Thesis (Ph. D.)--Griffith University, 2003. / "March 2003." Title taken from title screen (viewed October 25, 2007). Includes bibliographical references (p. 186-208) and appendices.

Paternal postnatal depression has begun to receive attention during the last decade. Studies have shown that the consequences of paternal and maternal postnatal depression are equally serious. There are currently no validated instrument for screening of paternal postnatal depression. In this cross-sectional study a self-report questionnaire, the Edinburgh Gotland Depression Scale (EGDS) is validated against the clinical interview SCID-CV as gold standard, and is further developed. A convenience sample of Swedish fathers (N = 95) who had children in the past year, answered an online questionnaire and a subsample (n = 52) of them were later interviewed with the SCID-CV. The revised EGDS showed improved criterion-related validity, sensitivity and specificity. The scale has problems disciminating between mildly and non-depressed fathers. A cut-off score of ≥8 on the revised EGDS results in sensitivity of 91.7 per cent and specificity of 85.0 per cent. This study should be replicated and cross-validated to provide further evidence of validity. / Postnatal depression hos fäder har börjat uppmärksammas under det senaste decenniet. Studier har visat att konsekvenserna av postnatal depression hos fäder och mödrar är lika allvarliga. Det finns för närvarande inga validerade instrument för screening av postnatal depression hos fäder. I denna tvärsnittsstudie har självskattningsformuläret, Edinburgh Gotland Depression Scale (EGDS) valideras mot den kliniska intervjun SCID-CV som gold standard, och vidareutvecklas. Ett bekvämlighetsurval av svenska fäder (N = 95) som fått barn under det senaste året, besvarade en webbenkät och en undergrupp (n = 52) av dem blev senare intervjuade med SCID-CV. Det reviderade EGDS visade förbättrad kriteriumrelaterad validitet, sensitivitet och specificitet. Skalan har problem med att diskriminera mellan milt och icke-deprimerade pappor. En cut-off poäng ≥8 för den reviderade EGDS resulterar i sensitivitet på 91,7 procent och specificitet på 85,0 procent. Denna studie bör replikeras och korsvalideras för att ge ytterligare belägg för validiteten.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Introduction : The health status of women in peri-urban areas has been influence by the South African political transition. Despite some progress, maternal and child mortality rates are still unacceptably high. A mother’s nutritional status is one of the most important determinants of maternal and birth outcomes. The Institute of Medicine’s pre-pregnancy Body Mass Index (BMI) method is not always appropriate to use in a peri-urban setting as many women attend their first antenatal clinic later on in their pregnancy. Two alternative methods, the gestational BMI (GBMI) and the gestational risk score (GRS), have been used elsewhere to screen for at risk pregnancies, but have not been used in a South African peri-urban setting. Furthermore, examining socio-economic variables (SEV) aids in the explanation of the impact of social structures on an individual. Risk factors can then be established and pregnant women in these higher risk groups can be identified and given additional antenatal clinic appointments and priority during labour. Aim: The first aim was to investigate the strength of the GBMI and GRS methods for predicting birth outcomes and maternal morbidities. The second aim was to investigate the relationships between SEV, GBMI and maternal morbidities. Methods: This was a sub-study of the Philani Mentor Mothers Study. A sample of 103 and 205 were selected for investigating the prediction methods and SEV respectively. Maternal anthropometry, gestational weeks and SEV were obtained during interviews before birth. Information obtained was used to calculate GBMI and GRS and to assess the SEV. Birth outcomes were obtained from the infant’s clinic cards and maternal morbidities were obtained from interviews two days after the birth. Results No significant association was found between GBMI and birth outcomes and maternal morbidities. A significant positive association was found between GRS and birth head circumference percentile (r=0.22, p<0.05). The higher the GRS, the higher the risk of an infant spending longer time in the hospital (Kruskal Wallis X2 = 4, p<0.05). A significant positive association was found between GBMI and the following SEV factors; age (r=0.33, p<0.05), height (r=0.15, p<0.05), parity (r=0.23, p<0.05), income (r=0.2, p<0.05), marital status (X2 = 9.35, p<0.05), employment (U=2.9, p<0.05) and HIV status (U=2.54, p<0.05). No statistically significant relationships were found between gestational hypertension and gestational diabetes mellitus and SEV. Conclusion: From the findings of this sub-study there were some promising results, however it is still unclear as to which method is the most appropriate to predict adverse birth outcomes and maternal morbidity. It is recommended that the GBMI and GRS once-off methods be repeated in a larger population to see if there are more parameters that could be predicted. Women who were older, shorter, married, had more pregnancies, HIV negative and had a higher socioeconomic status tended to have a greater GBMI. This can lead to adverse birth outcomes and increases the risk of women developing maternal morbidities and other chronic diseases later in their life. Optimal nutrition and health promotion strategies targeting women before conception should be implemented. / AFRIKAANSE OPSOMMING: Inleiding: Die gesondheidstatus van vroue in semi-stedelike areas is beïnvloed deur die Suid-Afrikaanse politiese oorgang. Ten spyte van ’n mate van vooruitgang is die sterftesyfers vir moeders en kinders steeds onaanvaarbaar hoog. ‘n Moeder se voedingstatus is een van die mees belangrike bepalende faktore van moeder- en geboorteuitkomste. Die Instituut van Geneeskunde se voorswangerskap Liggaamsmassa Indeks (LMI) metode is nie altyd toepaslik om te gebruik in ‘n semi-stedelike opset nie aangesien baie vroue hul eerste voorgeboorte-kliniek eers later in hul swangerskap bywoon. Twee alternatiewe metodes, die swangerskap LMI (SLMI) en die swangerskap risiko telling (SRT) is al elders gebruik as sifting vir hoë risiko swangerskappe, maar is nog nie gebruik in ‘n Suid-Afrikaanse semi-stedelike opset nie. Vervolgens kan ‘n ondersoek na sosio-ekonomiese veranderlikes (SEV) help om die impak van maatskaplike strukture op ‘n individu te verduidelik. Risiko faktore kan dan vasgestel word en swanger vroue wat in hierdie hoër risiko groepe val kan geïdentifiseer word. Dié vroue kan addisionele voorgeboorte-kliniek afsprake ontvang asook voorkeurbehandeling tydens die geboorteproses. Doelstellings: Die eerste doelstelling was om die sterkte van die SLMI en SRT metodes te ondersoek as voorspellers van geboorte uitkomste en moeder-morbiditeite. Die tweede doelstelling was om die verhoudings tussen SEV, SLMI en moeder-morbiditeite te ondersoek. Metodes: Hierdie projek was ‘n sub-studie van die Philani Mentor Moeders Studie. ‘n Steekproefgrootte van 103 en 205 was geselekteer om onderskeidelik die voorspeller metodes en SEV te ondersoek. Die moeder se antropometrie, swangerskap weke en SEV was verkry gedurende onderhoude voor geboorte. Informasie ingewin was gebruik om die SLMI en SRT te bereken en om die SEV te ondersoek. Geboorteuitkomste was verkry vanaf die babas se kliniekkaarte en moeder-morbiditeite was verkry tydens onderhoude twee dae na die geboorte. Resultate: Geen betekenisvolle assosiasie was gevind tussen SLMI, geboorteuitkomste en moeder-morbiditeite nie. ‘n Betekenisvolle positiewe assosiasie was gevind tussen SRT en die geboorte kopomtrek persentiel (r=0.22, p<0.05). Hoe hoër die SRT, hoe hoër die risiko dat ‘n baba langer in die hospitaal sou bly (Kruskal Wallis X2=4, p<0.05). ‘n Betekenisvolle positiewe assosiasie was gevind tussen SLMI en die volgende SEV faktore: ouderdom (r=0.33, p<0.05), lengte (r=0.15, p<0.05), pariteit (r=0.23, p<0.05), inkomste (r=0.2, p<0.05), huwelikstatus (X2=9.35, p<0.05), besit van ‘n identiteitsdokument (U=1.75, p<0.05), werkstatus (U=2.9, p<0.05) en MIV status (U=2.54, p<0.05). Geen statisties beduidende verhoudings was gevind tussen swangerskap hipertensie, swangerskap diabetes mellitus en SEV nie. Gevolgtrekking Sommige bevindinge van hierdie sub-studie dui op belowende resultate, alhoewel dit steeds nie duidelik is watter metode die mees toepaslike is om ongewenste geboorteuitkomste en moeder-morbiditeit te voorspel nie. Dit word aanbeveel dat die SLMI en SRT eenmalige metodes herhaal word in ‘n groter populasie om te sien of daar meer parameters is wat voorspel kan word. Vroue wat ouer, korter, getroud, meer swangerskappe, MIV negatief en ‘n hoër sosio-ekonomiese status gehad het was geneig om ‘n hoër SLMI te hê. Dit kan lei tot ongewenste geboorteuitkomste en verhoogde risiko om moeder-morbiditeite en ander chroniese siektes later in hul lewe te ontwikkel. Optimale voeding en gesondheidsbevordering strategieë wat vroue teiken voor bevrugting behoort geïmplementeer te word.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A Organização Mundial da Saúde estima que existam aproximadamente 250 milhões de mulheres tabagistas no mundo. Em países em desenvolvimento, a prevalência do tabagismo pode variar de 11 a 35% em mulheres grávidas, constituindo um problema de saúde pública. Nicotina, um agonista colinérgico considerado o mais importante componente ativo da fumaça do cigarro, é capaz de causar déficits em um cérebro em desenvolvimento, no entanto, muitos estudos investigam estes efeitos durante a gestação de roedores, que corresponde aos dois primeiros trimestres de gestação em humanos. O presente estudo, foi focado nos efeitos da nicotina sobre o sistema colinérgico cerebral durante o equivalente ao terceiro trimestre de gestação em humanos. Ratas lactantes foram expostas a nicotina (NIC, 6 mg/Kg/dia) ou a salina (SAL) via mini-bombas osmóticas (s.c.) a partir do 2 dia ate o 16 dia pós-natal (PN). Filhotes NIC e SAL foram sacrificados durante a exposição, em PN15, e após a retirada em três momentos diferentes, PN21, PN30 e em PN90. Quatro biomarcadores foram considerados. Para avaliação dos efeitos sobre os receptores nicotínicos de acetilcolina (nAChRs), nós utilizamos [3H]citisina, que é um ligante seletivo para &#945;4&#946;2. Nos também medimos o marcador [3H]hemicholinium-3 (CH-3) de alta afinidade para o transportador pré-sináptico de colina, e a atividade das enzimas colina acetiltransferase (ChAT) e acetilcolinesterase (AChE) no córtex cerebral (CX), mesencéfalo (MB) e hipocampo (HP) na prole. O grupo NIC apresentou supra-regulação de nAChRs em todas as regiões durante a exposição, este efeito foi revertido pouco tempo após a retirada. Interessantemente, uma significante infra-regulação de nAChRs foi observada após um longo tempo da retirada somente em CX. A exposição à nicotina reduziu a marcação para HC-3 durante a exposição em todas as regiões e foi revertida em PN21. Já em PN30, o grupo NIC apresentou uma diminuição do HC-3. Em contraste, em PN90, foi observado um aumento de HC-3. Não foram observados efeitos para atividade da ChAT e da AChE em CX. No que diz respeito ao MB, o grupo NIC apresentou um aumento de atividade para ambas as enzimas, ChAT e AChE, em PN30. Para a mesma idade, nos observamos um decréscimo desta atividade somente em HP. E, após um longo tempo de retirada, somente HP apresentou um aumento na atividade da ChAT. Estes dados sugerem que a exposição à nicotina em ratos durante o equivalente ao terceiro trimestre de gestação em humanos promove alterações no sistema colinérgico dos filhotes. Somado a isto, nossos resultados indicam que os efeitos prejudiciais são observáveis mesmo muito tempo após a exposição ter sido interrompida. / The Word Health Organization estimates that there are approximately 250 million women smokers in the world. In developing countries, the prevalence of smoking varies from 11% to 35% in pregnant women, constituting a public health concern. Nicotine, a cholinergic agonist that is considered one the main active components of cigarette smoke, causes deleterious effects on brain development, however, most studies investigate its effects during rodents gestation, which corresponds to the first two trimesters of human gestation. In the present study, we focused on nicotine effects on the brain cholinergic system during the third trimester equivalent of human gestation. Lactating rats were exposed either to nicotine (NIC, 6 mg/Kg/day) or to saline (SAL) via osmotic minipumps (s.c.) from the 2nd to the 16th postnatal day (PN). NIC and SAL offspring were sacrificed during exposure (PN15), or at withdrawal (PN21, PN30 and PN90). Four cholinergic biomarkers were considered. For evaluation of effects on nicotinic acetylcholine receptors (nAChRs), we utilized [3H]cytisine, a ligand that binds selectively to the a4b2 nAChR. We also assessed the binding of [3H]hemicholinium-3 (HC-3) to the high-affinity presynaptic choline transporter, choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) activities in the cerebral cortex (CX), midbrain (MB) and hippocampus (HP) of the offspring. NIC offspring presented nAChR upregulation in all regions during exposure that was reversed at short term withdrawal, in PN21. Interestingly, a significant nAChR downregulation was observed at long term withdrawal only in CX. Nicotine reduced HC-3 binding during exposure in all regions that was reversed on PN21. On PN30, NIC offspring presents a decrease HC-3 binding. In contrast, on PN90 was observed an increase on HC-3 binding. There were no effects for ChAT and AChE in the CX. Regarding MB, NIC offspring presents an increase in both ChAT and AChE activity on PN30. At the same age, we observed a decreased in both ChAT and AChE activity on HP. At long term withdrawal, only HP showed an increase in ChAT activity. These data indicate that maternal nicotine exposure during the third trimester equivalent of human gestation promotes cholinergic system alterations in the offsprings. In addition, our data indicate that detrimental effects are observable even long after the exposure has been interrupted.

Malgré sa complexité, le cerveau intègre en permanence de nouvelles cellules – à la fois neuronales et gliales – au-delà du développement embryonnaire et ce, tout le long de la vie. La période postnatale est caractérisée par une gliogenèse intense. A l’âge adulte, de nouveaux neurones et cellules gliales sont produits dans des régions restreintes à partir de cellules souches/progénitrices (CSP) localisées dans des niches. Les deux niches de CSP adultes les mieux décrites sont la zone sous-ventriculaire des ventricules latéraux, qui produit de nouveaux interneurones olfactifs, et la zone sous-granulaire du gyrus denté de l’hippocampe, où de nouveaux neurones en grain sont produits localement. Des travaux menés ces dernières années ont montré qu’une neuro- et une gliogenèse avaient aussi lieu dans l’hypothalamus postnatal, une petite région du diencéphale ventral qui régule des processus physiologiques vitaux tels que le métabolisme, la reproduction, le sommeil et la thermorégulation. Si l’identité des CSP hypothalamiques reste débattue, de nombreux travaux s’accordent sur l’importance de la neurogenèse hypothalamique postnatale dans le contrôle du métabolisme. Cependant, la possibilité que la genèse postnatale de cellules contribue aussi au contrôle de la fonction de reproduction, une autre fonction clé de l’hypothalamus, restait à explorer. L’objectif premier de mon travail de thèse était de rechercher si la genèse de cellules dans l’hypothalamus postnatal est impliquée dans le contrôle de la reproduction, une fonction physiologique qui requière un haut degré de plasticité. La fonction de reproduction est orchestrée par une petite population de neurones produisant la neurohormone Gonadotrophin-Releasing Hormone (GnRH). Ces neurones, qui naissent en dehors du cerveau, sont en place dans la région préoptique (RPO) de l’hypothalamus à la naissance. Cependant, ils doivent subir une maturation postnatale pour acquérir le profil de sécrétion qui leur permettra d’initier la puberté et d’assurer la fertilité de l’individu. Dans une première étude, grâce à une combinaison d’approches in vitro et in vivo, nous avons mis en évidence une vague d’astrogenèse dans l’environnement des neurones à GnRH au sein de la RPO au cours des deux premières semaines de vie postnatale chez la ratte. Nos résultats suggèrent que les neurones à GnRH utilisent la prostaglandine D2 pour attirer les progéniteurs environnants et que ce recrutement est important pour la maturation sexuelle. Dans une deuxième étude, nous avons recherché si de nouvelles cellules naissent à l’âge adulte dans des régions hypothalamiques qui contrôlent la fonction de reproduction. Nous montrons que des cellules sont produites dans la RPO chez la ratte adulte et que leur taux varie au cours du cycle oestral, suggérant une régulation par les stéroïdes sexuels. De plus, nous montrons que la survenue d’une gestation stimule la néogenèse cellulaire dans une zone de la RPO qui contrôle le comportement maternel. Si la néogenèse hypothalamique adulte a surtout été étudiée chez les rongeurs de laboratoire, il reste à déterminer si ce phénomène existe aussi chez l’homme. Pour aborder cette question, nous avons évalué dans une troisième étude l’expression de marqueurs de CSP dans l’hypothalamus humain adulte, comparativement au rongeur (souris, rat) et à un primate lémurien, le microcèbe. Nous montrons que l’hypothalamus humain adulte contient des populations de cellules au profil antigénique de CSP, dont certaines semblent propres à l’homme. Au total, ces travaux montrent que de nouvelles cellules naissent dans des régions hypothalamiques qui contrôlent la fonction de reproduction au cours de la vie postnatale et à l’âge adulte chez la ratte, et que ce phénomène est important pour la maturation sexuelle. L’observation de CSP putatives dans l’hypothalamus humain adulte suggère que la capacité de l’hypothalamus à produire de nouvelles cellules à l’âge adulte existe aussi dans notre espèce. / Despite its complexity, the brain keeps adding new cells – both neuronal and glial – beyond embryonic development and throughout life. The postnatal period is characterized by intense and widespread gliogenesis. During adulthood, both glio- and neurogenesis occur in restricted locations from stem/progenitor cells (NPC) residing in niches. The two best-described niches of adult NPC are the subventricular zone of the lateral ventricles, which provides new interneurons to the olfactory bulb, and the subgranular zone of the hippocampal dentate gyrus that locally produces new granule cells. The last decade has seen an accumulation of studies showing that neuro- and gliogenesis also occur in the postnatal hypothalamus, a small portion of the ventral forebrain surrounding the third ventricle that regulates essential physiological processes such as metabolism, reproduction, sleep and thermoregulation. Even though the identity of hypothalamic NPC remains a matter of debate, a growing body of evidence points to postnatal hypothalamic neurogenesis relevance for the control of metabolism. However, a possible contribution of postnatal hypothalamic cell generation to the central control of reproduction, another key function of the hypothalamus, remained to be explored.The main aim of my doctoral researches was to evaluate whether the generation of new cells in the postnatal hypothalamus contributes to the central control of reproduction, a physiological function known to require a high degree of plasticity. The reproductive function is controlled by a small population of neurons producing the neurohormone Gonadotrophin-Releasing Hormone (GnRH). These neurons, which are born in the nasal placodes, are in place at birth in the preoptic area (POA) of the hypothalamus. However, they need a postnatal maturation to reach a mature secretory pattern that will trigger puberty and subsequent fertility.In a first study, using a combination of in vitro and in vivo experiments, we showed that a wave of astrogenesis occurs in the POA from local progenitors in the environment of GnRH neurons during the first weeks of postnatal life in the female rat. We identified prostaglandin D2 as a factor used by GnRH neurons to attract progenitors in their vicinity and showed that impaired progenitor recruitment alters sexual maturation.In a second study, we evaluated whether cell neogenesis still occurs during adulthood in hypothalamic regions relevant for the reproductive function. Our results showed that new cells are born in the POA of adult female rats. The rate of cell neogenesis varies across the estrus cycle, suggesting a regulatory influence of gonadal steroids. Moreover, we showed that gestation impacts the rate of cell neogenesis in a POA region implicated in the control of maternal behavior.While cell neogenesis in the adult hypothalamus has been mainly studied in laboratory rodents, it remains to be known whether this phenomenon also occurs in humans. To start addressing this question, we evaluated in a third study the expression of a panel of NPC markers in the adult human hypothalamus and compared it to that found in rodents (mouse, rat) and a lemur primate, the grey mouse lemur. Our results showed that the adult human hypothalamus contains populations of cells with an antigenic profile of NPC, some of which appear specific to humans.Altogether, this work shows that new cells are born in hypothalamic regions controlling reproduction throughout postnatal and adult life in female rats, and that this process is required for sexual maturation. The identification of NPC marker-expressing cells in the adult human hypothalamus suggests that the capacity for cell neogenesis also exists in the hypothalamus of our species.

The purpose of this study was to investigate the utilization of Postnatal Services at St. Joseph's Clinic. Sixty women of child- bearing age participated in the study. Convenience sampling was utilised. An integration of Qualitative and Quantitative approaches were used for collection and analysis of data. The results of the study showed that women had high knowledge about the sixth week PNC. Women's attitudes regarding attendance at the sixth week PNC were both positive and negative. The relationship between knowledge and attitude was significant (r = .2999, p = .044) The study concluded that, the attitudes of women towards attendance at the sixth week PNC were mostly negative. Four themes emerged from the study. Some of the recommendations of the study included a need for review of information given to mothers regarding its relevance and appropriateness; a need to foster more positive attitudes in women towards attendance at the sixth week PNC. / Health Studies / M.A. (Nursing Science)

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A Organização Mundial da Saúde estima que existam aproximadamente 250 milhões de mulheres tabagistas no mundo. Em países em desenvolvimento, a prevalência do tabagismo pode variar de 11 a 35% em mulheres grávidas, constituindo um problema de saúde pública. Nicotina, um agonista colinérgico considerado o mais importante componente ativo da fumaça do cigarro, é capaz de causar déficits em um cérebro em desenvolvimento, no entanto, muitos estudos investigam estes efeitos durante a gestação de roedores, que corresponde aos dois primeiros trimestres de gestação em humanos. O presente estudo, foi focado nos efeitos da nicotina sobre o sistema colinérgico cerebral durante o equivalente ao terceiro trimestre de gestação em humanos. Ratas lactantes foram expostas a nicotina (NIC, 6 mg/Kg/dia) ou a salina (SAL) via mini-bombas osmóticas (s.c.) a partir do 2 dia ate o 16 dia pós-natal (PN). Filhotes NIC e SAL foram sacrificados durante a exposição, em PN15, e após a retirada em três momentos diferentes, PN21, PN30 e em PN90. Quatro biomarcadores foram considerados. Para avaliação dos efeitos sobre os receptores nicotínicos de acetilcolina (nAChRs), nós utilizamos [3H]citisina, que é um ligante seletivo para &#945;4&#946;2. Nos também medimos o marcador [3H]hemicholinium-3 (CH-3) de alta afinidade para o transportador pré-sináptico de colina, e a atividade das enzimas colina acetiltransferase (ChAT) e acetilcolinesterase (AChE) no córtex cerebral (CX), mesencéfalo (MB) e hipocampo (HP) na prole. O grupo NIC apresentou supra-regulação de nAChRs em todas as regiões durante a exposição, este efeito foi revertido pouco tempo após a retirada. Interessantemente, uma significante infra-regulação de nAChRs foi observada após um longo tempo da retirada somente em CX. A exposição à nicotina reduziu a marcação para HC-3 durante a exposição em todas as regiões e foi revertida em PN21. Já em PN30, o grupo NIC apresentou uma diminuição do HC-3. Em contraste, em PN90, foi observado um aumento de HC-3. Não foram observados efeitos para atividade da ChAT e da AChE em CX. No que diz respeito ao MB, o grupo NIC apresentou um aumento de atividade para ambas as enzimas, ChAT e AChE, em PN30. Para a mesma idade, nos observamos um decréscimo desta atividade somente em HP. E, após um longo tempo de retirada, somente HP apresentou um aumento na atividade da ChAT. Estes dados sugerem que a exposição à nicotina em ratos durante o equivalente ao terceiro trimestre de gestação em humanos promove alterações no sistema colinérgico dos filhotes. Somado a isto, nossos resultados indicam que os efeitos prejudiciais são observáveis mesmo muito tempo após a exposição ter sido interrompida. / The Word Health Organization estimates that there are approximately 250 million women smokers in the world. In developing countries, the prevalence of smoking varies from 11% to 35% in pregnant women, constituting a public health concern. Nicotine, a cholinergic agonist that is considered one the main active components of cigarette smoke, causes deleterious effects on brain development, however, most studies investigate its effects during rodents gestation, which corresponds to the first two trimesters of human gestation. In the present study, we focused on nicotine effects on the brain cholinergic system during the third trimester equivalent of human gestation. Lactating rats were exposed either to nicotine (NIC, 6 mg/Kg/day) or to saline (SAL) via osmotic minipumps (s.c.) from the 2nd to the 16th postnatal day (PN). NIC and SAL offspring were sacrificed during exposure (PN15), or at withdrawal (PN21, PN30 and PN90). Four cholinergic biomarkers were considered. For evaluation of effects on nicotinic acetylcholine receptors (nAChRs), we utilized [3H]cytisine, a ligand that binds selectively to the a4b2 nAChR. We also assessed the binding of [3H]hemicholinium-3 (HC-3) to the high-affinity presynaptic choline transporter, choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) activities in the cerebral cortex (CX), midbrain (MB) and hippocampus (HP) of the offspring. NIC offspring presented nAChR upregulation in all regions during exposure that was reversed at short term withdrawal, in PN21. Interestingly, a significant nAChR downregulation was observed at long term withdrawal only in CX. Nicotine reduced HC-3 binding during exposure in all regions that was reversed on PN21. On PN30, NIC offspring presents a decrease HC-3 binding. In contrast, on PN90 was observed an increase on HC-3 binding. There were no effects for ChAT and AChE in the CX. Regarding MB, NIC offspring presents an increase in both ChAT and AChE activity on PN30. At the same age, we observed a decreased in both ChAT and AChE activity on HP. At long term withdrawal, only HP showed an increase in ChAT activity. These data indicate that maternal nicotine exposure during the third trimester equivalent of human gestation promotes cholinergic system alterations in the offsprings. In addition, our data indicate that detrimental effects are observable even long after the exposure has been interrupted.

Spleen is the largest secondary lymphatic organ which develops in a short postnatal period. Information on postnatal development of rabbit spleen is minimal in available literary sources. This diploma thesis deals with the weight, morphometric and histological changes of the spleen of rabbits at age 0, 5, 10, 14, 19, 27, 32 and 39 days. During postnatal development of rabbits, a statistically significant (P <0.01) increase in the weight, length and width of the spleen occurred. The spleen of newborn rabbits was a relatively small organ with an average length of 1.03?0.12 cm, a width of 0.2?0.01 cm and a weight of 52.50?9.69 g. At age 39 days the size and shape of spleen of adult individuals (average length 4.97?0.73 cm, width 0.9?0.18 cm and weight 1078.40?143.35 g). Between the weight and morphometric parameters, high correlation coefficients were observed in the range of 0.891 to 0.998. Spleen growth was accompanied by increasing cellularisation of the parenchyma, by strengthening the connective tissue (from 8.04?1.50 m to 31.30?5.51 m) and the progressive occurrence of connective tissue in the parenchyma. In the newborn rabbits, a red pulp with a high level of erythrocytes prevailed in the spleen parenchyma. Lymphatic tissue consisted only of small irregular aggregations of basophilic mononuclear cells around several central arteries. Basophilic and vascularization increased in the course of the age and the white pulp was gradually formed. In 14 day rabbits, the marginal zone was well-known, and primary lymph nodes formed by CD79+ cells were first formed. From 14th to 39th day the spleen gradually increased the frequency and size of the individual compartments, with rare germinal centers observed in the lymph nodes until the 39th day. Throughout the course of the observation, extramedullary haematopoiesis of different intensity was seen in the spleen.

D.Cur. / The postpartum-period is a very emotional time for the mother with a new baby, which increases her need for support. Various factors contribute to this need for support, such as the change from the extended family to the nuclear family, which has reduced the number of network persons. The hospitalisation period of the mother after the birth of a baby has also decreased drastically, owing to the high medical costs associated with the birth of a baby. This results in the mother being discharged from the hospital much earlier and her accessibility to professional support being limited thereby. This source of support, namely the professional person who provides the mother with support, is also insufficient since the growth of the population far exceeds that of the nursing occupation, and the need is to huge for only professional persons to provide in. If the mother does not receive the necessary support that she may need, it could lead to postpartum-depression, which has a detrimental effect not only on the mother but also on the new baby and the mother's family. This research is therefore vitally important to the midwife, as it ensures a healthy mother and baby, not only in the hospital environment but also at home in her community where she must live and raise her baby. Community support to the mother during the postpartum-period is a relatively unfamiliar field in midwifery. Although the term community support is often used, the definition thereof has not yet been clarified, and it is used in different contexts, with different meanings. The term community support to the mother has therefore not yet been adequately described within the context of the postpartum-period. The objective of this research is to investigate and describe, and analyse the term community support to the mother during the postpartum-period, and to identify the characteristics of community support to the mother during the postpartum-period, as well as the network persons who must provide this community support to the mother, in order to establish the necessary guidelines for the provision of sufficient community support to the mother during the postpartum-period.

Background: Skilled birth attendance, usually available by promoting childbirth at health care institutions in low-resource settings, is known to prevent maternal and neonatal morbidity and mortality. While institutional childbirths in India have increased at an exponential rate, the infrastructure, material and manpower resources to support this practice are lagging, raising concerns about the quality of childbirth services. Methodology: A mixed-method approach was used in this project: in-depth interviews with women (n= 13); and focus-group-discussions with the care providers (n=27) were conducted and analysed using Grounded Theory. A cross-sectional survey (n= 1004) assessed prevalence of Fear of Birth (FoB) and postnatal depressive symptoms (PND), along with satisfaction with childbirth services among women in the immediate postpartum period. Results: The system of cashless childbirth provided at the public health facilities, in the women’s experiences, came at the hidden cost of them having to make themselves subordinate to the offered services. The prevalence of FoB and PND was 13.1% and 17.1%, respectively, and these were significantly associated (p &lt; 0.001). Among women with vaginal births (VB), 41.2% had experienced a perineal wound and 59% of them underwent repair without local anaesthesia. While the majority of the women were satisfied (VB 68.7%; Caesarean births 79.2%) with the services; women having VBs at Community Health Centres (nearly 81%) were more commonly satisfied compared to those at the District Hospitals (nearly 60%) (p &lt; 0.001). From the care providers’ perspective, maintaining quality of childbirth services was like a balancing act between the realities of low-resource settings with stakeholders’ expectations. While the providers remained proud and committed; the challenges often left them fatigued, disillusioned, irritable and sceptical. Conclusion: There is a need to improve the sensitivity with which childbirth services are being delivered to women coming to public health facilities; as well as towards improving the care providers’ work conditions. Suboptimal birth experiences are associated with the women’s perinatal mental health and satisfaction, while perpetual work challenges may make the care providers frustrated and/or apathetic. Improving manpower resources could reduce work-stress in care providers and thereby improve childbirth processes.