lose their lives during a fire, there is a severeover-representation amongst those with an impairment. Although thereexist certain efforts to solve or diminish this gap, there is still roomfor a great amount of improvement. Throughout this thesis, we lookinto the variables that this issue consists of and put forth a prototypicalsystem to be able to counteract this trend. We go through why solutionslike this are becoming more prevalent and why the focus needs to beput on subjects like this, both for the individual and as a society. Asinterest groups have expressed the necessity of change this can be thestart of a more major movement that encourages both judicial branchesof government as well as those whose goal is monetary gain to continueresearch and changes of policy.