Yes / Women are discharged home from hospital increasingly early, but there is little evidence examining the postnatal hospital discharge process and how this may impact on the health of women and babies. In particular, there is little on sepsis prevention advice, despite it being the biggest direct cause of maternal mortality. Aim To explore the perceptions of women and senior student midwives related to the postnatal hospital discharge process and maternal sepsis prevention advice. Methods Three focus group interviews were undertaken, involving 9 senior student midwives and 14 women attending paid or specialist classes for vulnerable migrant women. Findings All participants believed that the postnatal hospital discharge process was inadequate, rushed and inconsistent. Sepsis advice was patchy and the condition underplayed. Conclusions Cost effective, time-efficient and innovative ways to impart vital information are required to support the postnatal hospital discharge process.

Bakgrund: Forskning om psykisk ohälsa relaterat till föräldraskap har under en längre tid varit kopplad till kvinnan och barnets behov. Sedan 1990-talet har forskningen ökat inom området postpartum depression (PPD). Det är först under senare tid som fäders psykiska ohälsa har börjat undersökas mer grundligt. Enligt studier drabbas mellan 6-10 % av blivande och nyblivna fäder av depressionssymtom. Förutom lidande hos fadern, har negativa konsekvenser hos både partnern och barnet identifierats. Syfte: Syftet var att belysa depressionssymtom hos blivande och nyblivna fäder. Metod: En litteraturstudie i ett deskriptivt syfte med induktiv ansats som granskade relevanta originalartiklar som svarade på denna studies syfte och frågeställningar. Artiklarna kvalitetsgranskades initialt enligt kvalitativa och kvantitativa kvalitetsgranskningsmallar och resultatet analyserades. Resultat: Blivande och nyblivna fäder riskerar att drabbas av depression innan, under och efter förlossningen. Depressionssymtom är förknippat med destruktiva tankar och beteendeförändringar, vilka förutom att påverka faderns vardag, innebär negativa konsekvenser för familjen och för barnet. Riskfaktorer, bland annat depression hos partnern, har identifierats kunna öka risken ytterligare för depression hos fäder. Screening och strategier för att identifiera blivande och nyblivna fäders depression är motiverat, men har bevisats vara otillräckliga. Rutiner, omvårdnad och kompetens att inkludera fäder behöver förbättras inom MVC och BVC. Pappagrupper värderas högt och har visat sig normalisera tillvaron hos nyblivna fäder. Slutsats: Blivande och nyblivna fäder beskriver ett brett spektrum av negativa känslor och beteendeförändringar. Fäder riskerar att utveckla depressionssymtom i samband med en eventuell depression hos modern. Stöd som pappagrupper samt inkludering av vårdpersonal är friskfaktorer som identifierats och som beskrivits som positivt av fäder. / Background: Research on mental health related to parenting has for a long time been linked to the woman and the child's needs. Since the 1990s, research has increased in the field of postpartum depression (PPD). It is not until recently that the mental health of the fathers has been investigated more thoroughly. According to studies, between 6-10 % of future and first-time fathers suffer from depression symptoms. In addition to suffering in the father, negative consequences for both the partner and the child have been identified. Aim: The purpose was to illustrate depression symptoms in future and first-time fathers. Method: A literature study with a descriptive purpose with an inductive approach that examined relevant original articles that responded to the aim and issues of this study. The articles were quality tested initially with qualitative and quantitative quality assessment templates and then the result was analyzed. Results: Future and first-time fathers are at risk of depression before and after the child’s birth. The experience of this depression is associated with destructive thoughts and behavioral changes, which, apart from affecting the father's everyday life, have negative consequences for the family and for the child. Risk factors, including the partner’s depression, have been identified to further increase the risk of depression in fathers. Screening and strategies for identifying father’s depression are motivated, but proven to be insufficient. Routines, nursing and skills to include fathers need improvement in both maternity care center and child health care center. Dad groups are highly valued and have been shown to normalize first-time fathers existence. Conclusion: Fathers describe a wide range of negative emotions and behavioral changes. Fathers risk developing depression symptoms in the event of a possible depression in the mother. Support such as dad groups and being included by nurses and healthcare professionals are described as health factors that fathers appreciated.

Det finns många fördelar med att amma varför amning är förstahandsvalet. Antalet kvinnor som helammar sitt nyfödda barn minskar trots att majoriteten av svenska kvinnor planerar att helamma. WHO rekommenderar att barnet helammas till sex månaders ålder. Trots rekommendationen helammas 44 procent av barnen globalt vid sex månaders ålder. Amning är en del av barnmorskans kompetensområde vilket innebär att de ska främja amning. Barnmorskor har en plikt att genomföra amningsrådgivning till samtliga kvinnor. Många kvinnor upplever initialt amningssvårigheter och för att förhindra tidigt amningsstopp är barnmorskans amningsstöd grundläggande. För att utveckla barnmorskans amningsstöd är det därför viktigt att ta reda på hur kvinnor upplever att det är att ta emot amningsrådgivning. Syftet med studien var att undersöka kvinnors upplevelse av amningsstöd och amningsinformation från barnets födelse till sex månaders ålder. Metoden som valdes var en litteraturöversikt med systematisk metod. Studier med kvalitativ och mixad metod inkluderades och endast kvalitativa data användes i resultatet. Databassökning genomfördes i Pubmed och Cinahl. Därefter kvalitetsgranskades artiklarna och endast de som uppfyllde kvalitetskraven inkluderades i resultatet. Vald data analyserades sedan genom integrerad analys. I resultatet inkluderades femton artiklar. Likheter och skillnader i hur kvinnor upplevde amningsstödet identifierades och utformade subkategorierna: kontinuitet inom vårdkedjan, tid för amningsstöd, praktiskt amningsstöd, betydelsen av bekräftelse och uppmuntran samt information och rådgivning. Utifrån subkategorierna identifierades sedan kategorierna kontinuitet och tillgänglighet samt vårdpersonalens bemötande. Slutsatsen indikerade att kvinnorna hade både positiva och negativa upplevelser av amningsrådgivning. I resultatet framkom faktorer som barnmorskor kan påverka kvinnans amningsupplevelse på egen hand genom sitt bemötande. Vidare urskildes faktorer som barnmorskorna inte kan påverka, såsom barnmorskeutbildningens innehåll och tidsbrist. Resultatet ger en bredare förståelse för vad som behöver utvecklas för att amningsrådgivningen ska förbättras. / There are many benefits to breastfeeding and it is the preferred choice. Despite the majority of the Swedish women intending to exclusively breastfeed, the numbers are decreasing. WHO recommends exclusive breastfeeding until six months, however only 44 percent globally follow through. Midwives are experts in the field of breastfeeding, they should promote and provide efficient support. Many women experience initial difficulties with breastfeeding, and to prevent early disruption of breastfeeding, the midwife's support is essential. Understanding women's perception of breastfeeding advice is key to improving midwives' support. The aim of the study was to examine women's experiences of breastfeeding support and breastfeeding information from birth to six months of age. The method was a literature review using a systematic approach. Studies with qualitative and mixed methods were included, and only qualitative data were used in the results. A database search was conducted in PubMed and Cinahl. The articles were quality-reviewed, and only those meeting the quality criteria were included in the results. The selected data was then analyzed through integrated analysis. The results included fifteen articles. Similarities and differences in how women experienced breastfeeding support were identified and constituted the subcategories: continuity within the healthcare chain, time for breastfeeding support, practical breastfeeding support, the significance of affirmation and encouragement and information and guidance. Based on the subcategories, these categories where formulated: continuity and accessibility, as well as healthcare professionals' approach. The conclusion indicated that women had both positive and negative experiences of breastfeeding advice. The results revealed factors that midwives can independently influence women’s breastfeeding experience with their approach. Furthermore, factors were identified that midwives cannot change on their own, such as the content of midwifery education and time constraints. The results provide a broader understanding of what needs to be developed for breastfeeding advice to improve.

Text in English / The aim of the study was to describe the competencies of midwives during the provision of immediate postnatal care (PNC) with the intention of adapting and linking international best practice guidelines as well as a conceptual framework for the implementation of PNC in Swaziland. A quantitative cross-sectional design study was conducted to investigate the competencies of midwives during the provision of immediate postnatal care services to mothers and their infants. A systematic random sampling technique was used to select eighty-eight (88) midwives and six (6) senior midwives to participate in the study. Data collection was done using structured questionnaires. Quantitative data was complemented by data that was generated from open-ended questions at the end of the questionnaires. Data analysis was conducted using IBM SPSS Statistics version 22.0 software. The study highlighted that all the midwives who participated in this study had the relevant qualification. Of the respondents, 70.5% were state-certified midwives with a second registered certificate, 27.3% had bachelor’s degrees, while 2.3% had an advanced midwifery certificate. The study found no difference between the type of qualification of midwives and the knowledge of PNC interventions to be offered to mothers immediately post-delivery across different qualifications held by the midwives (Kruskal-Wallis test: x2=5.498, df=2, p=0.064). Gaps were identified in their knowledge and practices. There were discrepancies in the level of knowledge and practices regarding maternal vital sign assessment immediately after delivery (within 30 minutes). It was noted that these vital signs, i.e. blood pressure (12.5%), temperature (50.0%), pulse (54.5%), respiration (63.6%) were not taken after delivery. It was also noted that 15.0%, 58.0%, 64.8% of the respondents were not aware of the importance of assessing newborns for APGAR, skin-to-skin contact and drying the neonate. The study found that there were no postnatal care guidelines in Swaziland. The findings of the study led to the adaption and linkage of the latest international evidence-based guidelines and a conceptual framework for the implementation of immediate PNC to mothers and their infants in Swaziland. / Health Studies / D. Litt. et Phil. (Health Studies)

Bakgrund: Under graviditeten och efter förlossningen genomgår kvinnan en period som innebär en stor förändring i hennes liv och det är vanligt att uppleva ett brett spektrum av olika känslor. Den första tiden efter förlossningen kan symtom på allvarliga psykiska hälsoproblem utlösas, såsom en depression. Depression hos nyblivna mödrar, en så kallad postpartumdepression, har sedan 1990-talet ökat i intresse inom hälso- och sjukvården, inom omvårdnadsforskningen samt bland föräldrar.   Syfte: Syftet med denna studie var att belysa BVC-sköterskors upplevelser av att möta mödrar med symtom på postpartumdepression.   Metod: En induktiv ansats användes där datamaterialet analyserades med kvalitativ innehållsanalys. Datamaterialet utgjordes av intervjuer och åtta BVC-sköterskor intervjuades.   Resultat: Ur analysen av datamaterialet framkom fyra kategorier: etablera ett gott samarbete, ge råd och vägledning, att använda instrument som underlättar och kommunikativa hinder i arbetat samt tillhörande underkategorier.   Konklusion: För att kunna möta mödrar med symtom på postpartumdepression bör BVC-sköterskorna etablera ett bra samarbeta. Det första hembesöket var också betydelsefullt för att kunna etablera ett bra samarbete mellan BVC-sköterskorna och mödrarna. Att använda instrument såsom EPDS-formuläret, underlättade samtalet och var ett viktigt verktyg för BVC-sköterskorna. / Background:  During pregnancy and after childbirth the woman go through a period that represents a major change in her life and it´s common to experience a wide range of different emotions. The first time after birth, symptoms of serious mental health problems can be triggered, such as depression. Depression in new mothers, known as postpartum depression, has increased in interest since the 1990s in health care, nursing research and among parents.   Aim: The aim of the study was to illustrate Child health care nurses’ experiences of encounting mothers’ with symptoms of postpartum depression.   Method: Qualitative content analysis with inductive approach was used and data were collected through interviews. Eight Child health care nurses’, CHCN, were interviewed.   Results: Four categories emerged from the analysis: establish a good collaboration, provide advice and guidance, to use instruments that facilitate and communicative barriers at work and associated subcategorys.     Conclusion: In order to meet mothers with symptoms of postpartum depression CHCN need to establish a good collaboration. The first home visit was also important to establish a good collaboration between CHCN and mothers. The use of instruments such as EPDS, facilitate the conversation and was an important tool for the CHCN.

Cette thèse porte sur les interactions entre infirmières et usagères lors des suivis postnatals à domicile. À partir d’une enquête ethnographique réalisée sur le territoire de Bordeaux- Cartierville-Saint-Laurent à Montréal, je montre la façon dont les infirmières « négocient » leur pratique de soin. Ces « négociations » permettent l’accomplissement du mandat infirmier quelque soient les manifestations de la différence, à l’intersection de la rencontre entre la culture professionnelle infirmière et la culture profane de l’usagère. À partir d’une littérature de la sociologie des professions et de la sociologie de la santé et d’un cadre théorique construit autour du concept de négociation, cette étude montre que c’est principalement en modulant leur rapport aux normes de la santé publique que les infirmières parviennent à négocier leur pratique et ainsi à répondre aux besoins des populations qu’elles rencontrent. Cinq formes de négociation se dégagent : la négociation par coopération, par compromis, par détachement, par adaptation typifiée et par coercition. Faire le récit de ces différentes formes de négociation permet d’expliquer comment les infirmières concrétisent leur mandat infirmier alors qu’elles sont en interaction avec des usagères qui ne partagent pas les valeurs de prévention et de promotion des « saines habitudes de vie » proposées par la santé publique du Québec. / This thesis is an analysis of the interactions between nurses and service users in the context of post-natal home monitoring. Based on an ethnographic study I conducted in Montreal (Bordeaux-Cartierville-Saint-Laurent), I have defined how nurses negotiate care practice with their service users. These ‘‘negotiations’’ permit them to fulfill their mandate even with the manifestation of difference that can arise between the nurse’s professional and the service users’ profane culture. The theoretical framework that I have built around the concept of negotiation is also supported by sociological literature on profession and health. In order to cater to the service users’ needs, the nurses inherently modulate their relationship to the public health norms. Five types of negotiation have resulted form this study: Cooperation, Compromise, Detachment, Typified Adaptation and Coercion. This narrative of these different forms of negotiation tells us how nurses manage to fulfil their mandate with the service users who do not subscribe to the Quebec public health prevention and promotion of healthy living values.

Thesis (Ph. D.)--RAND Graduate School, 1998. / Includes bibliographical references (p. 241-258).

Background: Postnatal depression (PND) is one of the most common maternal mental health problems for women worldwide. Yet the wide range of reported rates of PND in different countries raises questions about how PND is experienced by women in different cultures and whether interventions developed in western cultures are appropriate in very different settings. It is important to establish how PND is defined, experienced and managed in different cultures in order to create culturally relevant interventions. No previous studies of experience of PND and its management have been conducted in Malaysia. The aim of this study was to explore women’s experiences and healthcare practitioners’ (HCPs) perspectives of PND in a multicultural country, Malaysia. Methods: This was a qualitative study informed by a critical realist approach. Semi-structured interviews were carried out with 33 women (from three different cultural backgrounds) attending for child or postnatal care and 18 HCPs in six purposively selected maternal and child health (MCH) clinics and a female psychiatric ward in Kuala Lumpur, Malaysia. Data were analysed using framework analysis. Findings: There were some differences in the women’s perceptions of PND experience across three different cultural backgrounds in Malaysia. Malay women were more likely to describe the symptoms of PND based on a combination of emotional and behavioural changes, whereas Chinese and Indian women talked more about emotional changes. Traditional postnatal practices were described as contributing to PND by some Malay women but were accepted as promoting maternal and infant well-being by the majority of Indian women. Religious activities were reported as an effective strategy for the Malay women but were not seen as helpful by the majority of Chinese women. Considering HCPs, it appeared that the absence of a clear and specific policy and guideline in the management of PND within the Malaysian healthcare system has resulted in a lack of professional ownership in the management of PND, especially among HCPs in MCH clinics. Conclusion: The women and the HCPs had distinct ways of conceptualising PND experiences, although they agreed on several symptoms and causal explanations. This study calls for a system-based enhanced PND care with an initiation of culturally appropriate care for PND within the healthcare system.

Les acides aminés sont des molécules importantes pour la synthèse des protéines, la fourniture de substrats énergétiques ou la production de facteurs de régulation de l'activité cellulaire. L'ornithine aminotransférase {OAT} est une enzyme clef du métabolisme des acides aminés qui relie l'arginine, un acide aminé indispensable à la synthèse protéique au cours de la croissance, et le glutamate, la glutamine et l'a-cétoglutarate, qui peuvent être transformées en glucose. Nous nous sommes intéressés à la caractérisation biochimique de l'activité de l'OAT et à ses variations chez la souris, en utilisant deux contraintes physiologiques, le développement postnatal et l'exposition au froid. Au cours d'une première étude, nous avons caractérisé une activité OAT fonctionnelle dans tous les organes étudiés. Nous avons démontré l'existence d'un dimorphisme sexuel de l'activité, en faveur des femelles, dans la plupart des organes. Dans une seconde étude, nous avons montré des variations organe et sexe spécifiques de l'activité OAT au cours du développement postnatal en réponse aux besoins spécifiques en acides aminés : une régulation de l'expression de l'OAT par la testostérone et le changement de régime alimentaire lors du sevrage ; une contribution potentielle importante et insoupçonnée du muscle squelettique au métabolisme de l'ornithine. Enfin, nous avons mis en évidence que l'exposition au froid augmente ou diminue l'activité OAT de façon tissu-spécifique en liaison avec les besoins énergétiques de l'organisme. Nos résultats montrent que l'activité OAT est modulée dans les différents organes en fonction des besoins en acides aminés et en substrats. Cela suggère un rôle important du métabolisme des acides aminés dans les réponses adaptatives des organismes à leur environnement / Amino acids are important molecules for protein synthesis and energetic substrates supply. Ornithine aminotransferase {OAT} is a key enzyme of amino acids metabolism linking arginine, an essential amino acid for protein synthesis during growth, and glutamate, glutamine and alpha-ketoglutarate which could be converted into glucose. We principally focused on biochemical characterization of OAT activity and its variations in the mouse using two physiological constraints, postnatal development and cold exposition. During a first study, we characterized a functional OAT activity in all the males and females mice organs studied. We showed the existence of a sexual dimorphism of OAT activity in almost all the organs studied, with a higher OAT activity in females. ln a second study, we showed that the variations of OAT activity were organ and sex specific during the postnatal development in response to the specific needs in amino acids during the growth. We linked these variations to the regulation of OAT expression by testosterone and the change of the diet during weaning. We demonstrated an important and unsuspected contribution of skeletal muscles in pups' ornithine metabolism. Finally, we showed that cold exposition modulates OAT activity in a tissue specific way, in relation with energetic needs and the multiple roles of the substrates generated by the metabolic pathways of OAT. Our results show that in the different organs, OAT activity is modulated in function of amino acids needs, energetic substrates or detoxification needs of the organism during the different metabolic constraints. This is suggesting an important role for the amino acids metabolism in adaptive responses of organisms to their environment

Bakgrund: Postpartumdepression (PPD) är en depression som debuterar efter förlossningen och kan drabba både män och kvinnor i all ålder och i all kultur. Postpartumdepressionen för med sig särskilda risker som kan innebära allvarliga konsekvenser för familjer. Forskning om PPD fokuserar i huvudsak på mödrars upplevelser och påverkan på barnet och familjen. Medan fäderna upplevelser har saknats. PPD kan drabba fäderna i lika stor utsträckning som mödrar men fortfarande ett dolt problem. Syfte: Postpartumdepression (PPD) är en depression som debuterar efter förlossningen och kan drabba både män och kvinnor i all ålder och i all kultur. Postpartumdepressionen för med sig särskilda risker som kan innebära allvarliga konsekvenser för familjer. Forskning om PPD fokuserar i huvudsak på mödrars upplevelser och påverkan på barnet och familjen. Medan fäderna upplevelser har saknats. PPD kan drabba fäderna i lika stor utsträckning som mödrar men fortfarande ett dolt problem. Metod: En litteraturöversikt utfördes med tio kvalitativa studier om föräldrarnas upplevelser av PPD. Artiklarnas olika tema identifierades, jämfördes, analyserades för att sedan kategoriseras i de slutgiltiga teman som presenterades i detta arbete. Resultat: Tre huvudteman redovisades: Postpartumdepressionens inverkan på det känslomässiga livet och självbilden, Postpartumdepressionens inverkan på attityder och sist Postpartumdepressionens inverkan på förmågan att söka stöd. Diskussion:  Föräldrarna upplever att postpartumdepression har stor inverkan i deras liv. Sjukdomens okunskap och stigma hindrar de att söka stöd. Fäderna upplever att de nonchaleras. Allmänsjukvårdspersonal bör söka sig kunskapen om vilken inverkan postpartumdepression har på föräldrars liv och hur föräldrarna upplever postpartumdepression. Detta skulle bidra till att bemötande förbättras som i sin tur skulle leda till att mer föräldrar söker vård för postpartumdepression / Background: Postpartum depression (PPD) is a depression that debuts after childbirth and can affect both men and women of all ages and in all cultures. Postpartum depression brings with it particular risks that can have serious consequences for families. Research on postpartum depression mainly focuses on maternal experiences and the influence on the child and the family while researches on father`s experiences have been lacking. Postpartum depression can affect fathers to the same extent as mothers but still a hidden problem. Aim: The aim was to highlight parents´ experiences of postpartum depression. Method: A literature review was conducted with ten qualitative studies of the parents' experiences of postpartum depression. The different topics were identified, compared, analyzed and then categorized into the final themes presented in this paper. Results: Three main themes were reported: Postpartum depression impact on emotional life and self-image, Postpartum depression impact on attitudes and last Postpartum depression impact on the ability to seek support. Discussion: Postpartum depression has a major impact on parents’ lives. The lack of knowledge on the disease and the stigma upon it prevents parents from seeking support. Fathers rapports that they are left by side. General healthcare professionals should seek knowledge about the effect of postpartum depression on parents' lives and how they themselves experience the disease. This would help improve treatment, which would in turn lead to more parents seek help for postpartum depression.