The role of the Midwife in the Final Examination of the Newborn

This poster illustrated the role of the midiwfe in the final examination and discharge of the newborn baby.

Prevalence and risk of Down syndrome in monozygotic and dizygotic multiple pregnancies in Europe: implications for prenatal screening

OBJECTIVE: To determine risk of Down syndrome (DS) in multiple relative to singleton pregnancies, and compare prenatal diagnosis rates and pregnancy outcome.

DESIGN: Population-based prevalence study based on EUROCAT congenital anomaly registries.

SETTING: Eight European countries.

POPULATION: 14.8 million births 1990-2009; 2.89% multiple births.

METHODS: DS cases included livebirths, fetal deaths from 20 weeks, and terminations of pregnancy for fetal anomaly (TOPFA). Zygosity is inferred from like/unlike sex for birth denominators, and from concordance for DS cases.

MAIN OUTCOME MEASURES: Relative risk (RR) of DS per fetus/baby from multiple versus singleton pregnancies and per pregnancy in monozygotic/dizygotic versus singleton pregnancies. Proportion of prenatally diagnosed and pregnancy outcome.

STATISTICAL ANALYSIS: Poisson and logistic regression stratified for maternal age, country and time.

RESULTS: Overall, the adjusted (adj) RR of DS for fetus/babies from multiple versus singleton pregnancies was 0.58 (95% CI 0.53-0.62), similar for all maternal ages except for mothers over 44, for whom it was considerably lower. In 8.7% of twin pairs affected by DS, both co-twins were diagnosed with the condition. The adjRR of DS for monozygotic versus singleton pregnancies was 0.34 (95% CI 0.25-0.44) and for dizygotic versus singleton pregnancies 1.34 (95% CI 1.23-1.46). DS fetuses from multiple births were less likely to be prenatally diagnosed than singletons (adjOR 0.62 [95% CI 0.50-0.78]) and following diagnosis less likely to be TOPFA (adjOR 0.40 [95% CI 0.27-0.59]).

CONCLUSIONS: The risk of DS per fetus/baby is lower in multiple than singleton pregnancies. These estimates can be used for genetic counselling and prenatal screening.

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

Generations and intention to leave current job : Belgian nurses in the workplace

This master thesis aims to identify work-related factors making Belgian nurses consider leaving their job voluntary and to compare the work-related factors across different generations. The purpose of this master thesis has a descriptive nature of research. The research approach chosen is a deductive approach and the research design chosen is a quantitative research design. Cluster sampling in combination with simple random sampling was used as sampling technique. 128 nurses were surveyed from April to May 2016. Nurses who reported to leave the organization due to retirement reasons, temporary employment contract or maternity leave were excluded from the study as this study investigates the voluntary turnover intention. A total of 68 nurses were included in the study which indicates an overall response rate of 53 %. Numerous of the findings in this master thesis are consistent with previous studies on turnover intention of different generations in other western-countries than Belgium. The work-related factor workload was most often reported by Belgian nurses with no intention to leave their job. Belgian nurses with an intention to leave their job indicated most often the work-related factor (non-)financial benefits. The generation-specific findings indicated both similarities and differences between the work-related factors selected. It was observed that Baby Boomers with an intention to leave their job selected most often variables related to the work-related factors (non-)financial benefits, supportive organization and workload. The variable lack of recognition appeared among Baby Boomers with an intention and no intention to leave their job. Surprisingly was the often selected variables lack of direct and/clear feedback on performances and unsupportive supervisor among Baby Boomers with professional turnover intention. Further, it was observed that Generation Xers with an intention to leave their job selected most often variables related to the work-related factors supportive organization, communication, (non-)financial benefits, work content and workload. The variables inadequate opportunity for advancement/professional growth and imbalance work-life appeared among Generation Xers with an intention and no intention to leave their job. Generation Yers with an intention to leave their job selected most frequently variables related to the work-related factors (non-)financial benefits, workload and commitment. The variables inadequate salary and opportunities elsewhere appeared among nurses with an intention and no intention to leave their job. Surprisingly was the often selected variable inadequate salary among Generation Yers with professional turnover intention.

Surrogacy under Indian Legal System: Legal and Human Rights Concerns

The advancements in medical science and technology have proved to be a boon to mankind. At the same time they have raised numerous challenges before the legal systems of the world. One such advancement is that of assisted human reproductive technologies and particularly surrogacy, which have given a new meaning to the concept of procreation. These technologies have made it possible for individuals to beget a genetically related child with the help of a third party and without sexual intercourse. Among all the assisted human reproductive technologies, the practice of surrogacy, in which women agree to have their bodies used to undergo a pregnancy and give birth to a baby for another, has raised various legal and human right controversies and diverse legal responses all over the world. India has particularly become a top destination for individuals who wish to beget a child through surrogacy and hence it is imperative for the Indian government to address the challenges posed by surrogacy. This study is an attempt to examine the need and importance of surrogacy practices and the conflicting legal and human rights issues raised by surrogacy in contemporary times. It also examines the adequacy of existing legal framework in India and attempts to provide pragmatic solutions for regulating surrogacy and protecting the interests of various stakeholders involved in surrogacy.

Generationsskillnader i arbetslivet: en kvalitativ studie med utgångspunkt från generation y

In previous studies research has shown that generation y experience resistance from older generations represented in the labor market in USA. The resistance is due to differences between the generations. On the other hand some studies say that differences are more likely to come from other factors such as gender and which stage in life the individual is in. The purpose of this study is to describe how (women in) generation y is experiencing the cooperation with colleagues from other generations and if they considers that differences due to generations exist. The study will also try to determine if the respondents are aware of each generation’s characteristics. To fulfill the purpose of the study a qualitative method was chosen in the shape of a focus group. To be able to answer the purpose an interview guide was developed from previous studies. The guide was divided in three sections; scenarios, exercises and finally questions. The focus group resulted in a two-hour discussion between four individuals belonging to generation y. The result of the study showed that generation y in Falun, Sweden did identify some of the characteristics each generation had. Further did the respondents conform that resistance due to generational differences was a problem. To answer the purpose of the study generation y felt underestimated by the older generations and expressed a certain degree of hopelessness.

Método mãe-canguru: vivência de mães no alojamento conjunto

DAVIM, Rejane Marie Barbosa;ENDERS, Bertha Cruz; DANTAS, Janmilli da Costa; SILVA, Richardson Augusto Rosendo da; NÓBREGA, Edualeide Jeane Pereira Bulhões da. Método mãe-canguru: vivência de mães no alojamento conjunto. Revista da Rede de Enfermagem do Nordeste, Fortaleza, v. 10, n. 1, p. 37-44, jan./mar.2009.

A Strategy for Maternity Care in Northern Ireland 2012-2018

DHSSPS has carried out a review of policy on maternity service provision in Northern Ireland. The review focused on the best available evidence for the care and treatment of mothers-to-be; quality, safety and service sustainability; wider workforce issues; and professional roles and responsibilities. As a result, a draft strategy was developed, which was the subject of a public consultation from 28 September 2011 to 23 January 2012. Following an analysis of the responses to the consultation, the final strategy, A Strategy for Maternity Care in Northern Ireland 2012-2018, was published on 2 July 2012. The Strategy is outcomes focused. The six outcomes are:- give every baby and family the best start in life; effective communication and high-quality maternity care; healthier women at the start of pregnancy (preconception care); effective, locally accessible, antenatal care and a positive experience for prospective parents; safe labour and birth (intrapartum) care with improved experiences for mothers and babies; and appropriate advice, and support for parents and baby after birth The strategy aims to provide women and their partners, HSC staff, commissioners and policy makers with a clear pathway for maternity care in Northern Ireland from pre conceptual care through to postnatal care. Within the document, twenty two objectives have been identified which link to the six outcomes identified above. The HSC Board and Public Health Agency will co-lead on implementation. An action plan will be developed to take account of the outcomes and objectives listed in the document. The Department will receive an annual report on progress towards implementation.

Fetal Movements in late Pregnancy : Categorization, Self-assessment, and Prenatal Attachment in relation to women’s experiences

Aim: To explore how pregnant women experience fetal movements in late pregnancy. Specific aims were:  to study women’s experiences during the time prior to receiving news that their unborn baby had died in utero (I), to investigate women’s descriptions of fetal movements (II), investigate the association between the magnitude of fetal movements and level of prenatal attachment (III), and to study women’s experiences using two different self-assessment methods (IV). Methods: Interviews, questionnaires, and observations were used. Results: Premonition that something had happened to their unborn baby, based on a lack of fetal movements, was experienced by the participants. The overall theme “something is wrong” describes the women’s insight that the baby’s life was threatened (I). Fetal movements that were sorted into the domain “powerful movements” were perceived in late pregnancy by 96 % of the participants (II). Perceiving frequent fetal movements on at least three occasions per 24 hours was associated with higher scores of prenatal attachment in all the three subscales on PAI-R. The majority (55%) of the 456 participants reported average occasions of frequent fetal movements, 26% several occasions and 18% reported few occasions of frequent fetal movements, during the current gestational week.  (III). Only one of the 40 participants did not find at least one method for monitoring fetal movements suitable. Fifteen of the 39 participants reported a preference for the mindfetalness method and five for the count-to-ten method. The women described the observation of the movements as a safe and reassuring moment for communication with their unborn baby (IV). Conclusion:  In full-term and uncomplicated pregnancies, women usually perceive fetal movements as powerful. Furthermore, women in late pregnancy who reported frequent fetal movements on several occasions during a 24-hour period seem to have a high level of prenatal attachment. Women who used self-assessment methods for monitoring fetal movements felt calm and relaxed when observing the movements of their babies. They had a high compliance for both self-assessment methods. Women that had experienced a stillbirth in late pregnancy described that they had a premonition before they were told that their baby had died in utero. 

IT Adoption and Usage in Non-Profit Organizations: a Cross-generational Case Study

A gulf has tended to develop between the adoption and usage of information technology by different generations, at the heart of which is different ways of experiencing and relating to the world around us. This research idea is currently being developed following data collection and feedback is sought on ways forward to enable impact. The research focuses on information technology in the form of multimedia. Multimedia meaning ‘media’ and ‘content’ that uses a combination of different content forms; or electronically integrated communication engaging all or most of the senses (e.g. graphic art, sound, animation and full-motion video presented by way of computer or other electronic means) mainly through presentational technologies. Although multimedia is not new, some organization’s particularly those in the non-profit sector do not always have the technical or financial resources to support such systems and consequently may struggle to adopt and support its usage amongst different generations. However non-profit organizations are being forced to pay more attention to the way they communicate with markets and the public due to the professionalism of communication everywhere in society. The case study used for this study is a church circuit comprising of 15 churches in the Midlands region of the United Kingdom which was selected due to the diverse age groups catered for within this type of non-profit organization. Participants in the study also had a range of skills, experiences and backgrounds which adds to the diversity of the population studied. Data gathered focused on the attitudes and opinions of the adoption and use of multimedia amongst different age groups. 395 questionnaires were distributed, comprising of 11 opinion questions and 4 demographic questions. 83% of the questionnaires were returned, representing 35% of the total circuit membership. Three people from each of the following age categories were also interviewed: 1920 – 1946 (Matures); 1947-1964 (Baby Boomers); 1965-1982 (Generation X); 1983-2004 (Net Generation). Results of the questionnaire and comments from the interviews were found not to tally with the widespread assumption that the younger generation is attracted by the use of multimedia in comparison to the older generation. The highest proportion of those who said that they gain more from a service enhanced by multimedia was from the Baby Boomers. Comments from interviews suggested that: ‘we need to embrace multimedia if we are to attract and retain the younger generation’; ‘multimedia often helps children to remain focused and clarifies the objective of the service’. However, because the younger generations’ world tends to be dominated by computer technology the questionnaire showed that they are more likely to have higher standards when it comes to the use of multimedia, such as identifying higher levels of equipment failing to work and annoying use of sounds compared to older age groups. In comparison problems experienced with multimedia for the Matures age group had the highest percentage of difficulty with the size of letters; the colour of letters and background and the sound not loud enough which is to be expected. Since every organization is unique any type of multimedia adopted and used should be specific to their needs, its stakeholders and the physical building in order to enhance that uniqueness and its needs. Giving thought to whether the type of multimedia is the best method for communicating the message to the particular audience alongside how technical and financial resources are best used can assist in accommodating different age groups that need to be catered for.

Parents’ Preparedness for Their Infants’ Discharge Following First-stage Cardiac Surgery: Development of a Parental Early Warning Tool

Aim The aim of this study was to explore parental preparedness for discharge and their experiences of going home with their infant after the first-stage surgery for a functionally univentricular heart. Background Technological advances worldwide have improved outcomes for infants with a functionally univentricular heart over the last 3 decades; however, concern remains regarding mortality in the period between the first and second stages of surgery. The implementation of home monitoring programmes for this group of infants has improved this initial inter-stage survival; however, little is known about parents’ experiences of going home, their preparedness for discharge, and parents’ recognition of deterioration in their fragile infant. Method This study was conducted in 2011–2013; eight sets of parents were consulted in the research planning stage in September, 2011, and 22 parents with children aged 0–2 years responded to an online survey during November, 2012–March, 2013. Description of categorical data and deductive thematic analysis of the open-ended questions were undertaken. Results Not all parents were taught signs of deterioration or given written information specific to their baby. The following three themes emerged from the qualitative data: mixed emotions about going home, knowledge and preparedness, and support systems. Conclusions Parents are not adequately prepared for discharge and are not well equipped to recognise deterioration in their child. There is a role for greater parental education through development of an early warning tool to address the gap in parents’ understanding of signs of deterioration, enabling appropriate contact and earlier management by clinicians.

Exploring the Impact of a Difficult Breastfeeding Experience on Maternal Identity: A Narrative Analysis

Introduction: Due to the implied health benefits for mother and baby, breastfeeding has become a key public health issue. Literature reviewed highlighted the ‘medical’ and ‘natural’ mother discourse which surrounds motherhood and impacts on women’s decisions to breastfeed. Whilst the emotional and physical strains of a difficult experience have been explored, it is unclear how these experiences impact on women’s identities as mothers and in what ways women are able to narrate and share their embodied experiences. Methods: Seven first time mothers who described themselves as having had a difficult breastfeeding experience were interviewed to gather data pertaining to how mothers construct narratives of breastfeeding and the impact of these narratives on their identity as mothers. An interest in both socio-political discourse and embodiment theory derived from the literature review led to the use of visual methods in eliciting narratives and the employment of a critical narrative analysis in exploring the data gathered. Findings: The participants’ narratives drew from ‘medical’ and ‘natural’ mother discourses and were found to constrain subjective experience and leave participants with feelings of guilt, frustration and loss. A prevailing assumption that unruly, excessive bodies must be controlled by a rational ‘mind’ led to the body becoming a site for control and resistance for participants as they attempted to conform to norms of motherhood and breastfeeding. Discussion: Results identified the ways in which women as mothers can see their subjective experiences diminished and their voices silenced due to a lack of available discourse and entrenched ideologies surrounding the ‘good’ mother. It is suggested that adopting a social justice agenda within therapeutic practice might prevent the internalisation of oppressive discourse which can lead to mothers’ psychological distress. Moreover, it is suggested that exploring the body in therapy might resist a mind/body dualism and lead to increasingly compassionate and accepting relationships with our bodies; in turn increasing awareness of subjective experience.

Balanceamento de linhas de montagem e aplicação de ferramentas Lean no contexto da Polisport

Cada vez mais, nos dias que correm, está presente em todas as organizações a metodologia lean, que assenta numa base de melhoria contínua, de forma a responder às necessidades do mercado e à satisfação do cliente, tendo como principal finalidade a criação de valor para o produto e a eliminação de desperdícios inerente aos processos de produção do mesmo. Um elemento essencial na gestão de qualquer organização com ênfase nos resultados é o uso de indicadores de desempenho no processo de tomada de decisão. Este projeto teve como objetivo principal a identificação e eliminação de desperdícios, melhorando os processos de montagem, através do estudo dos tempos de ciclo dos centros de trabalhos/produtos mais críticos, procedendo a um balanceamento adequado e posterior simulação dos resultados através do software Arena. Posteriormente foram analisados os resultados assim como o impacto que essas mudanças causaram na empresa, com base na implementação de ferramentas de melhoria, nomeadamente ferramentas lean. Essas mudanças tiveram um impacto positivo na produção final das cadeiras e dos porta-bebés, no que diz respeito à diminuição de filas de espera entre postos, diminuição dos tempos de processamento e aumento da produção para alguns dos modelos em estudo.

Medical journals and Wikipedia: a global health matter

Approximately 7000 stillbirths occur daily worldwide, and the vast majority of them (98%) Approximately 7000 stillbirths occur daily worldwide, and the vast majority of them (98%) take place in low-income and middle-income countries (LMICs). Despite this enormous burden, progress to reduce the death toll is slow and insufficient. WHO released its Making every baby count guide in 2016, which includes strategies aimed at addressing the challenge of stillbirths. Given the flurry of activity and attention on stillbirths from the Lancet Stillbirth Epidemiology investigator group and WHO, we expect that the wealth of information about stillbirths that is generated will filter down in a timely manner to where it is needed most: the general public.

Expectativas da grávida em relação ao parto

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Enfermagem