Being a bridge : Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study

Background: Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence. Methods: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis. Results: The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women. Conclusion: Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

Knowledge and perceptions regarding sexual and reproductive health among high school students in Kathmandu, Nepal

Background: Nepal recently began teaching sexual education in the school system and has established youth friendly services in order to meet the need of increased sexual and reproductive knowledge among the youth. Objective: To examine the sexual and reproductive knowledge and perceptions among young people attending schools in Kathmandu. Method: A written questionnaire was distributed to 160 students, in a classroom environment, in four schools in Kathmandu. Results: Two thirds of the females and nearly 60% of the males knew that it was possible to get sexually transmitted infection (STI) during one sexual encounter and more than half of the students knew when in the menstrual cycle conception was more likely to occur . One third of the participants did not know that it was possible to become pregnant after having intercourse once. The males demonstrated less knowledge than the females regarding every aspect of sex and reproduction, with the exception of pregnancy prevention. Conclusion and clinical implications: For the youths in this study, it was more important to prevent unwanted pregnancies than to protect oneself from STIs. Establishment of a hotline on the internet, where personalized and confidential counselling can be offered may complement the comprehensive sexual education in schools.

Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam

BACKGROUND: In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members. METHODS: Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis. RESULTS: Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators' lack of health knowledge was regarded as a deficit for assisting the groups' assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups. CONCLUSIONS: This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.

Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden

Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden. Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied. Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war. Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and

The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil

EMOND, Alan et al. The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil. Revista Panamericana de Salud Pública/ Pan American Journal of Public Health , v.12, n.2, p.101-110, 2002

Avaliação do retinol em parturientes com diabetes mellitus gestacional no pós parto imediato

Micronutrient deficiencies affect individuals mainly in developing countries, where vitamin A deficiency is a public health problem worldwide more worrying, especially in groups with increased physiological needs such as children and women of reproductive age. Vitamin A is supplied to the body through diet and has an important role in the visual process, cell differentiation, maintenance of epithelial tissue, reproductive and resistance to infection. The literature has demonstrated the relationship between vitamin A and diabetes, including gestational, leading to a risk to both mother and child. Gestational diabetes is any decrease in glucose tolerance of variable magnitude diagnosed each the first time during pregnancy, and may or may not persist after delivery. Insulin resistance during pregnancy is associated with placental hormones, as well as excess fat. Studies have shown that retinol transport protein produced in adipose tissue in high concentrations, this would be associated with resistance by interfering with insulin signaling. Therefore, this study aimed to evaluate the concentration of retinol in serum and colostrum from healthy and diabetic mothers in the immediate postpartum period. One hundred and nine parturient women were recruited, representing seventy-three healthy and thirty-six diabetic. Retinol was extracted and subsequently analyzed by High Performance Liquid Chromatography. Among the results highlights the mothers with gestational diabetes were older than mothers healthy, had more children and a higher prevalence of cases of cesarean section. Fetal macrosomia was present in 1.4% of healthy parturient women and in 22.2% of diabetic mothers. The maternal serum retinol showed an average of 39.7 ± 12.5 mg/dL for healthy parturients 35.12 ± 15 mg/dL for diabetic and showed no statistical difference. It was observed that in the group of diabetic had 17% vitamin A deficiency, whereas in the healthy group, only 4% of the women were deficentes. Colostrum, the concentration of retinol in healthy was 131.3 ± 56.2 mg/dL and 125.3 ± 41.9 mg/dL in diabetic did not differ statistically. This concentration of retinol found in colostrum provides approximately 656.5 mg/day for infants born to healthy mothers and 626.5 mg/day for infants of diabetic mothers, based on a daily consumption of 500 mL of breast milk and need Vitamin A 400 mg/day, thus reaching the requirement of the infant. The diabetic mothers showed significant risk factors and complications related to gestational diabetes. Although no 11 difference was found in serum retinol concentration and colostrum among women with and without gestational diabetes, the individual analysis shows that parturients women with diabetes are 4.9 times more likely to develop vitamin A deficiency than healthy parturients. However, the supply of vitamin A to the newborn was not committed in the presence of gestational diabetes

O Evangelho segundo a Pastoral da Criança :por uma pedagogia da sobrevivência

This work aims to analyze social and educational actions at Pastoral da Criança, using education as a survival tool. This was done at Parque dos Coqueiros, a neighborhood in Natal, Rio Grande do Norte. The methodology for data collection was composed of comprehensive interview (Jean Kaufmann), participant observation (Robert Bogdan) and documental analysis (Le Goff); all os which bring reflections related to concepts such as strategies, tatics and know how (Michel de Certeau), configuration (Nobert Elias), and control technology (Michel de Foucault), care ethics (Leonardo Boff) and etno-theories (Natália Ramos). Pastoral da Criança is a social action organism that belongs to the National Conference of Bishops of Brazil, originated at Florestópolis, Londrina (Paraná), in the year of 1983. These actions have been an expression of a new logic of actions of the Catholic Church. It values the participation of laymen in the activities of the Pastoral. Thus, the parish is seen as a nucleus that irradiates the Church s Social Doctrine. At Rio Grande do Norte this institution has guided poverty stricken families on issues related to children s health as well as working with laymen for volunteer work. This is considered devotion, that is firmed by an individual and group mystique. The social and educational actions are done in three axes: 1) Monthly home visits, where there is mother-child support; 2) Life Celebration Day, where they weigh children and promote nutritional surveillance; 3) Meeting for Evaluation and Reflection, that aims to articulate community leaders to think about problems attached to the social actions they realize. This action tripod , as it is called by the Pastoral Agents are the types of actions that fundament survival education for poor children ranging from 0 to 6 years old. The families learn to deal with prevention, the essential, the alternative and probabilities of survival tactics due to exclusion matters or even social extermination. The Pastoral da Criança aims to recover childhood emotions in poverty stricken areas. It also has influence in the diminishing of malnutrition and mother and child mortality. This education for survival is the base on the art of teaching and learning of poverty stricken children. It is a social educational action, non assistencialist, but considered a shy action in order to promote mobilization of the communities that are accompanied for the emancipation and change of social conditions

TERRITORIAL DISPUTES, LABOUR RELATIONS and ENVIRONMENTAL HEALTH IN AGROHIDRONEGOCIO sugarcane IN THE PONTAL PARANAPANEMA (SP)

This research aims to analyze the conflict over land in Postal do Paranapanema (state of São Paulo, Brazil), considering the competition for water resources and the degradation of environmental health in the area called the agrohidronegocio sugarcane. The survey results indicate that the expansion of sugarcane cultivation in this region is causing the worsening health of workers. Moreover, the research also seeks to identify alternative models to the hegemonic project of regional development based on matrix agrohidroenergetica. For this, the research has as interlocutors various types of social movements such as the Landless Workers Movement and the Movement of Dam Affected, and union leaders.

Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia

OBJETIVO: A peridural (AP) e a técnica de duplo bloqueio (DB) são utilizadas em analgesia para o trabalho de parto. Este estudo comparou os efeitos na mãe e no feto de ambas as técnicas em analgesia e anestesia para o parto. MÉTODOS: Quarenta parturientes ASA I e II receberam por via peridural 15 ml de ropivacaína a 0,125% (grupo AP) e 5 µg de sufentanil com 2,5 mg bupivacaína por via subaracnóidea (grupo DB). Foram avaliados: intensidade de dor, altura do bloqueio sensitivo, tempo de latência, bloqueio motor, duração da analgesia de parto, tempo para a resolução do parto, hipotensão materna e presença de prurido. Os recém-nascidos foram avaliados pelo índice de Apgar e escore da capacidade adaptativa e neurológica (ECAN), método de Amiel-Tison. RESULTADOS: Não houve diferenças significativas entre os grupos na intensidade da dor, no tempo de latência, no nível do bloqueio sensitivo e no índice de Apgar. O bloqueio motor, a duração da analgesia e o tempo para resolução do parto foram maiores no grupo DB, do qual sete parturientes apresentaram prurido leve. ECAN foi maior no grupo AP após meia hora, duas horas e 24 horas. Noventa e cinco por cento dos recém-nascidos do grupo AP e 60% do grupo DB foram considerados neurologicamente vigorosos ao exame de 24 horas. CONCLUSÃO: As duas técnicas mostraram-se eficazes para analgesia do trabalho de parto. As parturientes do grupo DB apresentaram prurido e trabalho de parto mais prolongado. Recém-nascidos de mães que receberam analgesia de parto via peridural apresentaram melhor ECAN.

Sintomas depressivos e ansiosos em mães de recém-nascidos com e sem malformações

OBJETIVO: comparar as condições emocionais de mães cujos filhos nascem com malformações visíveis (Grupo M) com as das mães de crianças eutróficas (Grupo E) logo após o nascimento. MÉTODO: foram avaliados os sintomas de ansiedade e depressão de 22 mães de cada grupo por meio do Inventário de Depressão de Beck (BDI) e do Inventário de Ansiedade Traço-Estado (IDATE). Foram excluídas as mães portadoras de deficiência sensorial incapacitante, HIV, distúrbios psiquiátricos e síndromes genéticas. Os dados foram complementados com consultas a prontuários médicos da criança e da mãe. Para análise comparativa entre as medianas dos grupos foi utilizado o teste não-paramétrico U de Mann-Whitney; para amostras independentes e para os escores indicativos de sintomas clínicos, o teste exato de Fisher e o teste do χ2. RESULTADOS: houve diferenças significativas nas medianas dos escores das três subescalas (ansiedade-traço, ansiedade-estado e disforia/depressão) entre os dois grupos de mães. Houve uma porcentagem significativamente maior de mães do Grupo M com escores indicativos de sinais clínicos para depressão ou ansiedade no pós-parto imediato e, para ambos os quadros, quando comparadas com mães do Grupo E. Os resultados podem ser decorrentes de traços de personalidade materna, visto que os índices de ansiedade-traço eram significativamente maiores nas mães de crianças malformadas, mas especialmente pelo estado da criança, seu encaminhamento para a UTI e sua condição de vida futura. CONCLUSÕES: a porcentagem de mães de recém-nascidos com malformações visíveis que apresentou escores indicativos de sinais clínicos para ansiedade, depressão e ambos sugerem a necessidade de suporte, individual ou em grupo.

Sentimentos e percepções de puérperas com relação à assistência prestada pelo serviço materno-infantil de um hospital universitário

OBJETIVOS: avaliar percepções e sentimentos de puérperas adultas e adolescentes, relacionados ao filho e a assistência materno-infantil, em hospital universitário de nível terciário. MÉTODOS: estudo transversal, envolvendo 180 puérperas, no Alojamento Conjunto (AC) e no Berçário Interno (BI) do Hospital das Clínicas da Faculdade de Medicina de Botucatu , entrevistadas no segundo e terceiro dia pós-parto e distribuídas em três grupos: adultas primíparas, adultas multíparas e adolescentes. Para comparação entre grupos e locais de internação utilizou-se o chi2 ou teste de Fisher. RESULTADOS: ultrasom obstétrico e cardiotocografia tiveram impacto positivo na emoção materna. Houve pouca diferença entre os grupos quanto aos sentimentos antes e após o parto, sendo felicidade, amor, responsabilidade, ansiedade e medo os mais freqüentes. A culpa predominou nas adolescentes do BI. As percepções relacionadas ao filho, a avaliação da assistência e equipe, não diferiram entre adultas e adolescentes. Nas duas enfermarias o relacionamento entre mães e cuidadores foi bom, as mães mostraram-se satisfeitas com a equipe e a assistência, mas o aleitamento materno foi pouco valorizado e poucas mães conheciam o médico. CONCLUSÕES: está ocorrendo um processo de humanização na assistência materno-infantil deste hospital universitário, mas alguns aspectos precisam ser melhorados, especialmente a valorização do aleitamento materno e a individualização no contato médico-paciente.

Cryptosporidium infection in Brazil: implications for veterinary medicine and public health

O objetivo deste trabalho foi relatar, por meio de revisão de literatura, os resultados de pesquisas sobre a criptosporidiose no Brasil, com ênfase em sua ocorrência em animais e suas implicações em medicina veterinária e em saúde pública. Um número crescente de trabalhos sobre a infecção por Cryptosporidium spp. no Brasil está disponível na literatura nacional e internacional. Nestes trabalhos, são abordados principalmente aspectos relacionados à ocorrência de Cryptosporidium spp. em alimentos, amostras ambientais, no homem e em diversas espécies animais, particularmente em aves, bovinos, cães e gatos. Por meio de técnicas de biologia molecular, a maioria das espécies e alguns genótipos identificados em outros países foram descritos no Brasil. em mamíferos, houve identificação de C. bovis, C. canis, C. felis, C. meleagridis, C. parvum e o genótipo cervídeo; em diversas espécies de aves, foi descrita infecção por C. baileyi, C. galli, C. meleagridis, C. parvum e pelos genótipos I, II e III de aves. Várias espécies foram descritas no homem, como C. parvum e C. hominis, além de algumas espécies adaptadas a hospedeiros animais, como C. canis, C. felis e C. meleagridis.