Objectives: To investigate the relationship between maternal separation anxiety, hours in non-maternal child care and security of motherinfant attachment in early infancy. Design: Prospective. Methods: The participants for this study were 67 mothers and their infants enrolled in a large scale prospective study. The first 100 women were sent a letter outlining the current study and requested to 'opt in'. Those mothers who agreed to participate completed the Maternal Separation Anxiety Scale (MSAS) when the infant was ten and seventeen months. The mother-infant attachment relationship was assessed according to the standardised Strange Situation Procedure when the infant was aged seventeen months (+/- two weeks). All other data were collected in the main study. Results: Maternal Separation Anxiety was not predictive (alone or in combination with other variables) of attachment status. Significant differences in levels of separation anxiety were found between mothers who were and mothers who were not employed outside the home. Separation anxiety was also related to a number of variables, including the age of the infant when the mother planned to use non-maternal child care, the total hours of non-maternal child care, infant temperament and maternal sensitivity. Conclusions: The non-significant results in the main analysis mean that no firm conclusions regarding a relationship between levels of maternal separation anxiety, hours in non-maternal child care and security of mother-infant attachment in infancy can be drawn. Future research (with a larger and more diverse sample) should continue to explore the concept of maternal separation anxiety in relation to a number of other variables, including maternal role preference and quality of child care, as it may hold important implications for social policy and preventative clinical work.

As the obesity epidemic continues to grow, attention has been turned towards the abundance of processed foods and beverages in the Western diet. Controversy has particularly surrounded high fructose corn syrup (HFCS), which is a commonly used sweetener in these products. Our study is designed to not only investigate the metabolic effects resulting from prolonged exposure to a highly sweetened diet, but also to determine the effects of this maternal diet on the offspring. For the study, three specially made, pelleted diets and a control were administered to weight matched groups of female Long Evans rats: Control "Chow" AIN-G93, Group (2) AIN-G93 + 10% HFCS, Group (3) AIN-G93 + 20% HFCS, and Group (4) 20% sucrose. All of the diets were isocaloric and differed only in the amount of added sweetener. At the end of the initial study, a strong phenotypic difference was not determined among the dams; however, postnatal body weights were increased in the pups born to dams raised on sweetened diets groups compared to the Chow-fed dams. Even further, following exposure to a LF or HF diet, the progeny showed altered sensitivity to the obesogenic effects of the diet as was seen in body weights and caloric intake. Glucose homeostasis, plasma triglyceride levels, and liver weights also appeared to be influenced by the maternal and post-weaning diets. To further examine this maternal diet effect, the study was repeated, and experiments were performed while the pups were in utero and also during lactation. Metabolic parameters measured during pregnancy showed a trend towards higher triglycerides in the HFCS dams compared to Chow. Tests during lactation aimed to determine whether the pups were hyperphagic, but showed no significance. Overall, these studies suggest that sweetener components such as sucrose or HFCS used in beverages and processed foods may potentially contribute to the development to the obesity and the metabolic syndrome in offspring. Additionally, HFCS may amplify this effect even further.

Made available in DSpace on 2014-06-11T19:29:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-28Bitstream added on 2014-06-13T18:39:59Z : No. of bitstreams: 1 viana_rc_me_botfm.pdf: 312488 bytes, checksum: 9cbe96e60f2b8c72151c29154796ac9e (MD5) / Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS) / Realizar uma revisão da literatura mundial e nacional sobre mortalidade materna, descrevendo a população vulnerável, os fatores de risco, as causas, as difi culdades para obtenção dos dados e as medidas de prevenção, de forma a subsidiar as ações de saúde. A coleta dos dados foi realizada por meio de pesquisa de artigos nas bases eletrônicas, SCIELLO, PUBMED, LILACS e MEDLINE, além de materiais publicados por organizações mundiais e nacionais. Foram selecionados estudos publicados no periodo de janeiro de 2000 a maio de 2011, utilizando-se os seguintes descritores: “maternal mortality”[MeSH Terms] OR (“maternal”[All Fields] AND “mortality”[All Fields]) OR “maternal mortality”[All Fields], nos idiomas português, inglês e espanhol. Foram selecionados 36 artigos que atendiam aos critérios de inclusão. O óbito materno está diretamente relacionado com as condições de vida da população e apresenta elevada disparidade entre as diversas regiões sócio-econômicas. Embora a mortalidade materna seja o melhor indicador de saúde da população feminina, seus números muitas vezes são apresentados de forma irreal, pela difi culdade da identifi cação dos casos nos registros de óbito. Medidas de prevenção associadas a diagnóstico e tratamento precoces e adequados são fatores benéfi cos na redução desses óbitos maternos. Apesar da tecnologia avançada e do reconhecimento de algumas medidas de prevenção, um grande número de mulheres morre diariamente por complicações no ciclo gravídico-puerperal. É evidente que para a redução desta tragédia é necessário o comprometimento político, social e econômico com a saúde, para promover as reformas necessárias na assistência ao ciclo gravídico-puerperal / Accomplishing a review of worldwide and Brazilian literature on maternal mortality, describing the vulnerable population, risk factors, causes, and difficulties in obtaining the data and preventive measures, in order to subsidize health actions. The data collection was accomplished through a search for articles in the electronic data basis SCIELLO, PUBMED, LILACS and MEDLINE, in addition to published materials from worldwide and Brazilian organizations. Studies published between January 2000 and May 2011 have been selected using the following reference: “maternal mortality” [MeSH Terms] OR (“maternal”[All Fields] AND “mortality” [All Fields]) OR “maternal mortality” [All Fields], in Portuguese, English and Spanish languages. 36 articles that fi tted the criteria for inclusion have been selected.. Maternal death is directly related to the quality of life of the population and presents high disparity among the diverse social-economic regions. Even though maternal mortality is the most accurate health indicator for the female population, its numbers many a time are presented in unreal manners, due to the diffi culties in identifying the cases based on obit registries. Preventing measures associated to early diagnosis and proper treatment are benefi cial factors to the decrease of such maternal deaths. In spite of advanced technology and the recognition of some preventive measures, a large number of women decease daily out of complications through the pregnant and puerperal cycle. It is evident that in order to reduce such tragedy, political, social and economical commitment to Health is necessary to promote the needed reforms in the pregnant and puerperal cycle assistance

Reducing maternal and child mortality has been a top global health priority for the past two decades. Through this thesis, I underline some of the strategies, barriers and determinants to optimal maternal and child health (MCH) in three specific districts of Jimma Zone in the southwest of Ethiopia. My first paper has a particular focus on the quality of MCH data collected within the health management information system (HMIS), while the second paper focuses on the utilization of antenatal care (ANC) services, assessments of malaria in pregnancy, and women’s access to malaria preventive measures using data from a cross-sectional survey conducted in the three study districts. The quality of MCH data collected within the HMIS from July 2014 to June 2015 for the 26 primary health care units (PHCUs) located within the three districts was evaluated using the World Health Organization’s Data Quality Report Card (DQRC). To complement the methods recommended in the DQRC, Pearson correlation coefficients, intraclass correlation coefficients, and Bland-Altman analysis were used to determine the agreement between MCH indicator coverage estimates derived from the HMIS and a population-based survey conducted with 3,784 women who had a birth outcome within the same time frame. The quality of MCH data collected within the HMIS was determined to be unsatisfactory, with many health facilities located in the three districts not reporting completely, consistently, or accurately MCH key indicators relating specifically to ANC, skilled birth attendance at delivery, and postnatal care. This finding is important since poor data quality can compromise effective decision-making and resource allocation processes aimed at contributing to better health outcomes in mothers and newborns. vi To address the objectives set in the second chapter, analysis of cross-sectional survey data from 3,784 women who had a birth outcome in the year preceding the survey was performed through logistic regression models adjusting for clustering of the participants by PHCU. While close to 85% of the women attended at least one ANC visit, less than 50% of the participants received four or more ANC visits. Lack of necessity, distance to health facility and unavailability of transportation were determined as key reasons for not attending ANC. Women who completed secondary or higher education, were from the richest households, were exposed to different media sources, and were able to make decisions about their healthcare by themselves or jointly with their husband were more likely to attend ANC services. Frequent visits by a health extension worker and pregnancy intendedness also influenced ANC attendance. Bed net ownership and utilization during last pregnancy were also relatively low (52% and 26%, respectively). The results also showed that the odds of owning and always using a mosquito net were higher in participants that attended ANC, with odds ratios of 1.98 (95% CI: 1.55-2.53) and 1.62 (95% CI: 1.23 – 2.13), respectively. The prevalence of malaria infection during pregnancy was low in our recruited sample, with 1.45% of the participants reporting suffering from malaria during their last pregnancy. We determined significant negative relationships between malaria infection and maternal age and education level. This work emphasizes the importance of improving the quality of MCH data within the HMIS in Ethiopia as well as addressing the inequities relating to ANC attendance in Jimma Zone. Given the adverse effects that malaria can have on the progress and outcomes of a pregnancy, the importance of promoting mosquito net ownership and use as part of ANC services is also highlighted.

Memoria (licenciado en ciencias jurídicas y sociales) / El objetivo de éste trabajo es analizar la eficacia de la actual legislación de descanso maternal, determinar las falencias detectadas por sus críticos y, finalmente, determinar soluciones a problemas actuales en cuanto a posibles modificaciones a la actual legislación. Se pone especial énfasis en determinar la necesidad de otorgar mayor flexibilidad al ejercicio de dichos descansos por parte de la madre. Al efecto analizamos la historia y pertinencia del descanso maternal en Chile, describimos el actual sistema y lo relacionamos con la legislación comparada e internacional. Posteriormente se sistematizan las diversas críticas de que ha sido objeto la actual legislación y las propuestas de reforma que se han presentado al Parlamento. En las conclusiones del trabajo se podrá comparar el descanso maternal consagrado en la legislación chilena con el de otras legislaciones. Adicionalmente se consagran opiniones en torno a la necesidad de mayor flexibilización en esta materia, aumento del período, ampliación de la cobertura a más trabajadoras, todos aspectos que traen aparejado la necesidad de una reforma sustantiva en la materia.

No description available.

Background: In spite of the importance of maternal sensitivity as a construct that fosters secure attachment and promotes a child’s social and cognitive development, no routine clinical screening currently identifies mothers at risk of poor maternal sensitivity. This is partly because researchers have not identified all the factors that influence maternal sensitivity. As a result, parenting interventions to promote maternal sensitivity and optimise child outcomes tend to focus on clinical groups. Thus, more attention is needed to identify possible determinant factors. The neurobiological mechanisms underlying natural variation in maternal sensitivity (i.e. sensitive and less sensitive mothers) are poorly understood, especially the putative role of the hormone Oxytocin (OT). Literature has suggested that this variation in maternal sensitivity is an outcome of interaction between maternal OT, as well as social factors (e.g. perceived parenting) and this interaction charts the discrete profile of the maternal brain that is mediated by stress- and reward-related neural systems. To date no study examined for the neurobiological correlates of maternal sensitivity in a distinct group of mothers representing natural variations in maternal sensitivity. Methods: Out of 105 women recruited from community antenatal clinics during their pregnancy, to complete a set of self-reported questionnaires assessing their psychosocial characteristics, a total of 80 new (i.e. early postpartum) mothers and their infants were followed up and underwent evaluation of maternal sensitivity at 4-6 months postpartum. Using a stepwise regression, we examined for predictors of maternal sensitivity among the sample (Study I). Later, at 7-9 months postpartum, 30 mothers, representing extremes in maternal sensitivity, were selected from this sample of 80: 15 mothers with higher scores (high sensitivity mothers - HSMs), and 15 with lower scores for maternal sensitivity (low sensitivity mothers - LSMs), underwent functional Magnetic Resonance Imaging (fMRI) to examine their brain responses when viewing videos of their own and an unknown infant. Maternal plasma OT levels were also measured before and following an interactive play with their infant (Study II). Results: Mothers’ self-reported experience of own parental care, and household income, independently predicted maternal sensitivity, accounting for 17% of the variance. Comparing mothers grouped by maternal sensitivity level, HSMs showed a drop in their plasma OT levels following the interaction with their infant. HSMs also showed significant brain activation in the right superior temporal gyrus in response to own infant (compared to unknown infant) when compared to LSMs. By contrast LSMs did not show any change in their plasma OT levels following interaction with their infant, and their brain responses to own infant did not show any significant brain activation when compared to HSMs. Conclusions: The findings may have implications for future novel approaches for early assessment of mothers at risk of low maternal sensitivity so they could be targeted by specialised assessments and consequently interventions to improve their parenting (Study I). Maternal sensitivity is accompanied by neural correlates that could act as a biomarker for future intervention studies that target vulnerable mothers (Study II).

This research involved the study of fifteen women who had their first child after the age of 30. By the use of an hour and half long unstructured interview it was discovered how these women experienced delayed motherhood, what problems they had and their coping strategies. From the transcripts of the interviews, the material was analyzed into 16 topics. From these 16 topics, 8 specific recommendations were developed to help women who delay having children in the transition to parenthood. The research concluded that although there are problems for women who delay having children, most women are content with their decision. They have developed strategies to cope with the problems they face. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

The aim of the study is to explore aspects of child safety in registered day care centres situated in a lower socio-economic area of the Cape Town Metropole. This can be achieved by: a) describing the physical environment in day care centres b) assessing the infrastructure of day care centres to deal with potential injurjes c) reviewing injury reporting systems already in place d) highlighting the issue of child safety in the course of conducting the study.

HIV/AIDS is a fairly new condition. Despite a large amount of published literature regarding its clinical aspects, there is a paucity of South African research and information relating to the attitudes and feelings of the physicians who diagnose, care for and make decisions with regard to these patients, especially children. Several studies suggest that health care workers who provide clinical care for Persons with HIV/AIDS (PWA's) may have an intolerant attitude towards them. As the number of children with HIV/AIDS increases, the burden of care will shift to health care workers at primary level care. It was therefore decided to assess the attitudes of doctors at primary level care facilities in Cape Town, towards paediatric patients with HIV/AIDS. The results of this study are crucial given the increasing exposure of doctors at this level to HIV/AIDS patients and understanding their response to its management. The objectives of the study were to: assess whether doctors' knowledge of the patient's HIV positive status affects their attitudes and management of the patient; assess doctors' perceived competency with regard to the management of paediatric AIDS; determine doctors' opinions with regard to HIV testing, the utilisation of diagnostic investigations and treatment; determine doctors' main concerns with regard to the management of paediatric patients with HIV/AIDS. A descriptive, cross-sectional survey was conducted amongst all doctors working at the clinics and day hospitals in Cape Town during the period February to April 1997. Seventy-eight doctors (51 % response rate) working in the clinics and day hospitals in Cape Town each completed an anonymous self-administered questionnaire. Doctors in this survey generally displayed a positive, humanistic attitude towards children with HIV/AIDS. In the majority of cases the knowledge of the child 's HIV positive status did not impact negatively on their management of the child. Interestingly, 86% of respondents felt that they would always/mostly take extra care in applying universal precautions when they know that the child is HIV positive. There is a lack of confidence in their counselling and clinical competency in the management of children with HIV/AIDS. The main source of information with regard to paediatric HIV/AIDS is journals (69%), followed by in-service training (53%) and colleagues (49%). In contrast, the preferred sources of information were in-service training (68%) and organised discussion groups/workshops (65%). Most were in favour of routine HIV testing of pregnant women and informed consent for HIV testing. However, not everyone agreed that pre-HIV test counselling was necessary in the case of children. Confidentiality of positive test results was not favoured in the majority of cases (65%) and disclosure even without the consent of the patient/carer was supported. Priority concerns relating to the management of paediatric HIV/AIDS, were lack of support in the community for parents and children, lack of policy and management guidelines and the lack of resources in the health services to cope with the burden of care. This study identifies the need for specific training in HIV/AIDS for medical doctors at primary level care facilities. The foundation of this training must begin with medical students during their clinical years but training and support should continue through in-service training. Training strategies, which address the clinical and psychological challenges presented by this disease, should be employed. In addition, clinical guidelines, which are relevant to South Africa and evidence-based, should be adopted nationally. Resources should be available to support these guidelines. It is further recommended that policies be underpinned by appropriate legislation which protects the rights of patients and health care workers in order to minimise the effects of individual attitudes and biases with regard to the treatment of PWAs.