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1.
Isr Med Assoc J ; 22(3): 142-147, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147977

RESUMO

BACKGROUND: Admission to an intensive care unit (ICU) is an objective marker of severe maternal morbidity (SMM). OBJECTIVES: To determine the prevalence of obstetric ICU admissions in one medical center in Israel and to characterize this population. METHODS: In this retrospective study the files of women coded for pregnancy, birth, or the perinatal period and admission to the ICU were pulled for data extraction (2005-2013). RESULTS: During the study period, 111 women were admitted to the ICU among 120,279 women who delivered babies (0.09%). Their average age was 30 ± 6 years, most were multigravida, a few had undergone fertility treatments, and only 27% had complicated previous pregnancies. Most pregnancies (71.2%) were uneventful prior to admission. ICU admissions were divided equally between direct (usually hemorrhage) and indirect (usually cardiac disease) obstetric causes. CONCLUSIONS: The indications for obstetrics ICU admission correlated with the proximate causes of maternal arrest observed worldwide. While obstetric hemorrhage is often unpredictable, deterioration of heart disease is foreseeable. Attention should be directed specifically toward improving the diagnosis and treatment of maternal heart disease during pregnancy in Israel.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Transtornos Puerperais/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Cuidados Críticos/métodos , Feminino , Humanos , Unidades de Terapia Intensiva , Israel/epidemiologia , Cuidado Pós-Natal/métodos , Gravidez , Complicações na Gravidez/terapia , Prevalência , Transtornos Puerperais/terapia , Estudos Retrospectivos , Fatores de Risco
3.
Rev Esp Salud Publica ; 932019 Nov 06.
Artigo em Espanhol | MEDLINE | ID: mdl-31690715

RESUMO

OBJECTIVE: Protection, promotion and support to the breastfeeding is considered as an area of priority in public health care and as a determining factor of child and maternal health. The use of good practice guides improves health outcomes and patients safety. The aim of study was to assess the impact on breastfeeding of a Guide of Good Clinic Practices about breastfeeding in the Mother and Child Center of the Virgen de las Nieves University Hospital in Granada. METHODS: Cross-sectional descriptive study. Mothers and newborns attended from 2015 to 2018 were studied. Process and outcome variables were considered to perform a descriptive and bivariate analysis for the comparison between years. RESULTS: The rate of exclusive breastfeeding at discharge went from 58.3% to 72.2%. Significant differences were found for the first intake of exclusive breastfeeding in eutocic births and in C-sections, from 90.8% to 93.2% in the first and from 21.7% to 60% in the second. Improvements were detected in the assessment of intake, postnatal education and onset and duration of skin-to-skin contact. CONCLUSIONS: Postnatal protocolized actions carried out by health professionals, such as the assessment of the intake of breastfeeding and postnatal education, were effective for the establishment of breastfeeding. The first moment of skin-to-skin contact and its duration are aspects to be reinforced for effective support.


Assuntos
Aleitamento Materno , Maternidades/normas , Hospitais Universitários/normas , Cuidado Pós-Natal/normas , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Cuidado Pós-Natal/métodos , Guias de Prática Clínica como Assunto , Espanha
4.
Pan Afr Med J ; 33: 305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31723372

RESUMO

Introduction: Every 90 seconds, a woman dies of complications related to pregnancy and childbirth, resulting in more than 340,000 maternal deaths a year. Antenatal care (ANC) and postnatal care (PNC) are significant determinants of maternal health and, particularly, safe motherhood. Antenatal care is an important predictor of safe delivery and provides health information and services that can improve the health of women and infants. mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems. This study aimed at assessing the acceptable implementation modalities of mHealth intervention on pregnant Women in Dschang health district, West Region of Cameroon.ng ba. Methods: This was a cross sectional descriptive study in the Dschang health district, West region of Cameroon. Key informants were all pregnant women from 18 years and above and a total of 372 pregnant women were included. This study was carried out from March to July 2017. Results: Majority of the women, that is, 252(67.74%) were married, 117(31.45%) declaredtheir status as being single, while 3(0.81%) were devorced. Out of the 335 women that declared wanting an mHealth intervention, 41.79% of this number preferred SMS texts in the afternoon, 111(33.13%) in the evening, 46(13.73%) anytime and 38(11.34%) in the morning hours. A total of 83.33% women confirmed using telephone services. Conclusion: This study reveals that cell phones would be the acceptable medium of providing pregnancy and postpartum support to women in the Dschang health district. This is justified by the fact that a vast majority of women interviewed had access to a cell phone and referred to it as their desired and accepted means of communication.


Assuntos
Cuidado Pós-Natal/métodos , Cuidado Pré-Natal/métodos , Telemedicina/métodos , Adolescente , Adulto , Camarões , Telefone Celular , Estudos Transversais , Feminino , Humanos , Gravidez , Mensagem de Texto , Adulto Jovem
5.
Prof Inferm ; 72(2): 111-119, 2019.
Artigo em Italiano | MEDLINE | ID: mdl-31550427

RESUMO

INTRODUCTION: Continuity of care in the postpartum period is strongly recommended by international guidelines. Several studies demonstrate how an individualized follow-up program may decrease newborn's mortality and morbidity and prevent or early identify chronic diseases or diseases with long-term effects for mother, newborn and family. In Italy the lastest recommendations on postnatal care of mothers and newborns have been relea- sed in 2000. AIM: To describe the organization of healthy term newborns post-discharge follow-up in the 10 birth centers of Ligurian public hospitals. METHODS: Descriptive study, conducted in 2015 through telephonic interview with head nurses (or their delegates) of the centers. RESULTS: All 10 birth centers participated in the study recommend a follow-up visit, but only half have a formalized procedure for follow-up. Most of them recommend the first follow-up visit within 2-3 days from discharge. Half of centers provide the first follow-up visit at the birth center's clinic, three don't recommend follow-up visits after the first one. None of them links the follow-up visit of the newborn with the mother's one; usually the needs of mother and newborn are identified and met by pediatric nurses, nurses and neonatologist. All the centers provide a telephone number for post-discharge needs. Two centers make calls to mothers considered to be at risk of postpartum depression. DISCUSSION: The study describes different newborn care pathways related to follow-up after discharge in the Ligurian birth centers. At the moment there is no homogeneous implementation of the interventions recommended at national level.


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Continuidade da Assistência ao Paciente/organização & administração , Cuidado Pós-Natal/métodos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Feminino , Hospitais Públicos , Humanos , Recém-Nascido , Itália , Alta do Paciente , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Inquéritos e Questionários , Fatores de Tempo
6.
BMC Pregnancy Childbirth ; 19(1): 339, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533640

RESUMO

BACKGROUND: There is broad agreement that antenatal care (ANC) interventions, skilled attendance at birth and management of complications arising after delivery are key strategies that can tackle the high burden of maternal mortality in sub-Saharan Africa. In Kenya, utilisation rate of these services has remained low despite a government policy on free maternal care. The present study sought to understand what factors are leading to the low healthcare seeking during pregnancy, child birth and postnatal period in Siaya County in Kenya. METHODS: Six Focus Group Discussions were conducted with 50 women attending ANC in 6 public primary healthcare facilities. Participants were drawn from a sample of 200 women who were eligible participants in a Conditional Cash Transfer project aimed at increasing utilization of healthcare services during pregnancy and postnatal period. Interviews were conducted at the health facilities, recorded, transcribed and analysed using thematic analysis. RESULTS: Multiple factors beyond the commonly reported distance to health facility and lack of transportation and finances explained the low utilization of services. Emergent themes included a lack of understanding of the role of ANC beyond the treatment of regular ailments. Women with no complicated pregnancies therefore missed or went in late for the visits. A missed health visit contributed to future missed visits, not just for ANC but also for facility delivery and postnatal care. The underlying cause of this relationship was a fear of reprimand from the health staff and denial of care. The negative attitude of the health workers explained the pervasive fear expressed by the participants, as well as being on its own a reason for not making the visits. The effect was not just on the woman with the negative experience, but spiraled and affected the decision of other women and their social networks. CONCLUSIONS: The complexity of the barriers to healthcare visits implies that narrow focused solutions are unlikely to succeed. Instead, there should broad-based solutions that focus on the entire continuum of maternal care with a special focus on ANC. There is an urgent need to shift the negative attitude of healthcare workers towards their clients.


Assuntos
Parto Obstétrico , Parto Domiciliar/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pós-Natal , Cuidado Pré-Natal , Adulto , Atitude do Pessoal de Saúde , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Quênia/epidemiologia , Mortalidade Materna , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/normas , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/organização & administração , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Pesquisa Qualitativa , Melhoria de Qualidade
7.
BMC Infect Dis ; 19(Suppl 1): 788, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31526372

RESUMO

BACKGROUND: Since 2001 the South African guidelines to improve child health and prevent vertical HIV transmission recommended frequent infant follow-up with HIV testing at 18 months postpartum. We sought to understand non-attendance at scheduled follow-up study visits up to 18 months, and for the 18-month infant HIV test amongst a nationally representative sample of HIV exposed uninfected (HEU) infants from a high HIV-prevalence African setting. METHODS: Secondary analysis of data drawn from a nationally representative observational cohort study (conducted during October 2012 to September 2014) of HEU infants and their primary caregivers was undertaken. Participants were eligible (N = 2650) if they were 4-8 weeks old and HEU at enrolment. All enrolled infants were followed up every 3 months up to 18 months. Each follow-up visit was scheduled to coincide with each child's routine health visit, where possible. The denominator at each time point comprised HEU infants who were alive and HIV-free at the previous visit. We assessed baseline maternal and early HIV care characteristics associated with the frequency of 'Missed visits' (MV-frequency), using a negative binomial regression model adjusting for the follow-up time in the study, and associated with missed visits at 18 months (18-month MV) using a logistic regression model. RESULTS: The proportion of eligible infants with MV was lowest at 3 months (32.7%) and 18 months (31.0%) and highest at 12 months (37.6%). HIV-positive mothers not on triple antiretroviral therapy (ART) by 6-weeks postpartum had a significantly increased occurrence rate of 'MV-frequency' (adjusted incidence rate ratio, 1.2 (95% confidence interval (CI), 1.1-1.4), p < 0.0001). Compared to those mothers with ART, these mothers also increased the risk of '18-month-MV' (adjusted odds ratio, 1.3 (CI, 1.1-1.6), p = 0.006). Unknown infant nevirapine-intake status increased the rate of 'MV-frequency' (p = 0.02). Mothers > 24 years had a significantly reduced rate of 'MV-frequency' (p ≤ 0.01) and risk of '18-month-MV' (p < 0.01) compared to younger women. Shorter travel time to health facility lowered the occurrence of 'MV-frequency' (p ≤ 0.004). CONCLUSION: Late initiation of maternal ART and infant prophylaxis under the Option- A policy and extended travel time to clinics (measured at 6 weeks postpartum), contributed to higher postnatal MV rates. Mothers older than 24 years had lower MV rates. Targeted interventions may be needed during the current PMTCT Option B+ (lifelong ART to pregnant and lactating women at HIV diagnosis) to circumvent these risk factors and reduce missed visits during HIV-care.


Assuntos
Sorodiagnóstico da AIDS , Saúde da Criança , Infecções por HIV/diagnóstico , HIV/imunologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Perda de Seguimento , Cuidado Pós-Natal/métodos , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade , Estudos Transversais , Feminino , Seguimentos , Infecções por HIV/tratamento farmacológico , Instalações de Saúde , Humanos , Lactente , Recém-Nascido , Lactação , Pessoa de Meia-Idade , Mães/educação , Cuidado Pós-Natal/economia , Período Pós-Parto , Gravidez , Fatores de Risco , África do Sul , Inquéritos e Questionários , Viagem , Adulto Jovem
8.
BMC Res Notes ; 12(1): 487, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387618

RESUMO

OBJECTIVE: The objective of this study was to assess knowledge and practice of immediate new-born care among midwives in central zone public health facilities Tigray region, 2016. RESULTS: The mean age of the study participants was 34.1 years. Majority of the participants (83%) were diploma midwives. The score of knowledge of participants on immediate new-born care was 17.7% good and 25.2% poor. More than half (52.4%) of midwives practiced immediate new-born care. Midwives working in health center have 82% lower odds of new-born care compared to those working in hospital (p = 0.000, OR = 0.18 (0.07, 0.43).


Assuntos
Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Tocologia/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Adulto , Estudos Transversais , Etiópia , Feminino , Humanos , Recém-Nascido , Masculino , Tocologia/normas , Análise Multivariada , Gravidez , Inquéritos e Questionários
9.
BMC Res Notes ; 12(1): 483, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382978

RESUMO

OBJECTIVE: Most neonatal deaths occur in low income and middle-income countries and about half of the deaths occur at home. It is estimated that about 75% of neonatal deaths could be avoided with simple, low-cost tools that already exist such as antibiotics for pneumonia and sepsis, sterile blades to cut the umbilical cords using knit caps and kangaroo care to keep babies warm. The aim of this study is to assess the knowledge, attitudes, and practices of newborn care among postnatal mothers at Bahir Dar, Ethiopia 2016. An institutional based cross-sectional study design was used. The sample size was calculated by using a single population proportion formula. The total sample size was 422. The collected data was coded and entered to Epi-Data version 3.1 and exported and analyzed using SPSS version 23.0. Both descriptive and multivariate logistic regression was performed. RESULT: A total of 414 postnatal mothers were interviewed with a response rate of 98.1%, among them 55.3% had good knowledge and 60.6% had a good practice of newborn care. Age of the mother, occupation, the month of pregnancy at first ANC visits, overall knowledge and attitude level was found to have a significant association with newborn care practice.


Assuntos
Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Mães/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
11.
BMC Womens Health ; 19(1): 88, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269928

RESUMO

BACKGROUND: Women with gestational diabetes have low diet quality. We evaluated the effectiveness of a group-based lifestyle modification program for improvement of dietary quality in women with previous gestational diabetes predominantly within their first postnatal year. METHODS: Women were randomised to intervention (n = 284) or usual care (n = 289). Dietary data was collected at baseline and twelve months using a food frequency questionnaire and recoded into the Australian Recommended Food Score (ARFS). Mixed model analyses investigated the intervention effect on ARFS (per-protocol-set (PPS) excluded women without the minimum intervention exposure). RESULTS: Baseline mean total ARFS was low (31.8 ± 8.9, maximum score = 74) and no significant changes were seen in total ARFS (Cohen's D = - 0.06). 2% reduction in alcohol for intervention (0.05, 0.26) compared with - 1% for usual care (Odds ratio: 0.68; 95%CI 0.46, 0.99). Dairy ARFS sub-category significantly improved (low fat/saturated fat foods) in the intervention group over time compared with usual care for the PPS analysis (dairy + 0.28 in intervention (95%CI 0.08, 0.48) compared with + 0.02 in usual care (95%CI -0.14, 0.18) (group-by-treatment interaction p = 0.05, Cohen's D = 0.14)). CONCLUSIONS: Engaging with the intervention improved aspects of diet quality that aligned with minimum intervention exposure, but the total diet quality remains low. Further research is needed to improve diabetes prevention program engagement. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZCTRN12610000338066 , April 2010.


Assuntos
Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Gestacional/dietoterapia , Dieta/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Prevenção Primária/métodos , Adulto , Austrália , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/prevenção & controle , Feminino , Humanos , Estilo de Vida , Gravidez
12.
Taiwan J Obstet Gynecol ; 58(4): 492-496, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307739

RESUMO

OBJECTIVES: Antenatal classes are a common method of preparation for birth with proven efficiency in improving perinatal outcomes. Yet, their impact on fear perception during labour has not been identified. The aim of the study was to analyse whether preparation for labour by means of antenatal classes attendance could be associated with decrease in level of experienced fear and pain during birth. MATERIALS AND METHODS: It was a cross-sectional study of 147 women who had given vaginal births. Data was collected from mothers between 24 and 72 h postpartum. Patients answered self-reported questionnaires concerning subjective perception of birth including Delivery Fear Scale (DFS) and Numeric Rating Scale (NRS) for fear and pain assessment. The study group was divided into subgroups depending on parity and antenatal classes attendance. RESULTS: Patients in the primiparas subgroup who attended antenatal classes scored lower in the DFS (48.7 ± 23.5 vs. 60.2 ± 16.5, p < .03). There was no difference in the DFS score in the multiparas subgroup (p < .90). No significant differences in the NRS score depending on antenatal classes attendance in any subgroup were observed. CONCLUSION: Participation in antenatal classes should be advised to every pregnant primiparous woman as this type of non-invasive preparation lowers level of fear experienced during childbirth.


Assuntos
Parto Obstétrico/efeitos adversos , Medição da Dor , Dor/etiologia , Dor/prevenção & controle , Cuidado Pré-Natal/métodos , Educação Pré-Natal/métodos , Adulto , Estudos Transversais , Parto Obstétrico/métodos , Feminino , Humanos , Satisfação do Paciente , Polônia , Cuidado Pós-Natal/métodos , Gravidez , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
13.
Taiwan J Obstet Gynecol ; 58(4): 531-535, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307746

RESUMO

OBJECTIVE: We purposed to review prenatal diagnoses of ureterocele, to determine the sonographic findings and additional abnormalities, and to illustrate the pregnancy outcomes of these patients. MATERIAL AND METHODS: We reviewed the records of 24 patients with the diagnosis of ureterocele in our referral center between January 2010-March 2017. Prenatal sonographic findings, antenatal course, and postnatal follow-up were obtained. RESULTS: The mean gestational age at first US diagnosis was 24.5 ± 2.9 weeks. 13 (54.1%) of fetuses were female, and 11 (45.9%) were male. Ureterocele was associated with the duplex kidney in 17 (70.8%), MCDK in 5 (20.8%) and hydronephrosis with a single system in 1 (4.2%) and pelvic kidney in 1 (4.2%) fetuses. Postnatal follow-up was achieved in 22 of 24 (91.6%) cases, and mean follow-up interval was 56 ± 14.2. Months. The diagnosis of ureterocele was confirmed in 22 (91.6%) cases postnatally. 15 of 22 (68%) cases were classified as extravesical ureterocele, and 7 (32%) cases were intravesical ureterocele. Postnatal confirmation of duplex kidney achieved in 16 of 17 (94.1%) patients. 17 (77.2%) patients were required surgical intervention, and 5 (22.8%) cases were managed conservatively. 15 of 16 (93.7%) cases who were diagnosed duplex kidney underwent surgery however 2 of 5 (40%) cases which were confirmed MCDK required an operation. Cystoscopic ureterocele incision was the initial approach for the surgical management and performed all of the cases which required surgery. It was curative in 10 of 17 (58.8%) patients and 7 (41.2%) cases needed to further operations. Ureteroselectomy and common-sheath ureteroneocystostomy was performed in 5 (29.1%) cases and. 2 (%11.7%) cases underwent partial nephrectomy. CONCLUSION: Ureterocele can be accurately diagnosed by prenatal sonography, and it is a significant clue for the diagnosis of a duplex kidney. Postnatal prognosis depends on associated anomaly and presence of reflux and upper pole function.


Assuntos
Idade Gestacional , Rim Displásico Multicístico/diagnóstico por imagem , Ultrassonografia Pré-Natal , Ureterocele/diagnóstico por imagem , Ureterocele/fisiopatologia , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/fisiopatologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Rim Displásico Multicístico/epidemiologia , Rim Displásico Multicístico/fisiopatologia , Cuidado Pós-Natal/métodos , Diagnóstico Pré-Natal/métodos , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Turquia , Ureterocele/congênito
15.
Midwifery ; 77: 137-143, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31325744

RESUMO

BACKGROUND: Previous studies in Tanzania have shown that mothers do not often receive the recommended number of postnatal contacts, which limits their ability to not only have health checks but also to be provided with sufficient and quality postnatal education. Educating mothers while in the hospital is important yet there remains a paucity on the experiences of mothers in a hospital setting related to newborn care education. Therefore, the objective of this study was to explore the experience of newborn care discharge education at a national hospital in Dar es Salaam, Tanzania from the perspective of mothers and nurse midwives. METHODS: Using convenience sampling, participants were recruited from Muhimbili National Hospital. Eight mothers who recently gave birth and eight nurse midwives working on the postnatal and labour ward participated. In-depth semi-structured interviews were conducted in Swahili and transcribed and translated into English. Interviews were analyzed using thematic coding. RESULTS: Most mothers were multiparous (75%) and averaged 29.6 years of age (SD = 5.1). Nurse midwives had an average of 10 years of experience (SD = 7.5). The primary themes identified included barriers, facilitators, and opportunities related to newborn care discharge education. Barriers included lack of standard postnatal education guidelines; community norms against hospital teaching; gaps in hospital care; and expectations of mothers' previous knowledge. Facilitators identified were that education was already being provided on some relevant newborn care topics; nurse midwives desired to teach; and mothers desired to learn and build on their previous knowledge and confidence. Opportunities to improve included developing standardized guidelines related to postnatal discharge education; training nurses how to engage mothers and families; and engaging mothers through varied learning methods. CONCLUSION: While mothers received some education prior to discharge and nurses expressed a desire to teach, challenges remained in receiving sufficient education on all recommended postnatal education topics. Opportunity to improve postnatal education can be addressed through the development of standardized education and engaging mothers through preferred learning methods.


Assuntos
Mães/psicologia , Alta do Paciente/normas , Cuidado Pós-Natal/normas , Adulto , Feminino , Humanos , Saúde do Lactente/normas , Recém-Nascido , Mães/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Satisfação do Paciente , Cuidado Pós-Natal/métodos , Gravidez , Pesquisa Qualitativa , Tanzânia
16.
Midwifery ; 77: 71-77, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31255911

RESUMO

OBJECTIVE: We aimed to explore midwives' perspectives on post-abortion care (PAC) in Uganda. Specifically, we sought to improve understanding of the quality of care. DESIGN: This was a qualitative study using individual in-depth interviews and an inductive thematic analysis. SETTING AND PARTICIPANTS: Interviews were conducted with 22 midwives (the 'informants') providing PAC in a public hospital in Kampala, Uganda. The narratives were based on experiences in current and previous workplaces, in rural and urban settings. FINDINGS: The findings comprise one main theme - morality versus duty to provide quality post-abortion care - and three sub-themes. Our findings confirm that the midwives were committed to saving women's lives but had conflicting personal morality in relation to abortion and sense of professional duty, which seemed to influence their quality of care. Midwives were proud to provide PAC, which was described as a natural part of midwifery. However, structural challenges, such as lack of supplies and equipment and high patient loads, hampered provision of good quality care and left informants feeling frustrated. Although abortion was often implied to be immoral, the experience of PAC provision appeared to shape views on legality, leading to an ambiguous, yet more liberal, stance. Abortion stigma was reported to exist within communities and the health workforce, extending to both providers and care-seeking women. Informants had witnessed mistreatment of women seeking care due to abortion complications, through deliberate care delays and denial of pain medication. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: Midwives in PAC were dedicated to saving women's lives; however, conflicting morality and duty and poor working conditions seemed to impede good-quality care. Enabling midwives to provide good quality care includes increasing the patient-midwife ratio and ensuring essential resources are available. Additionally, efforts that de-stigmatise abortion and promote accountability are needed. Implementation of policies on respectful post-abortion care could aid in ensuring all women are treated with respect.


Assuntos
Aborto Induzido/enfermagem , Obrigações Morais , Princípios Morais , Enfermeiras Obstétricas/psicologia , Cuidado Pós-Natal/métodos , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Cuidado Pós-Natal/psicologia , Cuidado Pós-Natal/estatística & dados numéricos , Pesquisa Qualitativa , Uganda
17.
Matern Child Health J ; 23(9): 1187-1195, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31228144

RESUMO

OBJECTIVES: Evidence suggests that maternal psychological distress is an under-diagnosed condition that can have lasting impacts on child outcomes. Models based solely on maternal outcomes have not found screening to be cost-effective. This research explores the effects of self-reported maternal psychological distress on children's language and behavioural development up to the age of 7. METHODS: Using longitudinal survey data from 10,893 families in the UK Millennium Cohort Study, multilevel models are used to explore the differential effects of maternal diagnosed and treated depression versus untreated maternal psychological distress during the postnatal year on longer-term child outcomes. RESULTS: Both diagnosed and treated depression and self-reported maternal psychological distress have detrimental effects on child behavioural development. Behavioural outcomes up to age 5 were better for children of women who received treatment for depression, compared with children those whose mothers' psychological distress was untreated, but this was not maintained to age 7. Little or no evidence of a difference was found between maternal psychological distress and child language development. CONCLUSIONS FOR PRACTICE: This research highlights the lack of effectiveness of existing treatment for maternal psychological distress both to benefit child development and to provide long-term symptom remediation for women. Future research could aim to identify more effective treatments for both women and children.


Assuntos
Desenvolvimento Infantil/fisiologia , Depressão Pós-Parto/complicações , Crescimento e Desenvolvimento/fisiologia , Mães/psicologia , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Depressão Pós-Parto/psicologia , Feminino , Humanos , Estudos Longitudinais , Mães/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/normas , Gravidez , Resultado da Gravidez , Inquéritos e Questionários , Reino Unido
18.
J Adv Nurs ; 75(10): 2223-2235, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31222789

RESUMO

AIM: To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress. BACKGROUND: Unmet needs postpartum can have a negative impact on mood and parenting stress. Technology-assisted nursing care may provide needed support and reduce risk. DESIGN: Randomized controlled trial (RCT) with three conditions. METHODS: Enrollment began on 11 May 2017. Participants were randomized into one of three groups after completion of the baseline survey. Intervention I participants received standardized electronic messages four times/week for 6 months postpartum. Intervention II participants additionally received the option for nurse contact. Depression and parenting stress as measured using the Edinburgh Postnatal Depression Scale (EPDS) and Parenting Stress Index-Short form (PSI-SF) was obtained at 3 weeks, 3 months and 6 months postpartum and results compared with a usual care group. Patient satisfaction and nursing factors were measured. RESULTS: Significantly higher satisfaction scores were found in both intervention groups as compared with control, but there were no significant changes in EPDS or PSI-SF. CONCLUSION: The interventions were perceived as helpful and not burdensome. Better nurse-sensitive outcome measures are needed to adequately assess effectiveness. IMPACT: Postpartum women report unmet needs for support and education. The interventions were perceived as being helpful but did not significantly reduce depressive symptoms or parenting stress. Nurses can use this research to inform development of innovative approaches to support postpartum women. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02843022.


Assuntos
Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/enfermagem , Invenções , Mães/psicologia , Cuidado Pós-Natal/métodos , Adulto , Feminino , Humanos , Gravidez
19.
PLoS Med ; 16(6): e1002832, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31226123

RESUMO

BACKGROUND: Unwanted pregnancies remain a burden for women living with HIV (WLWH). Family planning prevents unplanned pregnancies while promoting longer birth intervals, key strategies to eliminate perinatal transmission of HIV and promote maternal and child health. We evaluated the effect of a family planning voucher, inclusive of immediate postpartum counseling, on uptake, early initiation, and continuation of modern contraceptive methods among recently postpartum WLWH delivering at a publicly funded regional referral hospital in rural, southwestern Uganda. METHODS AND FINDINGS: We performed a randomized controlled trial between October, 2016 and June, 2018 at a referral hospital in southwestern Uganda. This interim analysis includes adult WLWH randomized and enrolled equally to receive a family planning voucher or standard of care (control). Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrollment and 6 months postpartum. Our primary outcome of interest for this analysis is initiation of a modern family planning method within 8 weeks postpartum. Secondary outcomes included family planning initiation at 12, 14, 16, and 20 weeks postpartum, family planning discontinuation and/or change, pregnancy incidence, and mean time without contraception. The trial was registered with clinicaltrials.gov (NCT02964169). At enrollment, half of the women in both the voucher (N = 87, 55%) and control (N = 86, 54%) groups wanted to have a child in 2 years postpartum. Over 80% of referent pregnancies in the voucher (N = 136, 86%) and control (N = 128, 81%) groups were planned. All women were accessing ART. The mean CD4 count was 396 cells/mm3 (SD = 61) for those enrolled in the control group versus 393 cells/mm3 (SD = 64) in the family planning voucher group. By 8 weeks postpartum, family planning was initiated in 144 (91%) participants in the voucher group and 83 (52%) participants in the control group (odds ratio [OR] 9.42; CI 4.67-13.97, P < 0.001). We also found high family planning uptake rates for both groups, with higher rates among the intervention group at 12 weeks (OR 5.66; CI 2.65-12.12, P < 0.001), 14 weeks (OR 2.51; CI 1.31-4.79, P < 0.001), 16 weeks (OR 4.02; CI 1.66-9.77, P = 0.001), and 20 weeks (OR 3.65; CI 1.40-9.47, P = 0.004) postpartum. The average time to family planning initiation was reduced to 5.9 weeks (SD = 2.4) for those in the voucher group compared to 9.3 weeks (SD = 5) in the control (P < 0.001). One pregnancy was recorded in the group receiving standard of care; none were reported in the voucher group. Method mix did not differ by group: injectables were selected by most women (N = 150, 50%), and 52% of this proportion were in the experimental arm, with <10% in each arm selecting condoms, oral contraception, or intrauterine devices (IUDs). Similar proportions of women changed contraceptive methods over the 6-month follow-up in the voucher and control groups (N = 8, 5% versus N = 5, 4%; P = 0.467). More women in the control group discontinued contraception for 1 to 2 weeks (N = 19, 13% versus N = 7, 5%; P = 0.008) or more than 4 weeks (N = 15, 10% versus N = 3, 2%; P = 0.002) compared to those given a family planning voucher. The main limitation of this study is that its findings may not be generalized to settings without improved availability of contraceptives in publicly funded facilities. CONCLUSION: These findings indicate that a well-structured, time-bound family planning voucher program appeared to increase early postpartum contraceptive uptake and continuation in a setting in which users are faced with financial, knowledge, and structural barriers to contraceptive services. Further work should clarify the role of vouchers in empowering WLWH to avoid unintended pregnancies over time. TRIAL REGISTRATION: ClinicalTrials.gov NCT02964169.


Assuntos
Comportamento Contraceptivo , Serviços de Planejamento Familiar/métodos , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Cuidado Pós-Natal/métodos , Adulto , Comportamento Contraceptivo/tendências , Serviços de Planejamento Familiar/tendências , Feminino , Seguimentos , Infecções por HIV/transmissão , Hospitais de Ensino/métodos , Hospitais de Ensino/tendências , Humanos , Cuidado Pós-Natal/tendências , Gravidez , Gravidez não Planejada , Uganda/epidemiologia
20.
BMC Health Serv Res ; 19(1): 357, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170973

RESUMO

BACKGROUND: Lifestyle interventions regularly rely on study staff to implement the intervention and collect outcomes data directly from study participants. This study describes the experiences of project staff in two randomized controlled trials of a postpartum lifestyle intervention to reduce risk factors for type 2 diabetes in Latinas. Latinas are the fastest growing minority group in the U.S. and have the highest rates of type 2 diabetes after a diagnosis of gestational diabetes mellitus. The challenges of implementing lifestyle interventions for postpartum women have been poorly documented. METHODS: A qualitative focus group was conducted with eight staff members (five health educators and three health interviewers) involved in Proyecto Mamá and Estudio Parto. The discussion was audio recorded, transcribed, and coded in NVivo. Focus group topics included: 1) participant recruitment, 2) participant retention, 3) implementation of the lifestyle intervention, 4) assessment of behavior change, 5) overall challenges and rewarding aspects of the trial, and 6) recommended changes for future trials. RESULTS: Key themes emerged regarding enabling factors and barriers to implementing a lifestyle intervention in postpartum Latinas. Enabling factors included: a) the staff's belief in the importance of the intervention, b) opportunities associated with the longitudinal nature of the trial, c) belief that the staff could empower participants to make behavior change, d) benefits of flexible intervention sessions, and e) connection with participants due to shared cultural backgrounds. Barriers included: a) participant stressors: home, food, and financial insecurity, b) low health literacy, c) issues related to recent immigration to the continental U.S., d) handling participant resistance to behavior change, e) involvement of family members in assessment visits, f) limitations of the assessment tools, and g) time limitations. CONCLUSIONS: Findings highlight the challenging contexts that many study participants face, and shed light on the potentially influential role of health educators and interviewers in intervention implementation and data collection. Specific recommendations are made for strategies to improve adherence to diabetes prevention programs in postpartum underserved and minority populations in this challenging, transitional period of life. TRIAL REGISTRATION: NCT01679210 . Registered 5 September 2012; NCT01868230 . Registered 4 June 2013.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/epidemiologia , Hispano-Americanos , Cuidado Pós-Natal , Adulto , Estudos de Avaliação como Assunto , Feminino , Grupos Focais , Educadores em Saúde , Humanos , Cuidado Pós-Natal/métodos , Gravidez , Comportamento de Redução do Risco , Adulto Jovem
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