Men, mindsets and birth: results of a prospective longitudinal study.

AIMS/BACKGROUND: In recent years, there has been an increased interested in the contribution of fathers to childbirth. In the present paper we explore whether the father's birth-related mindset (being either more natural or more medical) can predict the mother's labour and birth outcomes and whether the father's experience and evaluation of the birth can predict his psychological well-being after the birth. DESIGN/METHODS: We conducted a longitudinal study (N = 304 expecting fathers) spanning the first trimester of pregnancy up to six months after birth. RESULTS: The study results could be integrated into a Single Indicator Model. They indicated that a father's more natural birth-related mindset predicted low-intervention birth for the mother. A low-intervention birth led to a more positive birth experience for the father, and in turn to better postpartum adjustment, fewer symptoms of postpartum paternal depression eight weeks after birth, and more secure bonding to the infant six months after birth. CONCLUSION: The study results indicate that fathers do not take a merely passive role in childbirth. On the contrary, analogous to pregnant mothers, fathers' views about childbirth might contribute to the course of birth, and their own postpartum psychological well-being. The results of the present study, thus, highlight the importance of fathers for childbirth and in a broader sense, the results also contribute to a better understanding of the psychological framework of birth and represents a valuable starting point for further research.

Partner support and relationship quality as potential resources for childbirth and the transition to parenthood.

BACKGROUND: The aim of the present paper was to explore the role of partners for the stressful life events of birth and the transition to parenthood. METHODS: In a first prospective longitudinal study (N = 304 dyads) we tested whether relationship quality positively predicted fewer interventions during labor and birth, a more positive birth experience, and better well-being during the first six weeks after birth. In a second study we surveyed mothers (N = 980; retrospective quasi-experimental design) who had given birth during the first lockdown of the COVID-19 pandemic in spring 2020 - some in the absence of their partners - to test the assumption that regardless of relationship quality, the presence of the partner was positively related to low-intervention births and the birth experience. RESULTS: The results of the longitudinal study (Study 1) could be integrated into a Single Indicator model. They revealed that a high relationship quality assessed between week 5 and week 25 of pregnancy had a positive effect on birth experience for the mother and on psychological well-being during the transition to parenthood for both mothers and fathers. Results of the retrospective quasi-experimental field study (Study 2) revealed that the continuous presence of the partner was associated with a higher probability of a low-intervention birth and a more positive birth experience. Presence of a partner for only part of the birth did not positively predict labor and birth, but did positively predict the birth experience. The effects were independent of relationship quality. CONCLUSION: The results of both studies highlight the importance of partners for psychological well-being during labor and birth and the transition to parenthood.

Prenatal Sex Role Stereotypes: Gendered Expectations and Perceptions of (Expectant) Parents.

People assign attributes to a different degree to other persons depending on whether these are male or female (sex role stereotypes). Such stereotypes continue to exist even in countries with lower gender inequality. The present research tested the idea that parents develop sex role consistent expectations of their babies' attributes based on fetal sex (by ultrasound diagnostic), as well as gendered perceptions of their recently newborn babies. A total of 304 dyads of predominantly White expecting parents from Germany were followed over the course of pregnancy until after the birth and completed a sex role inventory on their babies' expected (before birth) as well as perceived traits (after birth). Specifically, they rated to what extent they expected their babies to have normatively feminine traits (e.g., soft-spoken and warm) and normatively masculine traits (e.g., independent and assertive) twice before birth (first half of pregnancy, six weeks before due date) and to what extent they perceived their baby to have these traits eight weeks after birth. The results suggested that fathers held gendered expectations and perceptions, whereas mothers did not. These results suggest that male and female babies are likely to encounter sex role stereotypes about their alleged attributes as soon as their birth.

[Conduct and reporting of focus groups in the health and nursing sciences: a scoping review]. / Durchführung und Berichterstattung von Fokusgruppen in der Gesundheits- und Pflegewissenschaft: ein Scoping Review.

BACKGROUND: Focus groups are used in qualitative research and increasingly so in the health and nursing sciences. There has been no previous research on how focus groups are used and reported in this context. A scoping review was conducted to address this question. METHODS: The databases MEDLINE via PubMed, CINAHL, and SSCI were searched for nursing and health science publications (2009-2019) that reported focus groups as a method. Due to the high number of hits, a one percent random sample was drawn per database. Two individuals checked the inclusion and exclusion criteria. Data extraction was performed using a literature-based matrix developed and discussed with experts. Results were content-analysed and quantified. RESULTS: The random sample was n=408 publications, of which n=319 were included after reviewing the inclusion and exclusion criteria. The use of semi-structured interview guides was reported most frequently (43.9 %) (more often referred to as focus group interviews in the publications); open discussions (11 %) and discussions without any guiding questions (6.3 %) were reported less frequently (more often referred to as focus group discussions in the publications). In none of the publications was the aspect of group interaction included into the analysis. Although the reporting is based on international standards, some specific methodological aspects were often inadequately reported or not reported at all: in 92 % of the publications there is no information about the interaction of the participants, and in 72 % the role of the moderating person was not described in detail. DISCUSSION: Semi-structured forms of focus groups predominate but open forms with only one introductory question are also used. It would have been expected that the interaction among the participants and group dynamic processes would have been considered in the more open approaches. Method-specific reporting items for focus groups have yet to be developed. This could contribute to an improvement of the reporting and critical reflection of, in particular, method-specific aspects. There is evidence that different nomenclature is used in the international literature, depending on the type of focus group. Researchers should choose the nomenclature carefully and describe the procedure precisely. CONCLUSION: The scoping review provides first insights into how focus groups are conducted and reported in health and nursing science research. The potential of the method could be more fully exploited regarding the analysis of group interaction. Future methodological work dealing with the focus group method should promote the establishment of an internationally consented nomenclature and the development of criteria for transparent reporting for different types of focus groups.

Arsenic removal with zero-valent iron filters in Burkina Faso: Field and laboratory insights.

Groundwater contaminated with geogenic arsenic (As) is frequently used as drinking water in Burkina Faso, despite adverse health effects. This study focused on testing low-cost filter systems based on zero-valent iron (ZVI), which have not yet been explored in West Africa for As removal. The active ZVI bed was constructed using small-sized iron nails, embedded between sand layers. Household filters were tested for nine months in a remote village relying on tube well water with As concentrations of 400-1350 µg/L. Daily filtered volumes were 40-60 L, with flow rates of ~10 L/h. In parallel, downscaled laboratory filter columns were run to find the best set-up for optimal As removal, with special attention given to the influence of input pH, flow rate and water/nail contact time. Arsenic removal efficiencies in the field were 60-80% in the first six months of operation. The laboratory experiments revealed that trapped air in the nail layer greatly lowered As removal due to preferential flow and decreased water/nail contact time. Measures taken to avoid trapped air led to a partial improvement in the field filters, but effluent As remained >50 µg/L. Similar structural modifications were however very successful in the laboratory columns, where As removal efficiencies were consistently >95% and effluent concentrations frequently <10 µg/L, despite inflow As >1000 µg/L. A constantly saturated nail bed and careful flow control is necessary for optimal As removal. Slow flow and longer pauses between filtrations are important for sufficient contact times and for transformation of brown amorphous Fe-hydroxides to dense magnetite with incorporated As(V). This preliminary study has shown that nail-based filters have the potential to achieve As removal >90% in a field context if conditions (filter bed saturation, flow rate, pauses between filtrations) are well controlled.

Cerebral oxygenation during pediatric congenital cardiac surgery and its association with outcome: a retrospective observational study.

PURPOSE: Non-invasive cerebral oxygen saturation (ScO2) monitoring is an established tool in the intraoperative phase of pediatric congenital cardiac surgery (CCS). This study investigated the association between ScO2 and postoperative outcome by investigating both baseline ScO2 values and intraoperative desaturations from baseline. METHODS: All CCS procedures performed in the period 2010-2017 in our institution in which ScO2 was monitored were included in this historical cohort study. Baseline ScO2 was determined after tracheal intubation, before surgical incision. Subgroups were based on cardiac pathology and degree of intracardiac shunting. Poor outcome was defined based on length of stay (LOS) in the intensive care unit (ICU)/hospital, duration of mechanical ventilation (MV), and 30-day mortality. Intraoperatively, ScO2 total time below baseline (TBBL) and ScO2 time-weighted average (TWA) were calculated. RESULTS: Data from 565 patients were analyzed. Baseline ScO2 was significantly associated with LOS in ICU (odds ratio [OR] per percentage decrease in baseline ScO2, 0.95; 95% confidence interval [CI], 0.93 to 0.97; P < 0.001), with LOS in hospital (OR, 0.93; 95% CI, 0.91 to 0.96; P < 0.001), with MV duration (OR, 0.92; 95% CI, 0.90 to 0.95; P < 0.001) and with 30-day mortality (OR, 0.94; 95% CI, 0.91 to 0.98; P = 0.007). Cerebral oxygen saturation TWA had no associations, while ScO2 TBBL had only a small association with LOS in ICU (OR, 1.02; 95% CI, 1.01 to 1.03; P < 0.001), MV duration (OR,1.02; 95% CI, 1.01 to 1.03; P = 0.002), and LOS in hospital (OR, 1.02; 95% CI, 1.01 to 1.04; P < 0.001). CONCLUSION: In pediatric patients undergoing cardiac surgery, low baseline ScO2 values measured after tracheal intubation were associated with several adverse postoperative outcomes. In contrast, the severity of actual intraoperative cerebral desaturation was not associated with postoperative outcomes. Baseline ScO2 measured after tracheal intubation may help identify patients at increased perioperative risk.

RéSUMé: OBJECTIF: Le monitorage non invasif de la saturation cérébrale en oxygène (ScO2) est un outil bien établi en phase peropératoire de chirurgie cardiaque congénitale pédiatrique. Cette étude a examiné l'association entre la ScO2 et le pronostic postopératoire en étudiant les valeurs de ScO2 initiales et les désaturations peropératoires par rapport à ces valeurs. MéTHODE: Toutes les interventions en chirurgie cardiaque congénitale réalisées entre 2010 et 2017 dans notre établissement et au cours desquelles la ScO2 a été monitorée ont été incluses dans cette étude de cohorte historique. La ScO2 de base était déterminée après l'intubation trachéale, avant l'incision chirurgicale. Les sous-groupes ont été catégorisés en fonction de la pathologie cardiaque et des shunts intracardiaques. Un mauvais pronostic était défini en fonction de la durée de séjour à l'unité de soins intensifs (USI)/ l'hôpital, de la durée de ventilation mécanique et de la mortalité à 30 jours. Pendant l'intervention, le temps total pendant lequel la ScO2 était au-dessous des valeurs de base et la moyenne pondérée dans le temps ont été calculés. RéSULTATS: Les données de 565 patients ont été analysées. Une association significative a été observée entre la ScO2 de base et la durée de séjour à l'USI (diminution du rapport de cotes [RC] par pourcentage de la ScO2 de base, 0,95; intervalle de confiance [IC] 95 %, 0,93 à 0,97; P < 0,001), la durée de séjour à l'hôpital (RC, 0,93; IC 95 %, 0,91 à 0,96; P < 0,001), la durée de ventilation mécanique (RC, 0,92; IC 95 %, 0,90 à 0,95; P < 0,001) et la mortalité à 30 jours (RC, 0,94; IC 95 %, 0,91 à 0,98; P = 0,007). La moyenne pondérée dans le temps de la saturation cérébrale en oxygène n'a pas révélé d'association, alors que le temps total au-dessous des valeurs de base de ScO2 n'a révélé qu'une petite association avec la durée de séjour à l'USI (RC, 1,02; IC 95 %, 1,01 à 1,03; P < 0,001), la durée de ventilation mécanique (RC, 1,02; IC 95 %, 1,01 à 1,03; P = 0,002), et la durée de séjour à l'hôpital (RC, 1,02; IC 95 %, 1,01 à 1,04; P < 0,001). CONCLUSION: Chez les patients pédiatriques subissant une chirurgie cardiaque, des valeurs de ScO2 basses lorsque mesurées après l'intubation trachéale étaient associées à plusieurs complications postopératoires. En revanche, la gravité de la désaturation cérébrale peropératoire n'était pas associée aux devenirs postopératoires. La ScO2 de base mesurée après l'intubation trachéale pourrait nous aider à identifier les patients courant un risque périopératoire accru.

Eligibility of Endovascular Repair for Popliteal Artery Aneurysms According the Instructions for Use.

BACKGROUND: Popliteal artery aneurysms (PAAs) are the most common peripheral aneurysms. Although rare and often asymptomatic, there is a significant risk of thrombosis, embolism, and limb loss. The aim of this study was to evaluate the eligibility for endovascular repair of patients treated for symptomatic and asymptomatic PAAs in accordance with the instructions for use (IFU). METHODS: All patients treated for PAA with open surgical repair between the years 2010 and 2017 were analyzed if suitable for endovascular treatment. Preoperative imaging was reviewed for applicability with an interventional radiologist and 2 vascular surgeons. Evaluation was performed in accordance with the following criteria adopted from the IFU of the Gore ® Viabahn stent graft: at least a single-vessel tibial runoff, proximal and distal landing zone more than 2 cm, no large difference in vessel diameter proximal and distal to the aneurysm, no overstenting of significant collaterals necessary, and no inadequate kinking of the artery. The patients were classified in 3 categories: the patient was eligible, endovascular treatment was feasible, and endovascular treatment was not appropriate. RESULTS: 51 patients with 61 symptomatic and asymptomatic PAAs were identified. Forty-five cases were asymptomatic, 11 cases showed clinical symptoms such as claudication, and in 5 cases, the patients presented with acute ischemia. Twenty-four patients were eligible for endovascular intervention, 14 cases were feasible, and in 23 cases, it was not appropriate in accordance with the IFU. CONCLUSIONS: In this study, more than one-third of the patients with PAA were not eligible for endovascular treatment in accordance with the IFU and another 23 % showed substantial reasons against endovascular treatment. These data suggest that endovascular repair remains a treatment option for selected patients only. Cross-sectional imaging is mandatory for procedure selection.

An exploratory study on the quality of patient screening and counseling for hypertension management in Tanzania.

BACKGROUND: The global burden of hypertension, currently estimated at 1 billion, is a leading Non-Communicable Disease (NCD) in Sub Saharan Africa. In Tanzania, the reported prevalence of hypertension is 25%. Inherent limitations of the healthcare system to control hypertension include inadequate provider knowledge, system capacity, medication access, and patient awareness, all of which hinder effective screening and disease management. To assess the quality of hypertension screening and patient counseling, we conducted a study in an ambulatory setting in Tanzania. METHODS: Observations of patient screening were conducted on 69 adult patients during routine outpatient care and screening camps. In addition, 33 healthcare providers participated in a pre-post knowledge assessment after observing instructional training videos. RESULTS: Patient observations indicated that blood pressure (BP) measurement was explained to 65% of patients, and 77% of the measurements were made with mercury sphygmomanometers. For several aspects of BP measurement, nurses performed better than doctors: patient's arm supported on a flat surface (doctors, 58% vs nurses 67%, p<0.05), and patient's back was supported (doctors, 50% vs nurses 88%, p<0.01). Among those diagnosed with hypertension, 7% were prescribed medications, 14% were advised on reduced salt during cooking, 29% on reduced salt consumption, 21% on reduced consumption of sodium rich foods, 21% on reducing caloric intake, 21% on increasing physical activity, and 43% were informed about follow up appointments. Provider knowledge assessments showed critical gaps in consequences of hypertension, 1st line medicines, and awareness of guidelines at baseline. Following the instructional videos there were improvements in some aspects: diagnostic criteria for hypertension (pre 45% vs post 91%, p<0.001) and counseling for controlling hypertension (pre 30% vs post 58%, p<0.01). CONCLUSION: Enhancing knowledge and performance competencies of health providers at the primary care level is a critical prerequisite for effective hypertension management in low resource settings.

Treatment of Severely Resorbed Maxilla Due to Peri-Implantitis by Guided Bone Regeneration Using a Customized Allogenic Bone Block: A Case Report.

The objective of this case report is to introduce a customized CAD/CAM freeze-dried bone allograft (FDBA) block for its use in Guided Bone Regeneration (GBR) procedures for severely deficient maxillary bones. Additionally, a special newly developed remote incision technique is presented to avoid wound dehiscence. The results show optimal integration behavior of the FDBA block after six months and the formation of new vital bone. Thus, the results of the present case report confirm the use of the customized CAD/CAM bone block for augmentation of complex defects in the maxillary aesthetic zone as a successful treatment concept.

Delayed allergic reaction to natalizumab associated with early formation of neutralizing antibodies.

BACKGROUND: Natalizumab is a new therapeutic option for relapsing-remitting multiple sclerosis. As with other antibody therapies, hypersensitivity reactions have been observed. In the Natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis (AFFIRM) trial, infusion-related hypersensitivity reactions developed in 4% of patients, usually within 2 hours after starting the infusion. OBJECTIVE: To report a significant, delayed, serum sickness-like, type III systemic allergic reaction to natalizumab. DESIGN: Case report describing clinical follow-up and the serial measurement of antinatalizumab antibodies. PATIENT: A 23-year-old man with relapsing-remitting multiple sclerosis developed a fever, arthralgias, urticarial exanthema, and a swollen lower lip during several days after his second infusion of natalizumab. RESULTS: The patient developed a delayed, serum sickness-like, type III systemic allergic reaction to natalizumab. Five weeks after initiation of this therapy, he tested positive for antinatalizumab antibodies and exhibited persistent antibody titers 8 and 12 weeks later. His symptoms completely resolved with a short course of oral glucocorticosteroids. CONCLUSION: Clinicians and patients should be alert not only to immediate but also to significantly delayed substantial allergic reactions to natalizumab.

Late-onset tumor necrosis factor receptor-associated periodic syndrome in multiple sclerosis patients carrying the TNFRSF1A R92Q mutation.

OBJECTIVE: Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is an autosomal-dominantly inherited autoinflammatory disorder caused by mutations in the TNFRSF1A gene. It is characterized by episodes of autoinflammation usually associated with fever, abdominal pain, myalgia, exanthema, arthralgia/arthritis, and ocular involvement. We undertook this study to investigate the prevalence of TRAPS in patients with multiple sclerosis (MS) who reported, in addition to their neurologic symptoms, at least 2 other symptoms compatible with TRAPS. METHODS: Twenty-five unrelated MS patients were prospectively screened for TNFRSF1A mutations. In addition, blood samples from 365 unrelated MS patients and 407 unrelated Caucasian controls were analyzed to determine the R92Q carrier frequency. RESULTS: Six of 25 adult MS patients (24%) with symptoms suggestive of TRAPS were found to carry the identical arginine-to-glutamine substitution at amino acid position 92 (R92Q or p.Arg121Gln) encoded by exon 4 of the TNFRSF1A gene. All R92Q heterozygotes had similar symptoms, including arthralgias/arthritis, myalgias, urticarial rash, and severe fatigue, which began before the onset of MS. In 5 of the 6 patients, we could identify family members who had TRAPS symptoms and had inherited the identical mutation. The R92Q exchange was also detected in 17 of 365 unselected MS patients (4.66%) and in 12 of 407 controls (2.95%) (P = 0.112). Three patients were heterozygous carriers of MEFV variants, in 1 patient in combination with the R92Q mutation. CONCLUSION: Autoinflammatory syndromes and especially late-onset TRAPS should be considered in MS patients who report symptoms such as arthralgias/arthritis, myalgias, urticarial rash, and severe fatigue.