RESUMEN
PURPOSE: Even when a screening study has demonstrated a mortality reduction, the degree of pre-testing and contamination is of importance as it can dilute the "true" effect of screening. Our object was to describe the level of pre-testing and contamination in the Göteborg-1 prostate cancer screening trial. MATERIALS AND METHODS: A total of 20,000 men, 50-64 years old, were invited in 1994 and randomized to either a screening group (offered prostate specific antigen testing every 2 years) or to a control group. Follow-up was through December 31, 2014. Outcome measurement was overall testing in the screening group and control group. A positive prostate specific antigen test was defined as a prostate specific antigen ≥3 ng/ml. RESULTS: In the study, 4.2% in the screening group and 4.6% men in the control group were tested before study start. During follow-up, 72% in the control group took at least 1 prostate specific antigen test (contamination) compared to 87% of men in the screening group. Of all prostate specific antigens, 24% in the screening group and 39% in the control group were above threshold. In total, 66% of the men underwent prostate biopsy within 12 months from a raised prostate specific antigen in the screening group and 28% in the control group. CONCLUSIONS: Similar proportions of men were prostate specific antigen-tested in both the screening group and control group, yet only a minority of contamination prostate specific antigens led to biopsy. Also, men in the screening group started screening at a younger age. These could both be explanations for our result that organized screening is more effective in reducing prostate cancer mortality than non-organized testing. When carried out properly and compared to an unscreened population, the effects of organized screening are likely even greater than previously shown in the Göteborg screening trial.
Asunto(s)
Antígeno Prostático Específico , Neoplasias de la Próstata , Biopsia , Detección Precoz del Cáncer , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Próstata/patologíaRESUMEN
OBJECTIVE: To investigate hair cortisol concentrations (HCC) monthly in pregnant women and to explore the effect of parity. DESIGN: Prospective cohort study from gestational week (GW) 26, at childbirth and postpartum. SETTING: An antenatal care clinic in southeast Sweden. SAMPLE: 390 pregnant women. METHODS: Cortisol was measured using radioimmunoassay in methanol extracts of ground hair samples. MAIN OUTCOME MEASURES: Hair cortisol concentrations. RESULTS: Both primi- and multiparae exhibited an increase in HCC throughout pregnancy. Primiparae had significantly higher HCC in the latter part of the last trimester compared with multiparae (1 month P = 0.003, 2 months P = 0.038). The use of psychotropic medication in the first trimester correlated to HCC postpartum (P < 0.001). HCC in GW 14-17 was associated with HCC in GW 18-21 (primiparae and multiparae, P < 0.001), GW 22-25 (primiparae P = 0.036, multiparae P = 0.033), and 2 months postpartum (primiparae P = 0.049). HCC in GW 18-21 was associated with GW 22-25 in both primiparae (P < 0.001) and multiparae (P < 0.001) as well as 2 months prior to childbirth among primiparae (<0.037). In general, all estimates of HCC in pregnancy and postpartum showed a significant association between HCC for a specific month and the HCC in the previous month (all P < 0.001), except for the association of HCC among primiparae in GW 22-25 and 3 months prior to childbirth. CONCLUSIONS: Increased cortisol concentrations in hair were observed during pregnancy, which decreased 3 months prior to childbirth in multiparae. The results indicate a quicker suppression of the hypothalamic CRH (corticotropin-releasing hormone) production by placenta CRH in multiparous women. TWEETABLE ABSTRACT: Multiparae have a quicker suppression of hypothalamic CRH production by placenta CRH during pregnancy compared to primiparae.
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Cabello/metabolismo , Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisario/metabolismo , Paridad/fisiología , Sistema Hipófiso-Suprarrenal/metabolismo , Embarazo/metabolismo , Adolescente , Adulto , Biomarcadores/metabolismo , Femenino , Humanos , Modelos Lineales , Periodo Posparto/metabolismo , Estudios Prospectivos , Radioinmunoensayo , Adulto JovenRESUMEN
OBJECTIVE: To examine whether women who undergo in vitro fertilisation (IVF) treatment are at greater risk of postnatal suicide or postnatal depression (PND) requiring psychiatric care, compared with women who conceive spontaneously. DESIGN: Case-control study using data from national registers. SETTING: Sweden during the period 2003-2009. POPULATION: Cases were 3532 primiparous women who had given birth following IVF treatment. An aged-matched control group of 8553 mothers was randomly selected from the medical birth register. METHODS: Logistic regression analyses were performed with PND as the outcome, and with known risk factors of PND as well as IVF/spontaneous birth as covariates. MAIN OUTCOME MEASURES: Postnatal depression (PND), defined as diagnoses F32-F39 of the tenth edition of the International Classification of Diseases (ICD-10), within 12 months of childbirth. RESULTS: Initial analyses showed that PND was more common in the control group than in the IVF group (0.8 versus 0.4%; P = 0.04); however, these differences disappeared when confounding factors were controlled for. A history of any psychiatric illness (P = 0.000; odds ratio, OR = 25.5; 95% confidence interval, 95% CI = 11.7-55.5), any previous affective disorder (P = 0.000; OR = 26.0; 95% CI = 10.5-64.0), or specifically a personality disorder (P = 0.028; OR = 3.8; 95% CI = 1.2-12.7) increased the risk of PND. No woman in either group committed suicide during the first year after childbirth. CONCLUSIONS: Whereas mothers who receive IVF treatment are not at increased risk of PND, the risk is increased among mothers with a history of mental illness. TWEETABLE ABSTRACT: A Swedish study on 3532 women showed that IVF treatment does not increase the risk of postnatal depression.
Asunto(s)
Depresión Posparto/epidemiología , Fertilización In Vitro/psicología , Suicidio/estadística & datos numéricos , Adulto , Estudios de Casos y Controles , Parto Obstétrico , Depresión Posparto/etiología , Femenino , Humanos , Embarazo , Sistema de Registros , Factores de Riesgo , Suecia/epidemiologíaRESUMEN
OBJECTIVE: To compare sociodemographics, parity and mode of delivery between women diagnosed with vaginismus or localised provoked vestibulodynia (LPV) to women without a diagnosis before first pregnancy. DESIGN: Retrospective, population-based register study. SETTING: Sweden. SAMPLE: All women born in Sweden 1973-83 who gave birth for the first time or remained nulliparous during the years 2001-09. METHODS: Nationally linked registries were used to identify the study population. Women diagnosed with vaginismus or LPV were compared to all other women. Odds ratios for parity and mode of delivery were calculated using multinominal regression analysis and logistic regression. MAIN OUTCOME MEASURES: Parity and mode of delivery. RESULTS: Women with vaginismus/LPV were more likely to be unmarried (P = 0.001), unemployed (P = 0.012), have a higher educational level (P < 0.001), a lower body mass index (P < 0.001) and use nicotine during pregnancy (P = 0.008). They were less likely to give birth (adjusted odds ratio [OR] 0.61, 95% confidence interval [95% CI] 0.56-0.67). Women with vaginismus/LPV more often delivered by caesarean section (P < 0.001) especially for maternal request (adjusted OR 3.48, 95% CI 2.45-4.39). In women having vaginal delivery, those with vaginismus/LPV were more likely to suffer a perineal laceration (adjusted OR 1.87, 95% CI 1.56-2.25). CONCLUSIONS: Women with vaginismus/LPV are less likely to give birth and those that do are more likely to deliver by caesarean section and have a caesarean section based upon maternal request. Those women delivering vaginally are more likely to suffer perineal laceration. These findings point to the importance of not only addressing sexual function in women with vaginismus/LPV but reproductive function as well.
Asunto(s)
Cesárea/estadística & datos numéricos , Parto Obstétrico/estadística & datos numéricos , Dispareunia/epidemiología , Complicaciones del Trabajo de Parto/epidemiología , Perineo/lesiones , Vaginismo/epidemiología , Vulvodinia/epidemiología , Adulto , Índice de Masa Corporal , Dispareunia/etiología , Dispareunia/psicología , Escolaridad , Femenino , Humanos , Estado Civil , Edad Materna , Complicaciones del Trabajo de Parto/etiología , Complicaciones del Trabajo de Parto/psicología , Oportunidad Relativa , Paridad , Embarazo , Sistema de Registros , Estudios Retrospectivos , Clase Social , Suecia/epidemiología , Vaginismo/complicaciones , Vaginismo/psicología , Vulvodinia/complicaciones , Vulvodinia/psicologíaRESUMEN
OBJECTIVE: To compare psychiatric in- and outpatient care during the 5 years before first delivery in primiparae delivered by caesarean section on maternal request with all other primiparae women who had given birth during the same time period. DESIGN: Prospective, population-based register study. SETTING: Sweden. SAMPLE: Women giving birth for the first time between 2002 and 2004 (n = 64 834). METHODS: Women giving birth by caesarean section on maternal request (n = 1009) were compared with all other women giving birth (n = 63 825). The exposure of interest was any psychiatric diagnosis according to the International Statistical Classification of Diseases and Related Health Problems (ninth revision, ICD-9, 290-319; tenth revision, ICD-10, F00-F99) in The Swedish national patient register during the 5 years before first delivery. MAIN OUTCOME MEASURES: Psychiatric diagnoses and delivery data. RESULTS: The burden of psychiatric illnesses was significantly higher in women giving birth by caesarean section on maternal request (10 versus 3.5%, P < 0.001). The most common diagnoses were 'Neurotic disorders, stress-related disorders and somatoform disorders' (5.9%, aOR 3.1, 95% CI 1.1-2.9), and 'Mood disorders' (3.4%, aOR 2.4, 95% CI 1.7-3.6). The adjusted odds ratio for caesarean section on maternal request was 2.5 (95% CI 2.0-3.2) for any psychiatric disorder. Women giving birth by caesarean section on maternal request were older, used tobacco more often, had a lower educational level, higher body mass index, were more often married, unemployed, and their parents were more often born outside of Scandinavia (P < 0.05). CONCLUSIONS: Women giving birth by caesarean section on maternal request more often have a severe psychiatric disease burden. This finding points to the need for psychological support for these women as well as the need to screen and treat psychiatric illness in pregnant women.
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Cesárea/psicología , Procedimientos Quirúrgicos Electivos/psicología , Trastornos Mentales/psicología , Madres , Adulto , Cesárea/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Femenino , Humanos , Trastornos Mentales/epidemiología , Madres/psicología , Oportunidad Relativa , Paridad , Embarazo , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Suecia/epidemiologíaRESUMEN
OBJECTIVE: To study the risk for congenital anomalies in the first child of women after bariatric surgery compared with all other women giving birth to their first child and divided by maternal body mass index (BMI) groups. DESIGN: Prospective, population-based register study. SETTING: Sweden. SAMPLE: All firstborn children to women born 1973-83 were studied to determine if they had a congenital anomaly and a mother who had undergone bariatric surgery before pregnancy. METHODS: A total of 270,805 firstborns; of which 341 had mothers who had had bariatric surgery before delivery. We retrieved information on the women's marital or cohabitation status, smoking, BMI, diabetes and hypertension during pregnancy. MAIN OUTCOME MEASURES: Congenital malformations. RESULTS: Of the firstborn children to mothers who had had bariatric surgery before pregnancy, 4.1% (95% confidence interval [95% CI] 2.2-6.0) were malformed compared with 3.4% (95% CI 3.3-3.5) of those whose mothers had not undergone bariatric surgery. The risk for congenital malformation in firstborn children increased with increasing maternal BMI. The adjusted odds ratio (OR) for congenital malformation among children whose mothers' BMI ranged between 25 and 29 kg/m(2) was 1.09 (95% CI 1.03-1.15), whose mothers' BMI ranged between 30 and 34 kg/m(2) was 1.14 (1.05-1.24) and whose mothers' BMI was ≥35 kg/m(2) was 1.30 (95% CI 1.16-1.45) compared with those whose mothers had a normal BMI. Bariatric surgery before pregnancy did not have any effect on the odds ratio for having congenital malformation (OR = 1.09, 95% CI 0.63-1.91). CONCLUSIONS: Preconception bariatric surgery does not seem to affect the risk for congenital malformations but a high to very high BMI does appear to increase the risk.
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Cirugía Bariátrica/efectos adversos , Orden de Nacimiento , Anomalías Congénitas/etiología , Adolescente , Adulto , Índice de Masa Corporal , Anomalías Congénitas/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/cirugía , Atención Preconceptiva/estadística & datos numéricos , Embarazo , Complicaciones del Embarazo/epidemiología , Estudios Prospectivos , Factores de Riesgo , Suecia/epidemiología , Adulto JovenRESUMEN
The HLA class I and class II loci are the most highly polymorphic coding regions in the human genome. Based on the similarity of the coding sequences of alleles between species, it has been claimed that the HLA polymorphism is ancient and predates the separation of human (Homo) and chimpanzee (Pan), 4-7.4 Myr ago. Analysis of intron sequences, however, provides support for a more recent origin and for rapid generation of alleles at the HLA class II DRB1 locus. The human DRB1 alleles can be divided into groups (allelic lineages); most of these lineages have diverged from each other before the separation of Homo and Pan. Alleles within such a lineage, however, appear to be, on average, 250,000 years old, implying that the vast majority (greater than 90%) of the more than 135 contemporary human DRB1 alleles have been generated after the separation of Homo and Pan. The coalescence time of alleles within allelic lineages indicates that the effective population size (Ne) for early hominids (over the last 1 Myr) was approximately 10(4) individuals, similar to estimates based on other nuclear loci and mitochondrial DNA. With a single exception, the genetic mechanisms (gene conversion and point mutation) that have diversified the exon-2 sequences do not appear to extend into the adjacent intron sequences. The part of exon 2 encoding the beta-sheet evolves in concert with the surrounding introns, while the alpha-helix appears to have been subjected to gene conversion-like events, suggesting that such exchange events are highly localised and occur over extremely short sequence tracts.
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Evolución Biológica , Variación Genética , Antígenos HLA-DR/genética , Modelos Genéticos , Alelos , Animales , Secuencia de Bases , Genética de Población , Cadenas HLA-DRB1 , Humanos , Intrones , Datos de Secuencia Molecular , Filogenia , Polimorfismo Genético , Primates/genética , Homología de Secuencia de Ácido Nucleico , Factores de TiempoRESUMEN
BACKGROUND: The aim of this study was to investigate if individuals born with sub-optimal birth characteristics have reduced probability of reproducing in adulthood. METHODS: Using population-based registries, the authors included 522 216 males and 494 692 females born between 1973 and 1983 and examined their reproductive status as of 2006. Outcome measure was the hazard ratio (HR) of reproducing. Adjustments were made for socio-economic factors. RESULTS: Males and females born very premature displayed a reduced probability of reproducing [HR = 0.78, 95% confidence interval (CI): 0.70-0.86 for males; HR = 0.81, CI: 0.75-0.88 for females]. Likewise for very low birthweight (HR = 0.83, CI: 0.71-0.95 for males; HR = 0.80, 95% CI: 0.72-0.89 for females). Individuals born large for gestational age (LGA) displayed no significant changes. Males born small for gestational age (SGA) had a 9% lower reproductive rate (CI: 0.89-0.94) and that reduction increased as the individuals aged. Women born SGA tended to start reproducing at an earlier age. CONCLUSION: The results suggest that being born with low birthweight, premature or SGA (for males) is associated with a reduced probability of reproducing as an adult. LGA shows no statistically significant relationship with future reproduction.
Asunto(s)
Recién Nacido de Bajo Peso , Nacimiento Prematuro/epidemiología , Sistema de Registros , Reproducción , Adulto , Estudios de Cohortes , Demografía , Femenino , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Masculino , Dinámica Poblacional , Suecia/epidemiologíaRESUMEN
OBJECTIVE: To perform a cost comparison of a weight gain restriction programme for obese pregnant women with standard antenatal care, and to identify if there were differences in healthcare costs within the intervention group related to degree of gestational weight gain or degree of obesity at programme entry. STUDY DESIGN: A comparison of mean healthcare costs for participants of an intervention study at antenatal care clinics with controls in south-east Sweden. METHODS: In total, 155 women in an intervention group attempted to restrict their gestational weight gain to <7 kg. The control group comprised 193 women. Mean costs during pregnancy, delivery and the neonatal period were compared with the costs of standard care. Costs were converted from Swedish Kronor to Euros (). RESULTS: Healthcare costs during pregnancy were lower in the intervention group. There was no significant difference in total healthcare costs (i.e. sum of costs during pregnancy, delivery and the neonatal period) between the intervention group and the control group. Within the intervention group, the subgroup that gained 4.5-9.5 kg had the lowest costs. The total cost, including intervention costs, was 1283 more per woman/infant in the intervention group compared with the control group (P=0.025). The degree of obesity at programme entry had no bearing on the outcome. CONCLUSIONS: The weight gain restriction programme for obese pregnant women was effective in restricting gestational weight gain to <7 kg, but had a higher total cost compared with standard antenatal care.
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Costos de la Atención en Salud/estadística & datos numéricos , Obesidad/prevención & control , Complicaciones del Embarazo/prevención & control , Atención Prenatal , Aumento de Peso , Adulto , Control de Costos , Costos y Análisis de Costo , Ejercicio Físico , Femenino , Humanos , Motivación , Embarazo , SueciaRESUMEN
OBJECTIVE: Preterm birth and restricted foetal growth are related to symptoms of psychiatric disorder. Our aim was therefore to investigate possible relations between being born preterm and/or small for gestational age (SGA) and later psychiatric hospitalization. METHOD: A population-based registry study of psychiatric hospitalization of in total 155,994 boys and 148,281 girls born in Sweden in 1973-1975. RESULTS: The risk of hospitalization for all mental disorders was increased for preterm SGA boys (OR 2.19, 95% CI 1.49-3.21); at-term SGA boys (OR 1.55, 95% CI 1.34-1.79); at-term SGA girls (OR 1.31, 95% CI 1.15-1.50). At-term SGA boys and girls suffered increased risk of anxiety and adjustment disorders (OR 1.70, 95% CI 1.18-2.45 and OR 1.49, 95% CI 1.14-1.94). Preterm SGA boys were at risk of personality disorders (OR 3.30, 95% CI 1.16-9.41) and psychotic disorders (OR 4.36, 95% CI 1.85-10.30). CONCLUSION: The results show a relationship between being born SGA and later psychiatric hospitalization, where preterm birth and male gender seem to increase the risk.
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Retardo del Crecimiento Fetal/epidemiología , Hospitales Psiquiátricos , Enfermedades del Prematuro/epidemiología , Recién Nacido Pequeño para la Edad Gestacional , Trastornos Mentales/epidemiología , Admisión del Paciente/estadística & datos numéricos , Trastornos de Adaptación/epidemiología , Adolescente , Trastornos de Ansiedad/epidemiología , Estudios de Cohortes , Femenino , Humanos , Recién Nacido , Masculino , Trastornos del Humor/epidemiología , Trastornos de la Personalidad/epidemiología , Embarazo , Trastornos Psicóticos/epidemiología , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Factores Sexuales , Estadística como Asunto , Suecia , Adulto JovenRESUMEN
AIM: To examine the effect of hospitalization during adolescence on the likelihood of giving birth. METHODS: 142 998 women born in 1973-75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio-economic characteristics and factors related to the studied women's own birth. RESULTS: The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29-1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20-24 years but a reduced thereafter. CONCLUSION: A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.
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Adolescente Hospitalizado/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Historia Reproductiva , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Parto , Embarazo , Modelos de Riesgos Proporcionales , Factores Socioeconómicos , Suecia , Adulto JovenRESUMEN
OBJECTIVE: To minimise obese women's total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome. DESIGN: A prospective case-control intervention study. SETTING: Antenatal care clinics in the southeast region of Sweden. POPULATION: One hundred fifty-five pregnant women in an index group and one hundred ninety-three women in a control group. METHODS: An intervention programme with weekly motivational talks and aqua aerobic classes for obese pregnant women. MAIN OUTCOME MEASURES: Weight gain in kilograms, delivery and neonatal outcome. RESULTS: The index group had a significantly lower weight gain during pregnancy compared with the control group (P < 0.001). The women in the index group weighed less at the postnatal check-up compared with the weight registered in early pregnancy (P < 0.001). The percentage of women in the index group who gained less than 7 kg was greater than that of women in the control group who gained less than 7 kg (P= 0.003). The percentage of nulliparous women in this group was greater than that in the control group (P= 0.018). In addition, the women in the index group had a significantly lower body mass index at the postnatal check-up, compared with the control group (P < 0.001). There were no differences between the index group and the control group regarding birthweight, gestational age and mode of delivery. CONCLUSION: The intervention programme was effective in controlling weight gain during pregnancy and did not affect delivery or neonatal outcome.
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Obesidad/prevención & control , Complicaciones del Embarazo/prevención & control , Aumento de Peso/fisiología , Adulto , Peso al Nacer , Estudios de Casos y Controles , Parto Obstétrico/estadística & datos numéricos , Femenino , Edad Gestacional , Humanos , Embarazo , Resultado del Embarazo , Estudios ProspectivosRESUMEN
Human papillomavirus 16 (HPV16) is a predominant cause of cervical neoplasia. However, no population-based study with long-term follow-up has clarified the temporal relationship between HPV16 infection and occurrence of carcinoma in situ, or the importance of recurrent or persistent infection. This nested case-control study was carried out in a population-based cohort of women participating in cytological screening whose initial smear, taken in 1969-1995, was normal. During up to 26 years of follow-up, carcinoma in situ was diagnosed in 484 eligible women. Archival smears from these women were compared with smears from 619 individually matched controls. After DNA extraction, a highly sensitive PCR system was used to detect HPV16. Among case women, the prevalence of HPV16 positivity was 56% at the time of diagnosis. The relative risk of cervical carcinoma in situ increased from 3.6 (95% confidence interval, 1.2-11.0) 13 years before diagnosis to 11.1 (95% confidence interval, 5.5-22.2) 1 year before diagnosis. Having a positive smear at entry to the cohort increased risk >5-fold, whereas having persistent infection with HPV in two subsequent smears increased risk 30-fold. We estimated that among HPV16-positive women, the median incubation period from infection to carcinoma in situ was 7-12 years. We conclude that evidence of persistent and/or recurrent infection is associated with a drastically higher risk of cervical carcinoma in situ than occasional infection with HPV16.
Asunto(s)
Carcinoma in Situ/virología , Carcinoma de Células Escamosas/virología , Papillomaviridae , Infecciones por Papillomavirus/complicaciones , Infecciones Tumorales por Virus/complicaciones , Neoplasias del Cuello Uterino/virología , Adolescente , Adulto , Anciano , Carcinoma in Situ/epidemiología , Carcinoma de Células Escamosas/epidemiología , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Tamizaje Masivo , Persona de Mediana Edad , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/virología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Suecia/epidemiología , Factores de Tiempo , Infecciones Tumorales por Virus/epidemiología , Infecciones Tumorales por Virus/virología , Neoplasias del Cuello Uterino/epidemiología , Frotis VaginalRESUMEN
OBJECTIVE: To assess self-perceived mental health in women treated with in vitro fertilisation (IVF) 20-23â years previously, while comparing them to a reference group, and to determine any differences in mental health between those who had given birth, those who had adopted a child, those who had given birth and adopted a child and those who remained childless. DESIGN: A cross-sectional study. SETTING: A Center of Reproductive Medicine (RMC) at a Swedish University hospital. PARTICIPANTS: 520 women who had undergone at least one IVF cycle at the University Hospital in Linköping between 1986 and 1989. 504 of 520 women (97%) were eligible for follow-up. While 34 women declined, 93 per cent (n=470) of the women agreed to participate. The reference group consisted of 150 women of the Swedish population included in a study that was used to validate the Symptom CheckList (SCL)-90. INTERVENTIONS: Follow-up was conducted in 2008-2009. The SCL-90 was used to measure the women's self-perceived mental health and a questionnaire specific for this study was used to retain demographic information. OUTCOME MEASURES: The SCL-90 assesses 9 primary dimensions; somatisation, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. There is also a global index of distress. RESULTS: Women who had previously undergone IVF treatment were at increased risk of symptoms of depression (p=0.017), obsessive-compulsion (p=0.02) and somatisation (p≤0.001) when compared to a reference group. In addition, the women who have remained childless are at increased risk of symptoms of depression (p=0.009) and phobic anxiety (p=0.017). CONCLUSIONS: The majority of the women who have been treated with IVF 20-23â years previously appear to be in good mental health. However, women who remain childless and/or without partner after unsuccessful infertility treatment constitute a vulnerable group even later on in life.
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Ansiedad/etiología , Depresión/etiología , Fertilización In Vitro/psicología , Infertilidad Femenina/psicología , Trastornos Mentales/etiología , Salud Mental , Conducta Reproductiva/psicología , Adopción , Adulto , Estudios Transversales , Femenino , Fertilización , Humanos , Infertilidad Femenina/terapia , Persona de Mediana Edad , Madres/psicología , Trastorno Obsesivo Compulsivo/etiología , Factores de Riesgo , Autoinforme , Trastornos Somatomorfos/etiología , Encuestas y Cuestionarios , Suecia , Resultado del TratamientoRESUMEN
The papillomaviruses form a nonenveloped virion with an icosahedral capsid structure and contain a double-stranded circular DNA genome of 7800-7900 bp. The HPV genome is organized into three major regions; two protein-coding regions (1) early and (2) late-expressing genes, and (3) a noncoding upstream regulatory region (URR) (Fig. 1). The early region is downstream of the URR and consist of six open reading frames (ORFs) (El, E2, E4, E5, E6, and E7). El encodes a DNA binding protein involved in the regulation of viral DNA replication. E2 regulates viral DNA replication and gene expression. E4 is only expressed during the viral infection phase, and important for the maturation and replication of the virus. The function of E5 is less well known and may involve a stimulation of cell proliferation in HPV-infected cells. E5 has also shown a weak transforming activity. The E6 and E7 are coding for two oncoproteins with a high transforming activity. Upon integration into the human genome, E2 and parts of the El gene are, in general, deleted. This is followed by high levels of E6 and E7 expression. The late region contains two ORFs termed LI and L2 that code for the viral capsid proteins (1). Finally, the URR, or LCR long control region, contains binding sites for different transcriptional repressors and activators, and along with E5-7, is highly variable among HPV types.
RESUMEN
Biological material in forensic casework frequently contains a mixture of genotypes, with a predominance of material from the victim and only trace amounts from the person committing the crime. Physical separation of the two genotypes or preferential lysis of different cell types may sometimes be possible. However, it is often difficult to achieve complete separation due to the lysis of cells or lack of material. We have developed an enzymatic amplification system for the HLA DQA1 locus, that will allow the presence of individual alleles in a sample with mixed genotypes to be determined, independent of their initial proportion in the sample. This system permits the identification of an allele representing less than 10(-4) of the background genotype. Use of polymerase chain reaction (PCR) with general primers allows only alleles representing more than about 1% to be detected, while the allele-specific amplification represents up to a 1000-fold increase in sensitivity. This method was applied to a rape case and a combined rape and murder case; in both cases the biological evidential materials contained a mixture of alleles from the victim and the rapist. Allele-specific PCR revealed the presence of alleles identical to those of the suspect using DNA from a vaginal swab taken after a rape incident, whereas by using general primers in the PCR only trace amounts of alleles other than those of the victim were found. Similarly, allele-specific amplification of DNA from vaginal swabs from the murder case revealed the presence of alleles identical to those of the suspect, while standard PCR only indicated the presence of genetic material from the victim.
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Alelos , ADN/análisis , Medicina Legal/métodos , Antígenos HLA-DQ/genética , Secuencia de Bases , Vestuario , ADN/sangre , Femenino , Genotipo , Cadenas alfa de HLA-DQ , Homicidio , Humanos , Masculino , Datos de Secuencia Molecular , Hibridación de Ácido Nucleico , Sondas de Oligonucleótidos/química , Reacción en Cadena de la Polimerasa , Valor Predictivo de las Pruebas , Violación/diagnóstico , Vagina/químicaRESUMEN
OBJECTIVE: The investigational AS04-adjuvanted herpes simplex virus type 2 (HSV-2) glycoprotein D (gD2) subunit prophylactic vaccine ('HSV vaccine'; GlaxoSmithKline Vaccines) has been shown to be well tolerated in adults, but limited data exist for pre-teen and adolescent girls, a likely target population. The primary objective of this study was to compare the occurrence of serious adverse events (SAEs) over 12 months between HSV vaccine recipients and saline recipients (placebo control group) in pre-teen and adolescent girls. The immunogenicity of the HSV vaccine was also assessed. METHODS: Healthy girls aged 10-17 years, stratified by age (10-15 years; 16-17 years), were randomised 2:1:1 to receive the HSV vaccine, a hepatitis A vaccine (Havrix™; HAV control) or placebo (saline) according to a 0-, 1-, 6-month schedule. Participants and study personnel not involved in the preparation or administration of vaccines were blinded to treatment. Safety and immunogenicity analyses were performed overall and by age (10-15 years; 16-17 years) and HSV serostatus. RESULTS: No statistically significant difference in the percentage of subjects with SAEs was observed between the HSV and saline group, or between the HSV and pooled control (HAV and saline) groups. The HSV vaccine was well tolerated, although a higher incidence of solicited local symptoms was observed in the HSV group than in the control group. Neither age nor HSV serostatus at the time of study entry had an impact on the safety profile of this vaccine. The HSV vaccine was immunogenic regardless of pre-vaccination HSV serostatus. Higher anti-gD geometric mean concentrations were observed in HSV-1 seropositive participants than in HSV-1 seronegative participants. CONCLUSION: The HSV vaccine had an acceptable safety profile, and was well tolerated and immunogenic when administered to girls aged 10-17 years regardless of age or HSV pre-vaccination serostatus.
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Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Herpes Genital/prevención & control , Vacunas contra Herpesvirus/efectos adversos , Vacunas contra Herpesvirus/inmunología , Adolescente , Niño , Método Doble Ciego , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/patología , Femenino , Herpes Genital/inmunología , Herpesvirus Humano 2/inmunología , Vacunas contra Herpesvirus/administración & dosificación , Humanos , Placebos/administración & dosificación , Vacunas de Subunidad/administración & dosificación , Vacunas de Subunidad/efectos adversos , Vacunas de Subunidad/inmunología , Proteínas del Envoltorio Viral/inmunologíaRESUMEN
OBJECTIVE: to investigate midwives' attitudes and opinions on mode of birth. DESIGN: exploratory descriptive study. Data were collected via study-specific questionnaires during 2006. SETTING: southeastern Sweden. PARTICIPANTS: all midwives working in two counties. FINDINGS: regardless of age, experience and working field, the midwives considered a reasonable caesarean rate to be around 11.5 per cent. None of the participants thought that the caesarean rate was too low. Midwives younger than 50 years tended to consider the current caesarean rate to be too high (p=0.059). Midwives working on labour wards stated that they thought the current caesarean rate was too high compared with midwives working at antenatal care clinics (ACCs) (p<0.001). Midwives working at ACCs agreed with the statements 'one should agree to a woman's right to have an elective caesarean' (p<0.001) and 'elective caesarean is the best choice for a woman with fear of birth' (p=0.046) more often than midwives working on labour wards, regardless of age or working experience. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: midwives working at ACCs are more willing to accept caesarean section at the woman's request and for women with fear of birth. It is of importance that ACC caregivers and professionals on labour wards increase their collaboration and have continuous discussions with one another in an attempt to reach consensus about the appropriate caesarean rates on evidence-based grounds.
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Actitud del Personal de Salud , Parto Obstétrico , Partería/estadística & datos numéricos , Parto , Adulto , Factores de Edad , Cesárea/enfermería , Conducta de Elección , Miedo , Femenino , Encuestas de Atención de la Salud , Humanos , Persona de Mediana Edad , Parto/psicología , Embarazo , SueciaAsunto(s)
Médicos Mujeres , Derechos de la Mujer/legislación & jurisprudencia , Femenino , Humanos , SueciaRESUMEN
OBJECTIVE: To investigate the prevalence of depressive symptoms and self reported health of women who have shown previous postpartum depressive symptoms. To examine the behavior of four-year-old children born to mothers affected by postpartum depression. METHODS: Longitudinal study. The index group (n = 251) constituted of all women with postpartum depressive symptoms on the Edinburgh Postnatal Depression Scale (EPDS), in a population-based study made in the late 1990s. The control group (n = 502) consisted of women without postpartum depressive symptoms on the EPDS at the same occasion. Approximately four years after delivery these women were asked to answer a short questionnaire on general health, the EPDS, and also to assess their child's behavior with the Richman Pre-School Behaviour Checklist. RESULTS: Women with a history of postpartum depressive symptoms were approximately 6 times more likely to have recurrent depressive symptoms (OR = 5.82, 95% CI: 3.79-8.93), compared to those without postpartum depressive symptoms, and they were also more likely to experience physical and mental illness. Although postpartum depressive symptoms in the mothers were involved in explaining the likelihood of behavioral problems in their four-year-old children, mothers with current depressive symptoms were the most likely to have a child with behavioral problems (OR = 4.71, 95% CI: 1.88-11.78). CONCLUSION: Postpartum depressive illness constitutes a risk for future illness as well as maternal perceived behavioral problems in offspring. In order to diminish long-term adverse consequences for the mother and the child there is a great need to recognize and treat women with postpartum depressive symptoms as early as possible.