<p><strong>ABSTRACT</strong></p><p><strong>Background</strong></p><p>Postpartum depression (PPD) occurs in 10% of women who have recently given birth. Postpartum depression is treatable but unidentified and untreated it could lead to serious consequences. There are multiple instruments for screening available. The Edinburgh Postnatal Depression Scale is the most frequently used and is regarded as the best instrument.</p><p><strong> </strong><strong>Aim</strong></p><p>The aim of this study was to analyze to what extent and how midwifes and primary care nurses identify mothers with symptoms of depression respectively PPD. A further aim was to enquire if there are routines for follow up and if there is any collaboration among the professions?</p><p><strong>Method</strong></p><p>A descriptive and comparative design with collection of quantitative and qualitative data was chosen. Midwifes (n=20) and primary care nurses (n=26) at 9 primary care centres answered a questionnaire concerning PPD.</p><p><strong>Results</strong></p><p>Almost all of the primary care nurses reported that they used EPDS as a screening instrument. They also described signs of depression/PPD. Midwifes and primary care nurses had some education in PPD, but there was a need for more education. Even if there was some collaboration among the professions there still was a wish for an increase of co-working.</p><p><strong>Conclusion</strong></p><p>EPDS-screening and referrals to psychologist, physicians and psychiatrists are routines used to identify PPD and also for follow-ups. The midwifes have not received education and does not use EPDS-screening in the same extension as the primary care nurses.</p><p><strong> </strong></p><p><strong></strong></p>

ABSTRACT Background Postpartum depression (PPD) occurs in 10% of women who have recently given birth. Postpartum depression is treatable but unidentified and untreated it could lead to serious consequences. There are multiple instruments for screening available. The Edinburgh Postnatal Depression Scale is the most frequently used and is regarded as the best instrument. Aim The aim of this study was to analyze to what extent and how midwifes and primary care nurses identify mothers with symptoms of depression respectively PPD. A further aim was to enquire if there are routines for follow up and if there is any collaboration among the professions? Method A descriptive and comparative design with collection of quantitative and qualitative data was chosen. Midwifes (n=20) and primary care nurses (n=26) at 9 primary care centres answered a questionnaire concerning PPD. Results Almost all of the primary care nurses reported that they used EPDS as a screening instrument. They also described signs of depression/PPD. Midwifes and primary care nurses had some education in PPD, but there was a need for more education. Even if there was some collaboration among the professions there still was a wish for an increase of co-working. Conclusion EPDS-screening and referrals to psychologist, physicians and psychiatrists are routines used to identify PPD and also for follow-ups. The midwifes have not received education and does not use EPDS-screening in the same extension as the primary care nurses.

The purpose of the research project was to examine the effects of exercise and social support for postnatal women who reported experiencing Postnatal Depression (PND). PND is a serious condition that affects up to 10%-15% of women (O'Hara & Swain, 1996). Many previous studies have reported an improvement of depressive symptomatology following a pram walking intervention. However, no published research exists which assesses postnatal women who report experiencing PND. A randomised controlled trial was used, where pre-test data were compared to post-test effects. Two studies were conducted. In study 1 (n= 20) a multi-intervention group (exercise and social support) was compared to a control group who received no intervention. Study 2 (n= 19) was conducted 20 months later on a different group of women and involved a pram walking intervention group and a comparison social support group. Structured questionnaires assessing depressive symptomatology, general health and levels of social support were administered at pre-test phase, week 6 and 12. A sub-maximal fitness test was conducted the week before the program started and at week 12. The chief investigator was present at all sessions to guide the participants. Study 1 (S1): The multi-intervention group attended 3 pram walking sessions per week. After the exercise session the group met for refreshments in a local hall. The control group was only required to perform the fitness tests and answer the questionnaires. A 6-week alternative program of exercise and social support was offered to all the women at the completion of the intervention period. Study 2 (S2): The pram walking group met for 2 exercise sessions and were required to make up the third session independently. The comparison social support group met once per week for morning tea with the children. The samples for both studies were drawn from the Gold Coast region in Australia. Women of childbearing age who were experiencing depressive symptoms were recruited. For S1 their child had to be less than or equal to 12 months and for S2 the age cut off was increased to less than or equal to 18 months. The participants were screened to ensure that they did not have a medical condition that would prevent regular aerobic exercise and they were also excluded if they had a previous history of mental illness or could not speak English. Demographic data were obtained from each participant and details such as height, weight and age were collected for use in analysing fitness levels. The data for each study were collected across three time points (pre, week 6 and week 12) using widely tested instruments. Some additional questions relating to the participants experiences were collected at the completion of the study from the women allocated to the intervention groups. Data were also collected on fitness levels (pre and week 12) and the instrument was tested for its reliability. Both pram walking intervention groups were required to complete a weekly exercise diary. For each study, to test for the effect of the intervention over time, a two-way analysis of variance was conducted on the major outcome variables. Group (intervention versus control) was the between subject factor and time (pre-test, week 6, week 12) was the within subject factor or repeated measures factor. Due to the small sample size, further tests were conducted to check the assumptions of the statistical test to be used. The results showed that using Mauchly's Test, the Sphericity assumptions of repeated measures for ANOVA were met. Further, tests of homogeneity of variance assumptions also confirmed that this assumption was met. Data analysis was conducted using the software package SPSS for Windows Release 10.0. (Norusis, 2000). Overall, the findings from both S1 and S2 showed that the groups who received the pram walking intervention improved their depressive symptomatology and fitness levels when compared to those of the control (S1) and social support group (S2). Social support levels did not alter for either group from both studies. These results are encouraging and suggest that a pram walking program is an effective form of intervention for postnatal women experiencing depressive symptomatology.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

Dans cette étude, nous avons utilisé un modèle de souris permettant d’induire des lésions de sévérité variable afin de mimer différentes anomalies de la myéline du cerveau que l'on peut rencontrer chez l'homme. La perte des OLs a été de 80% après 2 semaines de traitement au GCV (GCV1-14). Après l'arrêt du traitement, les processus de récupération ont conduit à une augmentation significative de la population OLs à 80% à la semaine 6 (W6). L’extension du traitement GCV à 3 semaines (GCV1-21) a entraîné une perte de 85% de la population OLs. Cependant la récupération est limitée et reste à 40% du niveau de contrôle à W6. Nous avons remarqué une augmentation rapide (de 2 fois) des cellules Olig2+ chez la souris GCV1-14 contre les souris GCV1-21 (de 1,5 fois) à W4. Nos résultats ont montré une augmentation significative des cellules Olig2-phosphorylé chez la souris GCV1-14 entre W3 et W4 après l'arrêt du traitement GCV. A l'opposé, dans le modèle GCV1-21, un très faible niveau de Olig2 phosphorylé a été observé. Nous avons observé des modifications transitoires dans l’expression de NgR et Caspr mais l’expression de P75 reste inchangée. Ensemble, ces résultats suggèrent que la reprise du déficit myéline du cerveau au cours du développement postnatal dépend de régénération suffisante des oligodendrocytes dans un laps de temps défini pour la myélinisation normale. / Abnormalities of myelination during brain development are thought to result in neurologic and psychiatric disorders. We tested the developmental time window required for oligodendrocyte generation and myelin formation in the central nervous system, using a transgenic mouse harboring HSV1-TK and eGFP genes under the control of MBP and PLP promoters respectively, to carry out the conditional ablation of oligodendrocytes. The first ablation program comprised daily injection of ganciclovir (GCV) for two weeks (GCV1-14) to induce a reversible myelin recovery. The second program comprised GCV injection for 3 weeks (GCV1-21) to create a model of irreversible myelin recovery. GCV1-14 model presented 85% reduction of oligodendrocytes at week 2 (W2) and significantly increased recovery of oligodendrocytes and myelin at W4, then slower recuperation in the following weeks after the arrest of GCV treatment. Similarly, GCV treatment for three weeks (GCV1-21) induced severe deficiency of oligodrndocytes (90%) and myelin at W3. Contrasting the GCV1-14 program, only 40-50% of oligodendrocyte population was recovered at W6 and brain remained severely deficient in myelin. Moreover, no significant recovery was observed during the following weeks and myelin at W4, then slower recuperation in the following weeks after the arrest of GCV treatment. Similarly, GCV treatment for three weeks (GCV1-21) induced severe deficiency of oligodrndocytes (90%) and myelin at W3. Contrasting the GCV1-14 program, only 40-50% of oligodendrocyte population was recovered at W6 and brain remained severely deficient in myelin. Moreover, no significant recovery was observed during the following weeks and frequently ended with premature death of mice. Since no significant changes in the expression of axonal markers including neurofilaments, NgR, P75, Caspr and neurofascin186 were detected at W5 in the two models, we conclude that an intrinsic defect of oligodendrocyte regeneration at W3-W4 underlies the irreversible model. Significant number of phosphorylated Olig2+ cells was observed at W3 in reversible model in demyelinated corpus callosum while at the same time-point, this population is absent from control and irreversible model. At the same period, the proliferation index (Ki67) of Olig2+ cells is 8 fold higher in the corpus callosum of GCV1-14 model than the control and the irreversible model. Together, these findings suggest that recovery from myelin deficit during postnatal brain development depends on sufficient regeneration of oligodendrocytes within a defined time frame for normal myelination to occur.

Les cellules microgliales constituent la population de macrophages résidents du système nerveux central. De par leur appartenance au système immunitaire, elles furent longtemps considérées actives uniquement en conditions pathologiques. Au contraire, ces dernières décennies, elles sont apparues comme physiologiquement actives, notamment au cours de la période critique de formation du système nerveux central. Au cours du développement embryonnaire et postnatal, les neurones nouvellement générés migrent vers leur position définitive avant de développer leur arbre dendritique et axonal afin de former les connexions synaptiques à la base des réseaux nécessaires aux fonctions cérébrales. L'étude des microglies au cours de la période postnatale, a montré l'implication d'un mode de communication spécifique entre les neurones et la microglie, la voie Fractalkine/CX3CR1, dans la mise en place des cellules microgliales d'une part et dans le développement synaptique glutamatergique d'autre part. Cependant, l'importance de cette communication neurone-microglie pour le développement du système inhibiteur GABAergique est peu connue. Au cours de mon travail de thèse, je me suis intéressée au rôle de la voie de communication FractalKine/CX3CR1 dans la distribution des cellules microgliales et le développement postnatal du réseau GABAergique de l'Hippocampe. Nous avons ainsi montré que la suppression du récepteur microglial CX3CR1 induit une diminution du nombre de microglies dans la région CA3 de l'Hippocampe, dans une fenêtre temporelle précise entre 7 et 2 jours après la naissance. Cette diminution du nombre de microglies est corrélée avec une altération de l'activité de réseau au niveau de cette région. En effet, la fréquence des GDPs (Giant Depolarizing Potentials), une activité de réseau impliquée dans la formation et la maturation des synapses et spécifiquement générée en CA3, est diminuée à la fin de la première semaine postnatale. De plus, malgré l'absence de modification majeure de l'activité synaptique glutamatergique et GABAergique, les évènements postsynaptiques GABAergiques présentent une sous population d'évènements plus amples et des cinétiques légèrement plus rapides, pouvant suggérer une modification de la population d'interneurones mis en jeu. L'ensemble de mon travail de thèse met en évidence l'impact de la communication neurone-microglie par la voie Fractalkine/CX3CR1 sur le développement postnatal de l'Hippocampe Son absence affecte d'une part, la colonisation microgliale, et d'autre part, une activité de réseau caractéristique de l'Hippocampe, dans une fenêtre temporelle critique pour la mise en place des connexions synaptiques et la formation des réseaux neuronaux . / Microglial cells, the resident macrophages of the central nervous system, were mainly studied for their role in pathological conditions, but they recently appeared to be involved in synaptic development and circuits formation during postnatal period. During this critical period, microglial cells colonize the central nervous system and interact with other cell types, including neurons. A specific way of communication between neurons and microglia involves neuronal released fractalkine (CX3CL1) and its specific microglial receptor CX3CR1. CX3CR1 KO mice contributed to unclose microglial role during development. Indeed, CX3CR1 ablation alters microglia distribution in the brain, and it affects glutamatergic transmission and synapse maturation. However, these effects seem to be transient and brain region specific and their mechanisms are poorly understood. Furthermore, some effects observed in juvenile or adult mice may have origin during development, when neuronal connections are established. GABA plays a fundamental role in this process since it is excitatory The influence of neuron.microglia interaction on neuronal activity in the hippocampus during this period is poorly understood. In particular, nothing is known on GABAergic activity, known to be synaptogenic during this period My PhD project aimed at investigating how the signaling fractalkine pathway impacts microglial coloniation of the hippocampus and neuronal activity during the first two postnatal weeks. Our results indicate that in CX3XR1KO mice there is a reduction in the density of microglial cells at P7-P9 in the CA3 hippocampal area, accompanied at P7 by a significant reduction of frequency of Giant Depolarizing Potentials (GDPs), a network activity involved in hippocampal synapse formation and maturation Furthermore, despite no overall difference in glutamatergic or GABAergic synaptic activity, GABAergic events display a subpopulation of larger events, and the kinetics was slightly faster. Thus, the disruption of the specific neuronal.microglia signaling pathway on one hand impacts the microglia coloniation of the hippocampus and on the other hands affects specifically neuronal network activity during a time window critical for the establishment of neuronal connections.

Magister Public Health - MPH / Common perinatal mental disorders (CPMDs) are increasingly being recognised as an important public health issue including depression and anxiety. In low and middle income countries such as Rwanda, CPMDs are prevalent among women in perinatal period. In Africa, the estimated prevalence rates of depression are 11.3% and 18.3% during ante-postnatal respectively, while ante-postnatal anxiety rates are 14.8% and 14% respectively. However, in Rwanda there is limited literature on CPMDs. This study was aimed at determining the occurrence of CPMDs in a selected district hospital of the Eastern Province in Rwanda as well as the factors associated with CPMDs in the selected study area. A descriptive quantitative cross-sectional survey was conducted with a sample of one hundred and sixty five mothers in perinatal period, who were selected systematically. Demographic data and factors associated with CPMDs were determined using structured questionnaire and combined screening tools such as Zungu Self-rating anxiety scale (SAS) and Edinburgh Postnatal Depression Scale (EPDS). The Cronbach alpha values were 0.87 and 0.89 for SAS and EPDS respectively. SPSS Version 21 was utilized to analyse data. Univariate, bivariate correlational and multivariate analyses were performed. Most of the respondents (38.2%) were aged 25-29 years; Protestants (77.6%); married (44.8%); unemployed (77%) and had a primary school level of education (60.6%). With respect to participants in antenatal period (51.5%); 14.5% had a clinical level of anxiety and 19.4% had depression. In terms of participants in postnatal period (46.7%); 22.5% had a clinical level of anxiety and 29.7% had depression. However, participants in both periods (1.8%) all had a normal level of anxiety and 1.2% had depression.

Model development for incorporating “indigenous” postnatal care into a midwifery healthcare system is of utmost importance in ensuring the provision of culturally congruent care. There has been only limited evidence of the availability of a model which addresses “indigenous” postnatal care practices in midwifery health care systems. As a result, the nurses operate from a modern healthcare point of view only, rather than combining the two worldviews. The main aim of the study was to develop a model for incorporating “indigenous” postnatal care practices into the midwifery health care system in Mopani District, Limpopo Province of South Africa. The study was conducted in three phases. During the first phase the meaning of the concept “incorporation” was analysed. The results guided the researcher during data collection in the second phase, consisting of in-depth individual and focus group interviews to explore the experiences and perceptions of postnatal patients, family members, traditional birth attendants, registered midwives, Midwifery lecturers and the maternal and child healthcare coordinators. The findings confirmed that currently the “indigenous” postnatal care practices are not incorporated in the Midwifery curriculum, books or guidelines for maternity care. As a result there is lack of knowledge amongst midwives regarding the “indigenous” postnatal care practices and it is difficult for them to provide culturally congruent care. Due to inadequate knowledge midwives are displaying negative attitudes towards the family members, traditional birth attendants and patients from diverse cultures. The participants confirmed that there is no teamwork between the registered midwives and the traditional birth attendants (family members). The study findings also confirmed that currently there are no follow-up visits by the midwives for patients during the postnatal period. The midwives are imposing their health beliefs an practices onto the patients on discharge after delivery, without the involvement of the family members or the traditional birth attendants, resulting in sub-standard postnatal care, leading to postnatal complications and an increasing maternal mortality rate. Based on the findings of phases one and two, a model for incorporating “indigenous” postnatal care practices into a midwifery healthcare system was developed and described. The implications for further studies suggested the evaluation and implementation of the model in the healthcare institutions, nursing colleges, clinics and hospitals as an initial step to assist the Department of Health in Limpopo Province in incorporating “indigenous” practices into healthcare systems. / Thesis (PhD)--University of Pretoria, 2012. / Nursing Science / unrestricted

Bakgrund: En postpartumdepression uppstår i samband med förlossningen och drabbar mellan 8–15 procent av alla nyförlösta kvinnor varje år bara i Sverige. Någon enskild orsak till tillståndet finns inte men sociala och psykologiska, socioekonomiska, traumatiska och stressrelaterade händelser, brist på socialt stöd och en tidigare historik av depression har påvisats vara betydande riskfaktorer för utvecklingen av tillståndet. Att drabbas av en postpartumdepression innebär ett stort lidande hos den drabbade kvinnan men påverkar även hela familjen. Det är av betydande vikt att tidigt kunna ställa en diagnos för att minska negativa konsekvenser i familjen. Syfte: Syftet var att belysa kvinnors upplevelser av postpartumdepression. Metod: En litteraturöversikt med grund från tio vetenskapliga artiklar av kvalitativ metod utfördes. Artiklarnas olika tema identifierades, jämfördes och analyserades för att sedan kategoriseras i de slutgiltiga teman som presenterades i detta arbete. Resultat: Resultatet består av två huvudsakliga teman och fem subteman; Att leva med postpartumdepression med subteman det förväntade moderskapet och stigmatisering och dess påverkan; Barriärer i vården med subteman behov av stöd, svårigheter att söka hjälp och normalisering i vården. Många kvinnor upplevde en bristande information och kunskap kring tillståndet. I resultatet framkom det att stigmatiseringen kring psykisk ohälsa och postpartumdepression resulterade i en rädsla att mötas av oförstående och fördomsfullhet. Vidare framkom det avgörande faktorer för hur kvinnorna upplevde svårigheter i sin kontakt med vården. Diskussion: Författaren diskuterar valda delar ur det framkomna resultatet i litteraturöversikten utifrån aktuell forskning, egna reflektioner och Phil Barkers tidvattenmodell. / Background: Postpartum depression is a serious form of depression that affects between 8-15 percent of all women just in Sweden every year. No individual cause of the condition exists, but social and psychological, socio-economic, traumatic and stress-related events, lack of social support and a previous history of depression have been shown to be significant risk factors for the development of the condition. Suffering from a postpartum depression means a great suffering for the affected women but it also affects the whole family. An early diagnosis is important in order to reduce negative consequences regarding family. Aim: The aim of this study was to explore women's experiences of postpartum depression. Method: A literature review based on ten scientific articles of qualitative method was conducted. The different themes of the articles were identified, compared and analyzed and then categorized into the final themes presented in this work. Results: The result consisted of two main themes and five subthemes; To live with postpartum depression with the subthemes the expected motherhood and stigmatization and it´s impact; Barriers in health care with the subthemes need for support and difficulties in seeking help and normalization in health care. Many women experienced a lack of information and knowledge about the condition. The result showed that the stigma surrounding mental illness and postpartum depression resulted in a fear of being confronted by ignorance and prejudice. Decisive factors emerged as to how women experienced difficulties in their contact with health care.  Discussion: The author discusses selected parts of the result obtained in the literature review based on current research, own reflections and Phil Barker´s The Tidal Model