Foetal iron exposure and cardiorespiratory health

Background/Objectives: Too low iron and too high iron during pregnancy could influence the development of the heart and lungs. Our study aimed to study the association between iron status during early pregnancy and child’s cardiorespiratory health. Subjects/Methods: Using data from the Generation R study, this thesis investigated the ethnic differences in iron status during early pregnancy. We additionally evaluated the association between iron status in early pregnancy and various aspects of childhood cardiorespiratory health, including respiratory function, respiratory tract infections, cardiometabolic risk factors, body composition, and cardiac function and structure. Results: Differences in iron status across ethnic groups was observed, and while socioeconomic and lifestyle factors provided some explanation for these differences, a large proportion remined unexplained. Moreover, higher maternal transferrin during pregnancy, was associated with an increased risk of child’s inhalant allergy sensitization. Both low and high maternal ferritin and transferrin during early pregnancy were associated with an overall increased risk of child’s upper respiratory tract infections. Maternal lower ferritin and higher transferrin in early pregnancy are associated with child’s general fat. In boys only, higher haemoglobin was associated with lower right and left diastolic function while anaemia was associated with higher left diastolic function. No other associations between other iron status during early pregnancy and other child cardiorespiratory outcomes were identified. Conclusion:Maternal iron status during early pregnancy differs according to ethnic background. Both too low and too high iron during early pregnancy might lead to an increased risk of child’s upper respiratory tract infections and altered cardiovascular function. Too low iron of mother during pregnancy might lead to an increased risk of higher child’s body fat composition.<br/

Infant Ustekinumab Clearance, Risk of Infection, and Development After Exposure During Pregnancy

Background:Evidence on ustekinumab safety in pregnancy is gradually expanding, but its clearance in the postnatal period is unknown. The aim of this study was to investigate ustekinumab concentrations in umbilical cord blood and rates of clearance after birth, as well as how these correlate with maternal drug concentrations, risk of infection, and developmental milestones during the first year of life. Methods: Pregnant women with inflammatory bowel disease were prospectively recruited from 19 hospitals in Denmark and the Netherlands between 2018 and 2022. Infant infections leading to hospitalization/antibiotics and developmental milestones were assessed. Serum ustekinumab concentrations were measured at delivery and specific time points. Nonlinear regression analysis was applied to estimate clearance. Results:In 78 live-born infants from 76 pregnancies, we observed a low risk of adverse pregnancy outcomes and normal developmental milestones. At birth, the median infant-mother ustekinumab ratio was 2.18 (95% confidence interval, 1.69–2.81). Mean time to infant clearance was 6.7 months (95% confidence interval, 6.1–7.3 months). One in 4 infants at 6 months had an extremely low median concentration of 0.015 μg/mL (range 0.005–0.12 μg/mL). No variation in median ustekinumab concentration was noted between infants with (2.8 [range 0.4–6.9] μg/mL) and without (3.1 [range 0.7–11.0] μg/mL) infections during the first year of life (P = .41). Conclusions: No adverse signals after intrauterine exposure to ustekinumab were observed with respect to pregnancy outcome, infections, or developmental milestones during the first year of life. Infant ustekinumab concentration was not associated with risk of infections. With the ustekinumab clearance profile, live attenuated vaccination from 6 months of age seems of low risk.</p

From harm to hope:Unraveling the intergenerational transmission of family violence

The main goal of this dissertation is to extend our knowledge on underlying mechanisms of the ‘making or breaking’ of the intergenerational transmission of family violence. The findings show that the intergenerational transmission can be explained by several mechanisms. The youth themselves explained this transmission especially by the mechanism of social learning; they did not have the right role model, and therefore, were less able to learn healthy conflict tactic skills, to talk about emotions and to develop emotion regulation skills. Underneath this behavior several trauma symptoms may exist, which can be triggered by certain stimuli, resulting in certain behavior. Additionally, based on interactions with their parents when they are young, children develop a secure or insecure attachment style. Family violence affects the attachment quality, increasing the risk of low self-esteem and mistrusting others, resulting in problems finding the right balance between connectedness and autonomy, setting boundaries, and sometimes even (justifying) controlling or aggressive behavior. Our results also highlight that children are resilient and able to break the intergenerational transmission of violence; with the right professional or social support and understanding, the youth can learn from their experiences with others, resulting in trust in self and others, reducing the risk of experiencing (later) violence within their romantic relationships. These findings highlight the need for specialized and long-term care, with a focus on strengthening the social network, to foster safe family environments for future generations of children exposed to family violence

Menstrual products:culprits or bystanders in endometriosis and adenomyosis pathogenesis?

Products that may reduce menstrual flow from the endometrial cavity to the vagina (i.e. tampons and menstrual cups) could facilitate retrograde menstruation and the spillage of blood into the myometrium, two mechanisms which could be major determinants in endometriosis and adenomyosis pathogenesis. The aim of this narrative review is to summarize the evidence regarding the mechanical role menstrual products may have in the pathogenesis of these two conditions. Evidence in this regard is inconclusive. While Darrow and colleagues observed that 14 or more years of tampon use were associated with endometriosis (OR 3.6; 95% CI, 1.04–13.5); in Meaddough and colleagues’ retrospective study, the percentage of women using pads only was significantly higher among those with endometriosis than among those without the condition (31% vs 22%). Three further groups failed to find an association between endometriosis/adenomyosis and any type of menstrual product. The only case that may be considered as a sort of proof-of-concept of the association between products potentially reducing anterograde menstrual flow and endometriosis was reported by Spechler and colleagues, who described the case of a 41 year-old who developed endometriosis after having used a menstrual cup on a regular basis. However, the number of studies on the subject is scarce, study populations are exiguous and a greater attention to temporality of endometriosis onset in relation to when women started habitually using a specific menstrual product is needed. Confounding variables including type and quantity of endocrine disruptors contained in menstrual products should also be addressed. At the present moment, no recommendation can be provided on the safety of one type of menstrual product compared to another.</p

HIV-1 Integrase T218I/S Polymorphisms Do Not Reduce HIV-1 Integrase Inhibitors' Phenotypic Susceptibility

The recently Food and Drug Administration (FDA)-approved cabotegravir (CAB) has demonstrated efficacy as an antiretroviral agent for HIV treatment and prevention, becoming an important tool to stop the epidemic in the United States of America (USA). However, the effectiveness of CAB can be compromised by the presence of specific integrase natural polymorphisms, including T97A, L74M, M50I, S119P, and E157Q, particularly when coupled with the primary drug-resistance mutations G140S and Q148H. CAB's recent approval as a pre-exposure prophylaxis (PrEP) may increase the number of individuals taking CAB, which, at the same time, could increase the number of epidemiological implications. In this context, where resistance mutations, natural polymorphisms, and the lack of drug-susceptibility studies prevail, it becomes imperative to comprehensively investigate concerns related to the use of CAB. We used molecular and cell-based assays to assess the impact of T218I and T218S in the context of major resistance mutations G140S/Q148H on infectivity, integration, and resistance to CAB. Our findings revealed that T218I and T218S, either individually or in combination with G140S/Q148H, did not significantly affect infectivity, integration, or resistance to CAB. Notably, these polymorphisms also exhibited neutrality concerning other widely used integrase inhibitors, namely raltegravir, elvitegravir, and dolutegravir. Thus, our study suggests that the T218I and T218S natural polymorphisms are unlikely to undermine the effectiveness of CAB as a treatment and PrEP strategy

Citizen satisfaction with arm's length bodies in local government:expert insights on policy and practice

Purpose: The purpose of this study is to investigate the application of citizen satisfaction (CS) as a tool for measuring performance by arm's length bodies (ALBs) in local governments across eleven countries, addressing central questions about its functionality and influencing factors. Design/methodology/approach: We employ a hybrid inductive-deductive explorative study design, characterized by an iterative interpretative approach guided by sensitizing concepts. Expert interviews are analyzed through template analysis and cover eleven countries where ALBs are present due to decentralization and outsourcing. Findings: Our study uncovers limited real-world applications of CS in evaluating public service delivery by ALBs. Expert interviews reveal insights into factors potentially influencing CS use, such as the level of autonomy of local governments, state traditions and austerity measures. A research agenda is formulated for further investigation. Originality/value: Contributing to the CS debate, our study focuses on its application in evaluating public service delivery by ALBs. The explorative design, expert opinions and theoretical foundations enhance understanding, offering insights into factors potentially shaping CS use in this context. The study proposes a research agenda, propelling further investigations into this underexplored, yet emerging, area.</p

Quality of reporting of pre-recorded music interventions in surgical patients ‐ A systematic review

Background: Perioperative music interventions are promising, with substantial beneficial effects on patients. However, adequate reporting is crucial for interpreting the outcomes and implementing the interventions. Our objective is to analyze the reporting quality of perioperative music interventions and to provide recommendations and a research agenda for future trials. Material and methods: This study utilized data from a systematic review, that was conducted as part of a separate previous analysis by Geensen, Dirven et al. For this analysis, a PROSPERO registration (CRD42023427138) was formalized. The Template for intervention Description and Replication (TiDieR) checklist was adapted and used. Nineteen intervention items were assessed, categorized in the aim, the core and the implementation. Results: Due to narrowed inclusion criteria, ten music intervention studies were included. None of the studies completely reported all intervention items. The reporting of core intervention items were poorly described. Complete description of implementation items, such as fidelity and modifications, was scarce. Conclusions: Perioperative music studies often lack the complete reporting of essential intervention items. This hinders replicability, generalization of the results and might contribute to research waste. We recommend adequate reporting in future studies to avoid these problems, by using our adapted TIDieR checklist.</p