Health care providers’ perspectives on the content and structure of a culturally tailored antenatal care programme to expectant parents and family members in Nepal.

Background: In Nepal childbirth is one of the most vulnerable periods of a woman's life and knowledge about the normal birth process, as well as danger signs, could be a life-saving intervention. Antenatal care programmes are therefore particularly relevant in Nepal where women deliver on their own in rural areas as well as in facility and hospital settings. Aim: This study aimed to describe the relevant content and structure of a culturally tailored antenatal care programme in Nepal to be developed from the input of healthcare providers. Methods: Qualitative semi-structured interviews with 26 health care providers were analyzed using Elo and Kyngäs’ content analysis. This study received ethical approval from the research ethics committee at Dalarna University, Sweden, and the Nepal Health Research Council. Findings: The results present possible (1) content and (2) structure of a culturally tailored antenatal care programme. Content is comprised of (a) how pregnancy affects the mother and how her lifestyle affects the unborn child; (b) normal childbirth, complications, and preparations; and (c) postpartum period – parenthood, childcare, and breastfeeding. Structure is related to (a) programme leader and location; (b) participants; and (c) pedagogy. Conclusion: This antenatal care programme will be culturally tailored to empower women with self-confidence and their decision-making power may increase in the family system regarding their own and their children’s health and wellbeing. Clinical Application: This study can help those designing culturally sensitive antenatal care programs in Nepal

Citrullinated proteins in arthritis: presence in joints and effects on immunogenicity

Contains fulltext : 60098.pdf (publisher's version ) (Open Access

Is wetter better? Exploring agriculturally-relevant rainfall characteristics over four decades in the Sahel

The semi-arid Sahel is a global hotspot for poverty and malnutrition. Rainfed agriculture is the main source of food and income, making the well-being of rural population highly sensitive to rainfall variability. Studies have reported an upward trend in annual precipitation in the Sahel since the drought of the 1970s and early ‘80s, yet farmers have questioned improvements in conditions for agriculture, suggesting that intraseasonal dynamics play a crucial role. Using high-resolution daily precipitation data spanning 1981–2017 and focusing on agriculturally-relevant areas of the Sahel, we re-examined the extent of rainfall increase and investigated whether the increases have been accompanied by changes in two aspects of intraseasonal variability that have relevance for agriculture: rainy season duration and occurrence of prolonged dry spells during vulnerable crop growth stages. We found that annual rainfall increased across 56% of the region, but remained largely the same elsewhere. Rainy season duration increased almost exclusively in areas with upward trends in annual precipitation (23% of them). Association between annual rain and dry spell occurrence was less clear: increasing and decreasing frequencies of false starts (dry spells after first rains) and post-floral dry spells (towards the end of the season) were found to almost equal extent both in areas with positive and those with no significant trend in annual precipitation. Overall, improvements in at least two of the three intraseasonal variables (and no declines in any) were found in 10% of the region, while over a half of the area experienced declines in at least one intraseasonal variable, or no improvement in any. We conclude that rainfall conditions for agriculture have improved overall only in scattered areas across the Sahel since the 1980s, and increased annual rainfall is only weakly, if at all, associated with changes in the agriculturally-relevant intraseasonal rainfall characteristics

P171Elevated free fetal haemoglobin threatens vasculoprotection in the fetal circulation of preeclamptic pregnancy

Placental up-regulation of free fetal haemoglobin (fHbF) occurs in preeclamptic (PE) pregnancy. Heme oxygenase-1 (HO-1) is an important vasculoprotective enzyme in the catabolism of the associated heme porphyrin structure. We have previously shown that fHbF negatively influences the vasculoprotective capacity of the fetal circulation. Here we study fHbF levels in the fetal cord blood of pregnancies complicated by PE; a pathology associated with dysregulated fetoplacental vascular tone. We have previously shown that fHbF binds nitric oxide (NO) to elicit elevated vascular resistance in the fetoplacental circulation, using ex vivo human dual placental perfusion and in vitro placental endothelial cell shear stress studies. Furthermore, fHbF causes morphological changes to the fetoplacental endothelium. Here we hypothesise that elevated levels of fHbF in fetal plasma associated with placental pathology contribute to fetoplacental hypertension. Purpose: To evaluate and derive a robust cord blood collection and processing protocol for the accurate measurement of fetal plasma fHbF levels in normal and PE pregnancies. Methods: Fetal venous cord blood was collected by syringe and needle, or Vacutainer method into either EDTA or citrate tubes, within 10 minutes of partum. Plasma recovery occurred immediately, or after 30 minutes, prior to centrifugation at 2000g x 10 min at room temperature. Following evaluation to reduce mechanical haemolysis, newly collected normal & PE plasma (n=13 & 6, respectively) was subjected to ELISAs for HbF and HO-1. Results: Venipuncture collection of cord venous blood taken from the cord-placenta insertion point by Vacutainer system with a 21G needle, into citrate collection tubes with immediate centrifugation prevented mechanical haemolysis. There was no difference in plasma HO-1 between groups (medians = 5.9 & 5.3 ng/mL; normal & PE, respectively; Mann-Whitney). Whilst there was no difference in fHbF between groups (Mann-Whitney), variability was high in the PE group and there were some very high values for fHbF compared to the normal range, whilst fHbF values in the control group were within a tighter lower range (medians & ranges = 45.9 & 0-206 and 118.8 & 29-640 μg/mL). Conclusion: Fetal plasma HO-1 levels appear stable in preeclamptic fetal plasma, permitting fHbF to remain unchecked in some cases. High pathophysiological levels of fHbF in some cases of PE pregnancies are capable of evoking elevated vascular resistance within the fetoplacental circulation, caused by nitric oxide sequestration and disruption to the endothelium. Further evaluation is require

Self-amplified Amazon forest loss due to vegetation-atmosphere feedbacks

Reduced rainfall increases the risk of forest dieback, while in return forest loss might intensify regional droughts. The consequences of this vegetation-atmosphere feedback for the stability of the Amazon forest are still unclear. Here we show that the risk of self-amplified Amazon forest loss increases nonlinearly with dry-season intensification. We apply a novel complex-network approach, in which Amazon forest patches are linked by observation-based atmospheric water fluxes. Our results suggest that the risk of self-amplified forest loss is reduced with increasing heterogeneity in the response of forest patches to reduced rainfall. Under dry-season Amazonian rainfall reductions, comparable to Last Glacial Maximum conditions, additional forest loss due to self-amplified effects occurs in 10-13% of the Amazon basin. Although our findings do not indicate that the projected rainfall changes for the end of the twenty-first century will lead to complete Amazon dieback, they suggest that frequent extreme drought events have the potential to destabilize large parts of the Amazon forest

Suppressed Charge Dispersion via Resonant Tunneling in a Single-Channel Transmon

We demonstrate strong suppression of charge dispersion in a semiconductor-based transmon qubit across Josephson resonances associated with a quantum dot in the junction. On resonance, dispersion is drastically reduced compared to conventional transmons with corresponding Josephson and charging energies. We develop a model of qubit dispersion for a single-channel resonance, which is in quantitative agreement with experimental data

Strengthening the integration of midwifery in health systems; a leader-to-leader collaboration

Barriers and facilitators for quality midwifery care exist on different levels in the health systems. After decades of challenges and varied degrees of success, a stakeholder leader-to-leader collaboration could provide added value through knowledge sharing on how to integrate the midwifery cadre into an existing health system. Initiated by The Midwifery Society of Nepal, Dalarna University Sweden and MAMTA - Health Institute for Mother and Child India, a research network focusing midwifery has been formed. The background, purpose and activities of this network has been described in this News and Events paper