Informing about childbirth without increasing anxiety: a qualitative study of first-time pregnant women and partners' perceptions and needs.

Complications requiring medical interventions during childbirth are far from rare, even after uncomplicated pregnancies. It is often a challenge for maternity healthcare professionals to know how to prepare future parents for these eventualities without causing unnecessary anxiety. Studies on traumatic birth experiences have shown that feelings of loss of control, insufficient information, and lack of participation in medical decisions during childbirth are factors of difficult experiences. However, little is known about the information and communication needs of expectant parents about childbirth during the prenatal period. To gain a deeper understanding of the information and communication needs of first-time pregnant women and partners, we explored their perceptions and expectations for their upcoming childbirth, and the actions they initiated to prepare for it. Semi-structured interviews were conducted individually with first-time pregnant women and partners of pregnant women aged 18 years or older, with an uncomplicated pregnancy. Thematic analysis was used to identify themes and sub-themes. Twenty expectant parents (15 pregnant women and five partners of pregnant women) were interviewed. Six themes were identified: Childbirth event; Childbirth experience; Childbirth environment; Organisation of care; Participation in decision making; Roles within the couple and transition to parenthood. This study contributes to a better understanding of the information needs of future parents expecting their first child. Results highlighted that the notion of "childbirth risks" went beyond the prospect of complications during birth, but also encompassed concerns related to a feeling of loss of control over the event. Expectant parents showed an ambivalent attitude towards consulting risk information, believing it important to prepare for the unpredictability of childbirth, while avoiding information they considered too worrying. They expressed a desire to receive concrete, practical information, and needed to familiarise themselves in advance with the birth environment. Establishing a respectful relationship with the healthcare teams was also considered important. The findings suggest that information on childbirth should not be limited to the transmission of knowledge, but should primarily be based on the establishment of a relationship of trust with healthcare professionals, taking into account each person's individual values and expectations

Levels of Free Granulocyte Elastase in Bronchial Secretions from Patients with Cystic Fibrosis: Effect of Antimicrobial Treatment Against Pseudomonas aeruginosa

Large amounts of free granulocyte elastase (GE), an enzyme capable of mediating airway damage, have been found in bronchial secretions of patients with cystic fibrosis who are infected with Pseudomonas aeruginosa. This finding indicates an imbalance between GE and its antiproteases, α1-proteinase inhibitor (α1-PI) and bronchial mucosal inhibitor (BMI), in the airways of these individuals. The effect of intravenous antimicrobial treatment against P. aeruginosa on activity and concentration of GE, BMI, and α1-PI was evaluated in 30 treatment courses of 20 patients with cystic fibrosis. Although sputum volume and level of immunoreactive GE decreased and concentrations of α1-PI and BMI increased significantly (P < .05), a high level of free GE persisted. No active α1-PI and BMI were detectable after treatment. High levels of GE correlated with a poor pulmonary condition (rs = .98, P < .001). In vitro, elastolytic activity of bronchial secretions from patients with cystic fibrosis was significantly inhibited by eglin C and an oxidation-resistant variant of α1-PI, both compounds currently produced by recombinant DNA technolog

Matrix Metalloproteinase (MMP)-8 and MMP-9 in Cerebrospinal Fluid during Bacterial Meningitis: Association with Blood-Brain Barrier Damage and Neurological Sequelae

To evaluate the spectrum and regulation of matrix metalloproteinases (MMPs) in bacterial meningitis (BM), concentrations of MMP-2, MMP-3, MMP-8, and MMP-9 and endogenous inhibitors of metalloproteinases (TIMP-1 and TIMP-2) were measured in the cerebrospinal fluid (CSF) of 27 children with BM. MMP-8 and MMP-9 were detected in 91% and 97%, respectively, of CSF speci-mens from patients but were not detected in control patients. CSF levels of MMP-9 were higher (P <.05) in 5 patients who developed hearing impairment or secondary epilepsy than in those who recovered without neurological deficits. Levels of MMP-9 correlated with concentrations of TIMP-1 (P <.001) and tumor necrosis factor-α (P =.03). Repeated lumbar punctures showed that levels of MMP-8 and MMP-9 were regulated independently and did not correlate with the CSF cell count. Therefore, MMPs may derive not only from granulocytes infiltrating the CSF space but also from parenchymal cells of the meninges and brain. High concentrations of MMP-9 are a risk factor for the development of postmeningitidal neurological sequela

Influence of climate change and human activities on the organic and inorganic composition of peat during the ‘Little Ice Age’ (El Payo mire, W Spain)

Acknowledgements We are grateful to Ana Moreno, Mariano Barriendos and Gerardo Benito who kindly provided us data included in Figure 5a. We also want to thank the two anonymous reviewers for their constructive comments. Funding This work was funded by the projects HAR2013-43701-P (Spanish Economy and Competitiveness Ministry) and CGL2010-20672 (Spanish Ministry of Science and Innovation). This research was also partially developed with Xunta de Galicia funding (grants R2014/001 and GPC2014/009). N Silva-Sánchez is currently supported by an FPU pre-doctoral grant (AP2010-3264) funded by the Spanish Government.Peer reviewedPostprin

Vulnerability and resilience of high-mountain pine forests of the Gredos range (Ávila, Spanish Central System): two thousand years of socio-ecological dynamics

RESUMEN: En este trabajo se presenta el análisis palinológico de la turbera de Pozo de la Nieve, localizada en el Parque Natural del Valle de Iruelas (Ávila), un área de alto valor sociocultural dentro de la Sierra de Gredos (Sistema Central). Con el objetivo de relacionar los cambios en el paisaje con la explotación de los recursos naturales y eventos climáticos, en primer lugar se han realizado 7 dataciones radiocarbónicas que sitúan el inicio del registro sedimentario ca. 240 cal BC. Los datos polínicos indican la existencia de un denso pinar altimontano dominado por Pinus sylvestris/nigra desde la Segunda Edad de Hierro hasta el periodo islámico. A partir del periodo cristiano las actividades antrópicas se intensifican, especialmente la ganadería en la Edad Contemporánea, lo cual conlleva la progresiva desaparición del pinar de alta montaña y el desarrollo de pastizales mediante el manejo del fuego, situación que culmina con el desarrollo del paisaje actual dominado por piornales pirófilos.ABSTRACT: We present the palynological study of Pozo de la Nieve peat bog, located in a very valuable socio-cultural placement within the Iruelas Valley Natural Park (Gredos range, Iberian Central System). We have focused in relating landscape changes to natural resources management and climatic events. Firstly, we carried out seven radiocarbon dates suggesting the origin of this record ca. 240 cal BC. The palynological data show the existence of dense high-mountain pine woodlands dominated by Pinus sylvestris/nigra from the Late Iron Age to the Muslim period. Later, from the Christian period, anthropogenic activities have intensified, especially livestock grazing in the Contemporary Age. Its consequences are the progressive disappearance of highmountain pine forests and the extension of grasslands by means of fire, which has shaped current landscape dominated by broom communities.Este trabajo ha sido financiado por el proyecto Desirè-HAR2013-43701-P (Plan Nacional I+D+I, Ministerio de Economía y Competitividad de España). Sebastián Pérez Díaz está financiado por el Programa Estatal de Promoción del Talento y su Empleabilidad en I+D+i en la modalidad Juan de la Cierva-Incorporación. Mónica Ruiz Alonso está financiada por el Programa Estatal de Promoción del Talento y su Empleabilidad en I+D+i en la modalidad Juan de la Cierva-Formación

Split Kinetic Energy Method for Quantum Systems with Competing Potentials

For quantum systems with competing potentials, the conventional perturbation theory often yields an asymptotic series and the subsequent numerical outcome becomes uncertain. To tackle such kind of problems, we develop a general solution scheme based on a new energy dissection idea. Instead of dividing the potential energy into "unperturbed" and "perturbed" terms, a partition of the kinetic energy is performed. By distributing the kinetic energy term in part into each individual potential, the Hamiltonian can be expressed as the sum of the subsystem Hamiltonians with respective competing potentials. The total wavefunction is expanded by using a linear combination of the basis sets of respective subsystem Hamiltonians. We first illustrate the solution procedure using a simple system consisting of a particle under the action of double delta-function potentials. Next, this method is applied to the prototype systems of a charged harmonic oscillator in strong magnetic field and the hydrogen molecule ion. Compared with the usual perturbation approach, this new scheme converges much faster to the exact solutions for both eigenvalues and eigenfunctions. When properly extended, this new solution scheme can be very useful for dealing with strongly coupling quantum systems.Comment: 30 pages, 6 fugures, 1 tabl

Familial Transmission of a Serious Disease—Producing Group A Streptococcus Clone: Case Reports and Review

Invasive group A streptococcus (GAS) infections are emerging diseases; however, person-to-person transmission of invasive GAS producing life-threatening infection has been observed rarely. We report a small intrafamilial cluster of life-threatening GAS infections. A previously healthy 47-year-old father developed necrotizing fasciitis of the neck. Two days later, his 16-year-old daughter developed streptococcal angina, pneumonia, and pleural empyema. Both patients had signs of streptococcal toxic shock syndrome. Pulsed field gel electrophoresis revealed that the M6 strains of GAS isolated from the father and daughter had identical patterns. Cases of person-to-person transmission of invasive GAS infection reported in the literature are also reviewe

Arthritis in adults with community-acquired bacterial meningitis: a prospective cohort study

BACKGROUND: Although the coexistence of bacterial meningitis and arthritis has been noted in several studies, it remains unclear how often both conditions occur simultaneously. METHODS: We evaluated the presence of arthritis in a prospective nationwide cohort of 696 episodes of community-acquired bacterial meningitis, confirmed by culture of cerebrospinal fluid, which occurred in patients aged >16 years. The diagnosis of arthritis was based upon the judgment of the treating physician. To identify differences between groups Fisher exact statistics and the Mann-Whitney U test were used. RESULTS: Arthritis was recorded in 48 of 696 (7%) episodes of community-acquired bacterial meningitis in adults. Joint-fluid aspirations were performed in 23 of 48 patients (48%) and joint-fluid cultures yielded bacteria in 6 of 23 patients (26%). Arthritis occurred most frequently in patients with meningococcal meningitis (12%). Of the 48 patients with bacterial meningitis and coexisting arthritis, four died (8%) and 10 (23%) had residual joint symptoms. CONCLUSION: Arthritis is a common manifestation in patients with community-acquired bacterial meningitis. Functional outcome of arthritis in bacterial meningitis is generally good because meningococcal arthritis is usually immune-mediated, and pneumococcal arthritis is generally less deforming than staphylococcal arthritis. Nevertheless, additional therapeutic measures should be considered if clinical course is complicated by arthritis. In patients with infectious arthritis prolonged antibiotic therapy is mandatory