Mamma, mamma og barn : Arbeidsdeling og foreldreskap hos lesbiske par med felles barn

Denne undersøkelsen er en eksplorerende kvalitativ studie av lesbiske par med felles barn. Gjennom dybdeintervjuer av åtte lesbiske mødre og medmødre, til sammen fire par, har jeg sett på hvordan de praktiserer foreldreskap, og hvordan de fordeler husarbeid, barneomsorg og jobb seg imellom. Jeg trekker delvis på et funksjonalistisk perspektiv på familie, men hovedsakelig på David Morgans praksisorienterte familieforståelse. Dette er et perspektiv på familie som noe man gjør, på familierelasjoner som noe man skaper og praktiserer gjennom både egne tanker om familie, og samfunnets ideologier rundt hvordan familie best gjøres. Familiene i utvalget er både nyskapende og konvensjonelle. De er nyskapende i det at foreldreparet består av to kvinner, som har brukt anonym donor for å få barn sammen. Dermed er det biologiske foreldreskapet delvis løsrevet fra parforholdet, samtidig som det sosiale foreldreskapet holdes innenfor parforholdets likekjønnete rammer. Siden de er kvinner kan de i utgangspunktet også velge hvem som skal bære frem barnet, noe som kan karakteriseres som grenseoverskridende sammenlignet med heterofile foreldre. På en annen side er disse familiene i stor grad konvensjonelle, gjennom deres heteronormative opprettholdelse av en sterk parnormativitet og kjernefamilienormativitet. Samtlige legger stor vekt på at foreldreskapet skal praktiseres innen parforholdet, en holdning som ga utslag i deres valg av anonym donor. Også i forhold til hva de anser som et godt foreldreskap etterlever parene konvensjonelle idealer. Tid med barna og nærværende foreldre er idealer som går igjen i dagens diskusjoner om foreldreskap og familieliv, og er gjennomgående viktig for mødrene i denne undersøkelsen. Gjennom materialet er det også mulig å se to likestillingsprosesser. Den ene i forhold til en likestilling mellom kvinnene som kjærester/partnere, den andre i forhold til en likestilling som foreldre. Som kjærester/partnere var det viktig at begge parter er likeverdige ovenfor hverandre, og alle parene har som mål å praktisere en likedeling av husarbeid, jobb og omsorg. Som foreldre var det viktig å være likestilt på tross av den biologiske ubalansen mellom biologisk mor og medmor, samt de manglende rettighetene det medførte for disse parene. Samtlige mødre la vekt på at de skulle være likeverdige foreldre ovenfor barna. De er alle bevisst den rollen praksis kan spille i utformingen av foreldreskap, særlig i forhold til betydningen av medmors initiativ, og hvordan dette kan veie opp for blant annet den nærheten biologisk mor får til barnet gjennom amming. Permisjon og tilrettelagt arbeidsdeling er stikkord her. Medmors aktive foreldreskap kan sammenlignes med det deltagende, omsorgsfulle og likestilte foreldreskapet en del nye fedre har begynt å vise til. Parenes bevisste familiekonstruksjon og reflekterte og aktive holdning til foreldreskap kan oppsummeres i en mer generell handlingsmodell. Ideologi rundt familieutforming manifesteres i praksis, som skaper emosjonelle bånd. Med praksis og emosjonsladede relasjoner som viktige argumenter, har homofile i Norge kjempet frem rettigheter likestilt med heterofile familier. Foreldreskapet jeg her undersøker, aktualiserer likestilling og arbeidsdeling i en familiekonstellasjon som bryter med det heteronormative idealet for familie og foreldreskap. Men på mange vis er familiene likevel heteronormative i måten de former og praktiserer familie på

Contemporary use of Selexipag in pulmonary arterial hypertension associated with congenital heart disease: a case series.

BackgroundThere are significant risks of parenteral prostacyclin use in patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD), which may limit their use. Selexipag is an oral, selective prostacyclin analogue that has been shown to reduce disease progression and improve exercise capacity in patients with PAH-CHD. Administering Selexipag in patients with PAH-CHD could potentially overcome some of the risks of parenteral therapy while improving clinical outcomes.Case summaryWe report five cases highlighting the clinical uses of Selexipag in patients with PAH-CHD. In the first two cases, Selexipag was initiated as part of a Treat-to-close strategy. In the third case, initiation of Selexipag improved symptoms and objective exercise capacity in a patient with Eisenmenger syndrome. In the fourth and fifth cases, rapid cross-titration protocols were used to transition from parenteral prostacyclins to Selexipag. In the fourth case, Selexipag was initiated in the context of significant side effects limiting parenteral prostacyclin use. In the fifth case, Selexipag was used to down-titrate from parenteral prostacyclins following closure of a sinus venosus atrial septal defect and redirection of anomalous pulmonary veins.DiscussionSelexipag is a promising oral therapy for patients with at various stages of the spectrum of PAH-CHD to improve symptoms, exercise capacity and, in some cases, haemodynamics. Our cases also highlight practical aspects of Selexipag use including targeting the individualized maximally tolerated dose for each patient, managing side effects and managing dose interruptions

Short- and long-term outcomes of out-of-hospital cardiac arrest following ST-elevation myocardial infarction managed with percutaneous coronary intervention

© 2020 Aim: Out-of-hospital cardiac arrest (OHCA) is frequently associated with ST-elevation myocardial infarction (STEMI) and has a high mortality. We aimed to identify differences in characteristics and very long-term outcomes for STEMI patients with and without OHCA managed with percutaneous coronary intervention (PCI). Methods: We analysed data from 12,637 PCI patient procedures for STEMI in the multi-centre Melbourne Interventional Group registry between January 2005 and December 2018. Multivariable models examined associations with OHCA presentation and 30-day mortality. Long-term outcomes were assessed through linkage with the Australian National Death Index. Results: Compared with patients without OHCA (N = 11,580), patients with OHCA (N = 1057) were younger, more often male, had less cardiovascular risk factors, and more often presented with cardiogenic shock. OHCA preceded an increasing proportion of STEMI PCI cases from 2005 to 2018 (2.4% vs. 9.2%). Factors independently associated with OHCA presentation were younger age, male gender, prior valve surgery, multi-vessel disease, LAD culprit, small vessel diameter, and renal impairment on presentation. Patients with OHCA had lower procedural success, higher rates of bleeding and stroke, larger infarct size (measured by peak CK), and higher 30-day mortality (37% vs. 5%; all p < 0.05). Cardiogenic shock, renal impairment and lower ejection fraction were independently associated with 30-day mortality. Long-term mortality was 44% vs. 20% (median follow-up 4.6 years), with Cox regression analysis demonstrating no difference in survival if patients survived beyond 30 days (HR 1.18, 95% CI 0.95–1.47). Conclusions: OHCA has a high short-term mortality and precedes an increasing proportion of STEMI PCI cases. Thirty-day survivors have an excellent long-term prognosis

Diagnosis, Classification, and Management Strategies for Mitral Annular Calcification: A Heart Valve Collaboratory Position Statement

Mitral annular calcium (MAC) with severe mitral valvular dysfunction presents a complex problem, as valve replacement, either surgical or transcatheter, is challenging because of anatomy, technical considerations, concomitant comorbidities, and advanced age. The authors review the clinical and anatomical features of MAC that are favorable (green light), challenging (yellow light), or prohibitive (red light) for surgical or transcatheter mitral valve interventions. Under the auspices of the Heart Valve Collaboratory, an expert working group of cardiac surgeons, interventional cardiologists, and interventional imaging cardiologists was formed to develop recommendations regarding treatment options for patients with MAC as well as a proposed grading and staging system using both anatomical and clinical features

Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation:prognostic implications

AIMS Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated. METHODS AND RESULTS A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. The principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure, and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. The most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%), and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug, and 7 (21.9%) after valvuloplasty (P = 0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%), and 2 (5.7%) at 30 days (P = 0.010) and 11 (12.6%), 14 (17.7%), and 4 (11.4%) at 1 year (P = 0.418), after redo-TAVI, plug, and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared with those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); P = 0.007]. CONCLUSION This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and the optimal PVR treatment modality require further investigation