Thesis (M.S.)--Boston University

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This master’s thesis is focused on the concept of the assessment centre method relevant for the positions of the guide, the expert salesman and the information centre employee, which are staffed in MOSER, a.s. company. The attention is located on the determination of the terms, the estimation of the specific positions through the project. The main aim was given on the realization of the assessment centre and especially to the proposals related to its implementation.

Several factors may affect the choice of place of delivery among expectant mothers in Ghana and few studies have examined the choice of place of delivery with a focus on differences between rural and urban areas. In this study, the factors that influence the choice of place of delivery among expectant mothers in both rural (Tolon District) and urban (Tamale) settings in the northern part of Ghana were identified and compared using the conceptual framework provided by Thaddeus and Maine. A mixed-method study was used to examine expectant mothers and their responses related to factors that affect their choice of place of delivery through a concurrent triangulation using health professional interviews and a detailed participant survey.. The sample consisted of 552 expectant mothers between the ages of 15 and 49 years. Individual interviews were held with 8 health professionals (4 each from rural and urban areas) with a minimum of 5 years of work experience and a focus group discussion with randomly selected pregnant women and lactating mothers. Themes were generated through open coding of the interview data, while multiple regression was performed to identify the factors associated with choice of place of delivery, rural area, preference (60.1%) was for home delivery compared to 20.7% for urban participants. Statistically significant variables affecting the choice of place of delivery among study participants were found to be educational background, the experience of previous deliveries, the attitude of hospital staff toward pregnant women during labor, and frequency of accessing antenatal care. The study's implications may lead to positive change where stakeholders develop and implement policies to promote health facility delivery for expectant mothers in both rural and urban areas of Ghana.

Bakgrund: Förlossningsupplevelser påverkar föräldrar psykologiskt, fysiskt, socialt och kulturellt. Föräldrarnas upplevelser av förlossningen har både omedelbara och långvariga effekter på deras hälsa och relation till varandra och sitt barn. Syfte: Syftet med studien var att belysa faktorer som kan bidra till negativa förlossningsupplevelser hos föräldrar. Metod: Datamaterialet bestod av ett frågeformulär som besvarats av 211 kvinnor som fött barn vid ett sjukhus i Norrland mellan åren 2006-2010 och som uppgivit en negativ förlossningsupplevelse på VAS-skala. Studien bygger på föräldrarnas svar på en öppen fråga "egna kommentarer" och "pappas kommentarer". Materialet har analyserats med kvalitativ innehållsanalys. Resultat: När kvinnornas svar hade analyserats framkom sex huvudkategorier. Huvudkategorierna var: "Bristande kommunikation och information", "Missnöje med personalens förhållningssätt", "Svårt att hantera smärtan", "Missnöje med förlossningen och förlossningssätt", "Oro och Rädsla" samt "Bristande närvaro och stöd". Diskussion: Faktorer som kunde bidra till negativa förlossningsupplevelser var om förlossningsförväntningarna inte motsvarade hur förlossningen faktiskt blev. Föräldrar som var rädda eller oroliga inför förlossningen fick i högre grad en negativ förlossningsupplevelse. Bristen på känslan av kontroll, där föräldrarna inte kände sig delaktiga eller hade kunnat påverka besluten under förlossningen ger oftare negativa förlossningsupplevelser. Förlossningens längd, förlossningssätt, interventioner och smärtupplevelser var viktiga komponenter hur förlossningsupplevelsen blev. Barnmorskans stöd, information och förhållningssätt till föräldrarna påverkade också förlossningsupplevelsen. / Background:Childbirth experiences affect parents psychologically, physically, socially and long-term effects on their health and their relationship to each other and their children. Purpose: Purpose of the study was to illuminate the factors that may contribute to adverse experiences of parents.Method: The data consisted of a questionnaire answered by 211 women who had a baby at a hospital in northern Sweden between the years 2006-2010 and who have provided a negative birth experience on the VAS scale. The study is based on parents responses to an open question "own comments" and "dad’s comments". Material was analyzed using qualitative content analysis.Results: When the women's responses were analyzed, revealed six major categories. Main categories were: "Lack of communication and information," " Dissatisfaction with staff attitude, " "Hard to manage pain," " Dissatisfaction with labor and mode of delivery," " Worry and fear" and "Lack of presence and support". Discussion:Factors that could contribute to negative birth experience was about childbirth expectations did not correspond to the birth actually became. Parents who were afraid or nervous about giving birth had a greater negative birth experience. Lack of sense of control, where the parents did not feel involved or had been able to influence decisions during labor gives more negative birth experiences. Redemption duration, mode of delivery, interventions and painful experiences were important components of the childbirth experience was. Midwife support, information and attitude to parents affected the birth experience.

Darbe atlikta turinio (content) analizė, siekiant išsiaiškinti koks socialinis įvaizdis apie bendruomenes formuojamas spaudoje. Taip pat atliktas veiklos tyrimas, tikintis pakeisti X bendruomenės socialinį įvaizdį. Iškeltos hipotezės: 1. Tikėtina, kad spauda pateikia įvairų (tiek „laukiančios“, tiek „galinčios“) bendruomenės įvaizdį, atspindėdama nepakankamai reikšmingą visuomenės požiūrį į bendruomenę ir jos veiklą. 2. Tikėtina, kad bendruomenei kryptingai bendradarbiaujant su spauda, galimi įvaizdžio pokyčiai (nuo „laukiančios“ iki „galinčios“). Tyrimo objektas. Spaudos poveikis formuojant bendruomenės, kaip ,,galinčios“ ar ,,laukiančios“ institucijos socialinį įvaizdį. Tyrimo dalykas. Bendruomenės socialinio įvaizdžio ypatumai ir jo formavimo galimybės spaudoje. Remiantis tyrimo objekto bei dalyko formuluote iškeltas tyrimo tikslas – išsiaiškinti, kokį bendruomenės įvaizdį pateikia spauda (bendruomenės, kaip ,,galinčios“ ar ,,laukiančios“ institucijos), bei atskleisti bendruomenės įvaizdžio formavimo galimybes. Duomenų patikimumo garantas siejamas su turinio (content) analizės tyrimo rezultatais. Tyrimo intersubjektyvumo kontrolė buvo vykdoma pasitelkiant ekspertų apklausą (apklausos taikymas turinio analizės situacijoje išsamiai aprašytas Kardelio, 2002). Šio magistro darbo ekspertų grupę sudarė keturi asmenys: bendruomenės kurso dėstytoja, vienas bendruomenės centro pirmininkas ir jo pavaduotojas, šio darbo autorė. Svarbiausios tyrimo išvados: 1. Mokslinės... [toliau žr. visą tekstą] / This paper work deals with the content analysis in order to find out what social image of communities is formed in the press. In addition to this, an activity research has been carried out with a view to changing social image of X community. The following hypothesis were made: 1. Presumably, the press presents a diverse image (both „expectant“ and „capable“) of community, reflecting insufficiently meaningful attitude of society towards the community, its activities and influence on social, economical, environmental, educational and cultural sectors. 2. Presumably, if the community purposefully cooperates with the press, there is a possibility of changes in image (from „expectant” to „capable”). Research object. Influence of the press on developing a social image of a community as „capable” or „expectant” institution. Research subject. Peculiarities of social image of a community and opportunities of its development in the press. Based on the statement of the research object and subject, the aim of the research was stated – to find out what image of community is made by the press (community as ,,capable” or ,,expectant” institution) and to reveal opportunities of developing image of a community. Guarantee of data reliability is related to the results of the research of content analysis. The control of research intersubjectivity was carried out with the help of experts’ survey (the use of this survey in the situation of content analysis was thoroughly described by... [to full text]

Background The Parent-Infant Home Visiting Programme (PIVHP) is a home-based parenting programme targeted at new and expectant mothers, characterised as vulnerable. Participants are recruited from low-income communities situated on the Cape Flats, in Cape Town, South Africa. The programme consists of antenatal and postnatal sessions, facilitated by trained Parent Infant Attachment Counsellors (PIACs) recruited from target communities. There are two programme cycles per year: one from January to June, and a second one from July to December. The overarching goal of PIHVP is to contribute towards the prevention of child abuse, abandonment and neglect; and to promote positive infant growth and development. The programme has to date not been guided by an explicit theory of change (TOC). There was no Monitoring and Evaluation (M&E) system in place, at the time of the evaluation, either. The programme engages in extensive data collection for administrative purposes. This data, however, is not captured nor analysed systematically to monitor progress or measure impact. This formative evaluation aims to capitalise on the existing data. Evaluation Focus This evaluation focused on the first 2019 programme cycle. The main objective of this evaluation was to determine the extent to which the PIHVP had been implemented with fidelity. As such, a process evaluation was conducted to address the following evaluation questions: 1. Did the PIHVP beneficiaries recruited for the first 2019 programme cycle meet the eligibility criteria specified by programme? 2. What proportion of participants completed and dropped out of the PIHVP during the first programme cycle of 2019? What are the reasons provided for programme dropout? questions: 3. To what extent did the PIHVP meet its targeted number of participants? What are the reasons for over/under coverage? 4. Did the participants receive the home-visiting sessions at the duration and frequency prescribed by the programme model? 5. Did PIACs complete and conduct all programme activities, developmental screenings and demonstrations as intended? 6. How did participants perceive PIACs in terms of the support they provided and their preparation level, knowledge, and reliability? 7. To what extent do PIACs implement the skills acquired through their training into their sessions? 8. Are the participants satisfied with the service they received? What are the strengths and limitations they identified? 9. To what extent did participants engage with the PIACs (around the content) during home-visit sessions? Methodology The evaluator first extracted and refined the programme's TOC through structured consultations with the programme manager. The plausibility of the PIHVP's programme theory was then assessed through an extensive literature review. The evaluator then proceeded with the process evaluation. A mixed methods approach was used, as combination of both primary and secondary data sources, and quantitative and qualitative data analysis were used to systematically answer the evaluation questions.

<p>Härtill 5 uppsatser.</p> / digitalisering@umu

Introdução: A Síndrome HELLP é uma complicação das formas graves de préeclampsia caracterizada por hemólise, elevação das enzimas hepáticas e plaquetopenia. O tratamento gera discussão principalmente nos casos abaixo de 34 semanas. Objetivos: Caracterizar a população internada com diagnóstico de Síndrome HELLP no HCFMUSP entre 2001 a 2011. Associar os parâmetros clínicos e laboratoriais maternos como preditores de complicações maternas e perinatais. Caracterizar os resultados perinatais e complicações maternas na conduta conservadora. Método: Estudo retrospectivo observacional e analítico. Resultados: Foram internadas 51 pacientes. A idade média foi de 27,48 anos, a maioria foi da cor branca (47%) e com pelo menos mais de 1 gestação (62,75%). Apenas 15,69% apresentavam hipertensão arterial crônica. A idade Gestacional média foi 30,94 semanas. Os sintomas clínicos e exames laboratoriais maternos não apresentaram relação com as complicações maternas e resultados perinatais. As complicações maternas não apresentaram relação com resultados perinatais, exceto a Idade gestacional. A conduta conservadora foi possível em 16 pacientes com ganho médio de 12,94 dias na gestação. As complicações maternas foram insuficiência renal aguda em 3 casos, descolamento de placenta em 2 casos e iminência de eclampsia em 1 caso. As complicações perinatais foram sepse em 10 casos, angústia respiratória em 10 casos, hemorragia intracraniana em 2 casos, enterocolite necrosante em 2 casos, Apgar < 7 no 5° min. em 2 casos e óbito neonatal tardio em 2 casos, permanência no berçário em média de 41,47 ± 21,75 dias. A idade gestacional média no parto foi de 30,56 ± 3,41 semanas. O peso médio dos recém-nascidos foi 1.116,64 ± 393,52 g. A conduta resolutiva foi necessária em 19 pacientes e as complicações maternas observadas foram insuficiência renal aguda em 5 casos, descolamento de placenta em 1 caso, iminência de eclampsia em 4 casos e eclampsia em 4 casos. As complicações perinatais foram sepse em 12 casos, angústia respiratória em 10 casos, hemorragia intracraniana em 4 casos, Apgar < 7 no 5° min. em 3 casos e óbito neonatal tardio em 2 casos, permanência no berçário em média de 58 ± 23 dias. A idade gestacional média no parto foi de 28,93 ± 2,11 semanas. O peso médio dos recém-nascidos foi 1.090 ± 307,49 g. Conclusão: Não há relação direta entre a gravidade da doença materna e resultados perinatais adversos. A Idade gestacional foi a única variável determinante para os resultados perinatais. Na conduta conservadora houve ganho de 2 semanas na gestação e 17 dias a menos de permanência no berçário / Introduction: The HELLP syndrome is a complication of severe forms of preeclampsia characterized by hemolysis, elevated liver enzymes and thrombocytopenia. The treatment is questioned especially in cases before 34 weeks. Objectives: This study aims to characterize the population of hospitalized patients with HELLP Syndrome at HCFMUSP 2001-2011. To associate maternal clinical and laboratory parameters as predictives for maternal complications and adverse perinatal outcomes. Other aim is to charaterize maternal and perinatal outcomes in the expectant management. Methods: This is a retrospective observational and analytical study. Results: There were 51 patients hospitalized. The mean age was 27.48 years, most were white (47%) and had at least one pregnancy (62.75%). Only 15.69% had chronic arterial hypertension. The average gestational age was 30.94 weeks. The maternal clinical symptoms and laboratory tests did not correlate with maternal complications and perinatal outcomes. Maternal complications were not associated with perinatal outcomes except gestational age. Expectant management was possible in 16 patients with in average gain of 12.94 days of pregnancy. Maternal complications were acute renal failure in 3 cases, placental abruption in 2 cases and imminent eclampsia in 1 case. Perinatal complications were neonatal sepsis in 9 cases, respiratory distress syndrome in 10 cases, intracranial hemorrhage in 1 case, Apgar score less than 7 at 5° minute in 2 cases and neonatal late death in 2 cases, period of hospitalization in average of 41.47 ± 21.75 days. The gestational age at delivery was in average 30.8 ± 3.41 weeks. The weight of the newborns was in average 1116.64 ± 393.52 in average. Immediate interruption was need in 19 patients and the maternal complications were acute renal failure in 5 cases, placental abruption in 1 case and imminent eclampsia in 3 cases, eclampsia in 4 cases; Perinatal complications were: neonatal sepsis in 12 cases, respiratory distress syndrome in 14 cases, intracranial hemorrhage in 4 cases, necrotizing enterocolitis in 1 case, Apgar score less than 7 at 5° minute in 3 cases and neonatal late death in 1 case, period of hospitalization in average of 58 ± 23 days. The gestational age at delivery was in average 29.4 ± 2.4 weeks. The weight of the newborns was in average 1090 ± 307.49 in average. Conclusion: There is no direct relationship between the severity of maternal disease and adverse perinatal outcomes. The gestational age of delivery was crucial to perinatal outcomes. There were gain of 2 weeks of gestational age between hospitalization and delivery and 17 days less of hospitalization for newborns in the expectant management

Introdução: A Síndrome HELLP é uma complicação das formas graves de préeclampsia caracterizada por hemólise, elevação das enzimas hepáticas e plaquetopenia. O tratamento gera discussão principalmente nos casos abaixo de 34 semanas. Objetivos: Caracterizar a população internada com diagnóstico de Síndrome HELLP no HCFMUSP entre 2001 a 2011. Associar os parâmetros clínicos e laboratoriais maternos como preditores de complicações maternas e perinatais. Caracterizar os resultados perinatais e complicações maternas na conduta conservadora. Método: Estudo retrospectivo observacional e analítico. Resultados: Foram internadas 51 pacientes. A idade média foi de 27,48 anos, a maioria foi da cor branca (47%) e com pelo menos mais de 1 gestação (62,75%). Apenas 15,69% apresentavam hipertensão arterial crônica. A idade Gestacional média foi 30,94 semanas. Os sintomas clínicos e exames laboratoriais maternos não apresentaram relação com as complicações maternas e resultados perinatais. As complicações maternas não apresentaram relação com resultados perinatais, exceto a Idade gestacional. A conduta conservadora foi possível em 16 pacientes com ganho médio de 12,94 dias na gestação. As complicações maternas foram insuficiência renal aguda em 3 casos, descolamento de placenta em 2 casos e iminência de eclampsia em 1 caso. As complicações perinatais foram sepse em 10 casos, angústia respiratória em 10 casos, hemorragia intracraniana em 2 casos, enterocolite necrosante em 2 casos, Apgar < 7 no 5° min. em 2 casos e óbito neonatal tardio em 2 casos, permanência no berçário em média de 41,47 ± 21,75 dias. A idade gestacional média no parto foi de 30,56 ± 3,41 semanas. O peso médio dos recém-nascidos foi 1.116,64 ± 393,52 g. A conduta resolutiva foi necessária em 19 pacientes e as complicações maternas observadas foram insuficiência renal aguda em 5 casos, descolamento de placenta em 1 caso, iminência de eclampsia em 4 casos e eclampsia em 4 casos. As complicações perinatais foram sepse em 12 casos, angústia respiratória em 10 casos, hemorragia intracraniana em 4 casos, Apgar < 7 no 5° min. em 3 casos e óbito neonatal tardio em 2 casos, permanência no berçário em média de 58 ± 23 dias. A idade gestacional média no parto foi de 28,93 ± 2,11 semanas. O peso médio dos recém-nascidos foi 1.090 ± 307,49 g. Conclusão: Não há relação direta entre a gravidade da doença materna e resultados perinatais adversos. A Idade gestacional foi a única variável determinante para os resultados perinatais. Na conduta conservadora houve ganho de 2 semanas na gestação e 17 dias a menos de permanência no berçário / Introduction: The HELLP syndrome is a complication of severe forms of preeclampsia characterized by hemolysis, elevated liver enzymes and thrombocytopenia. The treatment is questioned especially in cases before 34 weeks. Objectives: This study aims to characterize the population of hospitalized patients with HELLP Syndrome at HCFMUSP 2001-2011. To associate maternal clinical and laboratory parameters as predictives for maternal complications and adverse perinatal outcomes. Other aim is to charaterize maternal and perinatal outcomes in the expectant management. Methods: This is a retrospective observational and analytical study. Results: There were 51 patients hospitalized. The mean age was 27.48 years, most were white (47%) and had at least one pregnancy (62.75%). Only 15.69% had chronic arterial hypertension. The average gestational age was 30.94 weeks. The maternal clinical symptoms and laboratory tests did not correlate with maternal complications and perinatal outcomes. Maternal complications were not associated with perinatal outcomes except gestational age. Expectant management was possible in 16 patients with in average gain of 12.94 days of pregnancy. Maternal complications were acute renal failure in 3 cases, placental abruption in 2 cases and imminent eclampsia in 1 case. Perinatal complications were neonatal sepsis in 9 cases, respiratory distress syndrome in 10 cases, intracranial hemorrhage in 1 case, Apgar score less than 7 at 5° minute in 2 cases and neonatal late death in 2 cases, period of hospitalization in average of 41.47 ± 21.75 days. The gestational age at delivery was in average 30.8 ± 3.41 weeks. The weight of the newborns was in average 1116.64 ± 393.52 in average. Immediate interruption was need in 19 patients and the maternal complications were acute renal failure in 5 cases, placental abruption in 1 case and imminent eclampsia in 3 cases, eclampsia in 4 cases; Perinatal complications were: neonatal sepsis in 12 cases, respiratory distress syndrome in 14 cases, intracranial hemorrhage in 4 cases, necrotizing enterocolitis in 1 case, Apgar score less than 7 at 5° minute in 3 cases and neonatal late death in 1 case, period of hospitalization in average of 58 ± 23 days. The gestational age at delivery was in average 29.4 ± 2.4 weeks. The weight of the newborns was in average 1090 ± 307.49 in average. Conclusion: There is no direct relationship between the severity of maternal disease and adverse perinatal outcomes. The gestational age of delivery was crucial to perinatal outcomes. There were gain of 2 weeks of gestational age between hospitalization and delivery and 17 days less of hospitalization for newborns in the expectant management