Defects in protective cytokine profiles in spontaneous miscarriage in the first trimester.

OBJECTIVE: To study differences in cytokine expression profiles between women with ongoing pregnancy and those experiencing spontaneous miscarriage, among women who presented with threatened miscarriage before week 16 of gestation. DESIGN: Prospective cohort study. SETTING: Academic hospital. PATIENT(S): In this prospective cohort study, 155 pregnant women, comprising normal pregnant women recruited from antenatal clinics (n = 97) and women with threatened miscarriage recruited from an emergency walk-in clinic (n = 58). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Sixty-five serum cytokines quantified using multiplex immunoassay correlated with miscarriage outcomes. RESULT(S): Among women presenting with threatened miscarriage, those who eventually miscarried had significantly lower levels of interleukin (IL)-2, IL-12p70, IL-17A, B-cell-activating factor, B lymphocyte chemoattractant, basic nerve growth factor, interferon-γ, tumor necrosis factor-related apoptosis-inducing ligand, thymic stromal lymphopoietin, and tumor necrosis factor-α and higher levels of vascular endothelial growth factor A, IL-21, and stromal cell-derived factor 1α than those with ongoing pregnancy. Comparisons between normal pregnancies and women with threatened miscarriage who eventually miscarried revealed significant differences across 7 cytokines: B-cell-activating factor; B lymphocyte chemoattractant; basic nerve growth factor; IL-17A; fractalkine/CX3CL1; vascular endothelial growth factor A; and CCL22. Vascular endothelial growth factor A exhibited a negative correlation with the progesterone level (r = -0.270). The cluster of significant cytokines alludes to T cell proliferation, B-cell proliferation, natural killer cell-mediated cytotoxicity, and apoptosis as important pathways that determine pregnancy outcomes. Bioinformatic analysis further revealed alteration of the suppressor of cytokine signaling proteins family of Janus kinase-signal transducer and activator of transcription signaling axis by cytokines as a plausible key molecular mechanism in spontaneous miscarriage. CONCLUSION(S): This study demonstrates that the regulated balance between the proinflammatory and anti-inflammatory pathways is crucial to maintaining pregnancy. A better understanding of the cytokines associated with immunomodulatory effects may lead to novel targets for the prediction and treatment of spontaneous miscarriage.

Nocturnal Lifestyle Behaviours and Risk of Poor Sleep during Pregnancy.

The extent to which lifestyle practices at night influence sleep quality in pregnant women remains unknown. This study aimed to examine whether nocturnal behaviours were associated with poor sleep during pregnancy. We performed a cross-sectional analysis of a prospective cohort of pregnant women at 18-24 gestation weeks recruited from KK Women's and Children's Hospital, Singapore, between 2019 and 2021. Nocturnal behaviours were assessed with questionnaires, and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) with a global score ≥5 indicative of poor sleep quality. Modified Poisson regression and linear regression were used to examine the association between nocturnal behaviour and sleep quality. Of 299 women, 117 (39.1%) experienced poor sleep. In the covariate-adjusted analysis, poor sleep was observed in women with nocturnal eating (risk ratio 1.51; 95% confidence interval [CI] 1.12, 2.04) and nocturnal artificial light exposure (1.63; 1.24, 2.13). Similarly, nocturnal eating (ß 0.68; 95% CI 0.03, 1.32) and light exposure (1.99; 1.04, 2.94) were associated with higher PSQI score. Nocturnal physical activity and screen viewing before bedtime were not associated with sleep quality. In conclusion, reducing nocturnal eating and light exposure at night could potentially improve sleep in pregnancy.

Developing a lifestyle intervention program for overweight or obese preconception, pregnant and postpartum women using qualitative methods.

The time period before, during and after pregnancy represents a unique opportunity for interventions to cultivate sustained healthy lifestyle behaviors to improve the metabolic health of mothers and their offspring. However, the success of a lifestyle intervention is dependent on uptake and continued compliance. To identify enablers and barriers towards engagement with a lifestyle intervention, thematic analysis of 15 in-depth interviews with overweight or obese women in the preconception, pregnancy or postpartum periods was undertaken, using the integrated-Promoting Action on Research Implementation in Health Services framework as a guide to systematically chart factors influencing adoption of a novel lifestyle intervention. Barrier factors include time constraints, poor baseline knowledge, family culture, food accessibility, and lack of relevant data sources. Enabling factors were motivation to be healthy for themselves and their offspring, family and social support, a holistic delivery platform providing desired information delivered at appropriate times, regular feedback, goal setting, and nudges. From the findings of this study, we propose components of an idealized lifestyle intervention including (i) taking a holistic life-course approach to education, (ii) using mobile health platforms to reduce barriers, provide personalized feedback and promote goal-setting, and (iii) health nudges to cultivate sustained lifestyle habits.

Systematic review of determinants influencing antibiotic prescribing for uncomplicated acute respiratory tract infections in adult patients at the emergency department.

OBJECTIVE: Overuse of antibiotics in the emergency department (ED) for uncomplicated acute respiratory tract infections (uARTIs) is a public health issue that needs to be addressed. We aimed to identify factors associated with antibiotic use for uARTIs in adults presenting at the ED. DESIGN: We searched Medline, Embase, PsycINFO and the Cochrane Library for articles published from 1 January 2005 to 30 June 2017 using a predetermined search strategy. Titles and abstracts of English articles on antibiotic prescription and inappropriate antibiotic use for adult ARTI at EDs were assessed, followed by full article review, by 2 authors. SETTING: Emergency departments. PARTICIPANTS: Adults aged 18 years and older. RESULTS: Of the 2,591 articles retrieved, 12 articles met the inclusion criteria and 11 studies were conducted in the United States. Patients with normal C-reactive protein levels and positive influenza tests were less likely to receive antibiotic treatment. Nonclinical factors associated with antibiotic use were longer waiting time and perceived patient desire for antibiotics. Patients attended by internal medicine physicians comanaged by house staff or who visited an ED which provided education to healthcare providers on antibiotics use were less likely to receive antibiotics. CONCLUSIONS: English-language articles that fulfilled the selection criteria outside the United States were limited. Factors associated with antibiotics use are multifaceted. Education of healthcare providers presents an opportunity to improve antibiotic use.

Is comfort food really good for the soul? A replication of Troisi and Gabriel's (2011) Study 2.

We report the results of three high-powered replications of Troisi and Gabriel's (2011) idea that writing about comfort food reduces feelings of loneliness amongst securely attached individuals after a belongingness threat. We conducted our studies amongst a large group of participants (Total N = 649) amongst American (MTurk), Dutch (Tilburg University; TiU), and Singaporean (Singapore Management University; SMU) samples. Participants first completed an attachment style scale, followed by writing two essays for manipulating a sense of belongingness and salience of comfort food, and then reporting their loneliness levels. We did not confirm the overall effect over all three countries. However, exploratory results provide the preliminary suggestion that (1) the comfort food explanation likely holds amongst the American samples (including Troisi and Gabriel's), but not amongst the TiU and SMU samples, and potentially that (2) the TiU and SMU participants self-regulate through warmer (vs. colder) temperature foods. Both of these should be regarded with great caution as these analyses were exploratory, and because the Ns for the different temperature foods were small. We suspect we have uncovered first cross-cultural differences in self-regulation through food, but further confirmatory work is required to understand the cultural significance of comfort food for self-regulation.

Perceptual symbols of creativity: coldness elicits referential, warmth elicits relational creativity.

Research in the cognitive and social psychological science has revealed the pervading relation between body and mind. Physical warmth leads people to perceive others as psychological closer to them and to be more generous towards others. More recently, physical warmth has also been implicated in the processing of information, specifically through perceiving relationships (via physical warmth) and contrasting from others (via coldness). In addition, social psychological work has linked social cues (such as mimicry and power cues) to creative performance. The present work integrates these two literatures, by providing an embodied model of creative performance through relational (warm = relational) and referential (cold = distant) processing. The authors predict and find that warm cues lead to greater creativity when 1) creating drawings, 2) categorizing objects, and 3) coming up with gifts for others. In contrast, cold cues lead to greater creativity, when 1) breaking set in a metaphor recognition task, 2) coming up with new pasta names, and 3) being abstract in coming up with gifts. Effects are found across different populations and age groups. The authors report implications for theory and discuss limitations of the present work.

Embodied metaphors and creative "acts".

Creativity is a highly sought-after skill. Prescriptive advice for inspiring creativity abounds in the form of metaphors: People are encouraged to "think outside the box", to consider a problem "on one hand, then on the other hand", and to "put two and two together" to achieve creative breakthroughs. These metaphors suggest a connection between concrete bodily experiences and creative cognition. Inspired by recent advances in the understanding of body-mind linkages in the research on embodied cognition, we explored whether enacting metaphors for creativity enhances creative problem solving. Our findings from five studies revealed that both physical and psychological embodiment of metaphors for creativity promoted convergent thinking and divergent thinking (i.e., fluency, flexibility, or originality) in problem solving. Going beyond prior research, which focused primarily on the kind of embodiment that primes preexisting knowledge, we provide the first evidence that embodiment can also activate cognitive processes that facilitate the generation of new ideas and connections.