Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics.

In this study, the impact of a structured support group programme developed for HIV-positive women in South Africa is assessed. The programme has been developed to fit the needs of HIV-positive women in South Africa, using an action research approach. The study utilises a quasi-experimental design, with an intervention group and a control group taking part in both a pre- and post-intervention interview. The participant’s experiences and the impact of the intervention were assessed using a multi-method approach. The program was assessed quantitatively in terms of its impact on the participants’ levels of depression, self-esteem, coping, social support, disclosure, personal stigma, perceived community stigma, coping and knowledge. Qualitatively, participant feedback regarding their experience of the support groups was assessed to provide complementary data to augment the results from the quantitative analyses. Participants were recruited for the study through the Serithi project, and these women were invited to take part in the support group programme. Over a period of one year, 156 women were recruited for the study, 72 of whom agreed to participate in the groups (intervention group), with the remaining 84 women declining the invitation, forming the control group. Ten support groups were implemented during this time-period. Following the implementation of the program, the results from the pre-intervention assessment were analysed and compared, so as to acknowledge any differences that may have existed between the groups prior to their involvement in the study. Post-intervention results were then analysed and compared, in order to statistically determine the impact of the structured support group programme. Participants’ qualitative feedback regarding their participation in the intervention, and their perceived personal benefits from their involvement was analysed using content analysis. Although some differences were identified between the two groups in the pre-intervention analysis, the control group did seem to be a valid comparison. Findings of the research indicate that the intervention group showed significantly higher positive coping, self-esteem, levels of positive support and HIV-related support, and disclosure compared to the control group. Interesting results were found regarding depression and knowledge levels, although these were not found to be significant. No differences were identified between the groups in terms of negative coping, negative support or the experience of stigma. It was concluded that support groups can be effective in assisting HIV-positive women in their journey toward psychosocial adjustment to their HIV infection. It is important, however, that interventions aimed at HIVpositive individuals in South Africa should be developed to fit the specific needs of the target group. / Dissertation (MA)--University of Pretoria, 2008. / Psychology / unrestricted

Orientador: Milva Maria Figueiredo De Martino / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T12:34:20Z (GMT). No. of bitstreams: 1 Goncalves_FlaviaBegaliLucas_M.pdf: 1018900 bytes, checksum: 523a7d8d701e0e1b435fdf973d9049a8 (MD5) Previous issue date: 2011 / Resumo: O estado gravídico é um período da vida da mulher que envolve inúmeras alterações físicas, hormonais, psíquicas e de inserção social decorrentes da interação mãe e feto. Em consequências destas alterações, os distúrbios do sono são manifestações comuns na gestação, mas que pode repercutir de forma negativa no trabalho, nas atividades do cotidiano e na qualidade de vida da gestante. Uma das implicações no habito de sono e o desenvolvimento do estresse materno, em condições adversas pode implicar na saúde da gestante e causar reações e desequilíbrios fisiológicos no desenvolvimento do feto. Este trabalho teve por objetivo analisar a presença dos índices e os sintomas referentes ao estresse e suas correlações com o cronótipo no período gestacional em primigestas e multigestas. Participaram desta pesquisa as gestantes que fizeram o acompanhamento do pré-natal nas Unidades Básicas de Saúde do Município de Machado - MG, num total de n=124. Os dados foram coletados no período de agosto de 2010. Foram utilizados três instrumentos para a coleta de dados: questionário para a coleta de informações pessoais e de condições de saúde, o Inventario de Sintomas de Stress de LIPP (1989) e o questionário de classificação do cronótipo de Horne & Östberg (1976). Os resultados da analise do cronotipo com as características individuais mostraram dados significativos para a idade por meio do teste do Qui-Quadrado de Pearson (p=0.0074), com o aumento da idade tendem a matutinidade. Nas gestantes multiparas, casadas e no 2o trimestre predominou o cronótipo matutino. Os dados apresentados na correlação do cronótipo e estresse as gestantes classificadas do tipo indiferente e o de maior índice de estresse. Para os sintomas físicos houve uma prevalência de estresse nas gestantes do segundo trimestre e psicológicos para as do primeiro trimestre gestacional. Os índices de estresse foram mais exacerbados nas gestantes multigestas que do nas primigestas. Embora indicassem maiores níveis de estresse, a diferença entre grupos não foi significativa / Abstract: The state is a period pregnant woman's life that involves many physical changes, hormonal, psychological and social integration resulting from the interaction between mother and fetus. In consequence of these changes, sleep disturbances are common manifestations in pregnancy, but that may reflect negatively in the workplace, in daily activities and quality of life of the mother. One of the implications the habit of sleep is the development of maternal stress, in adverse conditions may involve the health of the pregnant woman and cause physiological reactions and imbalances in the developing fetus. This study aimed to analyze the presence of indexes and symptoms related to stress and its correlation with chronotype during pregnancy in primiparous and multiparous. Participated in this study those who have made the monitoring of prenatal care in the Basic Health of the municipality of Machado - MG, a total of n = 124. Data were collected between August 2010 We used three instruments for data collection: questionnaire to collect information and personal health, the Inventory of Stress Symptoms LIPP (1989) and a questionnaire for chronotype Horne & Ostberg (1976). The results of the analysis of the individual traits chronotype data showed significant age through the Chi-square Pearson's test (p = 0.0074) with increasing age tend to the morning. In multiparous mothers, married and the second quarter predominated chronotype morning. The data presented in the correlation chronotype stress and women were classified regardless of the type is the most stress index. For the physical and psychological symptoms were a prevelenciain the first trimester. The stress levels were exacerbated inpregnan twomen in themultiparous than primiparous. While indicatin ghigher stress levels, the difference between groups was not significant / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

No período gestacional a mulher está mais suscetível às recomendações dos profissionais de saúde que a acompanha durante todo o pré-natal, sendo um momento propicio para orientá-las a adotarem um estilo de vida ativo. Entretanto, devido à alta prevalência de inatividade física na gestação, deve-se analisar a lacuna que existe entre a recomendação e a prática de atividade física no lazer/exercício físico realizado pelas mulheres neste período. Dessa maneira, o objetivo do presente estudo é verificar a associação entre a prática regular de atividades físicas no lazer e/ou exercícios físicos na gestação e orientações recebidas durante o atendimento de pré-natal. Trata-se de um estudo transversal com 290 puérperas (captadas no pós-parto imediato) de dois hospitais de Santo André, sendo um da rede pública e outro da rede privada de atendimento de pré-natal. Adicionalmente, participaram 45 profissionais de saúde captados em clínicas, hospitais, consultórios e postos de saúde. Utilizou-se um questionário para obter informações referentes à prática de atividade física no lazer/exercício físico e ao aconselhamento realizado pelo profissional de saúde. Para avaliar associação e concordância foi realizado o teste de qui-quadrado, a análise de regressão logística binomial e análise de Kappa, considerando-se o nível de significância inferior a 5%. As usuárias do serviço privado possuíam maior idade, renda e escolaridade (p<0,001). Todavia, as puérperas do serviço público apresentavam maior nível de atividade física (p<0,001) e consequentemente maior gasto energético (p<0,001). Mas, 56,8% do gasto energético eram influenciados pela atividade física doméstica (p=0,011). Houve maior frequência de recomendação para a prática de atividade física no lazer/exercício físico para as mulheres do serviço privado. A prática de atividade física pré-gestacional e a presença de recomendação do profissional de saúde estavam associados ao nível de atividade física no lazer, aumentando a chance da mulher atingir a recomendação (150 minutos de atividade física semanal). A maioria das mulheres citou a falta de tempo e de interesse como principais barreiras a adoção de um estilo de vida ativo. Em relação aos profissionais, observou-se que há associação entre a recomendação de atividade física no lazer e a formação do profissional. A prática da caminhada e a hidroginástica foram as atividades mais recomendadas. Em relação ao volume semanal e a intensidade da atividade física, 35,4% dos profissionais recomendavam pelo menos 150 minutos e 66,7% recomendavam a intensidade leve. Não houve concordância entre as informações percebidas pelas mulheres durante o pré-natal com as recomendações proferidas pelos profissionais de saúde, demonstrando a importância de desenvolver estratégias para suprir esta lacuna na comunicação entre a usuária e o profissional. Ainda assim, observa-se que a adequação de conteúdo e forma das recomendações realizadas durante as consultas de pré-natal podem auxiliar no quadro do estilo de vida ativo da mulher. Sugere-se a realização de novos estudos com intervenções com os profissionais de saúde para que se possa formar uma equipe multidisciplinar e oferecer a saúde materno-fetal uma melhor qualidade de vida / During pregnancy women are more susceptible to the recommendations of health professionals who accompanies throughout the prenatal, being a propitious moment to target them to take an active lifestyle. However, due to the high prevalence of physical inactivity during pregnancy, you should analyze the gap between the recommendation and the practice of physical activity in leisure / exercise performed by women in this period. Thus, the objective of this study is to assess the association between regular physical activity in leisure and / or physical exercise during pregnancy and guidance received during prenatal care. It is a cross-sectional study of 290 women (captured in the immediate postpartum) of two hospitals in Santo André, one of public and other private health care providers of prenatal care. In addition, 45 health professionals raised in clinics, hospitals, clinics and health posts attended. We used a questionnaire to obtain information regarding the practice of leisure physical activity / exercise and counseling performed by a healthcare professional. The association agreement and the chi-square test and analysis of binomial logistic regression and analysis of agreement Kappa, considering the level of less than 5% significance was conducted. The private service users had higher age, income and education (p <0.001). However, the mothers of the public service had a higher level of physical activity (p <0.001) and consequently higher energy expenditure (p <0.001). But 56.8% of energy expenditure were influenced by domestic physical activity (p = 0.011). There was a higher frequency of recommendation for physical activity in leisure / exercise for women in the private service. The practice of pre-pregnancy physical activity and the presence of the recommendation of the health professional was associated with level of physical activity during leisure time, increasing the chance of women reach the recommended (150 minutes of physical activity per week). Most women cited lack of time and interest as the main barriers to adoption of an active lifestyle. Regarding professional, it was observed that there is an association between the recommendation of physical activity during leisure time and professional training. The practice of walking and aerobics were recommended activities. Regarding the weekly volume and intensity of physical activity, 35.4% of the professionals recommend at least 150 minutes and 66.7% recommended light intensity. There was no agreement between the information perceived by women during the prenatal to the recommendations given by health professionals, demonstrating the importance of developing strategies to fill this gap in communication between the user and the professional. Still, it is observed that the suitability of content and form of the recommendations made during prenatal consultations can assist within the active lifestyle of women. It is suggested to conduct further studies with interventions with health professionals so that they can form a multidisciplinary team and provide maternal-fetal a better quality of life

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-07-11T22:47:49Z No. of bitstreams: 1 Vers?o final Disserta??o RENATA com Ficha Catalogr?fica (2).pdf: 2528833 bytes, checksum: fa01f07b02b6ab95d9e09ead2c6b3048 (MD5) / Made available in DSpace on 2016-07-11T22:47:49Z (GMT). No. of bitstreams: 1 Vers?o final Disserta??o RENATA com Ficha Catalogr?fica (2).pdf: 2528833 bytes, checksum: fa01f07b02b6ab95d9e09ead2c6b3048 (MD5) Previous issue date: 2015-03-31 / During pregnancy, the occurrence of anemia is high due to the physiological changes to which a woman's body is subjected during fetal development. Even before the institution of the treatment protocol that the Ministry of Health recommended, the maintenance of high levels of prevalence of anemia during pregnancy was observed. Other causal factors still unknown, beyond those already investigated classics, are possibly contributing to this occurrence. OBJECTIVE: To identify socioeconomic, demographic, nutritional, and gynecological-obstetric factors associated with anemia as well as estimate the frequency of different types and levels of severity of anemia in pregnant women. METHOD: This is a cross-sectional study conducted with pregnant women who received prenatal care in the Family Health Units in Santo Ant?nio de Jesus in Bahia. Patients were classified as being diagnosed with anemia or not, according to the World Health Organization (WHO) criteria that consider the value of hemoglobin less than 11 g / dL. Was also performed to diagnose the types of anemia (pernicious, chronic disease, and iron deficiency) and assessment of the severity of anemia (mild, moderate, and severe). Data collection included the application of a questionnaire in which socioeconomic and demographic information was obtained along with reproductive and pregnancy information, and blood collection was also completed for the determination of haematological parameters. Data were analyzed using Stata, version 11, in which the frequency of different types of anemia was estimated and the association between the studied variables and the presence of anemia was assessed by estimating the prevalence ratio (PR), with its respective confidence interval (CI) of 95% and statistical significance level of 5%. RESULTS: They are presented in a scientific paper, "Determinants of Anemia in Pregnant Women Using the Health Family Program," to be submitted to the Portuguese Journal of Public Health. The final sample consisted of 349 pregnant women, and after the regression analysis model was used, the prevalence ratios?both as adjusted gross?found no statistically significant association between the selected features and the main outcome. The prevalence of anemia in the study sample was 22.64%, classified as moderate in Portuguese Journal of Public Health. CONCLUSIONS: No association was found between the investigated factors and anemia. In addition, the most common form of the disease was the anemia of chronic disease, with there being a low prevalence of iron deficiency anemia. Thus, the need exists to investigate other factors besides iron deficiency as well as examine therapeutic strategies targeting anemia in pregnant women, which are more effective than those existing in the health actions aimed at this group. / Durante o per?odo gestacional, a ocorr?ncia da anemia ? alta devido ?s altera??es fisiol?gicas que o corpo da mulher ? submetido para o desenvolvimento fetal. Mesmo diante do protocolo terap?utico preconizado pelo Minist?rio da Sa?de, a manuten??o de n?veis de preval?ncia elevados da anemia durante a gesta??o tem sido observada. Possivelmente, outros fatores causais ainda desconhecidos, al?m daqueles cl?ssicos j? investigados, est?o contribuindo para esta ocorr?ncia. OBJETIVO: Identificar os fatores socioecon?micos, demogr?ficos, nutricionais e gineco-obst?tricos associados ? ocorr?ncia de anemia, al?m de estimar a frequ?ncia de diferentes tipos e gravidade de anemia em gestantes. M?TODO: Trata-se de um estudo de corte transversal desenvolvido com gestantes que realizavam acompanhamento pr?-natal em Unidades de Sa?de da Fam?lia no munic?pio de Santo Ant?nio de Jesus, na Bahia. As gestantes foram classificadas com o diagn?stico de anemia ou n?o, de acordo com o crit?rio da OMS que considera o valor da hemoglobina menor que 11 g/dL. Foi tamb?m realizado o diagn?stico para tipos de anemia (perniciosa, de doen?a cr?nica e ferropriva), al?m de avalia??o da gravidade de anemia (leve, moderada e grave). A coleta de dados compreendeu a aplica??o de um question?rio em que foram obtidas informa??es socioecon?mico-demogr?ficas, reprodutivas e gestacionais, assim como a coleta de sangue para dosagem dos par?metros hematol?gicos. Os dados foram analisados no programa Stata, vers?o 11, no qual a frequ?ncia dos diferentes tipos de anemia foi estimada e a associa??o entre as vari?veis estudadas e a presen?a de anemia foi avaliada por meio da estimativa da raz?o de preval?ncia (RP), com seu respectivo intervalo de confian?a (IC) a 95% e n?vel de signific?ncia estat?stica de 5%. RESULTADOS: Est?o apresentados em forma de artigo cient?fico: ?Determinantes da anemia em gestantes usu?rias do Programa de Sa?de da Fam?lia?, a ser submetido ? Revista Portuguesa de Sa?de P?blica. A amostra final foi composta de 349 gestantes e ap?s a realiza??o do modelo de an?lise de regress?o, as raz?es de preval?ncia tanto bruta quanto ajustada n?o encontraram associa??o estatisticamente significante entre as caracter?sticas selecionadas e o desfecho principal. A preval?ncia de anemia, na amostra estudada foi de 22,64%, classificada como moderada em Sa?de P?blica. CONCLUS?ES: N?o foi detectada associa??o entre os fatores investigados e a anemia. Al?m disso, a forma mais frequente da enfermidade foi a anemia de doen?a cr?nica, sendo baixa preval?ncia de anemia ferropriva, havendo assim, a necessidade de investigar outros fatores, para al?m da car?ncia de ferro, visando estrat?gias terap?uticas de anemia em gestantes mais efetivas que as vigentes nas a??es de sa?de destinadas a esse grupo.

No description available.

As the number of pregnant defendents continues to grow, so too do the problems and concerns surrounding them. While literature can be found on related topics, the specific issue of pregnancy and judicial decisions has yet to be examined. The purpose of this particular research study is to heighten awareness of the issues surrounding the topic, and provide evidence indicating the influence, if any, pregnancy has on judicial decisions.

SAMMANFATTNING Övervikt och fetma är något som idag ökar globalt. I barnmorskans yrke ingår ett hälsofrämjande arbete och enligt lag ska vård ges på lika villkor. Övervikt i samband med graviditet anses vara förknippat med flera risker för såväl moder som foster. Det råder en kunskapsbrist hos den obstetriska vårdpersonalen och ämnet övervikt anses vara känsligt att prata om. Den obstetriska vårdpersonalen menar att det råder en kunskapsbrist avseende övervikt kopplat till graviditet även hos allmänheten. Vidare anser den obstetriska vårdpersonalen att övervikt på senare år blivit mer socialt accepterat och normaliserat i samhället. Slutligen menar den obstetriska vårdpersonalen att övervikt hos gravida kvinnor försvårar deras arbete inom förlossningsvården.  Syftet var att belysa överviktiga gravida kvinnors upplevelser av mötet med den obstetriska vården under graviditet och förlossning. Metoden var en integrerad litteraturöversikt baserad på 16 kvalitativa studier. Ur resultatet framkom tre teman med sex subteman. Det första temat var interaktioner med den obstetriska vårdpersonalen och skildrades i två subteman, ett gott bemötande och ett nedlåtande bemötande. Temat skildrade överviktiga gravida kvinnors olika upplevelser de fått i mötet med den obstetriska vårdpersonalen, kvinnan ville bli stöttad och vården skulle bedrivas individanpassat. Kvinnor hade upplevt att de mötts med misstro och fördomar vilket hade fått dem att känna sig utfrysta. Vidare hade kvinnorna upplevt att den obstetriska vården inte varit anpassad för dem. Det andra temat som framkom var rådgivning från den obstetriska vårdpersonalen, vilket skildrade kommunikationen mellan den överviktiga gravida kvinnan och den obstetriska vårdpersonalen, ur både positiva och negativa aspekter. Det tredje temat synen på fetma, skildrade hur kvinnorna hade upplevt ordet fetma, deras egen syn på fetma och hur kvinnorna hade upplevde sig stigmatiserade av den obstetriska vårdpersonalen. Slutsatsen var att arbetets resultat genererade flera skilda upplevelser av överviktiga gravida kvinnors möten med den obstetriska vårdpersonalen. I mötet med den obstetriska vårdpersonalen önskade kvinnorna bli mötta som enskilda individer och med en icke dömande attityd. Överviktiga gravida kvinnor upplever att den obstetriska vårdpersonalen var motvillig att diskutera ämnet övervikt då det ansågs vara ett känsligt ämne. Dessutom hade flera överviktiga gravida kvinnor upplevt stigmatisering av den obstetriska vårdpersonalen. Slutligen behövde barnmorskor mer kunskap för att således kunna erbjuda överviktiga gravida kvinnor en mer jämlik vård.           Nyckelord:  fetma, gravida kvinnor, mötet, upplevelse, övervikt

Magister Curationis / The National Programme of Prevention of Mother to Child transmission (PMTCT) in relation to HIV/AIDS was introduced by the Department of Health in different sites per province in South Africa in 2001. The number of women has a chance to access antenatal clinic services during pregnancy but they start to attend usually in late gestation.

Bakgrund: Psykisk hälsa är grundläggande för människors förmåga att tänka, interagera med varandra, fungera i samhället samt uppleva en meningsfull vardag. Covid-19 var en bekräftad pandemi den 11 mars 2020. En pandemi innebär att ett virus sprids över världen under samma tidsperiod. Graviditet kan beskriva som en process, ett ansvarstagande, ett mirakel, bildande av familj eller som det mest värdefulla i livet. Under en graviditet ändras kropp och hormoner vilket leder till att gravida kvinnor ofta känner sig mer känslosamma. Roys adaptionsmodell handlar om att anpassa sig till en miljö som ständigt förändrar sig. Psykisk ohälsa hos den gravida kvinnan kan ge allvarliga konsekvenser hos mamman. Syfte: var att beskriva hur covid-19 påverkat gravida kvinnors psykiska hälsa. Metod: Studien genomfördes som en allmän litteraturstudie och identifierades genom tio artiklar från två olika databaser till resultatet. Resultat: Resultaten från artiklarna kategoriserades i en tabell med teman som inkluderade; oro, stress nedstämdhet och psykisk hälsa. Covid-19 pandemin påverkade de gravida kvinnorna negativt under pandemin. Konklusion: Denna studie kan ge en inblick över hur sårbara grupper prioriterades bort under en tid av ovisshet och bör beaktas i liknande situationer i framtiden. / Background: Mental health is fundamental for people's ability to think, interact witheach other, function in society and experience a meaningful everyday life. Covid-19was a confirmed pandemic on March 11, 2020. A pandemic means that a virusspreads across the world during the same timeperiod. Pregnancy can be described as aprocess, a responsibility, a miracle, family formation or as the most valuable thing inlife. During a pregnancy, the body and hormones change, which leads to pregnantwomen often feeling more emotional. Roy's adaptation model is about adapting to anenvironment that is constantly changing. Pregnant woman with mental illness canlead to serious consequences for the woman. Aim: Describe how covid-19 affectedthe mental health of pregnant women. Method: The study was conducted as a generalliterature study and a total of ten studies from two different databases were used forthe results. Results: The results were categorized in a table, the themes were anxiety,stress, depression and mental health. Conclusion: The Covid-19 pandemic negativelyaffected the mental health of pregnant women. This study can provide an insight intohow vulnerable groups were unpriotized during a time of uncertainty and should beconsidered in similar situations in the future.