Preterm birth : parents' experiences, affect, stress and inflammatory markers

Preterm birth (PTB), before 37 completed weeks of gestation, is the principal risk factor for neonatal morbidity and mortality. In Sweden about 5.6% of women deliver preterm. The etiology of PTB is not fully understood, but it has been suggested that the mechanisms could have both biological and psychosocial origins. Parents’ health and experiences in association with PTB have been quite overlooked, particularly those of the fathers and of parents of infants born late preterm. However, stress in parents could influence the parent’s caregiving capacity. The aim of this thesis was to gain further understanding of the psychosocial contribution to the etiology of PTB, of a possible inflammatory pathway for the psychosocial contribution and of the consequences of PTB for parents’ health and experiences of caregiving. Study I is a population-based study where the association between antenatal scores of depressive symptoms and PTB was investigated. The results show that depressive symptoms contribute to increased risk for PTB, also after adjusting for other known risk factors for PTB. In Study II it was investigated if affectivity differs between mothers with PTB and mothers with term birth and if maternal and umbilical cord serum cytokines differ between these groups. Further, if there are associations between mothers’ emotions and maternal and cord cytokines at preterm and term birth. The findings indicate associations between negative emotions and both maternal and neonate immune activity in PTB. Study III is an interview study of first-time parents’ experiences of early and late PTB. The findings show hindering and facilitating factors in the development of parents’ caregiving. Hinders for mothers and fathers in both groups were attributed both to physical hinders, such as separation from the infant and to emotional hinders, such as fear, worry or few cues from the infant. Hinders were also attributed to the clinical practices. Facilitating factors were mental or physical closeness to the infant, being together as parents as well as support from the staff. Study IV aimed at investigating levels of and associations between perceived stress and an inflammatory marker, comparing parents of preterm and full term infants at two timepoints. Mothers of infants born preterm showed higher stress levels early post partum, compared to the term group. The stress declined over time and was comparable to levels in the term group at infant age four months. Subgroup analyses showed greater stress in mothers of infants born early preterm at both time-points compared to the term group. In fathers, no differences in stress levels were found between the preterm and term groups but fathers of infants born early preterm reported higher stress levels early post partum than fathers of infants born late preterm. No associations were found between stress levels and the inflammatory marker. In parents of preterm infants, high levels of stress at infant age four months were predicted by stress levels early post partum. The results support the notion of psychosocial contribution to the etiology of PTB via an inflammatory pathway. Future studies in this area should preferably include both psychological and biological markers. The findings also reveal hindering and facilitating factors to parents’ early caregiving after PTB and elevated stress levels, particularly in parents of infants born early preterm, suggesting a further need to support these parents

Smärtbedömning hos katt

Syftet med denna litteraturstudie är att undersöka vilken litteratur som finns inom området kronisk smärta hos katt, med fokus på smärta orsakad av osteoartrit (OA) och degenerativ ledsjukdom (DJD). Arbetet syftar också till att utreda vilka metoder det finns idag för att bedöma, utvärdera, diagnosticera samt behandla dessa tillstånd, både inom forskningen och på klinik. Katter är som djurslag bra på att dölja tecken på smärta och skada, vilket gör det till en stor utmaning att upptäcka och göra en korrekt klinisk bedömning av smärta. Smärttillstånd hos katt har länge varit både underskattade och underbehandlade. En av de vanligaste muskeloskeletala sjukdomarna som orsakar kronisk smärta hos katter är OA, vilket ingår i begreppet DJD. OA är en ledsjukdom som kännetecknas av ledvärk, stelhet och inskränkt rörlighet. Det är en låggradig inflammatorisk sjukdom i rörliga synovialleder, karakteriserad av förslitning av ledbrosket samt bildandet av nytt ben på ledytan och längs ledbroskets kant. Studier har visat att prevalensen av OA är hög, ffa hos äldre katter. En studie visade att 90 % av katter över 12 år hade tydliga tecken på degenerativa ledförändringar. Generellt vet man väldigt lite om riskfaktorer och bakomliggande orsaker till att katter utvecklar OA. Den största riskfaktorn för OA hos katt tros vara hög ålder. Det saknas i dagsläget objektiva, standardiserade utvärderingsinstrument, t.ex. gånganalyser för katt, vilket försvårar bedömning av smärta och diagnosticering av OA och DJD. Det har även visat sig att röntgen som diagnostiskt instrument ibland kan vara missvisande, d.v.s. alla röntgenologiska tecken på OA ger inte smärtsvar vid palpation av motsvarande led, samtidigt som leder som bedöms vara smärtsamma inte alltid visar tecken på OA på röntgen. En klinisk undersökning som inkluderar gånganalys och palpation, kompletterad med anamnes, är ofta nyckeln till upptäckt av muskeloskeletala sjukdomar hos katt. Dock är det en utmaning att genomföra en sådan undersökning, då katter ofta blir stressade i nya miljöer, som till exempel kliniker och samarbetar då inte alltid vid undersökning. Katter med OA uppvisar ofta förändrat beteende. Minskad aktivitetsnivå, försämrad hoppförmåga och lägre höjd på hoppen, minskad rörlighet, minskat putsningsbeteende samt ökad eliminering utanför kattlådan är vanliga sjukdomstecken. Det finns frågeformulär som ägaren kan fylla i med syfte att få fram information om beteendeförändringar, förändringar i aktivitetsnivå osv, vilket kan vara till hjälp i diagnostiken. En metod som hittills mest används forskningsmässigt är tryckmatta, med vilken man kan mäta hur katter belastar sina tassar vid gång och vid hopp. Nyligen har ett referensmaterial på friska katter tagits fram. OA är en livslång sjukdom som inte kan botas utan bara lindras. Vardagen för en drabbad katt kan underlättas med olika typer av hjälpmedel och det finns även godkända preparat för långtidsbehandling av smärtan. Vid de flesta fall av OA är de bakomliggande faktorerna fortfarande okända och det finns behov av mer forskning på området.The aim of this study is to investigate the literature available in the area of chronic pain in cats, with focus on pain caused by osteoarthritis (OA) and degenerative joint disease (DJD). The work also aims to investigate which methods are available today to assess, evaluate, diagnose and treat these conditions, both in research and in the clinic. Cats are good at hiding signs of pain and injury, which make it a great challenge to discover and make an accurate clinical assessment of pain. Pain in cats has long been both underestimated and undertreated. One of the most common musculoskeletal diseases that causes chronic pain in cats, is OA, which is included in the concept of DJD. OA is a disease characterized by joint pain, stiffness and limitation of mobility. It is a low-grade inflammatory disorder of the movable (synovial) joints characterized by deterioration of articular cartilage and by the formation of new bone at the joint surface and margins. Studies have showed that the prevalence of OA is high, particularly in older cats. One study showed that 90% of cats over 12 years had clear signs of degenerative joint changes. In general, little is known about risk factors and underlying causes in the development of OA in cats. The greatest risk factor for OA in cats is believed to be increased age. Today there is a lack of objective, standardized assessment instruments, such as gait analysis in cats, which complicates the assessment of pain and diagnosis of OA and DJD. It has also been shown that radiographic signs as a diagnostic instrument, sometimes can be misleading. Radiographic signs of OA not always give pain response to palpation of the same joint, while joints that seem to be painful, do not always show radiographic signs of OA. A clinical examination that includes gait analysis and palpation, supplemented by history, are often the key to the discovery of musculoskeletal disorders in cats. However, it is a challenge to implement such an examination, because cats are often stressed in new environments such as clinics, leading to non-cooperation during the examination. Cats with OA often exhibit altered behavior. Reduced activity level, reduced jumping ability, lower height of the jumps, decreased mobility, decreased grooming behavior and increased elimination outside of the litter box are common signs of the disease. There are questionnaires that the owner can fill out in order to obtain information about changes in behavior, changes in activity level, etc, which can be helpful in the diagnosis. One method that is still in the research stage is a pressure mat, with which one can measure how cats put weight on their paws while walking and jumping. Recently a reference material in healthy cats was developed. OA is a lifelong disease that can not be cured but only eased. It can make life easier for the cat with different types of tools and there is also approved drugs for long term treatment of pain. In most cases of OA, the etiology remains unknown, and there is need for more research in this area

Conditions for detecting lensed Population III galaxies in blind surveys with the James Webb Space Telescope, the Roman Space Telescope and Euclid

Dark matter halos that reach the HI-cooling mass without prior star formation or external metal pollution represent potential sites for the formation of small Population III galaxies at high redshifts. Such objects are expected to attain total stellar masses of at most $10^6$ solar masses and will therefore typically be extremely faint. Gravitational lensing may in rare cases boost their fluxes to detectable levels, but to find even a small number of such objects requires very large sky areas to be surveyed. Because of this, a small, wide-field telescope can in principle offer better detection prospects than a large telescope with a smaller field of view. Here, we derive the Pop III galaxy properties - in terms of comoving number density, stellar initial mass function and total stellar mass - required to allow gravitational lensing to lift such objects at redshift z = 5-16 above the detection thresholds of blind surveys carried out with the James Webb space telescope (JWST), the Roman space telescope (RST) or Euclid. We find that the prospects for photometric detections of Pop III galaxies are promising, and that they are better for RST than for JWST and Euclid. However, the Pop III galaxies favoured by current simulations have number densities too low to allow spectroscopic detections based on the strength of the HeII1640 emission line in any of the considered surveys unless very high star formation efficiencies (10 per cent) are envoked.Comment: 13 pages, 4 figure

Inflammatory biomarkers and perinatal depression: a systematic review

This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.Background: Approximately 10 to 20% of pregnant women worldwide experience perinatal depression (PND), a depressive episode with onset during pregnancy or after childbirth. We performed a systematic review to identify, summarize and discuss studies on inflammatory biomarkers described in relation to PND. Methods: Inclusion criteria defined the selection of observational studies written in English, French, Spanish or Portuguese, that evaluate analytical levels of inflammatory molecules (protein levels) in biological fluids in women, with a diagnosis of depression using ICD/DSM diagnostic criteria or depressive symptoms assessed by standardized psychometric instruments, during pregnancy and/or postpartum. Case reports, experimental studies, reviews, qualitative analysis, meta-analysis, gray literature or replicated data were excluded. Three electronic databases were used for search (Pubmed, Web of Science and PsychInfo) and quality assessment of selected studies were performed using the Newcastle-Ottawa Scale. Data extraction included study design; number of subjects; obstetric information; tools and timepoints of depression and inflammatory markers assessment. Results: 56 studies where the major aim was to analyze the association between depression and inflammatory biomarkers during pregnancy and postpartum period were included in this systematic review. Overall, the findings of our systematic review lend support to the hypothesis that several inflammatory markers may be associated with peripartum depressive symptoms. The associations were somewhat different looking at pregnancy compared to the delivery time-point and postpartum, and mainly referred to increased levels of IL-6, IL-8, CRP and TNF-α among depressed. Discussion: Our results revealed high heterogeneity in relation to the timing of biological sampling for markers, as well as timing and instruments used for depression assessment within the perinatal period for the different studies. Studies differed also in relation to use of biomarkers or depression as exposure and outcome respectively, and whether these were addressed at the same timepoint or separate ones. Given the high burden of PND on women, children and families, it is crucial to try to harmonize methods used in related studies, in order to be able to pool results that could give us insights into the pathophysiological mechanisms behind how the immune system and PND are connected; this could have great impact on early detection, prevention and even treatment of PND.AS-F was supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education, through the national funds, within the scope of the Transitory Disposition of the Decree No. 57/2016, of 29th of August, amended by Law No. 57/2017 of 19 July and previously through the fellowship grant SFRH/BPD/107732/2015. This paper is part of the COST Action Riseup-PPD CA18138 and was supported by COST under COST Action Riseup-PPD CA18138 (Virtual Mobility Grant)

The preterm cervix reveals a transcriptomic signature in the presence of premature pre-labor rupture of membranes

BACKGROUND: Premature prelabor rupture of fetal membranes accounts for 30% of all premature births and is associated with detrimental long-term infant outcomes. Premature cervical remodeling, facilitated by matrix metalloproteinases, may trigger rupture at the zone of the fetal membranes overlying the cervix. The similarities and differences underlying cervical remodeling in premature prelabor rupture of fetal membranes and spontaneous preterm labor with intact membranes are unexplored. OBJECTIVES: We aimed to perform the first transcriptomic assessment of the preterm human cervix to identify differences between premature prelabor rupture of fetal membranes and preterm labor with intact membranes and to compare the enzymatic activities of matrix metalloproteinases-2 and -9 between premature prelabor rupture of fetal membranes and preterm labor with intact membranes. STUDY DESIGN: Cervical biopsies were collected following preterm labor with intact membranes (n = 6) and premature prelabor rupture of fetal membranes (n = 5). Biopsies were also collected from reference groups at term labor (n = 12) or term not labor (n = 5). The Illumina HT-12 version 4.0 BeadChips microarray was utilized, and a novel network graph approach determined the specificity of changes between premature prelabor rupture of fetal membranes and preterm labor with intact membranes. Quantitative reverse transcription-polymerase chain reaction and Western blotting confirmed the microarray findings. Immunofluorescence was used for localization studies and gelatin zymography to assess matrix metalloproteinase activity. RESULTS: PML-RARA-regulated adapter molecule 1, FYVE-RhoGEF and PH domain-containing protein 3 and carcinoembryonic antigen-ralated cell adhesion molecule 3 were significantly higher, whereas N-myc downstream regulated gene 2 was lower in the premature prelabor rupture of fetal membranes cervix when compared with the cervix in preterm labor with intact membranes, term labor, and term not labor. PRAM1 and CEACAM3 were localized to immune cells at the cervical stroma and NDRG2 and FGD3 were localized to cervical myofibroblasts. The activity of matrix metalloproteinase-9 was higher (1.22 ± 4.403-fold, P < .05) in the cervix in premature prelabor rupture of fetal membranes compared with preterm labor with intact membranes. CONCLUSION: We identified 4 novel proteins with a potential role in the regulation of cervical remodeling leading to premature prelabor rupture of fetal membranes. Our findings contribute to the studies dissecting the mechanisms underlying premature prelabor rupture of fetal membranes and inspire further investigations toward the development of premature prelabor rupture of fetal membranes therapeutics

Health consultation to achieve lifestyle change

Bakgrund: Patientföljsamhet har en betydelsefull roll för att få en effektiv behandling. Motiverande samtal kan användas för att få patienten att hitta sin egen motivation för att uppnå livsstilsförändring samt följsamhet till behandling. Genom en hälsosammare kost tillsammans med rökstopp och ökad fysisk aktivitet skulle 80 % av alla fall av hjärtsjukdom, 90 % av diabetessjukdom och 30 % av all cancersjukdom, kunna förebyggas. Syfte: Att belysa hur sjuksköterskan, genom hälsosamtal med fokus på motiverande samtal, kan motivera och stödja patienten till en livsstilsförändring. Metod: En litteraturöversikt gjordes där 13 artiklar valdes ut för analys. Resultat: Hälsosamtal med inriktning på motiverande samtal visade sig ha positiva effekter på motivationen till att genomgå en livsstilsförändring och följsamheten för att följa behandlingsrekommendationerna. Motiverande samtal upplevdes positivt och förmedlade en god kommunikation mellan sjuksköterska och patient. Såväl svårigheter som möjligheter identifierades med metoden. Diskussion: Att visa empati, använda öppna frågor och reflektivt lyssnande identifierades som viktiga egenskaper i samtalet mellan patient och sjuksköterska. Att stödja patienten att tro på sig själv och sin egen förmåga till förändring var den främsta faktorn som gjorde patienten redo för att genomgå en livsstilsförändring. Motiverande samtal var en metod som ställer krav på sjuksköterskan och träning i metoden behövs. Det finns flera organisatoriska svårigheter som kan försvåra ett bra samtal. Slutsats: Ett bra hälsosamtal inriktat på motiverande samtal kan innebära ökad motivation hos patienten för att genomföra en livsstilsförändring och det kan öka följsamheten för behandlingsrekommendationerna med en bättre livskvalitet som resultat

Hidden gems

My interest in architecture is based on discovery and stories. The citys rooms is for everyone. Places for the people to use. Rooms programmed for different purposes, do they really need to be activated to be relevant and exist? I have selected three places that I discovered and became attached to, for strong senses and architectural qualities. Using archival materials and architectural representational techniques, working between 2D to 3D, digital and analog, have I explored the sites to better understand them. I have also found collective descriptions of experiences, activities and events from the places that have made me gain a different kind of understanding. How to convey the history of a place through architectural mediums and how can I work with representation to show the specific events or activities that has attended at the site?Can the narratives create more interest in hidden public places in the city? I've investigated Sagorummet; The chair that disappeared, Tysta Mari gången; The activety that closed down and Glasbrukstäppan; The Swan that flew awa