MMed(Obstetrics and Gynaecology) / Introduction Against the high background rate of HIV among our antenatal clinic attendees, 30.3% in Gauteng in 2007, and the importance of cancer of the cervix as a health issue; this study was undertaken to determine the rate of abnormality found in cervical smears performed on HIV positive women attending the postnatal clinic at Johannesburg Hospital. The degree of abnormality and where possible its management, was reviewed. Secondly it was determined whether the immune status, namely the WHO clinical stage, CD4 cell count and viral load, correlated with the Pap smear results. Lastly patients were also analyzed according to the treatment received for HIV and their Pap smear results. Patients and Methods The study is a retrospective record review. All the patients who attended the postnatal clinic (PNC) between October 2005 and the end of July 2006, who had a Pap smear, were included. Follow-up test results were collected to the end of June 2007. A total of 324 patients attended the clinic in the study time period, of which 248 (76.5%) had a Pap smear done and 76 (23.5%) did not. iv Results The main results of interest were as follows – 131 patients (52.8%) had normal Pap smears, 64(25.8%) had LGSIL, 32 (12.9%) had HGSIL, 10 (4.0%) had ASCUS and 11 (4.4%) had Pap smears that could not be classified. In total 47.2% of the Pap smears were abnormal. There was one case of malignancy developing after an abnormal Pap smear. Patients with abnormal Pap smears tended to have a lower mean CD4 cell count while the viral load and WHO Stage did not appear to have an impact on the final analysis of the Pap smears. Conclusion The rates of cervical abnormality in HIV sero-positive patients attending the Johannesburg Hospital postnatal clinic are much higher (47.2%) than would be expected in the general population (10%), with a significant portion requiring follow-up investigation and management. It is however preferable to deal with cervical cytological abnormalities comprehensively during the screening phase rather than trying to manage a potential increase in cervical cancer cases.

In comparison to the vast literature on postnatal depression, there exists a paucity of studies that examine anxiety and stress in postnatal populations. This thesis drew from the cognitive vulnerability-stress theories of depression, anxiety, and stress to form its theoretical basis. The underlying premise was that stressful life events have the potential to interact with cognitive vulnerability or characteristic ways of thinking to result in distress for some individuals. New motherhood was therefore conceptualized as a life event that can trigger not only depression, but anxiety and stress in vulnerable women. A major aim of this thesis was to assess the prevalence of postnatal distress using the Edinburgh Postnatal Depression Scale (EPDS) and the Depression Anxiety Stress Scales (DASS-21). The sample comprised 325 primiparous mothers who ranged in age from 18 to 44 years (M=32 years), whose babies were aged between 6 weeks and 6 months. Women were recruited through mother's groups and health centres in Melbourne. Results revealed that over and above the 61 women (19%) who were classified by the DASS-21 as depressed, a further 33 women (10%) showed symptoms of anxiety or stress without depression. This finding supports the assertions that postnatal women need to be assessed for broader indicators of psychological morbidity than that of depression alone. Moreover, 7% of the sample were both anxious and depressed, and had significantly higher mean scores on the EPDS and DASS-depression scales than their depressed-only counterparts. This sub-group also had significantly lower levels of maternal role satisfaction and general life satisfaction than depressed-only women. Other significant findings in relation to the anxious-depressed sub-group, point to the importance of assessing the comorbidity of anxious and depressive symtomatology, and of recognizing the extent to which these women may be at heightened risk compared to depressed-only women. This thesis adapted the biopsychosocial model of postnatal depression proposed by Milgrom, Martin, and Negri (1999) as a research framework for examining a number of unique predictors of postnatal distress. Drawing from an extensive literature on control, two control-related scales were developed (the Perception of Control and Order Scale, and the General Desire for Control and Order Scale). These scales, along with several other cognitive measures, were found to significantly differ in ratings between distressed and non-distressed women. The findings substantiated a role for both controlIII related perceptions (perceptions of control and order, self-efficacy, and perceived control of internal states) and individual characteristics (perfectionism and fear of negative evaluation) in the postpartum. In a final analysis of the cognitive vulnerability-stress model, factors that remained significant that made a unique contribution to the postnatal literature were perceptions of control and order, perceived control of internal states, fear of negative evaluation, and perceived criticism/judgement from women's mothers.

Much information is available through the print and other forms of media about pregnancy, parenthood, and the birth process, but significantly less information exists about postnatal depression or about how to cope with the often-painful realities of childbirth and parenting. Even less information exists about the effectiveness of caregiver intervention, especially from the point of view of womens' remembered experience. This study helps to fill the information gap identified in the literature. This is a hermeneutic phenomenological study guided by the ideas of van Manen (1990). I interviewed women who had experienced postnatal depression and health professional intervention, and asked them about their experiences. Some of the questions were, "What are the types and quality of health professional interventions provided for you by health professionals treating your postnatal depression?" "Which interventions did they use that were helpful for you, and which interventions were unhelpful?" The interviews were open-ended and tape-recorded, took one hour each, and the data was allowed to unfold naturally. The data were transcribed and analysed, then interpreted using the philosophical underpinning of phenomenology to guide my interpretation. The search for meaning in the text, and my attempts to make sense of the findings resulted in the development of two major themes, the first being Dual Reality and the second being Interventions, each theme had three sub-themes. Within the theme of Dual Reality were the sub themes of Behind the Mask, the Stresses involved in Being a New Mother, and The Depression Experience. Within the theme of Interventions were the three sub themes of Getting Help (the helpful interventions), Lack of Support, (the unhelpful interventions), and the Need for Education and More Services for Postnatal Depression (the missing interventions). The helpful and unhelpful health professional interventions were examined, some were positive and helped the women to heal from postnatal depression, and others were unhelpful (or simply absent), and the women were not assisted in their recovery. A number of recommendations are made and also suggestions for further research are included as a result of the findings of this study. / Thesis (Ph.D.)--Department of Clinical Nursing, 2005.

<p> </p><p><strong>Sammanfattning</strong></p><p><strong>Syfte</strong></p><p>Syftet är att undersöka hur partnern/närmast anhörig uppfattar personalens bemötande, information om rutiner och barnaskötsel samt hur delaktiga de känner sig i barnets omvårdnad under sin vistelse på familje-BB i en mellanstor stad i Sverige.</p><p> </p><p><strong>Metod</strong></p><p>Denna uppsats baseras på en deskriptiv enkätstudie som genomfördes under kalenderveckorna 6-10 år 2009 på familje-BBs återbesöksmottagning. 60 enkäter delades ut och 58 samlades in. Dessa enkäter analyserades sedan kvantitativt med hjälp av statistikprogrammet SPSS. Tillföljande kommentarer bearbetades genom en kvalitativ innehållsanalys.</p><p> </p><p><strong>Resultat</strong></p><p>Papporna i studien var generellt sett nöjda med sin vistelse på avdelningen. Några större skillnader kunde inte relateras till ålder, utbildning, antal barn eller om pappan sov kvar på avdelningen. Av kommentarerna att döma var papporna ofta nöjda med personalens kompetens och omtänksamhet, medan de tyckte mindre bra om avdelningsmiljön och maten som serverades. Resultaten stämmer till stor del överens med mammornas upplevelser i tidigare studier.</p><p> </p><p><strong>Slutsats </strong></p><p>De nyblivna papporna på familje-BB får god vård men skulle behöva mer information om hur de ska sköta barnet. Personalen bör i större utsträckning uppmärksamma och tillgodose pappornas behov.</p><p> </p> / <p><p><strong>Abstract</strong></p><p><strong>Aim </strong></p><p>The aim was to investigate what the father thinks of the staff’s treatment, the information about childcare, routines at the ward and how accessorial they feel in the nursing care of the baby during their stay at the post-natal ward 96E at Uppsala University Hospital, Sweden.</p><p> </p><p><strong>Method</strong></p><p>A descriptive questionnaire study that took place during calendar week 6-10 in 2009, at the post-natal revisit surgery at Uppsala University Hospital. 60 questionnaires were handed out and 58 were returned. These were analysed in the statistic programme SPSS.  The comments that followed were analyzed by content.</p><p><strong></strong></p><p><strong>Results </strong></p><p>The fathers in the study are in general pleased with their stay at the ward. No big differences related to age, education, number of children or if the father spent the night at the ward, can be seen. According to the comments, the fathers were satisfied with the staff’s qualification and consideration, but they did not like the environment at the ward or the food that was served during their stay. These results are consistent with the mothers’ experiences in an earlier study.</p><p> </p><p><strong>Conclusions </strong></p><p>The fathers at the post-natal ward are getting good care but would need more information regarding how to nurse the baby. The staff should in greater demand emphasize and supply the needs of the fathers.</p></p>

Sammanfattning Syfte Syftet är att undersöka hur partnern/närmast anhörig uppfattar personalens bemötande, information om rutiner och barnaskötsel samt hur delaktiga de känner sig i barnets omvårdnad under sin vistelse på familje-BB i en mellanstor stad i Sverige.   Metod Denna uppsats baseras på en deskriptiv enkätstudie som genomfördes under kalenderveckorna 6-10 år 2009 på familje-BBs återbesöksmottagning. 60 enkäter delades ut och 58 samlades in. Dessa enkäter analyserades sedan kvantitativt med hjälp av statistikprogrammet SPSS. Tillföljande kommentarer bearbetades genom en kvalitativ innehållsanalys.   Resultat Papporna i studien var generellt sett nöjda med sin vistelse på avdelningen. Några större skillnader kunde inte relateras till ålder, utbildning, antal barn eller om pappan sov kvar på avdelningen. Av kommentarerna att döma var papporna ofta nöjda med personalens kompetens och omtänksamhet, medan de tyckte mindre bra om avdelningsmiljön och maten som serverades. Resultaten stämmer till stor del överens med mammornas upplevelser i tidigare studier.   Slutsats De nyblivna papporna på familje-BB får god vård men skulle behöva mer information om hur de ska sköta barnet. Personalen bör i större utsträckning uppmärksamma och tillgodose pappornas behov. / Abstract Aim The aim was to investigate what the father thinks of the staff’s treatment, the information about childcare, routines at the ward and how accessorial they feel in the nursing care of the baby during their stay at the post-natal ward 96E at Uppsala University Hospital, Sweden.   Method A descriptive questionnaire study that took place during calendar week 6-10 in 2009, at the post-natal revisit surgery at Uppsala University Hospital. 60 questionnaires were handed out and 58 were returned. These were analysed in the statistic programme SPSS.  The comments that followed were analyzed by content. Results The fathers in the study are in general pleased with their stay at the ward. No big differences related to age, education, number of children or if the father spent the night at the ward, can be seen. According to the comments, the fathers were satisfied with the staff’s qualification and consideration, but they did not like the environment at the ward or the food that was served during their stay. These results are consistent with the mothers’ experiences in an earlier study.   Conclusions The fathers at the post-natal ward are getting good care but would need more information regarding how to nurse the baby. The staff should in greater demand emphasize and supply the needs of the fathers.

The natriuretic peptide system (NPS) is a hormonal system critical to mammalian cardiovascular homeostasis. The purpose of the present study was to investigate the role of ANP during early postnatal cardiac development by i) monitoring the development of cardiac hypertrophy during early postnatal development of the ANP-/- mice, and ii) comparing morphologic, morphometric and molecular differences in ANP+/+ mice compared to ANP-/- mice during this developmental period. Age matched male ANP+/+ and ANP-/- mice, aged day 1 and weeks 1 to 5, were evaluated. Body weight, organ weights and hematocrit were recorded. RNA was isolated and quantitative real-time RT-PCR was used to monitor cardiac gene expression. An additional cohort of animals was used for morphologic and morphometric analysis. Heart weight to body weight ratio (HW/BW) was dramatically higher in ANP-/- animals at all time points, indicating cardiac hypertrophy is established before the advent of adult blood pressure. Molecular analysis of gene expression revealed a compensatory response of the NPS in the ANP-/- mice. Specifically an up-regulation of BNP expression in ANP-/- mice was noted throughout postnatal development. Similarly, NPR-A and NPR-C demonstrated compensatory action for the lack of ANP, as expressional levels also varied throughout development. Morphological analysis of cardiac vasculature revealed striking structural differences between ANP+/+ and ANP-/- mice. Quantitative stereological analysis of LM images indicated a greater vessel volume in ANP-/- compared to ANP+/+ mice. This study demonstrates that alterations in early molecular events, such as changes in NPS expression, may be responsible for the maintenance and progression of cardiac hypertrophy during early postnatal development in the ANP-/- mice. The absence of ANP during this critical period of development has a profound impact on final cardiac structure leading to future pathological states. / Thesis (Master, Anatomy & Cell Biology) -- Queen's University, 2010-02-05 14:15:33.982

Objective To examine the father’s role when his partner and child are admitted to a perinatal mental health unit. Background Establishing attachment in the first months of life is crucial for infant mental health. Parental mental health and separation can interrupt the formation of attachment. Maternal postnatal mental health is known to affect the father’s well-being and mental health. A systematic review conducted found paternal depression in the first year after birth affects child behavioural and emotional difficulties. One previous study has gathered limited evidence of fathers experiences of a perinatal mental health unit. Method Eight interviews were conducted with fathers whose partner was a current or former inpatient in a perinatal psychiatric unit in Scotland. Grounded Theory was utilised in the collection and analysis of data. No participants reported symptoms of Depression, Anxiety, or Stress at time of interview. Transcripts were coded by the researcher and supervisors and categories were compared. Additionally, results were validated by a participant before completing analysis. Results Maternal postnatal mental illness and hospitalisation was challenging. Long admissions with infrequent visits were most difficult. The overarching category ‘managing the self and other relationships’ captured the father’s experience and how he tried to understand and manage, whilst making and maintaining family bonds. Five subcategories were Bonding with Baby, Keeping the Family Together, Feeling Contained, Feeling Overwhelmed, and Experiencing Uncertainty. Fathers had concerns about bonding and regarded the mother-baby bond as vital. Relationships were strained. Fathers experienced anxiety regarding illness and felt relief on admission. Fathers experienced demands such as work and travel. They tried to retain normality, take each day as it comes, and use family support to cope. Fathers were uncertain about illness and treatment and desired improved communication with professionals. Conclusion Severe maternal postnatal mental illness and inpatient admission affects fathers. Fathers have multiple demands which impact on participation in the unit. Fatherinfant bonding was affected by father availability. Recognition of the father’s experience and increasing father’s knowledge of illness and skills in caregiving is likely to improve the father’s experience and benefit the family.

No description available.

Bakgrund: 10-15% av alla nyblivna svenska mödrar drabbas idag av postpartum depression, även kallat förlossningsdepression. Sjukdomen uppkommer i samband med barnets födelse och utvecklas oftast inom två månader efter förlossningen. Postpartum depression påverkar moderns självbild och kan skapa problematik i anknytningen mellan modern och det nyfödda barnet. Syfte: Belysa mödrars upplevelser i samband med postpartum depression. Metod: Studien är baserad på sex självbiografier och är genomförd utifrån en kvalitativ ansats där resultatet har bearbetats med stöd av en manifest innehållsanalys. Resultat: Det framkom fem huvudkategorier: Lycka blev en obekant känsla, Förväntningarna på moderskapet uppfylldes inte, En främling för sig själv fångad i negativa tankar, När bägaren rann över samt Ljusa stunder. Ett tydligt fynd är att mödrarna känner stor besvikelse över att förväntningarna på postpartum perioden inte överensstämmer med verkligheten samt oförståelse över sina negativa tankar som överrumplade dem. Slutsats(er): Resultatet påvisar att postpartum depression måste synligöras bättre för att fler mödrar som drabbats ska våga söka hjälp. En bredare kunskap inom vården kan möjliggöra att postpartum depression uppmärksammas bättre.  Även allmänsjuksköterskor bör lära sig att uppmärksamma sjukdomen för att kunna fånga upp dessa mödrar i ett tidigt skede.

国立情報学研究所で電子化したコンテンツを使用している。