Association between serum levels of C-reactive protein and personality traits in women

<p>Abstract</p> <p>Background</p> <p>While low-grade inflammation has consistently been observed in subjects with depression, studies on the possible relationship between inflammation and other aspects of brain function are as yet sparse. In this study, we aimed to investigate the possible association between serum levels of the inflammation marker C-reactive protein (CRP) and personality traits.</p> <p>Methods</p> <p>In this study, serum levels of high-sensitivity CRP were determined by ELISA in a population of 270 42-year-old women recruited from the population registry who had been assessed using the Temperament and Character Inventory. Self-reported previous or ongoing depression was also recorded. Unpaired two-tailed <it>t</it>-tests were used for comparison between two groups and correlations were evaluated by the calculation of Pearson's r-coefficient.</p> <p>Results</p> <p>The temperament trait harm avoidance was positively (<it>r </it>= 0.227, <it>p </it>< 0.05) and the character trait self-directedness was negatively (<it>r </it>= -0.261, <it>p </it>< 0.01) associated with serum levels of CRP (<it>p</it>-values corrected for multiple comparisons). The correlations between the personality traits and CRP were observed also after exclusion of subjects reporting ongoing depression (n = 26). Whereas women reporting ongoing depression showed significantly increased levels of CRP as compared to non-depressed women (n = 155), women reporting a history of depression displayed no significant difference in CRP levels as compared to women that reported that they had never been depressed.</p> <p>Conclusion</p> <p>Serum levels of CRP in women was found to be associated with the personality traits harm avoidance and self-directedness. In addition, moderately elevated levels may be a state dependent marker of depression.</p

Pain, depression and anxiety in people with haemophilia from three Nordic countries : Cross-sectional survey data from the MIND study

Introduction People with haemophilia (PwH) may experience symptoms of haemophilia-related pain, depression or anxiety, which can negatively impact health-related quality of life. Aim To obtain the perspective of PwH and treaters from Sweden, Finland and Denmark on the management of haemophilia-related pain, depression and anxiety using cross-sectional survey data from the MIND study (NCT03276130). Methods PwH or their caregivers completed a survey about experiences of pain, depression and anxiety related to haemophilia, and the standard EQ-5D-5L instrument. Five investigators at haemophilia treatment centres (HTC) were sent a complementary survey containing questions about the management of pain and depression/anxiety. Results There were 343 PwH (mild: 103; moderate: 53; severe: 180; seven lacking severity information) and 71 caregiver responses. Experience of pain in the last 6 months was reported by 50% of PwH respondents and 46% of caregiver respondents. Anxiety/depression was reported by 28% of PwH respondents. Reporting of pain and anxiety/depression was associated with disease severity. Whilst 62% of PwH who had experienced pain at any time point (n = 242) felt this was adequately addressed and treated at their HTC, only 24% of those who had experienced depression/anxiety (n = 127) felt this was adequately addressed. Disease severity was negatively associated with EQ-5D-5L utility value (p < .001). In the HTC survey, 4/5 and 2/5 agreed that pain and depression/anxiety, respectively, are adequately addressed. Conclusions Pain and depression/anxiety occur more frequently with increasing haemophilia severity, with negative impacts on health-related quality of life. PwH with depression/anxiety or unaddressed pain could benefit from improved management strategies.Peer reviewe

Treatment outcomes in persons with severe haemophilia B in the Nordic region : The B-NORD study

Introduction Data on outcome in persons with haemophilia B (PwHB) are limited and mainly extrapolated from studies of haemophilia A (HA). Aim To characterize treatment outcomes in persons with severe HB in the Nordic region, with a focus on joint health, compared with matched controls with HA. Methods PwHB attending haemophilia centres in Denmark, Finland, Norway and Sweden were enrolled and matched with controls with HA. Joint assessment using Haemophilia Joint Health Score (HJHS) and ultrasound according to Haemophilia Early Arthropathy Detection protocol (HEAD-US) was conducted. Adherence was evaluated using the Validated Haemophilia Regimen Treatment Adherence Scale (VERITAS). Results Seventy-nine males with HB, with median age of 30 years (range 1-75), were enrolled. Eleven patients (14%) had a history of or current inhibitor. Twenty-nine PwHB (37%) reported joint bleeds during the prior year, and 35% had previously undergone joint surgery. Ninety-five per cent were on prophylaxis, and 70% used recombinant concentrates, with a median factor consumption of 3,900 IU/kg/year for standard half-life products. Only two patients had a VERITAS score corresponding to 'non-adherence'. Joint health, assessed with HJHS, showed a significant lower score among PwHB compared with HA controls, explained by a difference in the 18-49 age group, without observed differences in older or younger subgroups. The HEAD-US scores were overall low. Conclusion The Nordic cohort of PwHB is well treated by prophylaxis, but the goal of zero bleeds for all is not reached. Our findings suggest that patients with severe HB suffer from a milder arthropathy than patients with severe HA.Peer reviewe

Factor IX antibodies and tolerance in hemophilia B in the Nordic countries - The impact of F9 variants and complications

Introduction: The development of inhibitory antibodies (inhibitors) in persons with hemophilia B (PwHB) causes significant morbidity. Data on the impact of the F9 variant and immune tolerance induction (ITI) outcome are limited.The aim of this study was to investigate the presence of neutralizing and non-neutralizing antibodies (NNA) in severe hemophilia B (HB) and to evaluate ITI outcome and complications in relation to the pathogenic F9 variant.Materials and methods: Persons with severe HB in the Nordic countries were enrolled and information on F9 variants, inhibitors, ITI and complications were collected. Analyses of anti-FIX antibodies with a fluorescence -immunoassay (xFLI) and an ELISA method were conducted.Results: Seventy-nine PwHB were enrolled. Null variants were seen in 33 (42 %) PwHB and 12 (15 %) had a current or former inhibitor. Eleven (92 %) of the inhibitor patients had experienced allergic manifestations and three (25 %) nephrotic syndrome. Of 10 PwHB with at least one ITI attempt, eight (80 %) were considered tolerant at enrolment. Immunosuppression was included in seven of eight successful or partially successful at-tempts. Five PwHB had at least one ITI failure before a successful or partially successful ITI. No NNA could be identified.Conclusion: A high proportion of severe F9 gene defects among persons with severe HB in the Nordic countries may explain the observed relatively high prevalence of inhibitors. ITI success was independent of the F9 variant and attained despite allergic manifestations and previous ITI failures. Inclusion of immunosuppression tenta-tively enhances the chances of ITI success. No NNA were observed.Peer reviewe

Studies of hyperandrogenicity and the metabolic syndrome in premenopausal women

An androgenic sex hormone profile appears to be a typical feature of the metabolic syndrome (MetS) and a powerful risk factor for the development of type 2 diabetes in women. The causes of relative hyperandrogenicity (HA) are not clearly defined. Among possible pathophysiological pathways, the effect of insulin, abdominal obesity, ovarian dysfunction, environmental factors and disturbed hypothalamic-pituitary-adrenal (HPA) axis activity, as well as genetic factors, have been discussed.The overall aim was to study the associations of endogenous sex hormones and sex hormone-binding globulin (SHBG) with the features of the MetS, HPA axis estimates, ovarian morphology and genetic as well as psychosocial and socioeconomic factors.This thesis is based on a cross-sectional, population-based cohort of premenopausal healthy women born in 1956. The first stage of the investigations was performed in 1997-1998 and comprised 270 subjects. Examinations included assessments of anthropometry, blood pressure, endocrine and metabolic parameters, salivary cortisol levels on repeated occasions over a random working day and a dexamethasone suppression test. Symptoms of anxiety and depression, socioeconomic status and quality of life were determined using validated questionnaires. The influence of sex steroid-related gene polymorphisms (genes encoding androgen receptor (AR), estrogen receptor ¦Á (ER¦Á), estrogen receptor ¦Â (ER¦Â), CYP19 aromatase and SHBG) on sex hormones and SHBG levels was studied. A subgroup of this cohort (n = 55) within the highest and lowest quartiles of free testosterone values were included in a follow-up study in 2001 to perform a detailed gynecological examination, including ovarian sonography.The results revealed that women with HA, defined as the highest 25% levels of free testosterone (free T ¡Ý 6 pmol/L) in this population sample, displayed higher levels of cardiovascular disease (CVD) risk factors, such as fasting insulin, glucose, abdominal obesity, blood pressure, triglycerides and LDL-cholesterol levels, as well as lower HDL-cholesterol, compared with the remaining subjects. Increased adrenal androgen, dehydroepiandrosterone sulfate (DHEAS), appears to be related to some features of the MetS, including dyslipidemia and abdominal obesity. An unfavorable socioeconomic environment and impaired quality of life were associated with an androgenic sex hormone profile. It appears that a chronic challenge to the HPA axis in women due to stress factors may primarily lead to the elevated secretion of the adrenal androgens. Genetic influence may be at least partly responsible for the individual variations in androgen levels and SHBG concentrations. SHBG may play a central role in the regulation of the lipid profile in women, independent of other metabolic and CVD risk factors. There was no clear over-representation of women with polycystic ovaries (PCO) or polycystic ovary syndrome (PCOS). PCO appearance was associated with a tendency towards some non-beneficial changes in cardiovascular risk factors and was correlated with hirsutism. Insulin and free T were independently associated with ovarian volume. The results underline the complexity of HA in women

Comprative Study of Nursing PhD Curriculum in Iran, Turkey and Jordan

Background & Aim: The education and training of nursing PhD students is of great importance because they are expected to act as factors for the advancement of nursing science, professional counselors and future nursing researchers. The aim of this study was to compare the Iranian nursing curriculum with the two countries of Turkey and Jordan. Methods & Materials: A descriptive-comparative study was conducted in 2017. In this study, Iran's nursing education system was compared in PhD level with the components of educational program of the two countries of Turkey and Jordan. After searching the Internet, the required data was collected and using the Bread Model, four stages of description, interpretation, juxtaposition and comparison were done. Results: The beginning of Ph.D. nursing education in Turkey, Iran and Jordan was in 1972, 1995 and 2005, respectively. With regard to the characteristics and structure of the course among the three countries, there were many similarities. The only difference was that in Turkey, there were different branches in nursing and the possibility to enter the Ph.D. from the bachelor's degree. None of these three mentioned countries, uses advanced educational and telemedicine technologies. Conclusion: According to the results of this study, while considering the role and duties of nursing graduates and taking into account the complex and changing needs of society, it is suggested to make reviews in the goals, mission, curriculum content, presentation and evaluation of this cours

Surgical outcomes in patients with haemophilia A or B receiving extended half-life recombinant factor VIII and IX Fc fusion proteins : Real-world experience in the Nordic countries

Introduction: Perioperative dosing recommendations vary across Nordic haemophilia treatment centres (HTCs) for extended half-life (EHL) factor concentrates in haemophilia A/B (HA/HB) patients. Aim: To summarise Nordic real-world surgical experiences with EHL recombinant factor VIII/IX Fc (rFVIIIFc/rFIXFc) fusion proteins using retrospective data from clinical records at four HTCs in Finland, Sweden and Norway. Methods: Factor dosing and surgical outcomes were recorded from HA/HB patients who underwent surgery and were treated with rFVIIIFc/rFIXFc. Perioperative factor dosing regimens were clinician-determined based on local practises. Results: Twenty five surgeries were performed on 20 patients, all covered by bolus injections except one minor HA surgery; eight minor surgeries were in paediatric patients. Median preoperative rFVIIIFc dose for major HA surgeries (n = 8) was 48 IU/kg (range: 35–57), with total consumption up to Day 14 of 427 IU/kg (196–568). For the two major HB surgeries (in one patient), preoperative rFIXFc doses were 50 IU/kg and 20 IU/kg; total consumption up to Day 14 was 130 IU/kg and 40 IU/kg. Median preoperative rFVIIIFc/rFIXFc bolus doses for minor HA (n = 10) and HB (n = 4) surgeries were 50 IU/kg (24–79) and 47 IU/kg (40–71), with total consumption up to Day 5 of 138 IU/kg (49–404) and 100 IU/kg (43–125), respectively. Intraoperative and postoperative haemostatic responses were rated as at least good/excellent for 24/25 surgeries, with bleeding episodes reported in only three surgeries. Conclusion: Nordic real-world experiences suggest that EHL products can be used safely and effectively for peri-operative haemostasis. Further research is required to develop local dosing guidelines for optimised treatment schedules

Clotting factor level is not a good predictor of bleeding in carriers of haemophilia A and B.

Carriers of haemophilia are known to have a wide range of clotting factor levels and bleeding symptoms. This study aimed at investigating whether carriers of severe and moderate haemophilia had an increased bleeding tendency, compared with a control group, using a condensed version of a bleeding assessment tool developed by the Molecular and Clinical Markers for the Diagnosis and Management of Type 1 VWD study group (MCMDM-1VWD). One hundred and twenty-six genetically verified carriers of severe and moderate haemophilia and 90 controls were interviewed regarding bleeding symptoms. A bleeding score of at least 4 was considered positive, indicating a significant bleeding tendency. Clotting factor levels were tested in the carriers.Nineteen of the women were carriers of haemophilia B, with a mean factor (F)IX:C level of 0.54 (± 0.27) kIU/l, and 107 were carriers of haemophilia A, with a mean FVIII:C level of 0.74 (± 0.32) kIU/l. The median bleeding score was 2 (-3-12) among carriers and -1 (-3-8) among controls (P < 0.001). The bleeding score was weakly correlated to clotting factor levels in carriers of haemophilia A (rs = -0.36, P < 0.001). We conclude that the bleeding tendency in our cohort of carriers differed significantly from that in the controls and that clotting factor levels might not be sufficient to predict the bleeding tendency

Self-reported activity of Swedish persons with haemophilia: Change over 2.5 years

Objectives: To describe self-reported activity using the Haemophilia Activity List (HAL) for Swedish adults with haemophilia and to detect any changes over time. Method: The HAL was sent to the adult population with haemophilia A and B, moderate and severe form, living in Sweden (n = 260). Participants completed the HAL and a questionnaire on sociodemographic and medical information. From a previous study cohort, 61 persons had responded twice to the HAL. The investigated group was divided into early and later treatment onset groups with regard to access to medication. Results: The response rate was 50%. There was a significant difference (p< 0.001) between the early and later treatment groups in all domains in HAL. When analysing HAL “question by question” from the 2 reported time-points, the most prominent outcome was that the reported ability in activities was stable over time at the group level, except for participants who had no access to the clotting factor early in life. They reported greater limitations in some of the activities in the challenging domain “leisure activities and sport”. Conclusion: The early treatment group reported a significantly better ability in all activities compared with the late treatment group

Platelet aggregation in healthy women during normal pregnancy - a longitudinal study

Increased platelet activation is involved in obstetric complications such as preeclampsia and intrauterine growth retardation. It is of interest to study platelet aggregation during pregnancy, since increased aggregation theoretically could be a mechanism associated with placenta-mediated complications, which possibly could be prevented by drugs inhibiting platelet aggregation. There are, however, few robust studies describing platelet aggregation during normal pregnancy. The present longitudinal study was performed in order to study platelet aggregation during normal pregnancy resulting in a healthy child, during the puerperium and in nonpregnant, fertile women. Healthy, nonsmoking, pregnant women (n = 104), aged under 39 years and with BMI < 35, were followed during pregnancy and postpartum. Twenty-seven nonpregnant, non-puerperal, fertile women were studied for comparison. Platelet aggregation was determined with multiple electrode impedance aggregometry and analyzed at inclusion, 4 times during pregnancy and after at least 3 months postpartum. Platelet aggregation postpartum was compared with gestational weeks 8–15 and 37–40, respectively, and with nonpregnant, fertile women. Hemoglobin, leucocyte count, platelet count, prothrombin time, and activated partial thromboplastin time were determined at inclusion in order to verify normal hemostasis. Activation of platelets by arachidonic acid, adenosine diphosphate (ADP), and thrombin receptor activating peptide (trap-6) resulted in less aggregation during pregnancy, compared with postpartum (p < 0.03–< 0.001). Platelet aggregation following activation by collagen was unchanged. A minor increase in aggregation as pregnancy continued was found related to ADP (p < 0.021). Positive correlations were found between platelet counts and platelet aggregation. Postpartum platelet aggregation after activation with arachidonic acid, collagen, and trap-6 was lower than in the non-puerperal fertile state. Other hemostatic analyses were normal. In conclusion, there is a minor decrease in platelet aggregation after activation with arachidonic acid, trap-6, and ADP, measured with multiple electrode impedance aggregometry during normal pregnancy resulting in healthy babies, compared with the postpartum period. The small changes in platelet aggregation may be a consequence of a minor decrease in platelet count and probably lack clinical significance under normal conditions. Interindividual variations at certain time-points are substantial, which limits the usefulness of the multiple electrode impedance aggregometry for determining minor changes in platelet function