Lead is a toxic heavy metal associated with adverse health effects ranging from developmental neurotoxicity to reproductive effects. While lead affects people of all ages, infants and children are the most vulnerable and susceptible to the neuro-developmental effects of lead exposure. Maternal blood lead concentrations that do not produce clinical toxicity on pregnant women have been linked to adverse offspring development. Observed reproductive effects to low lead levels during pregnancy include the risk of spontaneous abortions, effects on birth weight and preterm birth. There are particular concerns with regard to reductions in IQ scores. Research evidence suggests that an incremental increase in blood lead levels of 1 µg/dL is associated with approximately 1 IQ point deficit. Of particular concern is that currently no threshold has been observed or exists for developmental neurotoxicity to the chronic low lead exposures levels. While the developed countries have built evidence for lead exposure sources, have identified the most vulnerable groups to lead exposure, and have instituted control actions for lead exposure, it is not the case in developing countries such as Botswana. Currently, there is very little knowledge about the potential sources of lead exposure among different population groups not only in Botswana but also in most developing nations. There is also an evident limited knowledge on the behaviours and practices of different population groups that could potentially expose them to lead in developing countries. This thesis explores the following questions: i) Are there specific risk behaviours and practices peculiar to pregnant women in Botswana that could potentially expose them to lead? ii) What are the environmental lead concentration levels and their potential to expose pregnant women? iii)What are the blood lead concentrations at each stage of pregnancy and after delivery in Botswana and, iv) Can we use the information from these three questions to predict lead exposure levels during pregnancy and after delivery? v) Can we use the new information to a develop a policy dissemination brief to inform policy on lead exposure sources in Botswana, develop guidelines for health professionals for assessing and screening lead exposure levels during pregnancy and after delivery, develop an awareness leaflet for lead education? To address the specific risk behaviour and practices of pregnant women, a comprehensive validated risk assessment questionnaire was administered among 142 pregnant women during the first trimester of pregnancy (defined as 8-12 weeks) in four villages of different geographical settings and nomenclature (small/rural, major and semi urban). For purposes of this work the validation process involved obtaining information (from experts in the field and communities) relevant to the purposes of the study and to confirm that the tools employed for collection of data in all trimesters were suitable in terms of both construct and content. Data was collected between September 2009 and February 2010. To address potential environmental sources of lead exposure during pregnancy soil (n=28), water (n=28) and traditional cosmetic clay - letsoku (n=3) samples were collected in November 2010, February 2011 and May 2011 from the homes and in the vicinity of the study population to determine lead concentrations. To know baseline blood lead levels at each stage of pregnancy, blood samples were collected from September 2009 to February 2011 from pregnant women between weeks 8-12 (first trimester, n=137), 20-24 (second trimester n=126) and weeks 34-36 (third trimester n=106). Blood lead levels of women who completed the entire study from trimester on until after delivery (n=63) were then used to construct blood lead prediction models using statistical models. Pregnant women in the study area ingested non-food items such as soil, match sticks, pencil, chalk and animal feed such as bone meal (86%). Women applied used and unused car oils (in particular brake fluid) and other harmful substances for “treatment of skin conditions and for beautification purposes (74%). Older women (defined as 35 years in this study) were at a significantly higher risk to ingest soils (p<0.01). Mean (±SEM) lead concentrations in water exceeded the WHO drinking water quality standards nineteen fold (0.19±0.019 ppm (n=28) Major villages, had significantly higher Pb concentrations (p<0.05) in soils and water compared to small villages. Mean blood lead levels (±SEM) for the first, second and third trimesters were 1.96(±0.14)µg/dL, 2.49(±0.17) µg/dL, 2.66(±0.19) µg/dL respectively. Blood lead levels increases from the first to third trimester ranged from 1.6-5%. Blood lead concentrations significantly differed among locations (p<0.01). The highest concentrations were observed in women from smaller villages that were poorer (p<0.02). Pica, multiple risk behaviours/practices (engaging in two or more risk behaviours/practices), trimester of pregnancy, poor food supplementation and diet were predictors of blood lead levels ≥ 2µg/dL. There was a dose response relationship between supplement intake and an increase in blood lead levels. These findings suggest that pregnant women and their unborn babies could potentially be exposed to lead because of the environment in which they live, their economic status, lifestyle, behaviors and practices. Drinking water is a potential threat for lead exposure, not only among pregnant women, but other vulnerable groups such as infants and children. This study is the first in Botswana and one of the few in Africa to investigate lead exposure sources at each stage of pregnancy and after delivery. It is also the first to identify new potential lead exposure behaviors and practices such as the application of auto oils by pregnant women for treatment of skin diseases. The findings suggest the need to train health workers and equip them with the skills and knowledge to assess and screen women who could potentially be exposed to lead. Further, pregnant women need to be sensitized on potential lead exposure sources, to prevent lead poisoning. This study has been able to use the results to develop a policy brief for disseminating the results to decision makers, guidelines for utilization by health workers to screen lead exposure levels and an awareness leaflet for pregnant women. These have been validated and pretested at community and Government levels. / Thesis (PhD)--University of Pretoria, 2013. / School of Health Systems and Public Health (SHSPH) / Unrestricted

Identification and analysis of therapy used by pregnant women III. Author: Edita Cimbálová Thesis Supervisor: PharmDr. Josef Malý, Ph.D. Thesis Consultant: Mgr. Pavel Horký Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and purpose: Therapy of pregnant women is accompanied by a variety of changes that need to be accounted for. The purpose of the theoretical part was to summarise available information in selected health issues of pregnant women. The purpose of the practical part was to identify and analyse the therapy used during pregnancy and the attitudes, opinions and awareness of women after delivery about over-the- counter drugs, medical devices and other forms of complementary and alternative medicine. Methods: The data were collected at the maternity ward of Jičín Hospital from November 2017 to February 2018 via questionnaires. The questionnaire contained information about the study and it was consisted of 50 questions of open, semi-closed and closed format focused on health issues during pregnancy, attitudes and opinions about homeopathy, herbal medicine, vaccination and the way to get informations during pregnancy. The collected data were transfered into an electronical form and subsequently analysed by methods of...

Magister Artium (Psychology) - MA(Psych) / The presence of a supportive and attentive father has been shown to hold a myriad of positive health outcomes for a pregnancy, and benefits the wellbeing of the mother, child, and the father himself. Pregnancy is a key period for fathers to become invested in their children’s lives. However, obstetric research continues to be largely feminised, therefore neglects the experiences of men. Considering that existing research shows that the antenatal period is a turbulent time for men, the aim of this research was to explore fathers’ subjective lived experiences of their partner’s medically high-risk pregnancy.

Magister Pharmaceuticae - MPharm / Malaria remains one of the top mortality causes in the sub-Saharan African region, especially among pregnant women and infants. Despite several measures being implemented within the affected areas such as the use of treated mosquito nets, sulfadoxine and pyrimethamine (SULPYR) as an intermittent preventive treatment (IPTp-SP) is still considered the standard prophylactic regimen for pregnant women. Recently, the WHO increased the regimen of IPTp- SP from three to four doses on a monthly interval, this recommendation poses a potential risk of toxicity and resistance to the drugs. An improvement towards this challenge is under clinical trial and consists of the inclusion of azithromycin (AZI), a macrolide antibiotic, to the current IPTp-SP treatment regimen. This will not only aid in the prophylaxis of malaria in pregnant women but will also assist in other pregnancy related infections. All three these drugs exhibit poor aqueous solubility; requiring high concentrations for oral administration to achieve therapeutic plasma concentrations. / 2024

Magister Public Health - MPH / In 2018 Opuwo Maternity Waiting Home (MWH) was inaugurated after its completion with the assistance from WHO and the European Union. This initiative by the Ministry of Health and Social Service and its partners was aimed to ensure safe deliveries as well as to overcome physical and socio-economic barriers such as long distances, communication and high transport costs to access health care facilities for safe deliveries in Opuwo District. However, since its inception the facility has been under-utilized. The aim of the study was to explore male partners’ experiences, perceptions and roles regarding the use of the MWH in Opuwo District, Namibia.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: The aim is to evaluate the association between sleep quality and perinatal depression in pregnant women between the 12th week of gestation and the 36th week of gestation in a maternity and child centre in Lima. Methods: Analytical cross-sectional study in pregnant women cared for in a primary care centre between August and December 2019. The data were collected through a self-administered survey. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The evaluation of perinatal depression was performed with the Edinburgh Postnatal Depression Scale (EPDS). For the multivariate analysis, Poisson regression with robust variances was used to calculate the crude and adjusted prevalence ratios and their respective confidence intervals. Results: The sample was composed of 200 participants. The median [IQR] age was 26 [22-32] years, and 111 (55.5%) pregnancies were unplanned. 52% presented a poor quality of sleep and the risk of perinatal depression was 31.5%. Poor quality of sleep was associated with a significantly higher frequency of perinatal depression (aPR = 4.8 for those with poor quality of sleep warranting medical attention, and aPR = 6.6 for those with poor quality of sleep warranting medical attention and treatment). Conclusions: There is a possible association between poor sleep quality and perinatal depression in pregnant women between weeks 12 and 36 of gestation. Operational research should be promoted to assess whether interventions to improve sleep quality could have a positive impact on reducing perinatal depression. / Revisión por pares

付記する学位プログラム名: グローバル生存学大学院連携プログラム / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20266号 / 医博第4225号 / 新制||医||1021(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 小泉 昭夫, 教授 中山 健夫, 教授 髙折 晃史 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

A Research Report submitted to the Faculty of Medicine, University of the Witwatersrand, in part fulfilment of the requirements for the degree of Master of Medicine in the branch of Haematology Johannesburg, October 1997 / Venous thromboembolic disease is a common health problem. It contributes considerably to morbidity as well as to mortality. Thrombosis usually occurs due to an underlying risk factor which may be environmental or genetic in origin. The recently described activated Protein C (APC) resistance is the commonest cause of familial thrombophilia documented to date. The molecular lesion is a single point mutation in the factor V (FV) gene which abolishes a cleavage site whereby it is normally inactivated by APC. This defect, termed the FV Leiden mutation, is highly prevalent in normal Caucasian populations. Although it would appear to have arisen due to a founder effect, there is a paucity of data concerning non-Caucasian populations. / IT2018

Excerpt: Tell patients that parvovirus infections before 20 weeks' gestation confer a risk of fetal morbidity and mortality as high as 16%, but don't significantly increase long-term developmental sequelae.

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