Syftet med föreliggande enkätstudie var att undersöka om distriktssköterskorna upplever att de har tillräckligt med kunskap och stöd för att genomföra stödsamtal med deprimerade mammor, samt att se hur handläggningen ser ut då mammor visar tecken på postnatal depression. Urvalet bestod i distriktssköterskor som genomgått utbildning i Postnatal depression och svarsfrekvensen i enkätstudien var 66 %. Samtliga respondenter upplever att utbildningen i Postnatal depression är användbar i deras arbete. Mest nytta har de av att veta hur en bra screening ska gå till. Majoriteten av respondenterna har tillgång till handledning med psykolog 1 gång/mån eller 2-3 gånger/halvår. Något mindre än hälften upplever att handledningen de får inte är tillräcklig. Samtliga respondenter använder The Edinburgh Postnatal Depression Scale (EPDS) i sitt arbete och remitterar alla mammor med mer än 16 poäng till psykolog. Mer än hälften genomför i genomsnitt 1-3 stödsamtal med varje deprimerad mamma. Knappt hälften av respondenterna upplever att de träffar för få deprimerade mammor för att känna sig trygga och säkra i situationen med stödsamtal. Slutsats Postnatal depressions utbildningen är användbar i arbetet som distriktssköterska. Tillgången till handledning är för de flesta god men otillräcklig. Många upplever att de träffar för få deprimerade mammor för att känna sig trygga och säkra med att genomföra stödsamtal. / The aim of this study was to investigate if the child health care nurses feel they have enough knowledge and support to operate counselling with mothers that feel depressed postpartum, further the aim also was to see how the child health care nurses handle mothers with signs of depression. The sample consists of child health care nurses who had taken the training-course in Postnatal depression, 66 % answered the questionnaire. All respondents experience that the training in Postnatal depression is useful in their work. Most useful to know is how a god screening is attended. The majority of respondents have access to supervision with psychologist once a month or 2-3 times over six months. Barely half feel they don’t get enough supervision. All respondents use The Edinburgh Postnatal Depression Scale (EPDS) in their work and also refer mothers with EPDS score 16 or more to psychologist. More than half of the respondents operate 1-3 counselling with each depressed mother. Almost half feel that they meet too few depressed mothers to feel secure with counselling. Conclusion: The training-course in Postnatal depression is useful in the work of child health care nurses. Supervision with psychologist is for the most child health care nurses adequate, but not enough. Many of the respondents experience that they meet too few depressed mothers to feel secure and to find a routine in counselling.

Thesis (M.S.)--University of Wisconsin--Madison, 1984. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 80-83).

Background: Wheezing is one of the most common respiratory illnesses in children worldwide. Severe wheeze can result in significant morbidity, caregiver burden and increased health care costs. In addition, early childhood wheeze may be associated with reduced lung function, diminished airway responsiveness, increased risk of asthma in late childhood and subsequent respiratory disease including asthma in adulthood. This is particularly true in those experiencing recurrent wheeze episodes, which in the presence of viral respiratory tract infections, are believed to lead to asthma diagnosis. Thus, it is imperative to understand the risk factors for early childhood wheeze to reduce the increasing burden of respiratory illness. Recent research has seen a shift to maternal psychosocial risk factors and the impact these have on child respiratory health outcomes, such as wheeze. Various studies, largely conducted in High Income Countries (HIC), have found associations between antenatal or postnatal psychosocial risk factors, such as depression, psychological distress, and Intimate Partner Violence (IPV), and child wheeze and/or asthma diagnosis in early stages of life. However, these studies predominantly considered those in low-income urban regions that were predisposed to respiratory illnesses, including wheeze and asthma. Utilising the techniques and knowledge gained from previous studies, this research considers the relationship between antenatal or postnatal maternal psychosocial exposures and the onset and recurrence of child wheeze in a South African setting. In the study population used for this research, the reported prevalence of antenatal psychological distress and depression was 23% and 20%, respectively, while 34% of the women were exposed to antenatal IPV. Often those suffering from poor mental health in these contexts are not recognised and therefore remain untreated. In addition, service provision in these settings is also generally poor. The combination of low levels of social and psychiatric support, with unique political and socio-economic risk factors, may result in more persistent and severe forms of psychosocial exposure in Low Middle Income Countries (LMIC). Given the high prevalence of psychosocial risk factors, as well as the high prevalence of child wheeze, South Africa provides an excellent platform to investigate the association between maternal antenatal or postnatal psychosocial exposure and the development and recurrence of child wheeze in an LMIC context. Methods: The data used for this research was provided by the Drakenstein Child Health Study (DCHS), a prospective birth cohort study conducted in the Drakenstein region, a peri-urban region outside of Paarl in the Western Cape of South Africa. Pregnant women over 18 years old, between 20-28 weeks' gestation, living in the region were enrolled in a parent study, in order to investigate the epidemiology and aetiology of respiratory illnesses in children. The parent study considered various risk factors, including psychosocial risk factors such as maternal depression, psychological distress and IPV, which were measured antenatally and postnatally by validated questionnaires. In the context of this research, wheeze was considered to be present if it was identified during any routine study follow-up visit, as well as at an unscheduled lower respiratory tract infection (LRTI) episode visit during the first two years of life. Recurrent wheeze was defined as experiencing two or more episodes of wheeze in a 12-month period. Logistic regression was used to investigate the relationship between antenatal and postnatal psychosocial risk factors and child wheeze. Results: From the results, postnatal psychological distress and IPV were associated with experiencing at least one episode of child wheeze (adjusted OR = 2.10, 95% CI: 1.16-3.79 and 1.60, 95% CI: 1.11-2.29 respectively) and recurrent wheeze (adjusted OR = 2.33, 95% CI: 1.09- 4.95 and 2.22, 95% CI: 1.35-3.63 respectively), within the first two years of life. No associations were found between antenatal psychosocial risk factors and child wheeze. Of clinical covariates explored, maternal smoking and household smoke exposure, birth weight, gestational age, sex and population group were associated with the presence of wheeze. All of these clinical covariates, as well as alcohol consumption were associated with recurrent child wheeze. Conclusion: Maternal postnatal psychological distress and postnatal IPV had the strongest impact on predicting wheeze outcomes. These findings suggest that screening and treatment programs which address maternal postnatal psychosocial risk factors may lessen the burden of childhood wheeze in LMIC settings.

Background: The study described the perspectives and experiences of women and health care providers with regard to use of postnatal care and reasons why some women do not attend postnatal care in order to identify strategies for improving postnatal care services. Methods: An explorative, descriptive, and contextual research design was used. In step one data was collected with semi-structured interviews with seventeen (17) women who attended postnatal care. The second sample consisted of ten (10) women who did not attend postnatal care but brought their babies for well-baby clinic. Focus groups were conducted with midwives who offered postnatal care to women. The midwives of the first focus group worked in the hospital while the second focus group worked at a filter clinic. Results: In step one, some women indicated positive experiences but most women had negative experiences about postnatal care. The positive experiences were related to the satisfaction of the women with good services received and not encountering problems with staff's care. Common concerns mentioned in step one and two about postnatal care were shortage of skilled midwives, need for staff to be trained on postnatal care services, lack of confidentiality, poor infrastructure and non-integration of maternal and child services. Reasons for not attending postnatal care that were mentioned by women in step three were inaccessibility of the health care facilities, poor roads infrastructure, lack of knowledge about postnatal services and socio-cultural factors. Conclusion: Based on the findings, strategies to improve postnatal care were developed: Firstly, the midwives need to be trained on postnatal care and highlighted on current postnatal policies and guidelines. Secondly, woman and baby should attend the postnatal care at the health facility. Thirdly, community health nurses and trained community health workers should visit the women at home soon after birth of the babies. Fourthly, postnatal care should be provided at the family and community level by a trained and skilled midwife during the early postnatal period. Fifthly, combination of care facility and home visit - when the woman and baby are discharged from the hospital, follow- up need to be done at home by the midwife. Lastly, a comprehensive integration of postnatal services with other programmes needs to be enforced and supported by the programme management and policy makers. / MCur, North-West University, Potchefstroom Campus, 2015

Background: The study described the perspectives and experiences of women and health care providers with regard to use of postnatal care and reasons why some women do not attend postnatal care in order to identify strategies for improving postnatal care services. Methods: An explorative, descriptive, and contextual research design was used. In step one data was collected with semi-structured interviews with seventeen (17) women who attended postnatal care. The second sample consisted of ten (10) women who did not attend postnatal care but brought their babies for well-baby clinic. Focus groups were conducted with midwives who offered postnatal care to women. The midwives of the first focus group worked in the hospital while the second focus group worked at a filter clinic. Results: In step one, some women indicated positive experiences but most women had negative experiences about postnatal care. The positive experiences were related to the satisfaction of the women with good services received and not encountering problems with staff's care. Common concerns mentioned in step one and two about postnatal care were shortage of skilled midwives, need for staff to be trained on postnatal care services, lack of confidentiality, poor infrastructure and non-integration of maternal and child services. Reasons for not attending postnatal care that were mentioned by women in step three were inaccessibility of the health care facilities, poor roads infrastructure, lack of knowledge about postnatal services and socio-cultural factors. Conclusion: Based on the findings, strategies to improve postnatal care were developed: Firstly, the midwives need to be trained on postnatal care and highlighted on current postnatal policies and guidelines. Secondly, woman and baby should attend the postnatal care at the health facility. Thirdly, community health nurses and trained community health workers should visit the women at home soon after birth of the babies. Fourthly, postnatal care should be provided at the family and community level by a trained and skilled midwife during the early postnatal period. Fifthly, combination of care facility and home visit - when the woman and baby are discharged from the hospital, follow- up need to be done at home by the midwife. Lastly, a comprehensive integration of postnatal services with other programmes needs to be enforced and supported by the programme management and policy makers. / MCur, North-West University, Potchefstroom Campus, 2015

Background: Adults benefit from participating in physical activity (PA) for chronic disease prevention and treatment. Postnatal women are encouraged to commence a gradual return to PA 4-6 weeks after giving birth, with participation in line with PA guidelines. The potential benefits of postnatal PA include weight management, improvements in cardiovascular fitness and psychological wellbeing. There has been limited high-quality information about the efficacy, feasibility and acceptability of PA interventions in postnatal women and few studies in the UK. Behavioural counselling interventions informed by behaviour change theory have been shown to successfully increase PA in low-active adults. Physical activity consultations (PACs) use structured and individualised behavioural counselling to enhance individuals’ motivation for change, and improve self-management skills. This approach may support adoption of PA in low-active postnatal women with research demonstrating that modifiable socio-cognitive factors influence PA behaviour. This thesis reports on the efficacy of a postnatal PA intervention, the More Active MuMs in Stirling (MAMMiS) study on change in PA behaviour. Efficacy of the intervention was tested in a randomised controlled trial. The effect on secondary health and wellbeing outcomes and PA cognitions targeted by the intervention and feasibility results are also reported. Methods: The intervention comprised a face-to-face PAC of around 35-45 minutes and 10-week group pramwalking programme. Non-attenders to the pramwalking group received a support telephone call. A follow-up PAC (15-20 minutes) was delivered after three month assessments. The first PAC involved raising awareness about benefits of PA, developing self-efficacy for change, setting goals and action planning PA, developing strategies for overcoming barriers, encouraging self-monitoring, prompting social support and selecting/changing the environment to support PA. The second PAC involved feedback about changes and preventing a return to sedentary habits. The pramwalking group met weekly for 6 walks of 30-55 minutes at a brisk pace, providing opportunities to demonstrate moderate-intensity walking and to encourage and support PA behaviour change. The control group received an NHS leaflet, which encouraged PA after childbirth. Postnatal women (six weeks to 12 months after childbirth) were identified through a variety of NHS-based and community-based strategies plus local advertisements and word-of-mouth. The primary outcome measure was evaluation of PA behaviour change using the Actigraph GT3X/GT3X+ accelerometer, an objective measure of PA behaviour; self-reported moderate-vigorous physical activity (MVPA) was measured using a recall questionnaire (Seven-Day Physical Activity Recall) and cardiovascular fitness using a submaximal step-test (Chester step-test). Secondary health and wellbeing measures were; anthropometric (i.e. weight and body mass index (BMI)) and body composition (measured using a bioelectrical impedance), psychological wellbeing (measured using the Adapted General Wellbeing Index) and fatigue (measured on a 100-point visual analogue scale). PA cognitions were measured via a questionnaire with constructs adapted from previous studies. All were taken at baseline (prior to randomisation), three and six months follow-up from baseline. Process measures were used to investigate intervention fidelity and feasibility. Acceptability was investigated in a post-trial interviews, conducted by a researcher not involved in the trial. RESULTS: Sixty-five postnatal women (average 33 years old with an infant 24 weeks old) were recruited (77% of those eligible). There was a 91% rate of retention at six months; participants who missed a follow-up assessment were younger (30 versus 34 years old) and had younger infants (21 versus 34 weeks old). Participants were less deprived and older compared with postnatal women in Scotland. Objectively measured PA behaviour did not change in response to the intervention. There was no between-groups difference in change in mean counts/minute from baseline to three months (p=0.35, 95% CI -73.50, 26.17, d=0.22) or three to six months (p=0.57, 95% CI -39.46, 71.18, d=0.13). There was no change in MVPA 7 minutes/day in either group from baseline to three (intervention =-0.70, IQR -9.86, 8.36; control =1.65, IQR -4.79, 8.21) or three to six months (intervention =0, IQR -1.13, 1.10; control =0, IQR -9.86, 8.23), with no between-groups difference baseline to three (p=0.43; r=0.10) or three to six months (p=0.75, r=0.09). Results for relative MVPA were similar. Median steps/day from baseline to three months did not change in the intervention group (0, IQR –1619.44, 1047.94) and increased by 195.95 (IQR -1519.55, 1691.03) among controls. The between-groups difference was non-significant (p=0.37, r=0.18). From three to six month follow-up steps/day increased in the intervention group and not in controls (0, IQR -1147.50, 1303.52), this between-groups difference was also non-significant (p=0.35, r=0.16). From baseline to three months self-reported MVPA declined in the intervention group (15 minutes/week; IQR -111, 15) and increased in the control group (30 minutes/week; IQR –68, 75): a non-significant between-groups difference, with a small effect size (p=0.71, r=0.22). From three to six months a decline in self-reported MVPA was found in controls (53 minutes/week; IQR -41,-101) and no change among the intervention group (0, IQ range -26, 71); a significant between-groups difference with a small effect size (p=0.04, r=0.26). There were no differences between the groups for the change in aerobic capacity from baseline to three months or three to six months with no evidence for change over time in aerobic capacity or fitness category in either group. Change in secondary outcomes did not differ between the groups from baseline to three or three to six months (although fatigue did improve in the intervention group relative to controls from baseline to three months). Considering PA cognitions, outcome expectancies declined in both groups from baseline to three months and continued to decline only in the intervention group from three to six months, a between-groups difference with a small effect size (p=0.03, r=0.26). Self-efficacy increased in the intervention group from baseline to three months and declined in the control group with a small effect size for the between-groups difference (p=0.03, r=-0.27). An increase in action 8 planning was seen among the intervention group but not controls from baseline to three months (p<0.01, r=-0.34). Both groups showed an increase in coping planning and action control; the change was larger among the intervention group relative to controls (i.e. p<0.01, r=0.44, r=0.43, respectively). Increased self-efficacy and action control were maintained from three to six months in the intervention group. Coping planning increased relative to controls (p<0.01, r=0.41) and action planning increased among controls from three to six months (p<0.01, r=0.39). Intervention fidelity and feasibility was good. All intervention participants received the initial PAC and adoption of self-management strategies was high for ‘thinking about the benefits of PA’, ‘action planning’ and ‘self-monitoring’, between baseline and three months. Most participants attended at least one walk (61% attended five or more), 89% of planned walks were conducted with no evidence of poor attendance due to season. Walks were conducted at a brisk pace and met moderate-intensity thresholds. DISCUSSION: MAMMiS aimed to recruit low-active healthy postnatal women to test the efficacy of a PAC and group pramwalking intervention. There was no evidence for an intervention effect on PA or on secondary health and wellbeing outcomes.

Postpartal adaptation and vulnerability to depression was assessed in a sample of eighty women during the third and eighth weeks after childbirth. A questionnaire (IPA) was developed to assess postpartal adaptation in five areas: activities of daily living, labor-delivery events, mother-infant interactions, social supports, and construal of self and future. Other questionnaires included a psychological screening inventory (PSI), two depression measurements (Beck's Inventory and Pitt's Questionnaire), and a maternal assessment scale (MAS). Data were processed through the Statistical Package for Social Sciences, developed by Nie and Associates, Version 7 procedure, Northwestern University, Vogelback Computing Center, to obtain correlation analyses. Results suggested several areas of postpartal adaptation to be correlated with depression reactions after childbirth: moods, sleep, eating schedule, energy level, negative emotions toward infant, and items assessing social supports and self-construal.

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No description available.

Background: Maternal postnatal depression (MPND) has been associated with child emotional, behavioural and cognitive problems, placing them at greater risk for later psychopathology. Therefore research into mechanisms of risk transmission is important. This longitudinal study considers the emotional quality of the mother-child relationship, using a measure of Expressed Emotion (EE), as a potential mechanism explaining the link between MPND and child emotional and behavioural problems in the postnatal period. It was predicted mothers with higher depressive symptoms at 3-months would show more negative EE and their child would have more internalising and externalising problems at 2-years, with maternal EE acting as a mediator. Methods: Data from the longitudinal Oxford Father’s Project for 130 (of 192 originally recruited) mother-child dyads was used. Mother’s depressive symptoms were measured using the Edinburgh Postnatal Depression Scale at 3-months. Maternal EE, specifically critical and positive comments, was coded from the Preschool Five Minute Speech Sample measured at 2-years. Maternal, paternal and independently rated child outcomes were measured at 2-years using the Child Behaviour Checklist for ages 1.5-5. Results: Mothers, fathers and “others” rated child problems similarly. EE-positive comments showed stability from 1-2 years. Mothers with more depressive symptoms at 3-months showed more EE-criticism at 2-years especially towards boys and rated their children higher in internalising and externalising problems. Maternal EE-criticism predicted child internalising and externalising problems at 2-years. EE was not a significant mediator between maternal depressive symptoms and child problems. Conclusions: Children of mothers with more depressive symptoms 3-months post-birth experience more maternal EE-criticism and show more internalising and externalising problems aged 2-years. Given the long-term consequences of early childhood problems, postnatal depression should be screened and treated early to reduce EE-criticism and negative child outcomes. Research should consider why mothers experiencing postnatal depression may be more critical of male children and how this may impact on development.