Search results for: violence during pregnancy
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1248

Search results for: violence during pregnancy

108 Contraceptives: Experiences of Agency and Coercion of Young People Living in Colombia

Authors: Paola Montenegro, Maria de los Angeles Balaguera Villa

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Contraceptive methods play a fundamental role in preventing unwanted pregnancies and protecting users from sexually transmitted infections (STIs). Despite being known to almost the entire population of reproductive age living in Colombia, there are barriers, practices and complex notions about contraceptives that affect their desired mass use and effectiveness. This work aims to analyse some of the perceptions and practices discussed with young people (13-28 years old) living in Colombia regarding the use of contraceptives in their daily lives, preferences, needs and perceived side effects. This research also examines the perceived paradox in autonomy that young people experience regarding contraceptive use: in one hand, its use (or lack of it) is interpreted as an act of self-determination and primary example of reproductive agency, on the other hand, it was frequently associated with coercion and limited autonomy derived from the gaps in reliable information available for young people, the difficulty of accessing certain preferred methods, and sometimes the experienced coercion exercise by doctors, partners and/or family members. The data and analysis discussed in this work stems from a research project whose objective was to provide information about needs and preferences in sexual and reproductive health of young people living in Colombia in relation to a possible telehealth service that could close the gap in access to quality care and safe information. Through a mixed methods approach, this study collected 5.736 responses to a virtual survey disseminated nationwide in Colombia and 47 inperson interviews (24 of them with people who were assigned female at birth and 21 with local key stakeholders in the abortion ecosystem). Quantitative data was analyzed using Stata SE Version 16.0 and qualitative analysis was completed through NVivo using thematic analysis. Key findings on contraception use in young people living in Colombia reveal that 85,8% of participants had used a contraceptive method in the last two years, and that the most commonly used methods were condoms, contraceptive pills, the morning-after pill and the method of interruption. The remaining 14,2% of respondents who declared to not have used contraceptives in the last two years expressed that the main four barriers to access were: "Lack of knowledge about contraceptive methods and where to obtain information and/or access them (13.9%)", "Have had sex with people who have vaginas (10.2%)", "Cost of contraceptive method (8.4%)" and "Difficulties in obtaining medical authorisations (7.6%)". These barriers coincided with the ones used to explain the non-use of contraceptives in young people, which reveals that limitations in information, cost, and quality care represent structural issues that need to be address in programmes, services, and public policy. Finally, interviews showed that young people perceive contraceptive use and non-use as an example of reaffirming reproductive agency and limitations to this can be explained through the widespread incomplete knowledge about how methods work and the prevalence of other social representations of contraception associated with trust, fidelity, and partner preferences, that in the end create limitations to young people’s autonomy.

Keywords: contraception, family planning, premarital fertility, unplanned pregnancy

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107 Integrating Sexual Reproductive Health and Rights in Promoting Gender Equality, Equity, and Empowerment of Women

Authors: Danielle G. Saique

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Introduction: Promoting Gender Equality, Equity and Empowerment of Women (GEE&EW) can be attained by practicing thereby exercising Sexual and Reproductive Health and Rights (SRHR). Gender Inequality is manifested thru Violence Against Women (VAW). Objectives: This study presents causes, prevalence, effects of Gender Inequality for not practicing and violating SRHR. This proposes Action Plan by promoting, integrating SRHR in the “holistic approach” of Social Work education, practice and service-delivery in any work-set-ups. Limitations: VAW cases showed victim and violator are known, related and living together. Cases transpired at home, reported, investigated in the police and filed in the legal court of law for the year 2013. Methods: Data from blotters, reports, filed cases, case studies gathered by the Social Worker (SWr). Qualitative analysis identified cause, prevalence of VAW related in violating SRHR. SWr serves innovative interventions in any work settings by applying SRHR background, skills in educating, counseling client-victims. Results: 65 VAW cases on non-negotiation or refusal of practicing SRHR. Non-acceptance of Family Planning yielded unwanted, unplanned pregnancies, abandoned children, battered women. Neglected pre-post natal maternal care caused complications or death. Rape, incest led trauma or death. Unsafe, unprotected sex transmitted STDs. Conclusions: Non-availing SRHR from health facilities, from Medical Health SWr concluded to non-practicing or violating rights to life, health care, protection, rights to information, education, rights to plan family, rights from torture, ill-treatment. VAW brings undesirable effects to the well-being, wellness and humaneness of the victim. Recommendations: The innovative intervention services on SRHR of a SWr and the findings, results in violating SRHR are recommendations in Action Planning by adding “The SRHR Concepts” in Social Work thereby preventing VAW; empowering women’s rights to development, gender equality, equity liberty, security, freedom; resilience and involvement in promoting, practicing, exercising SRHR at home. Recommended therefore to duplicate this innovative practice and experience on SRHR as implemented by the SWr in any work setting.

Keywords: women development, promoting gender equality, equity, empowerment of women

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106 The Combined Use of L-Arginine and Progesterone During the Post-breeding Period in Female Rabbits Increases the Weight of Their Fetuses

Authors: Diego F. Carrillo-González, Milena Osorio, Natalia M. Cerro, Yasser Y. Lenis

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Introduction: mortality during the implantation and early embryonic development periods reach around 30% in different mammalian species. It has been described that progesterone (P4) and Arginine (Arg) play a beneficial role in establishing and maintaining early pregnancy in mammals. The combined effect between Arg and P4 on reproductive parameters in the rabbit species is not yet elucidated, to our best knowledge. Objective: to assess the effect of L-arginine and progesterone during the post-breeding period in female rabbits on the composition of the amniotic fluid, the placental structure, and the bone growth in their fetuses. Methods: crossbred female rabbits (n=16) were randomly distributed into four experimental groups (Ctrl, Arg, P4, and Arg+P4). In the control group, 0.9% saline solution was administered as a placebo, the Arg group was administered arginine (50 mg/kg BW) from day 4.5 to day 19 post-breeding, the P4 group was administered progesterone (Gestavec®, 1.5 mg/kg BW) from 24 hours to day 4 post-breeding and for the Arg+P4 group, an administration was performed under the same time and dose guidelines as the Arg and P4 treatments. Four females were sacrificed, and the amniotic fluid was collected and analyzed with rapid urine test strips, while the placenta and fetuses were processed in the laboratory to obtain histological plates. The percentage of deciduous, labyrinthine, and junctional zones was determined, and the length of the femur for each fetus was measured as an indicator of growth. Descriptive statistics were applied to identify the success rates for each of the tests. Afterwards, A one-way analysis of variance (ANOVA) was performed, and a comparison of means was conducted by Tukey's test. Results: a higher density (p<0.05) was observed in the amniotic fluid for fetuses in the control group (1022±2.5g/mL) compared to the P4 (1015±5.3g/mL) and Arg+P4 (1016±4,9g/mL) groups. Additionally, the density of amniotic fluid in the Arg group (1021±2.5g/mL) was higher (p<0.05) than in the P4 group. The concentration of protein, glucose, and ascorbic acid had no statistical difference between treatments (p>0.05). The histological analysis of the uteroplacental regions, a statistical difference (p<0,05) in the proportion of deciduous zone was found between the P4 group (9.6±2.6%) when compared with the Ctrl (28.15±12.3%), and Arg+P4 (26.3±4.9) groups. In the analysis of the fetuses, the weight was higher for the Arg group (2.69±0.18), compared to the other groups (p<0.05), while a shorter length was observed (p<0.05) in the fetuses for the Arg+P4 group (25.97±1.17). However, no difference (p>0.05) was found when comparing the length of the developing femurs between the experimental groups. Conclusion: the combination of L-arginine and progesterone allows a reduction in the density of amniotic fluid, without affecting the protein, energy, and antioxidant components. However, the use of L-arginine stimulates weight gain in fetuses, without affecting size, which could be used to improve production parameters in rabbit production systems. In addition, the modification in the deciduous zone could show a placental adaptation based on the fetal growth process, however more specific studies on the placentation process are required.

Keywords: arginine, progesterone, rabbits, reproduction

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105 Intercultural Competence among Jewish and Arab Students Studying Together in an Academic Institution in Israel

Authors: Orly Redlich

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Since the establishment of the state of Israel, and as a result of various events that led to it, Jewish citizens and Arab citizens of the state have been in constant conflict, which finds its expression in most levels of life. Therefore, the attitude of one group member to the other group members is mostly tense, loaded, and saturated with mutual suspicion. Within this reality, in many higher education institutions in Israel, Jews and Arabs meet with each other intensively and for several years. For some students, this is their first opportunity for a meaningful cross-cultural encounter. These intercultural encounters, which allow positive interactions between members of different cultural groups, may contribute to the formation of "intercultural competence" which means long-term change in knowledge, attitudes, and behavior towards 'the other culture'. The current study examined the concept of the ‘other’ among Jewish and Arab students studying together and their "intercultural competence". The study also examined whether there is a difference in the perception of the ‘other’ between students studying in different academic programs, and between students taking academic courses on multiculturalism. This quantitative study was conducted among 274 Arab and Jewish students studying together, for bachelors or master's degree, in various academic programs at the Israel Academic College of Ramat-Gan. The background data of the participants are varied, in terms of religion, origin, religiosity, employment status, living area, and marital status. The main hypothesis is that academic, social, and intercultural encounters between Jewish and Arab students, who attend college together, will be a significant factor in building "intercultural competence". Additionally, the existence of "intercultural competence" has been linked to demographic characteristics of the students, as well as the nature of intercultural encounters between Jews and Arabs in a higher education institution. The dependent variables were measured by a self-report questionnaire, using the components of '"intercultural competence"' among students, which are: 1. Cognitive knowledge of the ‘others’, 2. Feelings towards the ‘others’, 3. Change in attitudes towards the 'others', and 4. Change in behavior towards the ‘others’. The findings indicate a higher "intercultural competence" among Arab students than Jews; it was also found higher level of "intercultural competence" among Educational Counseling students than the other respondents. The importance of this research lies in finding the means to develop "intercultural competence" among Jewish and Arab students, which may reduce prejudice and stereotypes towards the other culture and may even prevent occurrences of alienation and violence in cross-cultural encounters in Israel.

Keywords: cross-cultural learning, intercultural competence, Jewish and Arab students, multiculturalism

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104 Boko Haram Insurrection and Religious Revolt in Nigeria: An Impact Assessment-{2009-2015}

Authors: Edwin Dankano

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Evident by incessant and sporadic attacks on Nigerians poise a serious threat to the unity of Nigeria, and secondly, the single biggest security nightmare to confront Nigeria since after amalgamation of the Southern and Northern protectorates by the British colonialist in 1914 is “Boko Haram” a terrorist organization also known as “Jama’atul Ahli Sunnah Lidda’wati wal Jihad”, or “people committed to the propagation of the Prophet’s teachings and jihad”. The sect also upholds an ideology translated as “Western Education is forbidden”, or rejection of Western civilization and institutions. By some estimates, more than 5,500 people were killed in Boko Haram attacks in 2014, and Boko Haram attacks have already claimed hundreds of lives and territories {caliphates}in early 2015. In total, the group may have killed more than 10,000 people since its emergence in the early 2000s. More than 1 million Nigerians have been displaced internally by the violence, and Nigerian refugee figures in neighboring countries continue to rise. This paper is predicated on secondary sources of data and anchored on the Huntington’s theory of clash of civilization. As such, the paper argued that the rise of Boko Haram with its violent disposition against Western values is a counter response to Western civilization that is fast eclipsing other civilizations. The paper posits that the Boko Haram insurrection going by its teachings, and destruction of churches is a validation of the propagation of the sect as a religious revolt which has resulted in dire humanitarian situation in Adamawa, Borno, Yobe, Bauchi, and Gombe states all in north eastern Nigeria as evident in human casualties, human right abuses, population displacement, refugee debacle, livelihood crisis, and public insecurity. The paper submits that the Nigerian state should muster the needed political will in terms of a viable anti-terrorism measures and build strong legitimate institutions that can adequately curb the menace of corruption that has engulfed the military hierarchy, respond proactively to the challenge of terrorism in Nigeria and should embrace a strategic paradigm shift from anti-terrorism to counter-terrorism as a strategy for containing the crisis that today threatens the secular status of Nigeria.

Keywords: Boko Haram, civilization, fundamentalism, Islam, religion revolt, terror

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103 Restless Leg Syndrome as the Presenting Symptom of Neuroendocrine Tumor

Authors: Mustafa Cam, Nedim Ongun, Ufuk Kutluana

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Introduction: Restless LegsSyndrome (RLS) is a common, under-recognized disorder disrupts sleep and diminishes quality of life (1). The most common conditions highly associated with RLS include renalfailure, iron and folic acid deficiency, peripheral neuropathy, pregnancy, celiacdisease, Crohn’sdiseaseandrarelymalignancy (2).Despite a clear relation between low peripheral iron and increased prevalence and severity of RLS, the prevalence and clinical significance of RLS in iron-deficientanemic populations is unknown (2). We report here a case of RLS due to iron deficiency in the setting of neuroendocrinetumor. Report of Case: A 35 year-old man was referred to our clinic with general weakness, weight loss (10 kg in 2 months)and 2-month history of uncomfortable sensations in his legs with urge to move, partially relieved by movement. The symptoms were presented very day, worsening in the evening; the discomfort forced the patient to getup and walk around at night. RLS was severe, with a score of 22 at the International RLS ratingscale. The patient had no past medical history. The patient underwent a complete set of blood analyses and the following ab normal values were found (normal limitswithinbrackets): hemoglobin 9.9 g/dl (14-18), MCV 70 fL (80-94), ferritin 3,5 ng/mL (13-150). Brain and spinemagnetic resonance imaging was normal. The patient consultated with gastroenterology clinic and gastointestinal systemendoscopy was performed for theetiology of the iron deficiency anemia. After the gastricbiopsy, results allowed us to reach the diagnosis of neuroen docrine tumor and the patient referred to oncology clinic. Discussion: The first important consideration from this case report is that the patient was referred to our clinic because of his severe RLS symptoms dramatically reducing his quality of life. However, our clinical study clearly demonstrated that RLS was not the primary disease. Considering the information available for this patient, we believe that the most likely possibility is that RLS was secondary to iron deficiency, a very well-known and established cause of RLS in theliterature (3,4). Neuroendocrine tumors (NETs) are rare epithelial neoplasms with neuroendocrine differentiation that most commonly originate in the lungs and gastrointestinal tract (5). NETs vary widely in their clinical presentation; symptoms are often nonspecific and can be mistaken for those of other more common conditions (6). 50% of patients with reported disease stage have either regional or distant metastases at diagnosis (7). Accurate and earlier NET diagnosis is the first step in shortening the time to optimal care and improved outcomes for patients (8). The most important message from this case report is that RLS symptoms can sometimes be thesign of a life-threatening condition. Conclusion: Careful and complete collection of clinical and laboratory data should be carried out in RLS patients. Inparticular, if RLS onset coincides with weight loss and iron deficieny anemia, gastricendos copy should be performed. It is known about that malignancy is a rare etiology in RLS patients and to our knowledge; it is the first case with neuro endocrine tumor presenting with RLS.

Keywords: neurology, neuroendocrine tumor, restless legs syndrome, sleep

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102 Examining Terrorism through a Constructivist Framework: Case Study of the Islamic State

Authors: Shivani Yadav

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The Study of terrorism lends itself to the constructivist framework as constructivism focuses on the importance of ideas and norms in shaping interests and identities. Constructivism is pertinent to understand the phenomenon of a terrorist organization like the Islamic State (IS), which opportunistically utilizes radical ideas and norms to shape its ‘politics of identity’. This ‘identity’, which is at the helm of preferences and interests of actors, in turn, shapes actions. The paper argues that an effective counter-terrorism policy must recognize the importance of ideas in order to counter the threat arising from acts of radicalism and terrorism. Traditional theories of international relations, with an emphasis on state-centric security problematic, exhibit several limitations and problems in interpreting the phenomena of terrorism. With the changing global order, these theories have failed to adapt to the changing dimensions of terrorism, especially ‘newer’ actors like the Islamic State (IS). The paper observes that IS distinguishes itself from other terrorist organizations in the way that it recruits and spreads its propaganda. Not only are its methods different, but also its tools (like social media) are new. Traditionally, too, force alone has rarely been sufficient to counter terrorism, but it seems especially impossible to completely root out an organization like IS. Time is ripe to change the discourse around terrorism and counter-terrorism strategies. The counter-terrorism measures adopted by states, which primarily focus on mitigating threats to the national security of the state, are preoccupied with statist objectives of the continuance of state institutions and maintenance of order. This limitation prevents these theories from addressing the questions of justice and the ‘human’ aspects of ideas and identity. These counter-terrorism strategies adopt a problem-solving approach that attempts to treat the symptoms without diagnosing the disease. Hence, these restrictive strategies fail to look beyond calculated retaliation against violent actions in order to address the underlying causes of discontent pertaining to ‘why’ actors turn violent in the first place. What traditional theories also overlook is that overt acts of violence may have several causal factors behind them, some of which are rooted in the structural state system. Exploring these root causes through the constructivist framework helps to decipher the process of ‘construction of terror’ and to move beyond the ‘what’ in theorization in order to describe ‘why’, ‘how’ and ‘when’ terrorism occurs. Study of terrorism would much benefit from a constructivist analysis in order to explore non-military options while countering the ideology propagated by the IS.

Keywords: constructivism, counter terrorism, Islamic State, politics of identity

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101 Association between Obstetric Factors with Affected Areas of Health-Related Quality of Life of Pregnant Women

Authors: Cinthia G. P. Calou, Franz J. Antezana, Ana I. O. Nicolau, Eveliny S. Martins, Paula R. A. L. Soares, Glauberto S. Quirino, Dayanne R. Oliveira, Priscila S. Aquino, Régia C. M. B. Castro, Ana K. B. Pinheiro

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Introduction: As an integral part of the health-disease process, gestation is a period in which the social insertion of women can influence, in a positive or negative way, the course of the pregnancy-puerperal cycle. Thus, evaluating the quality of life of this population can redirect the implementation of innovative practices in the quest to make them more effective and real for the promotion of a more humanized care. This study explores the associations between the obstetric factors with affected areas of health-related quality of life of pregnant women with habitual risk. Methods: This is a cross-sectional, quantitative study conducted in three public facilities and a private service that provides prenatal care in the city of Fortaleza, Ceara, Brazil. The sample consisted of 261 pregnant women who underwent low-risk prenatal care and were interviewed from September to November 2014. The collection instruments were a questionnaire containing socio-demographic and obstetric variables, in addition to the Brazilian version of the Mother scale Generated Index (MGI) characterized by being a specific and objective instrument, consisting of a single sheet and subdivided into three stages. It allows identifying the areas of life of the pregnant woman that are most affected, which could go unnoticed by the pre-formulated measurement instruments. The obstetric data, as well as the data concerning the application of the MGI scale, were compiled and analyzed through the statistical program Statistical Package for the Social Sciences (SPSS), version 20.0. After the compilation, a descriptive analysis was carried out. Then, associations were made between some variables. The tests applied were the Pearson Chi-Square and the Fisher's exact test. The odds ratio was also calculated. These associations were considered statistically significant when the p (probability) value was less than or equal to a level of 5% (α = 0.05) in the tests performed. Results: The variables that negatively reflected the quality of life of the pregnant women and presented a significant association with the polaciuria were: gestational age (p = 0.022) and parity (p = 0.048). Episodes of nausea and vomiting also showed significant with gestational age correlation (p = 0.0001). Evaluating the crossing of stress, we observed a significant association with parity (p = 0.0001). In turn, emotional lability revealed dependence on the variable type of delivery (p = 0.009). Conclusion: The health professionals involved in the assistance to the pregnant woman can understand how the process of gestation is experienced, considering all its peculiar transformations; to meet their individual needs, stimulating their autonomy and their power of choice, envisaging the achievement of a better quality of life related to health in the perspective of health promotion.

Keywords: health-related quality of life, obstetric nursing, pregnant women, prenatal care

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100 Development of Infertility Prevention Psycho-Education Program for University Students and Evaluation of Its Effectiveness

Authors: Digdem M. Siyez, Bariscan Ozturk, Erol Esen, Ender Siyez, Yelda Kagnici, Bahar Baran

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Infertility is a reproductive disease identified with the absence of pregnancy after regular unprotected sexual intercourse that has been lasting for 12 months or more. Some of the factors that cause infertility, which has been considered as a social and societal issue since the first days of the humankind, are preventable. These are veneral diseases, age, the frequency of the intercourse and its timing, drug use, bodyweight, environmental and professional conditions. Having actual information about the reproductive health is essential to take protective and preventive measures, and it is accepted as the most effective way to reduce the rate of infertility. However, during the literature review, it has been observed that there are so few studies that focus on the prevention of the infertility. The aim of this study is to develop a psycho-education program to reduce infertility among university students and also to evaluate the program’s effectiveness. It is believed that this program will increase the information level about infertility among the university students, help them to adopt healthy attitudes, develop life skills, create awareness about the risk factors and also contribute to the literature. Throughout the study, first, the contents of sexual/reproductive health programs developed for university students were examined by the researches. Besides, “Views about Reproductive Health Psycho-education Program Survey” was developed and applied to 10221 university students from 21 universities. In accordance with the literature and the university students’ views about reproductive health psycho-education program consisting of 9 sessions each of which lasts for 90 minutes was developed. The pilot program was carried out with 16 volunteer undergraduate students attending to a state university. During the evaluation of the pilot study, at the end of each session “Session Evaluation Form” and at the end of the entire program “Program Evaluation Form” were administered to the participants. Besides, one week after the end of the program, a focus group with half of the group, and individual interviews with the rest were conducted. Based on the evaluations, it was determined that the session duration is enough, the teaching methods meet the expectation, the techniques applied are appropriate and clear, and the materials are adequate. Also, an extra session was added to psycho-education program based on the feedbacks of the participants. In order to evaluate program’s effectiveness, Solomon control group design will be used. According to this design, the research has 2 experiment groups and 2 control groups. The participants who voluntarily participated in the research after the announcement of the psycho-education program were divided into experiment and control groups. In the experiment 1 and control 1 groups, “Personal Information Test”, “Infertility Information Test” and “Infertility Attitude Scale”, “Self Identification Inventory” and “Melbourne Decision Scale” were administered as a preliminary test. Currently, at the present stage, psycho-education still continues. After this 10-week program, the same tests will be administered again as the post-tests. The decision upon which statistical method will be applied in the analysis will be made afterwards according to whether the data meets the presuppositions or not.

Keywords: infertility, prevention, psycho-education, reproductive health

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99 Influence of Interpersonal Communication on Family Planning Practices among Rural Women in South East Nigeria

Authors: Chinwe Okpoko, Vivian Atasie

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One of the leading causes of death amongst women of child-bearing age in southeast Nigeria is pregnancy. Women in the reproductive age group die at a higher rate than men of the same age bracket. Furthermore, most maternal deaths occur among poor women who live in rural communities, and who generally fall within the low socio-economic group in society. Failure of policy makers and the media to create the strategic awareness and communication that conform with the sensibilities of this group account, in part, for the persistence of this malaise. Family planning (FP) is an essential component of safe motherhood, which is designed to ensure that women receive high-quality care to achieve an optimum level of health of mother and infant. The aim is to control the number of children a woman can give birth to and prevent maternal and child mortality and morbidity. This is what sustainable development goal (SDG) health target of World Health Organization (WHO) also strives to achieve. FP programmes reduce exposure to the risks of child-bearing. Indeed, most maternal deaths in the developing world can be prevented by fully investing simultaneously in FP and maternal and new-born care. Given the intrinsic value of communication in health care delivery, it is vital to adopt the most efficacious means of awareness creation and communication amongst rural women in FP. In a country where over 50% of her population resides in rural areas with attendant low-level profile standard of living, the need to communicate health information like FP through indigenous channels becomes pertinent. Interpersonal communication amongst family, friends, religious groups and other associations, is an efficacious means of communicating social issues in rural Africa. Communication in informal settings identifies with the values and social context of the recipients. This study therefore sought to determine the place of interpersonal communication on the knowledge of rural women on FP and how it influences uptake of FP. Descriptive survey design was used in the study, with interviewer administered questionnaire constituting the instrument for data collection. The questionnaire was administered on 385 women from rural communities in southeast Nigeria. The results show that majority (58.5%) of the respondents agreed that interpersonal communication helps women understand how to plan their family size. Many rural women (82%) prefer the short term natural method to the more effective modern contraceptive methods (38.1%). Husbands’ approval of FP, as indicated in the Mean response of 2.56, is a major factor that accounts for the adoption of FP messages among rural women. Socio-demographic data also reveal that educational attainment and/or exposure influenced women’s acceptance or otherwise of FP messages. The study, therefore, recommends amongst others, the targeting of husbands in subsequent FP communication interventions, since they play major role on contraceptive usage.

Keywords: family planning, interpersonal communication, interpersonal interaction, traditional communication

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98 A Study of the Depression Status of Asian American Adolescents

Authors: Selina Lin, Justin M Fan, Vincent Zhang, Cindy Chen, Daniel Lam, Jason Yan, Ning Zhang

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Depression is one of the most common mental disorders in the United States, and past studies have shown a concerning increase in the rates of depression in youth populations over time. Furthermore, depression is an especially important issue for Asian Americans because of the anti-Asian violence taking place during the COVID-19 pandemic. While Asian American adolescents are reluctant to seek help for mental health issues, past research has found a prevalence of depressive symptoms in them that have yet to be fully investigated. There have been studies conducted to understand and observe the impacts of multifarious factors influencing the mental well-being of Asian American adolescents; however, they have been generally limited to qualitative investigation, and very few have attempted to quantitatively evaluate the relationship between depression levels and a comprehensive list of factors for those levels at the same time. To better quantify these relationships, this project investigated the prevalence of depression in Asian American teenagers mainly from the Greater Philadelphia Region, aged 12 to 19, and, with an anonymous survey, asked participants 48 multiple-choice questions pertaining to demographic information, daily behaviors, school life, family life, depression levels (quantified by the PHQ-9 assessment), school and family support against depression. Each multiple-choice question was assigned as a factor and variable for statistical and dominance analysis to determine the most influential factors on depression levels of Asian American adolescents. The results were validated via Bootstrap analysis and t-tests. While certain influential factors identified in this survey are consistent with the literature, such as parent-child relationship and peer pressure, several dominant factors were relatively overlooked in the past. These factors include the parents’ relationship with each other, the satisfaction with body image, sex identity, support from the family and support from the school. More than 25% of participants desired more support from their families and schools in handling depression issues. This study implied that it is beneficial for Asian American parents and adolescents to take programs on parents’ relationships with each other, parent-child communication, mental health, and sexual identity. A culturally inclusive school environment and more accessible mental health services would be helpful for Asian American adolescents to combat depression. This survey-based study paved the way for further investigation of effective approaches for helping Asian American adolescents against depression.

Keywords: Asian American adolescents, depression, dominance analysis, t-test, bootstrap analysis

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97 A Cross-Sectional Study on Evaluation of Studies Conducted on Women in Turkey

Authors: Oya Isik, Filiz Yurtal, Kubilay Vursavus, Muge K. Davran, Metehan Celik, Munire Akgul, Olcay Karacan

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In this study, to discuss the causes and problems of women by bringing together different disciplines engaged in women's studies were aimed. Also, to solve these problems, to share information and experiences in different disciplines about women, and to reach the task areas and decision mechanisms in practice were other objectives. For this purpose, proceedings presented at the Second Congress of Women's Studies held in Adana, Turkey, on 28-30 November 2018 was evaluated. The document analysis model, which is one of the qualitative research methods, was used in the evaluation of the congress proceedings. A total of 86 papers were presented in the congress and the topic distributions of the papers were determined. At the evaluation stage, the papers were classified according to their subjects and descriptive analyses were made on the papers. According to the analysis results of the papers presented in the congress, 64 % of the total 86 papers presented in the Congress were review-based and 36 % were research-based studies. When the distribution of these reports was examined based on subject, the biggest share with the rate of 34.9% (13 reviews and 17 research-based papers) has been studied on women's issues through sociology, psychology and philosophy. This was followed by the economy, employment, organization, and non-governmental organizations with 20.9% (9 reviews and nine research-based papers), arts and literature with 17.4% (15 reviews based papers) and law with 12.8% (11 reviews based papers). The lowest share of the congress was presented in politics with one review based paper (1.2%), health with two research-based paper (2.3%), history with two reviews based papers (2.3%), religion with two reviews and one research-based papers (3.5%) and media-communication with two compilations and two researches based papers (4.7%). In the papers categorized under main headings, women were examined in terms of gender and gender roles. According to the results, it was determined that discrimination against women continued, changes in-laws were not put into practice sufficiently, education and economic independence levels of women were insufficient, and violence against women continued increasingly. To eliminate all these problems and to make the society conscious, it was decided that scientific studies should be supported. Furthermore, support policies should be realized jointly for women and men to make women visible in public life, tolerance or mitigation should not be put forward for any reason or in any group in cases of harassment and assault against women. However, it has been determined that women in Turkey should be in a better position in the social, cultural, psychological, economic and educational areas, and future studies should be carried out to improve women's rights and to create a positive perspective.

Keywords: gender, gender roles, sociology, psychology and philosophy, women studies

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96 Mother Tongues and the Death of Women: Applying Feminist Theory to Historically, Linguistically, and Philosophically Contextualize the Current Abortion Debate in Bolivia

Authors: Jennifer Zelmer

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The debate regarding the morality, and therefore legality, of abortion has many social, political, and medical ramifications worldwide. In a developing country like Bolivia, carrying a pregnancy to delivery is incredibly risky. Given the very high maternal mortality rate in Bolivia, greater consideration has been given to the (de)criminalization of abortion – a contributing cause of maternal death. In the spring of 2017, the Bolivian government proposed to loosen restrictions on women’s access to receiving a safe abortion, which was met with harsh criticism from 'pro-vida' (pro-life) factions. Although the current Bolivian government Movimiento al Socialismo (Movement Toward Socialism) portrays an agenda of decolonization, or to seek a 'traditionally-modern' society, nevertheless, Bolivia still has one of the highest maternal mortality rates in the Americas, because of centuries of colonial and patriarchal order. Applying a feminist critique and using the abortion debate as the central point, this paper argues that the 'traditionally-modern' society Bolivia strives towards is a paradox, and in fact only contributes to the reciprocal process of the death of 'mother tongues' and the unnecessary death of women. This claim is supported by a critical analysis of historical texts about Spanish Colonialism in Bolivia; the linguistic reality of reproductive educational strategies, and the philosophical framework which the Bolivian government and its citizens implement. This analysis is demonstrated in the current state of women’s access to reproductive healthcare in Cochabamba, Bolivia based on recent fieldwork which included audits of clinics and hospitals, interviews, and participant observation. This paper has two major findings: 1) the language used by opponents of abortion in Bolivia is not consistent with the claim of being 'pro-life' but more accurately with being 'pro-potential'; 2) when the topic of reproductive health appears in Cochabamba, Bolivia, it is often found written in the Spanish language, and does not cater to the many indigenous communities that inhabit or visit this city. Finally, this paper considers the crucial role of public health documentation to better inform the abortion debate, as well as the necessity of expanding reproductive health information to more than text-based materials in Cochabamba. This may include more culturally appropriate messages and mediums that cater to the oral tradition of the indigenous communities, who historically and currently have some of the highest fertility rates. If the objective of one who opposes abortion is to save human lives, then preventing the death of women should equally be of paramount importance. But rather, the 'pro-life' movement in Bolivia is willing to risk the lives of to-be mothers, by judicial punishment or death, for the chance of a potential baby. Until abortion is fully legal, safe, and accessible, there will always be the vestiges of colonial and patriarchal order in Bolivia which only perpetuates the needless death of women.

Keywords: abortion, feminist theory, Quechua, reproductive health education

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95 Comparison of Incidence and Risk Factors of Early Onset and Late Onset Preeclampsia: A Population Based Cohort Study

Authors: Sadia Munir, Diana White, Aya Albahri, Pratiwi Hastania, Eltahir Mohamed, Mahmood Khan, Fathima Mohamed, Ayat Kadhi, Haila Saleem

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Preeclampsia is a major complication of pregnancy. Prediction and management of preeclampsia is a challenge for obstetricians. To our knowledge, no major progress has been achieved in the prevention and early detection of preeclampsia. There is very little known about the clear treatment path of this disorder. Preeclampsia puts both mother and baby at risk of several short term- and long term-health problems later in life. There is huge health service cost burden in the health care system associated with preeclampsia and its complications. Preeclampsia is divided into two different types. Early onset preeclampsia develops before 34 weeks of gestation, and late onset develops at or after 34 weeks of gestation. Different genetic and environmental factors, prognosis, heritability, biochemical and clinical features are associated with early and late onset preeclampsia. Prevalence of preeclampsia greatly varies all over the world and is dependent on ethnicity of the population and geographic region. To authors best knowledge, no published data on preeclampsia exist in Qatar. In this study, we are reporting the incidence of preeclampsia in Qatar. The purpose of this study is to compare the incidence and risk factors of both early onset and late onset preeclampsia in Qatar. This retrospective longitudinal cohort study was conducted using data from the hospital record of Women’s Hospital, Hamad Medical Corporation (HMC), from May 2014-May 2016. Data collection tool, which was approved by HMC, was a researcher made extraction sheet that included information such as blood pressure during admission, socio demographic characteristics, delivery mode, and new born details. A total of 1929 patients’ files were identified by the hospital information management when they apply codes of preeclampsia. Out of 1929 files, 878 had significant gestational hypertension without proteinuria, 365 had preeclampsia, 364 had severe preeclampsia, and 188 had preexisting hypertension with superimposed proteinuria. In this study, 78% of the data was obtained by hospital electronic system (Cerner) and the remaining 22% was from patient’s paper records. We have gone through detail data extraction from 560 files. Initial data analysis has revealed that 15.02% of pregnancies were complicated with preeclampsia from May 2014-May 2016. We have analyzed difference in the two different disease entities in the ethnicity, maternal age, severity of hypertension, mode of delivery and infant birth weight. We have identified promising differences in the risk factors of early onset and late onset preeclampsia. The data from clinical findings of preeclampsia will contribute to increased knowledge about two different disease entities, their etiology, and similarities/differences. The findings of this study can also be used in predicting health challenges, improving health care system, setting up guidelines, and providing the best care for women suffering from preeclampsia.

Keywords: preeclampsia, incidence, risk factors, maternal

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94 Implementing a Structured, yet Flexible Tool for Critical Information Handover

Authors: Racheli Magnezi, Inbal Gazit, Michal Rassin, Joseph Barr, Orna Tal

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An effective process for transmitting patient critical information is essential for patient safety and for improving communication among healthcare staff. Previous studies have discussed handover tools such as SBAR (Situation, Background, Assessment, Recommendation) or SOFI (Short Observational Framework for Inspection). Yet, these formats lack flexibility, and require special training. In addition, nurses and physicians have different procedures for handing over information. The objectives of this study were to establish a universal, structured tool for handover, for both physicians and nurses, based on parameters that were defined as ‘important’ and ‘appropriate’ by the medical team, and to implement this tool in various hospital departments, with flexibility for each ward. A questionnaire, based on established procedures and on the literature, was developed to assess attitudes towards the most important information for effective handover between shifts (Cronbach's alpha 0.78). It was distributed to 150 senior physicians and nurses in 62 departments. Among senior medical staff, 12 physicians and 66 nurses responded to the questionnaire (52% response rate). Based on the responses, a handover form suitable for all hospital departments was designed and implemented. Important information for all staff included: Patient demographics (full name and age); Health information (diagnosis or patient complaint, changes in hemodynamic status, new medical treatment or equipment required); and Social Information (suspicion of violence, mental or behavioral changes, and guardianship). Additional information relevant to each unit included treatment provided, laboratory or imaging required, and change in scheduled surgery in surgical departments. ICU required information on background illnesses, Pediatrics required information on diet and food provided and Obstetrics required the number of days after cesarean section. Based on the model described, a flexible tool was developed that enables handover of both common and unique information. In addition, it includes general logistic information that must be transmitted to the next shift, such as planned disruptions in service or operations, staff training, etc. Development of a simple, clear, comprehensive, universal, yet flexible tool designed for all medical staff for transmitting critical information between shifts was challenging. Physicians and nurses found it useful and it was widely implemented. Ongoing research is needed to examine the efficiency of this tool, and whether the enthusiasm that accompanied its initial use is maintained.

Keywords: handover, nurses, hospital, critical information

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93 Iron Metabolism and Ferroptosis in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Authors: Fangfang Wang, Tianjing Wang, Leyi Fu, Feng Yun, Ningning Xie, Jue Zhou, Fan Qu

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Background: Ferroptosis, a recently discovered form of programmed cell death characterized by iron-dependent lipid peroxidation, may be linked to polycystic ovary syndrome (PCOS). Diseases marked by iron overload have been correlated with ferroptosis. Coincidently, investigations have revealed anomalies in iron metabolism among women with PCOS; however, there were inconsistencies in the evidence. Objective and Rationale: This review aimed to comprehensively explore the potential relationship between ferroptosis and PCOS by investigating the differences in iron metabolism among women with PCOS in comparison to a control group. Additionally, a narrative synthesis was provided on the past research status regarding the association between PCOS and ferroptosis. Methods: A systematic search of the literature was performed using PubMed, Embase, Web of Science from inception up to December 2022. Search terms relating to assisted PCOS, ferroptosis, and iron metabolism were used. PRISMA guidance was followed. RevMan 5.4 was utilized for conducting the meta-analysis, wherein the investigated outcomes included iron status (ferritin, iron, transferrin saturation) and a systemic iron-regulatory hormone (hepcidin). A narrative synthesis was performed to explore the correlation between PCOS and ferroptosis. Results: In the meta-analysis comprising a total of 16 studies, significant differences in serum ferritin levels between the PCOS group and the control group were observed (15 studies, standardized mean difference (SMD): 0.41, 95% CI: 0.22 to 0.59, P<0.01). This indicates elevated serum ferritin levels in PCOS patients compared to women without PCOS. The transferrin saturation in PCOS patients was significantly higher than that in the control group (3 studies, mean difference (MD): 4.39, 95% CI: 1.67 to 7.11, P<0.01). Regarding serum iron (6 studies, SMD: 0.05, 95% CI: -0.24 to 0.33, P=0.75) and serum hepcidin (4 studies, SMD: -0.44, 95% CI: -1.41 to 0.52, P=0.37), no statistically significant differences were observed between the PCOS group and the control group. Other studies have found that ferroptosis is involved in the occurrence and development of PCOS, offering valuable insights for guiding potential treatment measures and prognosis evaluation of PCOS. In addition, ferroptosis is involved in the miscarriage of PCOS-like rats; thus, controlling ferroptosis might improve pregnancy outcomes in PCOS. Conclusions: The observation of a significant elevation in serum ferritin and transferrin saturation levels in women with PCOS may suggest an underlying disturbance in iron metabolism, potentially inducing the activation of ferroptosis. Further research is imperative to elucidate the underlying pathophysiology, providing insights for potential preventive measures and therapeutic strategies. Limitation: There are some limitations as follows: First, due to limited extractable information, we excluded purely abstract publications and non-English publications. Second, the majority of original articles were case-control studies, making it difficult to determine the causal relationship between iron metabolism abnormalities and the onset of PCOS. Third, there is substantial heterogeneity in the definition of PCOS.

Keywords: polycystic ovary syndrome, ferroptosis, iron metabolism, systematic review and meta-analysis

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92 The Clash of the Clans in the British Divorce

Authors: Samuel Gary Beckton

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Ever since the Scottish Independence Referendum in 2014, there has been a threat of a second referendum. However, if there was another referendum and the majority favoured independence, it is highly likely to be by a small majority. In this paper, it will look into the hypothetical situation of what could have happened if Scotland had voted in favour of independence in 2014. If this occurred, there would be many Unionists within Scotland, including devoted supporters of the Better Together campaign. There was a possibility of some Scottish Unionists not willing to accept the result of the Referendum unchallenged and use their right of self-determination through the UN Charter for their region to remain within the United Kingdom. The Shetland and Orkney Islands contemplated of opting out of an independent Scotland in 2013. This caught the attention of some politicians and the media, via confirming the possibility of some form of partition in Scotland and could have gained extra attention if partition quickly became a matter of ‘need’ instead of ‘want’. Whilst some Unionists may have used petitions and formed pressure groups to voice their claims, others may have used more hard-line tactics to achieve their political objectives, including possible protest marches and acts of civil unrest. This could have possibly spread sectarian violence between Scottish Unionists and Nationalists. Glasgow has a serious issue of this kind of sectarianism, which has escalated in recent years. This is due to the number communities that have been established from Irish Immigrants, which maintain links with Northern Irish loyalists and republicans. Some Scottish Unionists not only have sympathy towards Northern Irish loyalists but actively participate with the paramilitary groups and gave support. Scottish loyalists could use these contacts to create their own paramilitary group(s), with aid from remaining UK (RUK) benefactors. Therefore, this could have resulted in the RUK facing a serious security dilemma, with political and ethical consequences to consider. The RUK would have the moral obligation to protect Scottish Unionists from persecution and recognise their right of self-determination, whilst ensuring the security and well-being of British citizens within and outside of Scotland. This work takes into consideration the lessons learned from the ‘Troubles’ in Northern Ireland. As an era of ‘Troubles’ could occur in Scotland, extending into England and Northern Ireland. This is due to proximity, the high number of political, communal and family links in Scotland to the RUK, and the delicate peace process within Northern Ireland which shares a similar issue. This paper will use British and Scottish Government documents prior to the Scottish referendum to argue why partition might happen and use cartography of maps of a potential partition plan for Scotland. Reports from the UK National Statistics, National Rail, and Ministry of Defence shall also be utilised, and use of journal articles that were covering the referendum.

Keywords: identity, nationalism, Scotland, unionism

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91 Islam, Gender and Education in Contemporary Georgia: The Example of Kvemo Kartli

Authors: N. Gelovani, D. Ismailov, S. Bochorishvili

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Religious minorities of Georgia include Muslims. Their composition is sufficiently miscellaneous, enclosing both ethnical viewpoint and belonging to the inner Islamic denomination. A majority of Muslims represent Azerbaijanis, who chiefly live in Kvemo Kartli (Bolnisi, Gardabani, Dmanisi, Tetri Tskaro, Marneuli and Tsalka). The catalyst for researchers of Islamic History is the geopolitical interests of Georgia, centuries-old contacts with the Islamic world, the not entirely trivial portion of Islam confessor population, the increasing influence of the Islamic factor in current religious-political processes in the world, the elevating procedure of Muslim religious self-consciousness in the Post-Soviet states, significant challenges of international terrorism, and perspectives of rapid globalization. The rise in the level of religious identity of Muslim citizens of Georgia (first of all of those who are not ethnic Georgians) is noticeable. New mosques have been constructed and, sometimes, even young people are being sent to the religious educational institutions of Muslim countries to gain a higher Islamic education. At a time when gender studies are substantive, the goal of which is to eliminate gender-based discrimination and violence in societies, it is essential in Georgia to conduct researches around the concrete problem – Islamic tradition, woman and education in Georgia. A woman’s right to education is an important indicator of women’s general status in a society. The appropriate resources, innovative analysis of Georgian ethnological materials, and surveying of the population (quantitative and qualitative research reports, working papers), condition the success of these researches. In the presented work, interrelation matters of Islam, gender and education in contemporary Georgia by the example of the Azerbaijani population in Kvemo Kartli during period 1992-2016 are studied. We researched the history of Muslim religious education centers in Tbilisi and Kvemo Kartli (Bolnisi, Gardabani, Dmanisi, Tetri Tskaro, Marneuli and Tsalka) in 1992-2016, on the one hand, and the results of sociological interrogation, on the other. As a result of our investigation, we found that Azeri women in the Kvemo Kartli (Georgia) region mostly receive their education in Georgia and Azerbaijan. Educational and Cultural Institutions are inaccessible for most Azeri women. The main reasons are the absence of educational and religious institutions at their places of residence and state policies towards Georgia’s Muslims. 

Keywords: Islam, gender, Georgia, education

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90 Towards a Mandatory Frame of ADR in Divorce Cases: Key Elements from a Comparative Perspective for Belgium

Authors: Celine Jaspers

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The Belgian legal system is slowly evolving to mandatory mediation to promote ADR. One of the reasons for this evolution is the lack of use of alternative methods in relation to their possible benefits. Especially in divorce cases, ADR can play a beneficial role in resolving disputes, since the emotional component is very much present. When children are involved, a solution provided by the parent may be more adapted to the child’s best interest than a court order. In the first part, the lack of use of voluntary ADR and the evolution toward mandatory ADR in Belgium will be indicated by sources of legislation, jurisprudence and social-scientific sources, with special attention to divorce cases. One of the reasons is lack of knowledge on ADR, despite the continuing efforts of the Belgian legislator to promote ADR. One of the last acts of ADR-promotion, was the implementation of an Act in 2018 which gives the judge the possibility to refer parties to mediation if at least one party wants to during the judicial procedure. This referral is subject to some conditions. The parties will be sent to a private mediator, recognized by the Federal Mediation Commission, to try to resolve their conflict. This means that at least one party can be mandated to try mediation (indicated as “semi-mandatory mediation”). The main goal is to establish the factors and elements that Belgium has to take into account in their further development of mandatory ADR, with consideration of the human rights perspective and the EU perspective. Furthermore it is also essential to detect some dangerous pitfalls other systems have encountered with their process design. Therefore, the second part, the comparative component, will discuss the existing framework in California, USA to establish the necessary elements, possible pitfalls and considerations the Belgian legislator can take into account when further developing the framework of mandatory ADR. The contrasting and functional method will be used to create key elements and possible pitfalls, to help Belgium improve its existing framework. The existing mandatory system in California has been in place since 1981 and is still up and running, and can thus provide valuable lessons and considerations for the Belgian system. Thirdly, the key elements from a human rights perspective and from a European Union perspective (e.g. the right to access to a judge, the right to privacy) will be discussed too, since the basic human rights and European legislation and jurisprudence play a significant part in Belgian legislation as well. The main sources for this part will be the international and European treaties, legislation, jurisprudence and soft law. In the last and concluding part, the paper will list the most important elements of a mandatory ADR-system design with special attention to the dangers of these elements (e.g. to include or exclude domestic violence cases in the mandatory ADR-framework and the consequences thereof), and with special attention for the necessary the international and European rights, prohibitions and guidelines.

Keywords: Belgium, divorce, framework, mandatory ADR

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89 School Refusal Behaviours: The Roles of Adolescent and Parental Factors

Authors: Junwen Chen, Celina Feleppa, Tingyue Sun, Satoko Sasagawa, Michael Smithson

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School refusal behaviours refer to behaviours to avoid school attendance, chronic lateness in arriving at school, or regular early dismissal. Poor attendance in schools is highly correlated with anxiety, depression, suicide attempts, delinquency, violence, and substance use and abuse. Poor attendance is also a strong indicator of lower achievement in school, as well as problematic social-emotional development. Long-term consequences of school refusal behaviours include fewer opportunities for higher education, employment, and social difficulties, and high risks of later psychiatric illness. Given its negative impacts on youth educational outcomes and well-being, a thorough understanding of factors that are involved in the development of this phenomenon is warranted for developing effective management approaches. This study investigated parental and adolescent factors that may contribute to school refusal behaviours by specifically focusing on the role of parental and adolescents’ anxiety and depression, emotion dysregulation, and parental rearing style. Findings are expected to inform the identification of both parental and adolescents’ factors that may contribute to school refusal behaviours. This knowledge will enable novel and effective approaches that incorporate these factors to managing school refusal behaviours in adolescents, which in turn improve their school and daily functioning. Results are important for an integrative understanding of school refusal behaviours. Furthermore, findings will also provide information for policymakers to weigh the benefits of interventions targeting school refusal behaviours in adolescents. One-hundred-and-six adolescents aged 12-18 years (mean age = 14.79 years old, SD = 1.78, males = 44) and their parents (mean age = 47.49 years old, SD = 5.61, males = 27) completed an online questionnaire measuring both parental and adolescents’ anxiety, depression, emotion dysregulation, parental rearing styles, and adolescents’ school refusal behaviours. Adolescents with school refusal behaviours reported greater anxiety and depression, with their parents showing greater emotion dysregulation. Parental emotion dysregulation and adolescents’ anxiety and depression predicted school refusal behaviours independently. To date, only limited studies have investigated the interplay between parental and youth factors in relation to youth school refusal behaviours. Although parental emotion dysregulation has been investigated in relation to youth emotion dysregulation, little is known about its role in the context of school refusal. This study is one of the very few that investigated both parental and adolescent factors in relation to school refusal behaviours in adolescents. The findings support the theoretical models that emphasise the role of youth and parental psychopathology in school refusal behaviours. Future management of school refusal behaviours should target adolescents’ anxiety and depression while incorporating training for parental emotion regulation skills.

Keywords: adolescents, school refusal behaviors, parental factors, anxiety and depression, emotion dysregulation

Procedia PDF Downloads 93
88 Executive Order as an Effective Tool in Combating Insecurities and Human Rights Violations: The Case of the Special Anti-Robbery Squad and Youths in Nigeria

Authors: Cita Ayeni

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Following countless violations of Human Rights in Nigeria by the various arms and agencies of government; from the Military to the Federal Police and other law enforcement agencies, Nigeria has been riddled with several reports of acts by these agencies against the citizens, ranging from illegal arrest and imprisonment, torture, disappearing, and extrajudicial killings, just to mention a few. This paper, focuses on SARS (Special Anti-Robbery Squad), a division of the Nigeria Police Force, and its reported threats to the people’s security, particularly the Nigerian youths, with continuous violence, extortion, illegal arrest and imprisonment, terror, and extrajudicial activities resulting in maiming and in most cases death, thus infringing on the human rights of the people it’s sworn to protect. This research further analyses how the activities of SARS has over the years instigated fear on the average Nigerian youth, preventing the free participation in daily life, education, job, and individual development, in turn impeding the realization of their full potentials for growth and participation in collective national development. This research analyzes the executive order by the then Acting President (Vice-President) of Nigeria, directing the overhauling of SARS, and its implementation by the Federal Police Force in determining if it’s enough to prevent or put a stop to the continuous Human Rights abuse and threat to the security of the individual citizen. Concluding that although the order by the Acting President was given with an intent to halt the various violations by SARS, and the Inspector General of Police’s (IGP) subsequent action by releasing a statement following the order, the bureaucracy in Nigeria, with a history of incompetency and a return to 'business as usual' after a reduced public outcry, it’s most likely that there will not be adequate follow up put in place and these violations would be slowly 'swept under the rug' with SARS officials not held accountable. It is recommended therefore that the Federal Government through the NPF, following the reforms made, in collaboration with the mentioned Independent Human Rights and civil societies organizations should periodically produce unbiased and publicly accessible reports on the implementation of these reforms and progress made. This will go a long way in assuring the public of actual fulfillment of the restructuring, reduce fear by the youths and restore some public faith in the government.

Keywords: special anti-robbery squad, youths in Nigeria, overhaul, insecurities, human rights violations

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87 Policies to Reduce the Demand and Supply of Illicit Drugs in the Latin America: 2004 to 2016

Authors: Ana Caroline Ibrahim Lino, Denise Bomtempo Birche de Carvalho

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The background of this research is the international process of control and monitoring of illicit psychoactive substances that has commenced in the early 20th century. This process was intensified with the UN Single Convention on Narcotic Drugs of 1961 and had its culmination in the 1970s with the "War on drugs", a doctrine undertaken by the United States of America. Since then, the phenomenon of drug prohibition has been pushing debates around alternatives of public policies to confront their consequences at a global level and in the specific context of Latin America. Previous research has answered the following key questions: a) With what characteristics and models has the international illicit drug control system consolidated in Latin America with the creation of the Organization of American States (OAS) and the Inter-American Drug Abuse Control Commission (CICAD)? b) What drug policies and programs were determined as guidelines for the member states by the OAS and CICAD? The present paper mainly addresses the analysis of the drug strategies developed by the OAS/CICAD for the Americas from 2004 to 2016. The primary sources have been extracted from the OAS/CICAD documents and reports, listed on the Internet sites of these organizations. Secondary sources refer to bibliographic research on the subject with the following descriptors: illicit drugs, public policies, international organizations, OAS, CICAD, and reducing the demand and supply of illicit drugs. The "content analysis" technique was used to organize the collected material and to choose the axes of analysis. The results show that the policies, strategies, and action plans for Latin America had been focused on anti-drug actions since the creation of the Commission until 2010. The discourses and policies to reduce drug demand and supply were of great importance for solving the problem. However, the real focus was on eliminating the substances by controlling the production, marketing, and distribution of illicit drugs. Little attention was given to the users and their families. The research is of great relevance to the Social Work. The guidelines and parameters of the Social Worker's profession are in line with the need for social, ethical, and political strengthening of any dimension that guarantees the rights of users of psychoactive substances. In addition, it contributed to the understanding of the political, economic, social, and cultural factors that structure the prohibitionism, whose matrix anchors the deprivation of rights and violence.

Keywords: illicit drug policies, international organizations, latin America, prohibitionism, reduce the demand and supply of illicit drugs

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86 Fulfillment of Models of Prenatal Care in Adolescents from Mexico and Chile

Authors: Alejandra Sierra, Gloria Valadez, Adriana Dávalos, Mirliana Ramírez

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For years, the Pan American Health Organization/World Health Organization and other organizations have made efforts to the improve access and the quality of prenatal care as part of comprehensive programs for maternal and neonatal health, the standards of care have been renewed in order to migrate from a medical perspective to a holistic perspective. However, despite the efforts currently antenatal care models have not been verified by a scientific evaluation in order to determine their effectiveness. The teenage pregnancy is considered as a very important phenomenon since it has been strongly associated with inequalities, poverty and the lack of gender quality; therefore it is important to analyze the antenatal care that’s been given, including not only the clinical intervention but also the activities surrounding the advertising and the health education. In this study, the objective was to describe if the previously established activities (on the prenatal care models) are being performed in the care of pregnant teenagers attending prenatal care in health institutions in two cities in México and Chile during 2013. Methods: Observational and descriptive study, of a transversal cohort. 170 pregnant women (13-19 years) were included in prenatal care in two health institutions (100 women from León-Mexico and 70 from Chile-Coquimbo). Data collection: direct survey, perinatal clinical record card which was used as checklists: WHO antenatal care model WHO-2003, Official Mexican Standard NOM-007-SSA2-1993 and Personalized Service Manual on Reproductive Process- Chile Crece Contigo; for data analysis descriptive statistics were used. The project was approved by the relevant ethics committees. Results: Regarding the fulfillment of interventions focused on physical, gynecological exam, immunizations, monitoring signs and biochemical parameters in both groups was met by more than 84%; the activities of guidance and counseling pregnant teenagers in Leon compliance rates were below 50%, on the other hand, although pregnant women in Coquimbo had a higher percentage of compliance, no one reached 100%. The topics that less was oriented were: family planning, signs and symptoms of complications and labor. Conclusions: Although the coverage of the interventions indicated in the prenatal care models was high, there were still shortcomings in the fulfillment of activities to orientation, education and health promotion. Deficiencies in adherence to prenatal care guidelines could be due to different circumstances such as lack of registration or incomplete filling of medical records, lack of medical supplies or health personnel, absences of people at prenatal check-up appointments, among many others. Therefore, studies are required to evaluate the quality of prenatal care and the effectiveness of existing models, considering the role of the different actors (pregnant women, professionals and health institutions) involved in the functionality and quality of prenatal care models, in order to create strategies to design or improve the application of a complete process of promotion and prevention of maternal and child health as well as sexual and reproductive health in general.

Keywords: adolescent health, health systems, maternal health, primary health care

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85 The Significance of Urban Space in Death Trilogy of Alejandro González Iñárritu

Authors: Marta Kaprzyk

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The cinema of Alejandro González Iñárritu hasn’t been subjected to a lot of detailed analysis yet, what makes it an exceptionally interesting research material. The purpose of this presentation is to discuss the significance of urban space in three films of this Mexican director, that forms Death Trilogy: ‘Amores Perros’ (2000), ‘21 Grams’ (2003) and ‘Babel’ (2006). The fact that in the aforementioned movies the urban space itself becomes an additional protagonist with its own identity, psychology and the ability to transform and affect other characters, in itself warrants for independent research and analysis. Independently, such mode of presenting urban space has another function; it enables the director to complement the rest of characters. The basis for methodology of this description of cinematographic space is to treat its visual layer as a point of departure for a detailed analysis. At the same time, the analysis itself will be supported by recognised academic theories concerning special issues, which are transformed here into essential tools necessary to describe the world (mise-en-scène) created by González Iñárritu. In ‘Amores perros’ the Mexico City serves as a scenery – a place full of contradictions- in the movie depicted as a modern conglomerate and an urban jungle, as well as a labyrinth of poverty and violence. In this work stylistic tropes can be found in an intertextual dialogue of the director with photographies of Nan Goldin and Mary Ellen Mark. The story recounted in ‘21 Grams’, the most tragic piece in the trilogy, is characterised by almost hyperrealistic sadism. It takes place in Memphis, which on the screen turns into an impersonal formation full of heterotopias described by Michel Foucault and non-places, as defined by Marc Augé in his essay. By contrast, the main urban space in ‘Babel’ is Tokio, which seems to perfectly correspond with the image of places discussed by Juhani Pallasmaa in his works concerning the reception of the architecture by ‘pathological senses’ in the modern (or, even more adequately, postmodern) world. It’s portrayed as a city full of buildings that look so surreal, that they seem to be completely unsuitable for the humans to move between them. Ultimately, the aim of this paper is to demonstrate the coherence of the manner in which González Iñárritu designs urban spaces in his Death Trilogy. In particular, the author attempts to examine the imperative role of the cities that form three specific microcosms in which the protagonists of the Mexican director live their overwhelming tragedies.

Keywords: cinematographic space, Death Trilogy, film Studies, González Iñárritu Alejandro, urban space

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84 Initiating the Provision of Adolescent Reproductive Health Information and Services (ARHIS) to Communities in Quezon City, Beginning with District 2

Authors: Erickson Bernardo, Caridad Pineda

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The project Adolescent Reproductive Health Information and Services (ARHIS) is a nine-month pilot project which intends to bridge the existing gap between reproductive health information and services, particularly with regard to family planning and HIV, among adolescent boys and girls aged 10-19 years in the 2nd Congressional District of Quezon City, in the Philippines. It aims to increase adolescents' and young people's awareness about their reproductive health concerns and at the same time make a wide range of reproductive health (RH) services accessible and available to them. A number of methodologies were utilized in the implementation of the project. At the onset, a baseline survey was conducted by community mobilizers to gather a situational analysis of adolescents' and young people's issues and concerns. The results of this survey were then presented in a multi-stakeholders' meeting to gather community support and foster their involvement. Further, interactive learning sessions (ILS) on a variety of reproductive health topics, among young people, parents and community leaders based on the results of the baseline survey was conducted. With regard to reproductive health service provision, both facility-based delivery and conduct of outreach activities were employed. In the span of nine months, the project was able to yield the following results: • A total of 521 adolescents and youth (AY) were reached by ILS on puberty, responsible relationships, teenage pregnancy, family planning, as well as HIV & AIDS. • A total of 218 parents and community leaders were informed of AY RH-related issues and concerns. • More than 350 AYs availed of a wide range of FP services including pills – both combined oral and progestin-only, and progestin-only injectables and implants. • More than 380 AYs availed of condoms as means of STI and HIV prevention. A noble initiative of the project is the utilization of a "condom distributor", a youth leader who has been educated about STI and HIV prevention as well as correct condom use, as the focal point for condom access in the community. • A total of 25 young people, parents, and community leaders were identified as ARHIS champions who have been instrumental in the achievement of project deliverables through their dedication and commitment to support the project. The concept of adolescent sexual and reproductive health (ASRH) remains to be a major challenge in the Philippine context. This is due to the fact that majority of Filipinos are still not keen on discussing issues and concerns related to ASRH, albeit the alarming number of teenage pregnancies and the rapid increase of HIV cases among 15- 24 year olds. In addition, Republic Act 10354 or the Responsible Parenthood and Reproductive Health Act of 2012, requires minor adolescents to present a written parental consent prior to accessing RH services. However, with the involvement and support of parents and key community stakeholders, these barriers may be addressed. The project has demonstrated how adolescents and young people yearn for reproductive health information and services.

Keywords: adolescent sexual reproductive health, barriers to access, reproductive health information and services, teenage pregnancies

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83 Antiinflammatory and Wound Healing Activity of Sedum Essential Oils Growing in Kazakhstan

Authors: Dmitriy Yu. Korulkin, Raissa A. Muzychkina

Abstract:

The last decade the growth of severe and disseminated forms of inflammatory diseases is observed in Kazakhstan, in particular, septic shock, which progresses on 3-15% of patients with infectious complications of postnatal period. In terms of the rate of occurrence septic shock takes third place after hemorrhagic and cardiovascular shock, in terms of lethality it takes first place. The structure of obstetric sepsis has significantly changed. Currently the first place is taken by postabortive sepsis (40%) that is connected with usage of imperfect methods of artificial termination of pregnancy in late periods (intraamnial injection of sodium chloride, glucose). The second place is taken by postnatal sepsis (32%); the last place is taken by septic complications of caesarean section (28%). In this connection, search for and assessment of effectiveness of new medicines for treatment of postoperative infectious complications, having biostimulating effect and speeding up regeneration processes, is very promising and topical. Essential oil was obtained by the method hydrodistillation air-dry aerial part of Sedum L. plants using Clevenger apparatus. Pilot batch of plant medicinal product based on Sedum essential oils was produced by Chimpharm JSC, Santo Member of Polpharma Group (Kazakhstan). During clinical test of the plant medicinal product based on Sedum L. essential oils 37 female patients at the age from 35 to 57 with clinical signs of complicated postoperative processes and 12 new mothers with clinical signs of inflammatory process on sutures on anterior abdominal wall after caesarean section and partial disruption of surgical suture line on perineum were examined. Medicine usage methods - surgical wound treatment 2 times a day, treatment with other medicines of local action was not performed. Before and after treatment general clinical test, determination of immune status, bacterioscopic test of wound fluid was performed to all women, medical history data was taken into account, wound cleansing and healing time, full granulations, side effects and complications, satisfaction with the used medicine was assessed. On female patients with inflammatory infiltration and partial disruption of surgical suture line anesthetic wound healing effect of plant medicinal product based on Sedum L. essential oils was observed as early as on the second day after beginning of using it, wound cleansing took place, as a rule, within the first row days. Hyperemia in the area of suture line also was not observed for 2-3-d day of usage of medicine, good constant course was observed. The absence of clinical effect on this group of patients was not registered. The represented data give evidence of that clinical effect was accompanied with normalization of changed laboratory findings. No allergic responses or side effects were observed during usage of the plant medicinal products based on Sedum L. essential oils.

Keywords: antiinflammatory, bioactive substances, essential oils, isolation, sedum L., wound healing

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82 To Live on the Margins: A Closer Look at the Social and Economic Situation of Illegal Afghan Migrants in Iran

Authors: Abdullah Mohammadi

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Years of prolong war in Afghanistan has led to one of the largest refugee and migrant populations in the contemporary world. During this continuous unrest which began in 1970s (by military coup, Marxist revolution and the subsequent invasion of USSR), over one-third of the population migrated to neighboring countries, especially Pakistan and Iran. After the Soviet Army withdrawal in 1989, a new wave of conflicts emerged between rival Afghan groups and this led to new refugees. Taliban period, also, created its own refugees. During all these years, I.R. of Iran has been one of the main destinations of Afghan refugees and migrants. At first, due to the political situation after Islamic Revolution, Iran government didn’t restrict the entry of Afghan refugees. Those who came first in Iran received ID cards and had access to education and healthcare services. But in 1990s, due to economic and social concerns, Iran’s policy towards Afghan refugees and migrants changed. The government has tried to identify and register Afghans in Iran and limit their access to some services and jobs. Unfortunately, there are few studies on Afghan refugees and migrants’ situation in Iran and we have a dim and vague picture of them. Of the few studies done on this group, none of them focus on the illegal Afghan migrants’ situation in Iran. Here, we tried to study the social and economic aspects of illegal Afghan migrants’ living in Iran. In doing so, we interviewed 24 illegal Afghan migrants in Iran. The method applied for analyzing the data is thematic analysis. For the interviews, we chose family heads (17 men and 7 women). According to the findings, illegal Afghan migrants’ socio-economic situation in Iran is very undesirable. Its main cause is the marginalization of this group which is resulted from government policies towards Afghan migrants. Most of the illegal Afghan migrants work in unskilled and inferior jobs and live in rent houses on the margins of cities and villages. None of them could buy a house or vehicle due to law. Based on their income, they form one of the lowest, unprivileged groups in the society. Socially, they face many problems in their everyday life: social insecurity, harassment and violence, misuse of their situation by police and people, lack of education opportunity, etc. In general, we may conclude that illegal Afghan migrant have little adaptation with Iran’s society. They face severe limitations compared to legal migrants and refugees and have no opportunity for upward social mobility. However, they have managed some strategies to face these difficulties including: seeking financial and emotional helps from family and friendship networks, sending one of the family members to third country (mostly to European countries), establishing self-administered schools for children (schools which are illegal and run by Afghan educated youth).

Keywords: illegal Afghan migrants, marginalization, social insecurity, upward social mobility

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81 Clinical Cases of Rare Types of 'Maturity Onset Diabetes of the Young' Diabetes

Authors: Alla Ovsyannikova, Oksana Rymar, Elena Shakhtshneider, Mikhail Voevoda

Abstract:

In Siberia endocrinologists increasingly noted young patients with the course of diabetes mellitus differing from 1 and 2 types. Therefore we did a molecular genetic study for this group of patients to verify the monogenic forms of diabetes mellitus in them and researched the characteristics of this pathology. When confirming the monogenic form of diabetes, we performed a correction therapy for many patients (transfer from insulin to tablets), prevented specific complications, examined relatives and diagnosed their diabetes at the preclinical stage, revealed phenotypic characteristics of the pathology which led to the high significance of this work. Materials and Methods: We observed 5 patients (4 families). We diagnosed MODY (Maturity Onset Diabetes of the Young) during the molecular genetic testing (direct automatic sequencing). All patients had a full clinical examination, blood samples for biochemical research, determination of C-peptide and TSH, antibodies to b-cells, microalbuminuria, abdominal ultrasound, heart and thyroid ultrasound, examination of ophthalmologist. Results: We diagnosed 3 rare types of MODY: two women had MODY8, one man – MODY6 and man and his mother - MODY12. Patients with types 8 and 12 had clinical features. Age of onset hyperglycemia ranged from 26 to 34 years. In a patient with MODY6 fasting hyperglycemia was detected during a routine examination. Clinical symptoms, complications were not diagnosed. The patient observes a diet. In the first patient MODY8 was detected during first pregnancy, she had itchy skin and mostly postprandial hyperglycemia. Upon examination we determined glycated hemoglobin 7.5%, retinopathy, non-proliferative stage, peripheral neuropathy. She uses a basic bolus insulin therapy. The second patient with MODY8 also had clinical manifestations of hyperglycemia (pruritus, thirst), postprandial hyperglycemia and diabetic nephropathy, a stage of microalbuminuria. The patient was diagnosed autoimmune thyroiditis. She used inhibitors of DPP-4. The patient with MODY12 had an aggressive course. In the detection of hyperglycemia he had complaints of visual impairment, intense headaches, leg cramps. The patient had a history of childhood convulsive seizures of non-epileptic genesis, without organic pathology, which themselves were stopped at the age of 12 years. When we diagnosed diabetes a patient was 28 years, he had hypertriglyceridemia, atherosclerotic plaque in the carotid artery, proliferative retinopathy (lacerocoagulation). Diabetes and early myocardial infarction were observed in three cases in family. We prescribe therapy with sulfonylureas and SGLT-2 inhibitors with a positive effect. At the patient's mother diabetes began at a later age (30 years) and a less aggressive course was observed. She also has hypertriglyceridemia and uses oral hypoglycemic drugs. Conclusions: 1) When young patients with hyperglycemia have extrapancreatic pathologies and diabetic complications with a short duration of diabetes we can assume they have one of type of MODY diabetes. 2) In patients with monogenic forms of diabetes mellitus, the clinical manifestations of hyperglycemia in each succeeding generation are revealed at an earlier age. Research had increased our knowledge of the monogenic forms of diabetes. The reported study was supported by RSCF, research project No. 14-15-00496-P.

Keywords: diabetes mellitus, MODY diabetes, monogenic forms, young patients

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80 Vitamin B9 Separation by Synergic Pertraction

Authors: Blaga Alexandra Cristina, Kloetzer Lenuta, Bompa Amalia Stela, Galaction Anca Irina, Cascaval Dan

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Vitamin B9 is an important member of vitamins B group, being a growth factor, important for making genetic material as DNA and RNA, red blood cells, for building muscle tissues, especially during periods of infancy, adolescence and pregnancy. Its production by biosynthesis is based on the high metabolic potential of mutant Bacillus subtilis, due to a superior biodisponibility compared to that obtained by chemical pathways. Pertraction, defined as the extraction and transport through liquid membranes consists in the transfer of a solute between two aqueous phases of different pH-values, phases that are separated by a solvent layer of various sizes. The pertraction efficiency and selectivity could be significantly enhanced by adding a carrier in the liquid membrane, such as organophosphoric compounds, long chain amines or crown-ethers etc., the separation process being called facilitated pertraction. The aim of the work is to determine the impact of the presence of two extractants/carriers in the bulk liquid membrane, i.e. di(2-ethylhexyl) phosphoric acid (D2EHPA) and lauryltrialkylmetilamine (Amberlite LA2) on the transport kinetics of vitamin B9. The experiments have been carried out using two pertraction equipments for a free liquid membrane or bulk liquid membrane. One pertraction cell consists on a U-shaped glass pipe (used for the dichloromethane membrane) and the second one is an H-shaped glass pipe (used for h-heptane), having 45 mm inner diameter of the total volume of 450 mL, the volume of each compartment being of 150 mL. The aqueous solutions are independently mixed by means of double blade stirrers with 6 mm diameter and 3 mm height, having the rotation speed of 500 rpm. In order to reach high diffusional rates through the solvent layer, the organic phase has been mixed with a similar stirrer, at a similar rotation speed (500 rpm). The area of mass transfer surface, both for extraction and for reextraction, was of 1.59x10-³ m2. The study on facilitated pertraction with the mixture of two carriers, namely D2EHPA and Amberlite LA-2, dissolved in two solvents with different polarities: n-heptane and dichloromethane, indicated the possibility to obtain the synergic effect. The synergism has been analyzed by considering the vitamin initial and final mass flows, as well as the permeability factors through liquid membrane. The synergic effect has been observed at low D2EHPA concentrations and high Amberlite LA-2 concentrations, being more important for the low-polar solvent (n-heptane). The results suggest that the mechanism of synergic pertraction consists on the reaction between the organophosphoric carrier and vitamin B9 at the interface between the feed and membrane phases, while the aminic carrier enhances the hydrophobicity of this compound by solvation. However, the formation of this complex reduced the reextraction rate and, consequently, affects the synergism related to the final mass flows and permeability factor. For describing the influences of carriers concentrations on the synergistic coefficients, some equations have been proposed by taking into account the vitamin mass flows or permeability factors, with an average deviations between 4.85% and 10.73%.

Keywords: pertraction, synergism, vitamin B9, Amberlite LA-2, di(2-ethylhexyl) phosphoric acid

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79 The Influence of Perinatal Anxiety and Depression on Breastfeeding Behaviours: A Qualitative Systematic Review

Authors: Khulud Alhussain, Anna Gavine, Stephen Macgillivray, Sushila Chowdhry

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Background: Estimates show that by the year 2030, mental illness will account for more than half of the global economic burden, second to non-communicable diseases. Often, the perinatal period is characterised by psychological ambivalence and a mixed anxiety-depressive condition. Maternal mental disorder is associated with perinatal anxiety and depression and affects breastfeeding behaviors. Studies also indicate that maternal mental health can considerably influence a baby's health in numerous aspects and impact the newborn health due to lack of adequate breastfeeding. However, studies reporting factors associated with breastfeeding behaviors are predominantly quantitative. Therefore, it is not clear what literature is available to understand the factors affecting breastfeeding and perinatal women’s perspectives and experiences. Aim: This review aimed to explore the perceptions and experiences of women with perinatal anxiety and depression, as well as how these experiences influence their breastfeeding behaviours. Methods: A systematic literature review of qualitative studies in line with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). Four electronic databases (CINAHL, PsycINFO, Embase, and Google Scholar) were explored for relevant studies using a search strategy. The search was restricted to studies published in the English language between 2000 and 2022. Findings from the literature were screened using a pre-defined screening criterion and the quality of eligible studies was appraised using the Walsh and Downe (2006) checklist. Findings were extracted and synthesised based on Braun and Clark. The review protocol was registered on PROSPERO (Ref: CRD42022319609). Result: A total of 4947 studies were identified from the four databases. Following duplicate removal and screening 16 studies met the inclusion criteria. The studies included 87 pregnant and 302 post-partum women from 12 countries. The participants were from a variety of economic, regional, and religious backgrounds, mainly from the age of 18 to 45 years old. Three main themes were identified: Barriers to breastfeeding, breastfeeding facilitators, emotional disturbance, and breastfeeding. Seven subthemes emerged from the data: expectation versus reality, uncertainly about maternal competencies, body image and breastfeeding, lack of sufficient breastfeeding support for family and caregivers’ support, influences positive breastfeeding practices, breastfeeding education, and causes of mental strain among breastfeeding women. Breastfeeding duration is affected in women with mental health disorders, irrespective of their desire to breastfeed. Conclusion: There is significant empirical evidence that breastfeeding behaviour and perinatal mental disturbance are linked. However, there is a lack of evidence to apply the findings to Saudi women due to lack of empirical qualitative information. To improve the psychological well-being of mothers, it is crucial to explore and recognise any concerns with their mental, physical, and emotional well-being. Therefore, robust research is needed so that breastfeeding intervention researchers and policymakers can focus on specifically what needs to be done to help mentally distressed perinatal women and their new-born.

Keywords: pregnancy, perinatal period, anxiety, depression, emotional disturbance, breastfeeding

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