Nausea and vomiting of pregnancy - studies with pregnancy-unique quantification of emesis questionnaire

Majority of women experience at least some degree of nausea and vomiting of pregnancy (NVP). The severity of the condition ranges from mild symptoms to intractable nausea and vomiting, hyperemesis gravidarum (HG). An internationally widely used questionnaire, the Pregnancy-Unique Quantification of emesis (PUQE), has been developed to categorise the severity of NVP. The present study aimed to assess the usability of the PUQE both in inpatient and outpatient settings for the first time in Finland. Moreover, associations between NVP and maternal factors, physical quality of life (QoL), mental QoL and sleep quality were assessed. The PUQE was applied in two cohorts of pregnant women: 106 hospitalised women with HG and 2411 women recruited from maternal health care clinics (MHCC). At the hospital, among women with HG, the PUQE scores decreased from admission to discharge, reflecting the alleviation of HG. The change in PUQE scores was associated with improved physical QoL and in repeated admissions also with improved mental QoL. The women recruited from MHCCs recalled the worst NVP in their current pregnancy and replied to the PUQE accordingly. In general, NVP was frequent and most often rated as moderate. The severity of NVP was mainly associated with higher gravidity and previous nausea related to motion sickness, migraine, and other kind of headache. In addition, family history of NVP was associated with more severe NVP. Further, women with more severe NVP had worse physical QoL, worse mental QoL and worse sleep quality. Moreover, the women replied the PUQE at different gestational weeks, but the PUQE total scores were comparable whether the scores were given in early or in late pregnancy. The findings of the present study support clinical use of the PUQE also in Finland. The PUQE scores were usable at hospital in HG treatment follow-up. In outpatient care the PUQE could be used as a screening tool to assess the severity of NVP. Using the PUQE for the severity assessment of NVP, the present study found various associative factors for NVP. Notably, along increasing severity of NVP the present study highlighted the deterioration of QoL and sleep quality. These results are important in antenatal counselling.Raskauspahoinvointi – Tutkimuksia Pregnancy-Unique Quantification of Emesis -kyselykaavakkeella Suurin osa odottajista kokee jonkinasteista raskauspahoinvointia, jonka vaikeusaste vaihtelee lievästä aina hallitsemattomaan pahoinvointiin ja oksenteluun nimeltään hyperemesis gravidarum (HG). Raskauspahoinvoinnin vaikeusasteen luokitteluun on kehitetty kansainvälisesti laajasti käytetty kyselykaavake Pregnancy-Unique Quantification of Emesis (PUQE). Tässä väitöstutkimuksessa selvitettiin PUQEn käytettävyyttä sekä sairaalassa että avoterveydenhuollossa ensimmäistä kertaa Suomessa. Lisäksi tutkittiin äidin ominaisuuksien, fyysisen ja psyykkisen elämänlaadun sekä unen laadun yhteyttä raskauspahoinvointiin. PUQEa käytettiin kahdessa eri raskaana olevien aineistossa: 106 naisella, jotka olivat HG:n vuoksi sairaalahoidossa ja 2411 neuvoloista rekrytoiduilla odottajilla. Sairaalassa PUQE-pisteet laskivat tulopäivästä lähtöpäivään kuvastaen HG:n lieventymistä. Tämä muutos oli yhteydessä kohentuneeseen fyysiseen elämänlaatuun ja toistuvissa hoitojaksoissa myös kohentuneeseen psyykkiseen elämänlaatuun. Neuvoloista rekrytoidut odottajat vastasivat PUQEn raskauden pahimman pahoinvointijakson mukaisesti. Raskauspahoinvointi oli yleistä ja PUQEn mukaan yleisimmin keskivaikeaa. Aiemmat raskaudet, matkapahoinvointitausta ja taipumus pahoinvointiin migreenin tai muun päänsäryn yhteydessä sekä sukulaisilla esiintynyt raskauspahoinvointi olivat yhteydessä voimakkaampaan raskauspahoinvointiin. Niillä naisilla, joilla raskauspahoinvointi oli voimakkaampaa, oli myös sekä huonompi fyysinen ja psyykkinen elämänlaatu että huonompi unen laatu. Odottajat vastasivat PUQEn eri raskausviikoilla, mutta PUQE-pisteet olivat vertailukelpoisia alkuraskauden ja loppuraskauden vastausten välillä. Väitöstutkimuksen mukaan PUQE sopii hyvin kliiniseen käyttöön myös Suomessa. PUQE soveltuu sairaalahoidossa HG potilaiden hoitovasteen seurantaan. Avoterveydenhuollossa PUQE soveltuu raskauspahoinvoinnin voimakkuuden seulontaan. Väitöstutkimus toi esiin useita raskauspahoinvoinnin taustatekijöitä sekä sen elämänlaatua ja unen laatua heikentävän vaikutuksen. Tuloksia voidaan hyödyntää odottajien neuvonnassa

Hyperemesis gravidarum

Valtaosa odottajista kokee alkuraskaudessa ainakin lievää pahoinvointia ja oksentelua (emesis gravidarum). Harvinaisempi raskauspahoinvoinnin ja oksentelun äärimuoto on hyperemesis gravidarum, jossa oksentelu on hallitsematonta ja johtaa merkittävään kuivumiseen, vajaaravitsemukseen sekä elektrolyyttihäiriöihin ja painon vähenemiseen. Tila vaatii usein sairaalahoitoa, jossa sekä suun kautta että suonensisäisesti annettavalla nesteytyksellä tuetaan ravitsemusta ja korjataan kuivuminen sekä elektrolyyttihäiriöt. Lievemmissä tapauksissa nestehoito voidaan antaa perusterveydenhuollossakin, tarvittaessa useina peräkkäisinä päivinä. Voimakkaasta raskauspahoinvoinnista ja oksentelusta kärsivät odottajat tarvitsevat myös psyykkistä tukea. Valtaosalla vaikeatkin oireet helpottavat raskauden edetessä. Raskauden ennuste on yleensä hyvä, eikä hyperemesis gravidarum aina toistu seuraavissa raskauksissa.</p

Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study

BackgroundNausea and vomiting of pregnancy (NVP) deteriorates many aspects of daily lives of women. However, little is known about associations between NVP and sleep quality.MethodsWomen attending to routine mid-pregnancy visits in maternity health care clinics in Turku city area and surrounding municipalities, Finland, during 2011-2014, were invited to participate. A cohort of 1203 volunteers (mean age 30years, mean gestational week 16.6, mean BMI 24.4kg/m(2), nulliparous 46%) was recruited. The severity of NVP in the worst 12-h period of current pregnancy was assessed with Pregnancy Unique Quantification of Emesis Questionnaire (PUQE) and categorized accordingly into no/mild/moderate and severe NVP. Sleep disturbances during the past 3months were assessed with selected questions (difficulty falling asleep, night awakenings, too early morning awakenings and sleepiness during the day) from Basic Nordic Sleep Questionnaire (BNSQ). In addition, general sleep quality, as well as physical and mental quality of life (QoL) were rated with three visual analog scales (VAS). Associations between PUQE categories (severity of NVP) and sleep disturbances, general sleep quality, physical QoL and mental QoL were evaluated with multinomial regression analysis.ResultsAccording to PUQE, NVP was most frequently moderate (n=629, 52.3%), followed by mild (n=361, 30.0%) and severe (n=77, 6.4%). Only 11.3% had no NVP (n=136). The most frequent sleep disturbance was night awakenings (69.9%, n=837), followed by sleepiness during the day (35.7%, n=427), too early morning awakenings (12.0%, n=143) and difficulty falling asleep (7.1%, n=81). In adjusted analysis (age, parity, body mass index, smoking, employment), more severe NVP was associated with night awakenings (AOR 3.9, 95% CI 1.79-8.47, P<0.0001) and sleepiness during the day (AOR 4.7, 95% CI 2.20-9.94, P<0.0001). In VAS, women with more severe NVP rated worse general sleep quality and worse physical and mental QoL. However, in multivariable analysis, the association between the severity of NVP and physical and mental QoL was stronger than that of sleep .ConclusionsMore severe NVP is associated with sleep disturbances and in close relation to lower physical and mental QoL. Thus, in comprehensive care of women with NVP, also sleep quality should be evaluated

Neurological Music Therapy Rebuilds Structural Connectome after Traumatic Brain Injury: Secondary Analysis from a Randomized Controlled Trial

Background: Traumatic brain injury (TBI) is a common and devastating neurological condition, associated often with poor functional outcome and deficits in executive function. Due to the neuropathology of TBI, neuroimaging plays a crucial role in its assessment, and while diffusion MRI has been proposed as a sensitive biomarker, longitudinal studies evaluating treatment-related diffusion MRI changes are scarce. Recent evidence suggests that neurological music therapy can improve executive functions in patients with TBI and that these effects are underpinned by neuroplasticity changes in the brain. However, studies evaluating music therapy induced structural connectome changes in patients with TBI are lacking. Design: Single-blind crossover (AB/BA) randomized controlled trial (NCT01956136). Objective: Here, we report secondary outcomes of the trial and set out to assess the effect of neurological music therapy on structural white matter connectome changes and their association with improved execute function in patients with TBI. Methods: Using an AB/BA design, 25 patients with moderate or severe TBI were randomized to receive a 3-month neurological music therapy intervention either during the first (AB, n = 16) or second (BA, n = 9) half of a 6-month follow-up period. Neuropsychological testing and diffusion MRI scans were performed at baseline and at the 3-month and 6-month stage. Findings: Compared to the control group, the music therapy group increased quantitative anisotropy (QA) in the right dorsal pathways (arcuate fasciculus, superior longitudinal fasciculus) and in the corpus callosum and the right frontal aslant tract, thalamic radiation and corticostriatal tracts. The mean increased QA in this network of results correlated with improved executive function. Conclusions: This study shows that music therapy can induce structural white matter neuroplasticity in the post-TBI brain that underpins improved executive function

Women with polycystic ovary syndrome have poorer work ability and higher disability retirement rate at midlife : a Northern Finland Birth Cohort 1966 study

Objective: Polycystic ovary syndrome (PCOS) presents with multiple comorbidities potentially affecting function. This was the first general population-based study to evaluate work ability, participation in working life, and disability retirement in middle-aged women with and without PCOS. Design: This is a cohort study. Methods: Women with PCOS (n = 280) and women without PCOS symptoms or diagnosis (n = 1573) were identified in the Northern Finland Birth Cohort in 1966 and were evaluated for self-rated work ability and potential confounders at age 46. Next, incidence rate ratios (IRRs) for disability and unemployment days were extracted from national registers during a prospective 2-year follow-up. Lastly, we assessed hazard ratios (HRs) for disability retirement between 16 and 52 years of age from national registers. Results: The women with PCOS reported poorer ability to work at age 46, especially due to poorer health. During the 2-year follow-up period, the affected women gained on average an additional month of disability and unemployment days, corresponding to an approximately 25% higher risk for both disability (IRR (95% CI): 1.25 (1.22-1.27)) and unemployment days (IRR (95% CI): 1.26 (1.23-1.28)) in models adjusted for health and socioeconomic factors. Lastly, we found a two-fold higher cumulative risk for disability retirement by age 52 compared to non-PCOS women (HR (95% CI): 1.98 (1.40-2.80)), which remained after adjusting for confounding factors (aHR (95% CI): 1.55 (1.01-2.38)). Conclusions: PCOS is associated with lower participation in working life already in midlife. Acknowledging PCOS-related multimorbidity, concerted efforts are needed to support sustainable careers for women with PCOS.Peer reviewe

Neurological Music Therapy Rebuilds Structural Connectome after Traumatic Brain Injury: Secondary Analysis from a Randomized Controlled Trial

Background: Traumatic brain injury (TBI) is a common and devastating neurological condition, associated often with poor functional outcome and deficits in executive function. Due to the neuropathology of TBI, neuroimaging plays a crucial role in its assessment, and while diffusion MRI has been proposed as a sensitive biomarker, longitudinal studies evaluating treatment-related diffusion MRI changes are scarce. Recent evidence suggests that neurological music therapy can improve executive functions in patients with TBI and that these effects are underpinned by neuroplasticity changes in the brain. However, studies evaluating music therapy induced structural connectome changes in patients with TBI are lacking. Design: Single-blind crossover (AB/BA) randomized controlled trial (NCT01956136). Objective: Here, we report secondary outcomes of the trial and set out to assess the effect of neurological music therapy on structural white matter connectome changes and their association with improved execute function in patients with TBI. Methods: Using an AB/BA design, 25 patients with moderate or severe TBI were randomized to receive a 3-month neurological music therapy intervention either during the first (AB, n = 16) or second (BA, n = 9) half of a 6-month follow-up period. Neuropsychological testing and diffusion MRI scans were performed at baseline and at the 3-month and 6-month stage. Findings: Compared to the control group, the music therapy group increased quantitative anisotropy (QA) in the right dorsal pathways (arcuate fasciculus, superior longitudinal fasciculus) and in the corpus callosum and the right frontal aslant tract, thalamic radiation and corticostriatal tracts. The mean increased QA in this network of results correlated with improved executive function. Conclusions: This study shows that music therapy can induce structural white matter neuroplasticity in the post-TBI brain that underpins improved executive function

Usability of Pregnancy-Unique Quantification of Emesis questionnaire in women hospitalised for hyperemesis gravidarum: a prospective cohort study

Objectives Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire is mainly used in outpatient care to assess the severity of nausea and vomiting of pregnancy (NVP). Our aim was to evaluate the usability of the Finnish-translated PUQE in hospitalised women with hyperemesis gravidarum (HG).Design Prospective cohort study.Setting University hospital in Finland.Participants Ninety-five women admitted due to HG for at least overnight.Primary and secondary outcome measures Categorised and continuous PUQE scores, physical and mental quality of life (QoL) and urine ketones at admission and at discharge, analysing the first admission and readmissions separately.Results The most common PUQE categories at admission were ‘moderate’ and ‘severe’, whereas at discharge they were ‘mild’ and ‘moderate’. Likewise, continuous PUQE scores improved between admission and discharge (pConclusions PUQE scores reflected alleviation of NVP severity in women hospitalised due to HG. Further, the decrease in PUQE score was associated with improved physical QoL and partly also with improved mental QoL. We therefore suggest PUQE as a complementary instrument for inpatient setting.</p

Neuroanatomical correlates of speech and singing production in chronic post-stroke aphasia

A classical observation in neurology is that aphasic stroke patients with impairments in speech production can nonetheless sing the same utterances. This preserved ability suggests a distinctive neural architecture for singing that could contribute to speech recovery. However, to date, these structural correlates remain unknown. Here, we combined a multivariate lesion–symptom mapping and voxel-based morphometry approach to analyse the relationship between lesion patterns and grey matter volume and production rate in speech and singing tasks. Lesion patterns for spontaneous speech and cued repetition extended into frontal, temporal and parietal areas typically reported within the speech production network. Impairment in spontaneous singing was associated with damage to the left anterior–posterior superior and middle temporal gyri. Preservation of grey matter volume in the same regions where damage led to poor speech and singing production supported better performance in these tasks. When dividing the patients into fluent and dysfluent singers based on the singing performance from demographically matched controls, we found that the preservation of the left middle temporal gyrus was related to better spontaneous singing. These findings provide insights into the structural correlates of singing in chronic aphasia and may serve as biomarkers to predict treatment response in clinical trials using singing-based interventions for speech rehabilitation.Peer reviewe

Music therapy enhances executive functions and prefrontal structural neuroplasticity after traumatic brain injury : Evidence from a randomized controlled trial

Traumatic brain injury (TBI) causes lifelong cognitive deficits, particularly impairments of executive functioning (EF). Musical training and music-based rehabilitation have been shown to enhance cognitive functioning and neuroplasticity, but the potential rehabilitative effects of music in TBI are still largely unknown. The aim of the present crossover randomized controlled trial (RCT) was to determine the clinical efficacy of music therapy on cognitive functioning in TBI and to explore its neural basis. Using an AB/BA design, 40 patients with moderate or severe TBI were randomized to receive a 3-month neurological music therapy intervention either during the first (AB, n = 20) or second (BA, n = 20) half of a 6-month follow-up period. Neuropsychological and motor testing and magnetic resonance imaging (MRI) were performed at baseline and at the 3-month and 6-month stage. Thirty-nine subjects who participated in baseline measurement were included in an intention-to-treat analysis using multiple imputation. Results showed that general EF (as indicated by the Frontal Assessment Battery [FAB]) and set shifting improved more in the AB group than in the BA group over the first 3-month period and the effect on general EF was maintained in the 6-month follow-up. Voxel-based morphometry (VBM) analysis of the structural MRI data indicated that gray matter volume (GMV) in the right inferior frontal gyrus (IFG) increased significantly in both groups during the intervention versus control period, which also correlated with cognitive improvement in set shifting. These findings suggest that neurological music therapy enhances EF and induces fine-grained neuroanatomical changes in prefrontal areasPeer reviewe

The effect of past use of oral contraceptive on bone mineral density, bone biochemical markers and muscle strength in healthy pre and post menopausal women

<p>Abstract</p> <p>Background</p> <p>during adulthood, most studies have reported that oral contraceptive (OC) pills had neutral, or possibly beneficial effect on bone health. We proposed this study of pre and post menopausal women assessing BMD, bone biochemical markers and physical performance among OC past users and comparable women who have never use Ocs.</p> <p>Methods</p> <p>A cross-sectional study comparing the bone density, bone biochemical markers (osteocalcin, CTX) and three measures to assess physical performance: timed get-up-and-go test "TGUG", five-times-sit-to-stand test "5 TSTS" and 8-feet speed walk "8 FSW" of users and never users OC. We were recruited 210 women who used OC for at least 2 years with that of 200 nonusers was carried out in pre and postmenopausal women (24-86 years).</p> <p>Results</p> <p>when analysing the whole population, BMD and biochemical markers values were similar for Ocs past users and control subjects. However when analysing the subgroup of premenopausal women, there was a statistically significant difference between users and never-users in osteocalcin (15,5 ± 7 ng/ml vs 21,6 ± 9 ng/ml; p = 0,003) and CTX (0,30 ± 0,1 ng/ml vs 0,41 ± 0,2 ng/ml; p = 0,025). This difference persisted after adjustment for age, BMI, age at menarche and number of pregnancies. In contrast, in post menopausal women, there was no difference in bone biochemical markers between OC users and the control. On the other hand OC past users had a significant greater performance than did the never users group. And when analysing the physical performance tests by quartile OC duration we found a significant negative association between the three tests and the use of OC more than 10 years.</p> <p>Conclusion</p> <p>the funding show no evidence of a significant difference in BMD between Ocs users and never user control groups, a decrease in bone turn over in OC pre menopausal users and a greater physical performances in patients who used OC up than 10 years.</p