No description available.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24201号 / 医博第4895号 / 新制||医||1061(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 西浦 博, 教授 森田 智視, 教授 松村 由美 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Congenital anomalies are a leading cause of infant death and disability and their incidence varies between ethnic groups in the UK. Rates of infant death are highest in children of Pakistani origin, and congenital anomalies are the most common cause of death in children younger than 12 in this ethnic group. We investigated the incidence of congenital anomalies in a large multiethnic birth cohort to identify the causes of the excess of congenital anomalies in this community. Methods: We obtained questionnaire data from the mothers of children with one or more anomalies from the Born in Bradford study, a prospective birth cohort study of 13 776 babies and their families in which recruitment was undertaken between 2007 and 2011. Details of anomalies were prospectively reported to the study and we cross checked these details against medical records. We linked data for anomalies to maternal questionnaire and clinical data gathered as part of the Born in Bradford study. We calculated univariate and multivariate risk ratios (RRs) with 95% CIs for various maternal risk factors. Findings: Of 11 396 babies for whom questionnaire data were available, 386 (3%) had a congenital anomaly. Rates for congenital anomaly were 305·74 per 10 000 livebirths, compared with a national rate of 165·90 per 10 000. The risk was greater for mothers of Pakistani origin than for those of white British origin (univariate RR 1·96, 95% CI 1·56–2·46). Overall, 2013 (18%) babies were the offspring of first-cousin unions. These babies were mainly of Pakistani origin—1922 (37%) of 5127 babies of Pakistani origin had parents in first-cousin unions. Consanguinity was associated with a doubling of risk for congenital anomaly (multivariate RR 2·19, 95% CI 1·67–2·85); we noted no association with increasing deprivation. 31% of all anomalies in children of Pakistani origin could be attributed to consanguinity. We noted a similar increase in risk for mothers of white British origin older than 34 years (multivariate RR 1·83, 95% CI 1·14–3·00). Maternal education to degree level was protective (0·53, 95% CI 0·38–0·75), irrespective of ethnic origin. Interpretation: Consanguinity is a major risk factor for congenital anomaly. The risk remains even after adjustment for deprivation, and accounts for almost a third of anomalies in babies of Pakistani origin. High levels of educational attainment are associated with reduced risk in all ethnic groups. Our findings will be valuable in health promotion and public health, and to those commissioning antenatal, paediatric, and clinical genetic services. Sensitive advice about the risks should be provided to communities at increased risk, and to couples in consanguineous unions, to assist in reproductive decision making. Funding: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care programme.

Background: The death of a child has been found to have long term consequences for both individual and family functioning. This is particularly true for bereaved siblings who have been found to be at increased risk of developing mental health difficulties in later life. Literature on parental bereavement proposes that the parenting phenomenon, such as replacement child syndrome, subsequent child syndrome and the parenting paradox, which can emerge after the death of a child, may account for this. However, there is very little research on these labels of observed parenting phenomenon and, as a result, any hypothesis offered remains under elaborated. In addition, limited evidence suggests that, due to the sudden, unexpected and unexplained nature of the loss, SIDS parents are more likely to experience a greater degree of distress and adjustment difficulties than other perinatally bereaved populations. Given this, it could be hypothesised that SIDS parents may be likely to experience these parenting phenomena. Despite this, however, SIDS remains a neglected area of research. Aims: As a consequence of this research gap, the study aims to explore mothers’ experiences of parenting in their transition from being a parent unaffected by Sudden Infant Death Syndrome to a parent affected by Sudden Infant Death Syndrome. Methodology: Semi-structured interviews were conducted with seven mothers who had experienced an incident of Sudden Infant Death Syndrome. The interviews were then transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Results: Five master themes emerged from the analysis: ‘Channelling the Parent Within’, a naturally developing and responsive parenting style that is facilitated by internal mechanisms, such as flexibility and confidence; ‘Parenting Outside of Yourself’, a parenting style that develops in the aftermath of a SIDS event, which is characterised by self doubt and a reliance on external mechanisms such as reassurance and restriction; ‘Restoration Through You’, the restorative effect of the subsequent and surviving children, which allows vindication and re-establishes happiness; ‘The Bitter Restoration’, a restoration that encompasses internal knowledge and external evidence of loss, including a disrupted family composition and a continued awareness of existential threat; ‘A Disruptive Appreciation’, the development of a greater appreciation for the subsequent and surviving children that impacts discipline and incorporates indulgence. These, along with the subthemes contributing to them, are presented as a narrative account. Conclusion: The results imply that mothers who have experienced a SIDS event shift into a permissive and anxious style of parenting which is characterised by safety behaviours. A model of parenting in the aftermath of SIDS has been proposed in order to explain the underlying cognitions and processes which drive this behaviour and the factors which serve to maintain it. By doing this it is hoped that, when working with bereaved parents and siblings, clinicians will be better positioned to frame parenting practices and intervene at a cognitive level.

Submitted by Angela Maria de Oliveira (amolivei@uepg.br) on 2018-06-05T13:57:08Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Adriele Siqueira.pdf: 3157302 bytes, checksum: f88abb8338221a76b0e8b9c24d5aa7f5 (MD5) / Made available in DSpace on 2018-06-05T13:57:08Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Adriele Siqueira.pdf: 3157302 bytes, checksum: f88abb8338221a76b0e8b9c24d5aa7f5 (MD5) Previous issue date: 2018-03-26 / Este trabalho tem como objetivo apresentar discursos que circulavam nas fotografias pós-morte e tumulares infantis entre os anos de 1920 a 1965 na cidade de Ponta Grossa, analisando as formas como as crianças são representadas. Deste modo, como metodologia utiliza-se três acervos fotográficos: foto Bianchi, localizado na Casa da Memória de Ponta Grossa; fotografias da Casa do Divino e três cemitérios da cidade, São José, São João Batista e Colônia Dona Luiza. Essas fotos foram escolhidas por retratarem a criança morta por meio de sua particularização demostrando crenças que são oriundas da religiosidade popular na cidade. Assim, totalizam-se vinte e quatro fotos pós-morte e vinte fotos tumulares que serão analisadas por meio da linguagem fotográfica e representações contidas nelas. Para que essa análise seja possível, será exposta a relação da fotografia com a morte, fazendo um estudo da história da morte e da fotografia e a sua relação com a memória. Além disso, se faz uma ligação entre a morte e o sentimento pela criança, expondo como a infantilidade ganhou reconhecimento e particularização até mesmo após a morte. Após isso, realiza-se um apanhado histórico da cidade de Ponta Grossa e sua relação com as fotografias pós-morte, destacando o local de origem dos objetos analisados para então se fazer a análise das fotos a partir da linguagem fotográfica e também das simbologias existentes nas fotos. Da mesma forma, analisam-se as fotos tumulares das crianças, descrevendo a história dos cemitérios ponta-grossenses e demonstrando que existia um padrão nas fotografias encontradas. Os estudos revelam que as fotografias da morte buscavam imortalizar as crianças por meio da memória e que existiam formas de representações particulares relacionadas a infância, mostrando a religiosidade popular em torno das crianças por meio da particularização infantil. / The purpose of this work is to show which discourses circulated in the infant post-mortem photographs and infant tumular photographs between 1920 to 1965 in the city of Ponta Grossa, analyzing how the children are represented. Thus, as methodology is used three photographic collections: photo Bianchi, located in the Casa da Memória in Ponta Grossa; photographs of the Casa do Divino and three cemeteries of the city, São José, São João Batista and Colônia Dona Luiza. These photos were chosen for portraying the dead child through his particularization demonstrating beliefs that are derived from the popular religiosity in the city. Thus, twenty-four postmortem photos are added and twenty tumular photographs that will be analyzed through the photographic language and representations contained in them. For this analysis to be possible, the relationship between photography and death will be exposed, making a study of the history of death and photography and its relation to memory. In addition, a connection is made between death and feeling for the child, exposing how childishness has gained recognition and particularization even after death. After this, a historical survey of the city of Ponta Grossa and its relation with the postmortem photographs is carried out, highlighting the place of origin of the objects analyzed so that the analysis of the photos can be made from the photographic language and also from the existing symbologies in the pictures. In the same way, the children's tomb pictures are analyzed, describing the history of the cemeteries in Ponta Grossa and demonstrating that there was a pattern in the photographs found. Studies reveal that death photographs sought to immortalize children through memory and that there were forms of particular representations related to childhood, showing the popular religiosity around children through the child's particularization.

Abstract not available

The overall aim of this thesis is to evaluate the risk for increased morbidity and mortality due to long-term arsenic exposure via drinking water by use of epidemiological and spatial approaches in studies performed in Matlab, Bangladesh. A total of 166,934 individuals aged 4 years and above were screened for skin lesions in 2002-2003. Another sample of 115,903 adults aged 15 years or more and a third sample of 26,972 pregnancies in 1991-2000 were considered in a historical cohort and an ecological study, respectively, where risk of adult mortality and spatial clusters of foetal loss and infant death were analysed in relation to arsenic exposure. More than 70% of the tube-wells in the study area exceeded the threshold for arsenic contamination according to the WHO guideline (10 µg/L). The prevalence of arsenic-induced skin lesions was 3/1000 and men had significantly higher prevalence of skin lesions (SMR 158, 95% CI: 133-188) compared to women. There was an increased risk for death in adulthood due to all non-accidental causes (hazards ratio = 1.16, [95% CI 1.06-1.26]) even at a low level of arsenic contamination (10-49 µg/L). Slightly lower risks were observed for death in cancers (1.44 [1.06-1.95]) and infectious diseases (1.30 [1.13-1.49]) at 50-149 µg/L, but for cardiovascular diseases, it was evident (1.23 [1.01-1.51]) from the level 150-299 µg/L. A dose-response relationship was observed for each of these causes. We identified high and low risk clusters of foetal loss and infant death that coincided with identified high and low clusters of arsenic exposure. Water arsenic concentration of the reported main water source was significantly correlated with arsenic concentration in urine, which reflects current arsenic intake from all sources (R2=0.41, ρ< 0.0001), and the influence of neighbouring water sources was minimal. The study findings underlines that the ongoing arsenic exposure has resulted in a series of severe public health consequences in Bangladesh that call for reinforcement in the mitigation efforts. Knowledge about the spatial distribution of exposure and health effects may be of value in that process.

Title from PDF of title page. / Document formatted into pages; contains 62 pages. / Thesis (M.S.P.H.)--University of South Florida, 2003. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT: Sudden Infant Death Syndrome (SIDS) is the third leading cause of infant mortality between birth and the first year of life in the United States. Along with the identication of various maternal risk factors, the role of fetal hypoxia has been hypothesized to be one of many causal factors associated with SIDS. The purpose of this study was to develop a profile of the SIDS infant and assess whether six pregnancy complications consistent with fetal hypoxia were associated with the increased outcome of SIDS. The secondary data analysis of Florida linked birth to death certificate data specific to Hillsborough County and Duval County were analyzed retrospectively for the period of time between 1998 and 2000. Of the 86, 342 births, 69 SIDS cases were identified, 34 in Hillsborough County and 35 in Duval County. / A majority of the infants were White males with an average age of death of 80 days. The Chi-Square test for Independence with Cramer's V, odds ratios and 95% confidence intervals were calculated to determine if an association existed between pregnancy complications, specific maternal risk factors and SIDS. Eclampsia was the only statistically significant prenatal complication found in this cohort (OR=4.67: 95% CI 1.49, 14.57). Maternal tobacco use (OR= 3.13: 95% CI 1.83, 5.36) and late initiation into prenatal care were also found to be significant in the SIDS cases, with the greatest risk occuring in women who did not receive prenatal care (OR=4.37: 95% CI 1.38, 13.89). These findings will assist with the development of a profile of infants who are at greater risk of dying of SIDS in Hillsborough County and Duval County as well as contribute to what is currently known about the association between fetal hypoxia and SIDS. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.

The aim of the present study was to examine whether there was a significant difference within each spouse&amp / #8217 / s reports on grief reactions after an infant death. It was also aimed to investigate whether demographic variables including gender, age, education of grieved parents, gender and age of deceased infant, presence of other children were predictors of parental grief reactions after an infant death. The sample of the present study consisted of 55 couples experiencing an infant death within the last 2 years. Sample was recruited through death records kept in hospital and municipalities of Ankara by the researcher. To test the hypotheses of the study paired samples t-test and stepwise regression analyses were performed. According to the results of the study, it was found that there was a significant difference within each spouse&amp / #8217 / s reports on despair, panic behavior, blame and anger, detachment, and disorganization as separate dimensions of grief. Mothers experienced higher levels of despair, panic behavior, blame and anger, detachment, and disorganization than fathers. There was no significant difference within each spouse&amp / #8217 / s score on personal growth. It was found that being a mother and having lost boy infant were proved as the predictors of parents&amp / #8217 / higher levels of grief reactions. Age and education of grieved parents, age of deceased infant, presence of other children were not associated with parental grief reactions. It was found that younger age of deceased infant and presence of other children were proved as predictors of grieved parents&amp / #8217 / higher levels of personal growth. The findings of the study were discussed with related literature.