Made available in DSpace on 2016-01-26T12:51:15Z (GMT). No. of bitstreams: 1 katiajairagalisteu_dissert.pdf: 6806647 bytes, checksum: ab1b8f140157ecb1f877fc0e8939bf8b (MD5) Previous issue date: 2007-06-22 / The aim of our study was to assess toxoplasmosis frequency and its risk factors in pregnant women and their newborns from São Paulo State Northwest region. From two thousand and a hundred pregnant women, 232 patients were screened in the referral outpatient clinics of two Health Units in São José do Rio Preto, between June 2005 and March 2006. Serological analysis was performed by the IgG indirect hemagglutination assay. The 133 positive pregnant women were also evaluated by the IgG-avidity test followed by ELISA assays for IgM and IgG for their newborns. The transmission risk factors were accomplished by interview. The independence among rates was determined by the Chi-Square method and odds ratio test with a 5% significance level. The obtained data showed 57.3% of IgG reagent pregnant women, all of them providing highly IgG-avidity results. The newborns showed positivity to IgG but they were all negative to IgM. Our data suggest that the transmission of this protozoan occurs in the studied area. However, we could not demonstrate congenital transmission. Ingestion of water from public reservoirs and unpasteurized milk were considered to be risk factors to toxoplasmosis in the Northwest region of São Paulo State. Due to the Toxoplasma gondii ascertained transmission, serological accompaniment of pregnant women it is highly recommended. / Os objetivos deste trabalho foram avaliar a freqüência de toxoplasmose e os fatores de risco associados em grávidas e seus neonatos do Noroeste Paulista. Das 2.100 gestantes atendidas em ambulatórios de referência nas duas Unidades de Saúde de São José do Rio Preto, no período de junho de 2005 a março de 2006, foram triadas 232 mulheres grávidas e realizado exame sorológico para a pesquisa de IgG por meio do teste de Hemaglutinação indireta. Destas, 133 grávidas forneceram resultado positivo, as quais foram também avaliadas pelo teste de avidez para IgG. Posteriormente, os neonatos foram investigados quanto a presença de IgM e IgG pelo teste de ELISA. O levantamento dos fatores de risco na transmissão da toxoplasmose foi realizado por entrevista. A independência entre as proporções foi determinada pelo método do teste Qui-Quadrado e o teste de razão de chances. O nível de significância adotado foi de 5%. Os resultados demonstraram que 57,3% eram IgG reagentes. Todas as grávidas positivas apresentaram alta avidez para IgG. Os recém-nascidos mostraram positividade para IgG, entretanto, foi observada negatividade para a pesquisa de IgM. A transmissão do protozoário ocorre na região, no entanto, a transmissão congênita não foi evidenciada. A água de consumo e o leite não-pasteurizado estão associados a essa infecção no Noroeste Paulista. O acompanhamento sorológico para o T. gondii, durante todo o pré-natal, é de extrema importância.

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-20T16:29:39Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) CIENCIAS MEDICAS GABRIELA AVILA.pdf: 1035117 bytes, checksum: 1e557cad3ea706ebe746a5080324d310 (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-20T16:29:50Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) CIENCIAS MEDICAS GABRIELA AVILA.pdf: 1035117 bytes, checksum: 1e557cad3ea706ebe746a5080324d310 (MD5) / Made available in DSpace on 2017-09-20T16:29:50Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) CIENCIAS MEDICAS GABRIELA AVILA.pdf: 1035117 bytes, checksum: 1e557cad3ea706ebe746a5080324d310 (MD5) Previous issue date: 2017 / Universidade Federal Fluminense / O padrão da epidemia da infecção pelo vírus da imunodeficiência humana (HIV) entre crianças modificou-se substancialmente nos últimos anos, com declínio no número de novas infecções na população pediátrica após a implementação, em 1994, do protocolo PACTG 076 (Pediatric Aids Clinical Trials Group 076). Posteriormente, o impacto da terapia antirretroviral combinada durante a gestação, primariamente para diminuir a morbidade na mãe, apresentou o benefício adicional da redução das taxas de TVHIV. Este estudo é uma série de casos, cujo objetivo é conhecer o perfil clínico-epidemiológico das gestantes infectadas pelo HIV atendidas no Serviço de Infectologia do Hospital Universitário Antônio Pedro no período de 1998 a 2013, o resultado de suas gestações ea taxa de transmissão vertical do HIV. Foram investigadas 115 gestantes, que resultaram em 152 gestações, através da seleção mediante consulta ao registro de atendimento no ambulatório de Serviço de Infectologia do HUAP. A média de idade das gestantes atendidas foi de 26 anos (desvio padrão - DP = 2,1) e 57,9% eram brancas. A idade gestacional média na primeira consulta foi de 22,8 semanas gestacionais (DP = 7,8). Embora a maioria já soubesse ser portadora do HIV, 46,4% foram diagnosticados em mulheres que não tinham conhecimento do seu estado sorológico. A percentagem de gestações consideradas em imunossupressão grave (CD4 + <200 células / mm3) caiu de 17,9% antes de iniciar a terapêutica anti-retroviral para 8,9% na consulta pré-parto. Houve também um aumento na proporção de mulheres grávidas que atingiram uma carga viral não detectada, de 10,4% para 37,9%. A taxa de transmissão vertical do HIV foi de 1,6%., corroborando para a importância do acompanhamento pré-natal adequado e do tratamento com antirretrovirais potentes, fundamentais para a saúde das gestantes e para prevenção da transmissão do HIV aos recém-nascidos. / The pattern of the human immunodeficiency virus (HIV) epidemic among children has changed substantially in recent years, with a decline in the number of new infections in the pediatric population following the implementation in 1994 of the PACTG 076 protocol (PEDIATRIC AIDS CLINICAL TRIALS GROUP 076). Subsequently, the impact of combination antiretroviral therapy during pregnancy, primarily to reduce maternal morbidity, had the additional benefit of reducing maternal-fetal transmission rates of the virus. This study is a series of cases, whose objective is to know the clinical-epidemiological profile of HIV-infected pregnant women attended the Infectious Disease Department of the Antônio Pedro University Hospital from 1998 to 2013, the outcome of their pregnancies and the vertical HIV transmission rate. 115 pregnant women, resulting in 152 pregnancies, were investigated through the selection by consulting medical records. The mean age of the pregnant women attended was 26 years (standart deviation - ST = 2.1), 57.9% of them were white. The mean gestational age at the first outpatient clinic was 22.8 gestational weeks (ST = 7.8). Although most of them already knew to be HIV carrier, 46.4% were diagnosed in women who were unaware of their serological status. The percentage of pregnancies considered in severe immunosuppression (CD4+ < 200 cells/mm3) fell from 17.9% before starting antiretroviral therapy to 8.9% in the prepartum consultation. There was also an increase in the proportion of pregnant women who achieved an undetected viral load, from 10.4% to 37.9%. The vertical HIV transmission rate was 1.6%, corroborating the importance of adequate prenatal care and treatment with potent antiretroviral drugs, which are essential for the health of pregnant women and for the prevention of HIV transmission to newborns.

Haiti's political and economy history has led to a maternity care system that lies out of reach, geographically and financially, of most Haitians, resulting in excessively high maternal and infant mortality. The most common birth practitioners are homebirth midwives (matwòns), who attend roughly three-fourths of all births in Haiti (UNICEF), often without the benefit of emergency obstetric services. In this ethnographic study, I examine how matwòns experience caring for mothers and babies in extraordinarily low-resource and high-risk settings. This qualitative research employed a critical approach and feminist research methodologies. In in-depth interviews I asked participants to describe the challenges they find in their work. Then, in an innovative style of group meeting called Open Space, matwòns reflected on those challenges collectively, with an aim to ameliorate their current situations. Data analysis utilized a modified grounded theory approach, which allowed the matwòns' own narratives to determine the categories of analysis. Emergent themes resulting from this analysis revealed four main challenges in the work of matwòns, as well as matwòns' own strategies to mitigate those challenges. The four broad challenges, which include physical risks, social/spiritual threats, a lack of livelihood, and an obligation to practice, are experienced either as episodic hazards or chronic stressors. Matwòns' personal mitigation strategies centered on two broad approaches, providing protection, and offering service. However, the Open Space meeting created an opportunity for matwòns to strategize collective mitigation efforts through professional organization. Based on these findings, I argue that a more nuanced understanding of matwòns' experiences reveals their adaptive skills, which, in part, resemble Davis Floyd's (2007) notion of a postmodern midwife, and offers opportunities for mutual accommodation (Jordan 1997[1978]). Recommendations include support and advocacy for the self-organization of Haitian matwòns, as well as their greater inclusion in efforts to improve maternal and infant health outcomes in post-earthquake Haiti. / Graduation date: 2013

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Researchers have provided evidence that living in intimate partner violence while pregnant negatively impacts the health of both the women and their unborn children. The purpose of this narrative study was twofold, first to gain understanding of the meaning of health as described by pregnant women who lived in intimate partner violence, and second to gain strategies for health care professionals. Six purposefully selected women participated in two interviews. The data were arranged under five themes: loss of body health, loss of mind health, loss of spirit health, coping with loss of body, mind and spirit health, and advice for health care professionals. The results revealed that these women’s health was negatively affected by living in intimate partner violence while pregnant. Universal screening, coalition building, further research, changes in health care policies, and changes in nursing education and practice are needed to properly address this serious health issue. / xi, 153 leaves ; 29 cm

<p>Many of the known risk factors associated with low birth weight, such as socio-economic status, ethnicity, genetic makeup, and obstetric history, are not within a women's immediate control. However, there are many things that a woman can do to improve her chances of having a normal healthy child. Lifestyle behaviours, such as cigarette smoking, nutrition and the use of alcohol, play an important role in determining the growth of the fetus. The aim of this study was to establish the knowledge, attitudes and practices related to lifestyle factors such as alcohol use, smoking and nutrition among childbearing women and health care workers on the farms in Stellenbosch and Vredendal.</p>

A quantitative, descriptive and cross sectional study was conducted in four (4) health care facilities to determine whether pregnant women attending antenatal care are aware of danger signs of obstetric complications. The objectives of the study were to assess awareness of danger signs of obstetric complications and to associate demographic and obstetric factors with awareness of danger signs of obstetric complications among pregnant women attending antenatal care in Eastern Wollega zone. Data was collected by means of structured questionnaire from 384 pregnant women attending antenatal care in the 4 health facilities and analysed using the Statistical Package for Social Sciences (SPSS) 16 computer program. The findings revealed that the proportion of women who were aware of danger signs of obstetric complications was inadequate. Recommendations were made in line with the research findings / Health Studies / Health Studies / M.A. (Public Health)

MSCPNT / Department of Nutrition

Post-natal care is a care given to the mother and the newborn during post-natal period. This period is crucial to save the lives of the mother and the newborn. Despite its importance, the utilisation of this service is very low in Ethiopia. This study was conducted to establish the views and experiences of women and health care workers on post-natal care services and determine the factors influencing its utilisation with the ultimate purpose of developing guidelines to improve uptake and quality of the services in South West Shoa Zone of Oromia Region, Ethiopia. The objectives of the study were to explore and describe the women’s views and experiences on utilisation of post-natal care service. Furthermore, the study sought to explore and describe health care workers views and experiences on provision of the services and to assess the factors facilitating or hindering to the utilisation of it. Ultimately, the study had intended to develop guidelines that would contribute towards improving the uptake and quality of the post-natal care services. The study used a qualitative descriptive and explorative research design to address the research questions. Qualitative data were collected from 19 women who gave birth in the past six months and from 24 health care workers providing post-natal care services (health care workers and health extension workers) and coordinating the overall maternal, neonatal and child health services in the study area (Zone and district health officials; primary health care units heads). The study used in-depth interview guides to collect data from the aforementioned study participants. Inductive thematic analysis was performed on the verbatim transcriptions using the Atlas ti version 8 qualitative data analysis software. Overall, the emerged themes from the analysis are categorised into women’s views and experiences on utilisation of PNC services, views and experiences of health care workers on PNC and factors facilitating and hindering the utilisation of PNC services. The study identified wide range of socio-cultural, knowledge and attitude related, physical, health facility related and health care workers related factors affecting the utilisation of post-natal care services. Consequently, after a systemic review of literature and stakeholders consultation the researcher used the findings of the study to develop guidelines to improve the uptake and quality of post-natal care services. The developed guidelines were also validated by maternal, neonatal and child health service providers and program leaders and the researcher strongly recommend the use of the developed guidelines that would improve the uptake and quality of post-natal care services. / Health Studies / Ph. D. (Public Health)

In 2011, representatives from the Multnomah County Health Departments and several Native-serving organizations came together to address substance-exposed pregnancies among urban Native Americans in Portland, Oregon. From these partnerships, the Future Generations Collaborative was formed representing a significant shift toward community-led maternal child health research and planning. Additionally, the Future Generations Collaborative adopted a historical trauma-informed community based participatory research and planning process. This is particularly significant considering government agencies' role in colonization within Native communities. The purpose of this case study is to explore partnerships between government agencies and the Portland Native community within the Future Generations Collaborative. Given the profound influence of historical trauma in Native communities, this paper addresses how the partnerships between government agencies and the Portland Native community pose distinct opportunities, challenges, and implications. Drawing from FGC members' lived experiences and an interdisciplinary body of research, I develop a theoretical model for explaining the government's role in creating and sustaining historical trauma within Native communities. This analysis provides critical context for examining the impact of historical trauma on the relationships between government agencies and the Portland Native community within the FGC. By entering methodological discussions of Native-specific community-based participatory research, this study also addresses how the use of a trauma-informed research and planning model affects the relationships between government agencies and the Portland Native community within the FGC.