The Role of Demand Factors in Utilization of Professional Care during Childbirth: Perspectives from Yemen

Background. Utilization of professional care during childbirth by women in low-income countries is important for the progress towards MDG 5. In Yemen, home births have decreased minimally during the past decades. Objective. The study investigates the influence of socio-demographic, birth outcome and demand factors on women's future preference of a home or institutional childbirth. Method. We interviewed 220 women with childbirth experience in urban/rural Yemen. We performed bivariate chi-square tests and multiple logistic regression analysis. A multistage sampling process was used. Results. The issues of own choice, birth support and birth complications were the most important for women's preference of future location of childbirth. Women who had previously been able to follow their own individual choice regarding birth attendance and/or location of childbirth were six times more likely to plan a future childbirth in the same location and women who received birth support four times more likely. Birth complications were associated with a 2.5-fold decrease in likelihood. Conclusions. To offer women with institutional childbirth access to birth support is crucial in attracting women to professional care during childbirth. Yemeni women's low utilization of modern delivery care should be seen in the context of women's low autonomy and status

Understanding chronic immunodeficiency disorders through assessment of cytotoxic lymphocyte function

Representing an evolving and diverse group of syndromes, immunodeficiencies can currently be viewed as a spectrum of disorders where a dysfunction of the immune system plays a significant etiologic role. Cytotoxic lymphocytes are immune cells that are pivotal for the eradication of infected and malignant cells. They also contribute to immune-regulation. Congruently, patients with defects in cytotoxic lymphocyte function show increased susceptibility to infections, malignancies and inflammation. This work focuses on the role of cytotoxic lymphocytes in syndromes where their pathophysiological involvement is suspected, but not established. The first study investigates the variability in cytotoxic effector functions introduced by commonly used pharmacological substances, knowledge that is important for the interpretation of patient data. The second study establishes a robust and sensitive addition to the arsenal of diagnostic assays for cytotoxic lymphocyte dysfunctions. The third study shows that myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), linked to viral infections and hypothesized to be caused by immune dysregulation, is not a syndrome where a substantial fraction of the patients has any obvious primary defect in lymphocyte cytotoxicity. The fourth and the fifth studies identify and functionally dissect the impact of autoantibodies directed against an inhibitory cytotoxic lymphocyte receptor, NKG2A, in patients with systemic lupus erythematosus (SLE), an autoimmune disorder. In summary, the studies expand our knowledge and toolbox for assessing lymphocyte cytotoxicity and highlight the complexity of interpreting experiments investigating cytotoxic lymphocyte function in the context of chronic immunodeficiency disorders. Furthermore, they provide clinically relevant insights about the role of cytotoxic lymphocytes in both ME/CFS and SLE

A topological data analysis based classification method for multiple measurements

HR was partly supported by a collaboration agreement between the University of Aberdeen and EPFL. WC was partially supported by VR 2014-04770 and Wallenberg AI, Autonomous System and Software Program (WASP) funded by Knut and Alice Wallenberg Foundation, Göran Gustafsson Stiftelse. JT is fully funded by the Wenner-Gren Foundation. JH is partially supported by VR K825930053. RR is partially supported by MultipleMS. The collaboration agreement between EPFL and University of Aberdeen played a role in the design of the neuron spiking analysis and in providing the data required, i.e. the neuronal network and the spiking activity. Open access funding provided by Karolinska Institute.Peer reviewedPublisher PD

Validating the Demand Control Support Questionnaire among white-collar employees in Switzerland and the United States

Background: The Demand Control Support Questionnaire (DCSQ) is an established self-reported tool to measure a stressful work environment. Validated German and English versions are however currently missing. The aim of this study was therefore to evaluate the psychometric properties of German and English versions of the DCSQ among white-collar employees in Switzerland and the US. Methods: This cross-sectional study was carried out on 499 employees in Switzerland and 411 in the US, respectively. The 17-item DCSQ with three scales assessed psychosocial stress at work (psychological demands, decision latitude, and social support at work). Depressive symptoms were measured by the 2-item Patient Health Questionnaire. Cronbach’s α and item-total correlations tested the scale reliability (internal consistency). Construct validity of the questionnaire was examined using exploratory factor analysis (EFA). Logistic regressions estimated associations of each scale and job strain with depressive symptoms (criterion validity). Results: In both samples, all DCSQ scales presented satisfactory internal consistency (Cronbach’s α ≥ 0.72; item-total correlations ≥ 0.33), and EFA showed the 17 items loading on three factors, which is in line with the theoretically assumed structure of the DCSQ construct. Moreover, all three scales as well as high job strain were significantly associated with depressive symptoms. The associations were stronger in the US sample. Conclusions: The German and the English versions of the DCSQ seem to be reliable and valid instruments to measure psychosocial stress based on the job demand-control-support model in the workplace of white-collar employees in Switzerland and the US

Predictors of self-rated health: a 12-month prospective study of IT and media workers

OBJECTIVE: The aim of the present study was to determine health-related risk and salutogenic factors and to use these to construct prediction models for future self-rated health (SRH), i.e. find possible characteristics predicting individuals improving or worsening in SRH over time (0–12 months). METHODS: A prospective study was conducted with measurements (physiological markers and self-ratings) at 0, 6 and 12 months, involving 303 employees (187 men and 116 women, age 23–64) from four information technology and two media companies. RESULTS: There were a multitude of statistically significant cross-sectional correlations (Spearman's Rho) between SRH and other self-ratings as well as physiological markers. Predictors of future SRH were baseline ratings of SRH, self-esteem and social support (logistic regression), and SRH, sleep quality and sense of coherence (linear regression). CONCLUSION: The results of the present study indicate that baseline SRH and other self-ratings are predictive of future SRH. It is cautiously implied that SRH, self-esteem, social support, sleep quality and sense of coherence might be predictors of future SRH and therefore possibly also of various future health outcomes