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1.
Scand J Public Health ; : 14034948241248684, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38720640

RESUMO

AIMS: Sexual harassment is common and may have serious consequences for well-being and health. We investigated the prevalence of sexual harassment in the general population of Stockholm County across socio-demographic groups and sexual identity, and its association with self-reported health. METHODS: Experiences of sexual harassment in the previous 12 months and its associations with self-reported health (depression, anxiety, suicidal ideation) were assessed in 2021/2022 among a random sample of 22,890 residents in Stockholm County aged 16 and older. Analyses were done using descriptive statistics and multivariate logistic regression (odds ratios and 95% confidence intervals (CI)). Calibration weights were used to estimate population-representative rates with 95% CI. RESULTS: The highest weighted prevalence was observed among 16- to 24-year-olds (18.9%, 95% CI 16.9%-20.9%). Women (9.5%; 95% CI 8.8%-10.1%) reported a higher prevalence than men (2.9%; 95% CI 2.5%-3.3%). Compared to heterosexual people, bisexual and homosexual people reported a higher prevalence of sexual harassment. No significant difference was observed related to country of birth. People who were students, unemployed or on sick leave were more exposed than employed people, although this was not significant when adjusted for age and registered sex. Experiences of sexual harassment was associated with higher odds of all aspects of self-reported health. CONCLUSIONS: Experiences of sexual harassment in the general population are common and associated with adverse self-reported health. There is a need for enhanced efforts to prevent sexual harassment in the general population and to empower specific risk groups such as women and sexual minorities.

2.
BMC Health Serv Res ; 24(1): 411, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38566080

RESUMO

BACKGROUND: Digital health care services have the potential to improve access to sexual and reproductive health care for youth but require substantial implementation efforts to translate into individual and public health gains. Health care providers are influential both regarding implementation and utilization of the services, and hence, their perceptions of digital health care services and the implementation process are essential to identify and address. The aim of this study was to explore midwives' perception of digital sexual and reproductive health care services for youth, and to identify perceived barriers and facilitators of the implementation of digital health care provision in youth clinics. METHODS: We performed semi-structured interviews with midwives (n = 16) working at youth clinics providing both on-site and digital sexual and reproductive health care services to youth in Stockholm, Sweden. Interview data were analyzed using a content analysis approach guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS: Midwives acknowledged that the implementation of digital health care improved the overall access and timeliness of the services at youth clinics. The ability to accommodate the needs of youth regarding their preferred meeting environment (digital or on-site) and easy access to follow-up consultations were identified as benefits of digital health care. Challenges to provide digital health care included communication barriers, privacy and confidentiality concerns, time constraints, inability to offer digital appointments for social counselling, and midwives' preference for in person consultations. Experiencing organizational support during the implementation was appreciated but varied between the respondents. CONCLUSION: Digital sexual and reproductive health care services could increase access and are valuable complements to on-site services in youth clinics. Sufficient training for midwives and organizational support are crucial to ensure high quality health care. Privacy and safety concerns for the youth might aggravate implementation of digital health care. Future research could focus on equitable access and youth' perceptions of digital health care services for sexual and reproductive health.


Assuntos
Tocologia , Serviços de Saúde Reprodutiva , Gravidez , Humanos , Adolescente , Feminino , Saúde Reprodutiva , Suécia , Atitude do Pessoal de Saúde , Aconselhamento
3.
Acta Oncol ; 62(11): 1496-1501, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37647380

RESUMO

BACKGROUND: The randomized clinical trial ESO-SPARE investigates if oesophagus-sparing radiotherapy (RT) can reduce dysphagia in patients with metastatic spinal cord compression (MSCC). Patient-reported outcome (PRO) is the only follow-up measure. Due to the fragile patient population, low respondent compliance was anticipated. We performed a planned interim analysis of dosimetry and respondent compliance, to ensure that the protocol requirements were met. METHODS: Patients >18 years referred for cervical/thoracic MSCC radiotherapy in 1-10 fractions were included from two centres. Patients were randomized (1:1) to standard RT or oesophagus-sparing RT, where predefined oesophageal dose constraints were prioritized over target coverage. Patients completed a trial diary with daily reports of dysphagia for 5 weeks (PRO-CTC-AE) and weekly quality of life reports for 9 weeks (QLQ-C30, EQ-5D-5L). According to power calculation, 124 patients are needed for primary endpoint analysis. The sample size was inflated to 200 patients to account for the fragile patient population. The co-primary endpoints, peak patient-reported dysphagia, and preserved ability to walk (EQ-5D-5L), are analysed at 5 and 9 weeks, respectively. The interim analysis was conducted 90 days after the inclusion of patient no 100. Respondent compliance was assessed at 5 and 9 weeks. In all RT plans, oesophagus and target doses were evaluated regarding adherence to protocol constraints. RESULTS: From May 2021 to November 2022, 100 patients were included. Fifty-two were randomized to oesophagus-sparing RT. In 23% of these plans, oesophagus constraints were violated. Overall, the dose to both target and oesophagus was significantly lower in the oesophagus-sparing plans. Only 51% and 41% of the patients were evaluable for co-primary endpoint analysis at five and nine weeks, respectively. Mortality and hospitalization rates were significantly larger in patients who completed <4 days PRO questionnaires. CONCLUSION: Compliance was lower than anticipated and interventions to maintain study power are needed.


Assuntos
Transtornos de Deglutição , Compressão da Medula Espinal , Humanos , Qualidade de Vida , Compressão da Medula Espinal/radioterapia , Medidas de Resultados Relatados pelo Paciente
4.
Eur J Epidemiol ; 38(10): 1043-1052, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37555907

RESUMO

Periodic revisions of the international classification of diseases (ICD) ensure that the classification reflects new practices and knowledge; however, this complicates retrospective research as diagnoses are coded in different versions. For longitudinal disease trajectory studies, a crosswalk is an essential tool and a comprehensive mapping between ICD-8 and ICD-10 has until now been lacking. In this study, we map all ICD-8 morbidity codes to ICD-10 in the expanded Danish ICD version. We mapped ICD-8 codes to ICD-10, using a many-to-one system inspired by general equivalence mappings such that each ICD-8 code maps to a single ICD-10 code. Each ICD-8 code was manually and unidirectionally mapped to a single ICD-10 code based on medical setting and context. Each match was assigned a score (1 of 4 levels) reflecting the quality of the match and, if applicable, a "flag" signalling choices made in the mapping. We provide the first complete mapping of the 8596 ICD-8 morbidity codes to ICD-10 codes. All Danish ICD-8 codes representing diseases were mapped and 5106 (59.4%) achieved the highest consistency score. Only 334 (3.9%) of the ICD-8 codes received the lowest mapping consistency score. The mapping provides a scaffold for translation of ICD-8 to ICD-10, which enable longitudinal disease studies back to and 1969 in Denmark and to 1965 internationally with further adaption.

5.
BMC Public Health ; 23(1): 2115, 2023 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-37891509

RESUMO

BACKGROUND: Growing evidence indicates that gender-based violence (GBV) increased during COVID-19. We investigated self-reported impact of the pandemic on GBV at community, household and intimate partner (IPV) levels among young people and its associations with psychosocial wellbeing, i.e., COVID-related stressors and mental health. METHODS: Cross-sectional data were drawn from a survey with young people ages 13-24 (N = 536) living with HIV (YPLWH) and without HIV (YPLWoH), in peri-urban Cape Town, South Africa. The survey, conducted February-October 2021, examined the impact of the initial lockdown on experience and perceived changes in GBV at each level, and pandemic-related psychosocial wellbeing. Descriptive statistics and binomial and multinomial regression analyses were conducted to illustrate exposure and perceived changes in GBV since lockdown, and their association with COVID-related stress factors (e.g., social isolation, anxiety about COVID), mental health (e.g., depression, anxiety), and other risk factors (e.g., age, gender, socioeconomic status) by HIV status. RESULTS: Participants were 70% women with mean age 19 years; 40% were living with HIV. Since lockdown, YPLWoH were significantly more likely than YPLWH to perceive community violence as increasing (45% vs. 28%, p < 0.001), and to report household violence (37% vs. 23%, p = 0.006) and perceive it as increasing (56% vs. 27%, p = 0.002) (ref: decreasing violence). YPLWoH were also more likely to report IPV experience (19% vs. 15%, p = 0.41) and perception of IPV increasing (15% vs. 8%, p = 0.92). In adjusted models, COVID-related stressors and common mental health disorders were only associated with household violence. However, indicators of economic status such as living in informal housing (RRR = 2.07; 95% CI = 1.12-3.83) and food insecurity (Community violence: RRR = 1.79; 95% CI = 1.00-3.20; Household violence: RRR = 1.72; 95% CI = 1.15-2.60) emerged as significant risk factors for exposure to increased GBV particularly among YPLWoH. CONCLUSIONS: Findings suggest that for young people in this setting, GBV at community and household levels was more prevalent during COVID-19 compared to IPV, especially for YPLWoH. While we found limited associations between COVID-related stressors and GBV, the perceived increases in GBV since lockdown in a setting where GBV is endemic, and the association of household violence with mental health, is a concern for future pandemic responses and should be longitudinally assessed.


Assuntos
COVID-19 , Violência de Gênero , Infecções por HIV , Violência por Parceiro Íntimo , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Masculino , África do Sul/epidemiologia , Estudos Transversais , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Fatores de Risco , Infecções por HIV/epidemiologia
6.
Sex Transm Infect ; 97(2): 141-146, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-31628248

RESUMO

An estimated 350 million cases of STIs occur globally each year. In Sweden, Chlamydia is the most common STI with approximately 30 000 cases annually, disproportionally affecting youth. National surveys report low condom use among youth. Smartphone coverage is high among this tech-savvy group. In collaboration with youth, we developed an interactive smartphone application comprising games, peer experiences and information snippets to promote condom use. OBJECTIVES: To evaluate in a randomised controlled trial, the effectiveness of this smartphone application to improve condom use among youth in Stockholm, Sweden. METHODS: This two-arm, individually randomised controlled trial was implemented through the Youth Health Clinics (YHC) in Stockholm, Sweden. Youth aged 18-23 years, who owned a smartphone and had ≥2 sexual partners during the past 6 months were eligible. The intervention delivered the interactive elements described above over 180 days. The control group received a 'dummy' application. Both groups received standard of care at the YHC. The primary outcome was proportion of consistent (100%) self-reported condom use at 6 months. Secondary outcomes included self-reported number of partners, occurrence of STIs/pregnancy and STI tests during the study period. An intention-to-treat approach was used. RESULTS: 214 and 219 youth were randomised to the intervention and control groups, respectively. Consistent condom use was reported for 32/214 (15.0%) in the intervention group and for 35/219 (16.0%) in the control group (OR 0.9, 95% CI 0.5 to 1.6). No significant differences in secondary outcomes were seen. CONCLUSION: We were unable to detect an effect of the intervention. Future research should focus on targeting different subgroups within the overall risk group, with tailored mHealth interventions. The potential for such interventions in settings where sexual health services are unavailable should be evaluated. TRIAL REGISTRATION NUMBER: ISRCTN13212899.


Assuntos
Promoção da Saúde/métodos , Aplicativos Móveis , Saúde Sexual/estatística & dados numéricos , Telemedicina , Adolescente , Feminino , Promoção da Saúde/estatística & dados numéricos , Humanos , Masculino , Sexo Seguro/estatística & dados numéricos , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Smartphone , Suécia/epidemiologia , Adulto Jovem
7.
Nature ; 514(7523): 518-22, 2014 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-25132545

RESUMO

Zinc is an essential micronutrient for all living organisms. It is required for signalling and proper functioning of a range of proteins involved in, for example, DNA binding and enzymatic catalysis. In prokaryotes and photosynthetic eukaryotes, Zn(2+)-transporting P-type ATPases of class IB (ZntA) are crucial for cellular redistribution and detoxification of Zn(2+) and related elements. Here we present crystal structures representing the phosphoenzyme ground state (E2P) and a dephosphorylation intermediate (E2·Pi) of ZntA from Shigella sonnei, determined at 3.2 Å and 2.7 Å resolution, respectively. The structures reveal a similar fold to Cu(+)-ATPases, with an amphipathic helix at the membrane interface. A conserved electronegative funnel connects this region to the intramembranous high-affinity ion-binding site and may promote specific uptake of cellular Zn(2+) ions by the transporter. The E2P structure displays a wide extracellular release pathway reaching the invariant residues at the high-affinity site, including C392, C394 and D714. The pathway closes in the E2·Pi state, in which D714 interacts with the conserved residue K693, which possibly stimulates Zn(2+) release as a built-in counter ion, as has been proposed for H(+)-ATPases. Indeed, transport studies in liposomes provide experimental support for ZntA activity without counter transport. These findings suggest a mechanistic link between PIB-type Zn(2+)-ATPases and PIII-type H(+)-ATPases and at the same time show structural features of the extracellular release pathway that resemble PII-type ATPases such as the sarcoplasmic/endoplasmic reticulum Ca(2+)-ATPase (SERCA) and Na(+), K(+)-ATPase. These findings considerably increase our understanding of zinc transport in cells and represent new possibilities for biotechnology and biomedicine.


Assuntos
Adenosina Trifosfatases/química , Adenosina Trifosfatases/metabolismo , Shigella/enzimologia , Trifosfato de Adenosina/metabolismo , Sítios de Ligação , Cádmio/metabolismo , ATPases Transportadoras de Cálcio/química , Sequência Conservada , Cristalografia por Raios X , Chumbo/metabolismo , Modelos Moleculares , Fosforilação , Proteolipídeos/química , Proteolipídeos/metabolismo , ATPases Translocadoras de Prótons/química , ATPases Translocadoras de Prótons/metabolismo , ATPase Trocadora de Sódio-Potássio/química , Zinco/metabolismo
8.
Anal Chem ; 91(11): 7418-7425, 2019 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-31056901

RESUMO

This work demonstrates for the first time the creation of microchip electrophoresis devices with ∼50 µm cross-sectional dimensions by stereolithographic 3D printing and their application in the analysis of medically significant biomarkers related to risk for preterm birth (PTB). We determined that device current was linear with applied potential up to 800 V (620 V/cm). We optimized device and separation conditions using fluorescently labeled amino acids as a model system and compared the performance in our 3D printed microfluidic devices to that in other device materials commonly used for microchip electrophoresis analysis. We demonstrated for the first time microchip electrophoresis in a 3D printed device of three PTB biomarkers, including peptides and a protein, with suitable separation characteristics. Limits of detection for microchip electrophoresis in 3D printed microfluidic devices were also determined for PTB biomarkers to be in the high picomolar to low nanomolar range.


Assuntos
Eletroforese em Microchip , Dispositivos Lab-On-A-Chip , Nascimento Prematuro/diagnóstico , Impressão Tridimensional , Aminoácidos/química , Biomarcadores/análise , Feminino , Corantes Fluorescentes/química , Humanos , Gravidez
9.
Electrophoresis ; 40(21): 2853-2859, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31373007

RESUMO

Preterm birth (PTB) related health problems take over one million lives each year, and currently, no clinical analysis is available to determine if a fetus is at risk for PTB. Here, we describe the preparation of a key PTB risk biomarker, thrombin-antithrombin (TAT), and characterize it using dot blots, MS, and microchip electrophoresis (µCE). The pH for fluorescently labeling TAT was also optimized using spectrofluorometry and spectrophotometry. The LOD of TAT was measured in µCE. Lastly, TAT was combined with six other PTB risk biomarkers and separated in µCE. The ability to make and characterize TAT is an important step toward the development of an integrated microfluidic diagnostic for PTB risk.


Assuntos
Antitrombina III/análise , Eletroforese em Microchip/métodos , Espectrometria de Massas/métodos , Peptídeo Hidrolases/análise , Biomarcadores , Humanos , Limite de Detecção , Sistemas Automatizados de Assistência Junto ao Leito
10.
Anal Bioanal Chem ; 411(21): 5405-5413, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30382326

RESUMO

Preterm birth (PTB) is defined as birth before the 37th week of pregnancy and results in 15 million early deliveries worldwide every year. Presently, there is no clinical test to determine PTB risk; however, a panel of nine biomarkers found in maternal blood serum has predictive power for a subsequent PTB. A significant step in creating a clinical diagnostic for PTB is designing an automated method to extract and purify these biomarkers from blood serum. Here, microfluidic devices with 45 µm × 50 µm cross-section channels were 3D printed with a built-in polymerization window to allow a glycidyl methacrylate monolith to be site-specifically polymerized within the channel. This monolith was then used as a solid support to attach antibodies for PTB biomarker extraction. Using these functionalized monoliths, it was possible to selectively extract a PTB biomarker, ferritin, from buffer and a human blood serum matrix. This is the first demonstration of monolith formation in a 3D printed microfluidic device for immunoaffinity extraction. Notably, this work is a crucial first step toward developing a 3D printed microfluidic clinical diagnostic for PTB risk.


Assuntos
Dispositivos Lab-On-A-Chip , Gravidez/sangue , Nascimento Prematuro , Impressão Tridimensional/instrumentação , Biomarcadores/sangue , Feminino , Humanos , Recém-Nascido , Polimerização
11.
Electrophoresis ; 39(18): 2300-2307, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29683528

RESUMO

Preterm birth (PTB) is responsible for over one million infant deaths annually worldwide. Often, the first and only indication of PTB risk is the onset of early labor. Thus, there is an urgent need for an early PTB risk diagnostic that is inexpensive, reliable, and robust. Here, we describe the development of a microchip electrophoresis (µCE) method for separating a mixture of six PTB protein and peptide biomarkers present in maternal blood serum. µCE devices were photografted with a poly(ethylene glycol) diacrylate surface coating to regulate EOF and reduce nonspecific analyte adsorption. Separation conditions including buffer pH, buffer concentration, and applied electric field were varied to improve biomarker peak resolution while minimizing deleterious effects like Joule heating. In this way, it was possible to separate six PTB biomarkers, the first µCE separation of this biomarker panel. LODs were also measured for each of the six PTB biomarkers. In the future, this µCE separation can be integrated with upstream maternal blood serum sample preparation steps to yield a complete PTB risk diagnosis microdevice.


Assuntos
Biomarcadores/sangue , Proteínas Sanguíneas/análise , Eletroforese em Microchip/métodos , Peptídeos/sangue , Nascimento Prematuro/sangue , Feminino , Humanos , Concentração de Íons de Hidrogênio , Limite de Detecção , Polietilenoglicóis/química , Gravidez , Soro/química , Propriedades de Superfície
12.
Anal Bioanal Chem ; 410(3): 933-941, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28799040

RESUMO

We have developed multichannel integrated microfluidic devices for automated preconcentration, labeling, purification, and separation of preterm birth (PTB) biomarkers. We fabricated multilayer poly(dimethylsiloxane)-cyclic olefin copolymer (PDMS-COC) devices that perform solid-phase extraction (SPE) and microchip electrophoresis (µCE) for automated PTB biomarker analysis. The PDMS control layer had a peristaltic pump and pneumatic valves for flow control, while the PDMS fluidic layer had five input reservoirs connected to microchannels and a µCE system. The COC layers had a reversed-phase octyl methacrylate porous polymer monolith for SPE and fluorescent labeling of PTB biomarkers. We determined µCE conditions for two PTB biomarkers, ferritin (Fer) and corticotropin-releasing factor (CRF). We used these integrated microfluidic devices to preconcentrate and purify off-chip-labeled Fer and CRF in an automated fashion. Finally, we performed a fully automated on-chip analysis of unlabeled PTB biomarkers, involving SPE, labeling, and µCE separation with 1 h total analysis time. These integrated systems have strong potential to be combined with upstream immunoaffinity extraction, offering a compact sample-to-answer biomarker analysis platform. Graphical abstract Pressure-actuated integrated microfluidic devices have been developed for automated solid-phase extraction, fluorescent labeling, and microchip electrophoresis of preterm birth biomarkers.


Assuntos
Hormônio Liberador da Corticotropina/análise , Eletroforese em Microchip/instrumentação , Ferritinas/análise , Nascimento Prematuro/diagnóstico , Extração em Fase Sólida/instrumentação , Biomarcadores/análise , Hormônio Liberador da Corticotropina/sangue , Eletroforese em Microchip/métodos , Desenho de Equipamento , Ferritinas/sangue , Corantes Fluorescentes/análise , Humanos , Nascimento Prematuro/sangue , Extração em Fase Sólida/métodos
13.
BMC Public Health ; 18(1): 216, 2018 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-29402241

RESUMO

BACKGROUND: Genital Chlamydia trachomatis infection is a major public health problem worldwide affecting mostly youth. Sweden introduced an opportunistic screening approach in 1982 accompanied by treatment, partner notification and case reporting. After an initial decline in infection rate till the mid-90s, the number of reported cases has increased over the last two decades and has now stabilized at a high level of 37,000 reported cases in Sweden per year (85% of cases in youth). Sexual risk-taking among youth is also reported to have significantly increased over the last 20 years. Mobile health (mHealth) interventions could be particularly suitable for youth and sexual health promotion as the intervention is delivered in a familiar and discrete way to a tech savvy at-risk population. This paper presents a protocol for a randomized trial to study the effect of an interactive mHealth application (app) on condom use among the youth of Stockholm. METHODS: 446 youth resident in Stockholm, will be recruited in this two arm parallel group individually randomized trial. Recruitment will be from Youth Health Clinics or via the trial website. Participants will be randomized to receive either the intervention (which comprises an interactive app on safe sexual health that will be installed on their smart phones) or a control group (standard of care). Youth will be followed up for 6 months, with questionnaire responses submitted periodically via the app. Self-reported condom use over 6 months will be the primary outcome. Secondary outcomes will include presence of an infection, Chlamydia tests during the study period and proxy markers of safe sex. Analysis is by intention to treat. DISCUSSION: This trial exploits the high mobile phone usage among youth to provide a phone app intervention in the area of sexual health. If successful, the results will have implications for health service delivery and health promotion among the youth. From a methodological perspective, this trial is expected to provide information on the strength and challenges of implementing a partially app (internet) based trial in this context. TRIAL REGISTRATION: ISRCTN 13212899, date of registration June 22, 2017.


Assuntos
Preservativos/estatística & dados numéricos , Promoção da Saúde/métodos , Aplicativos Móveis , Sexo Seguro , Comportamento Sexual/psicologia , Saúde Sexual , Telemedicina , Adolescente , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/prevenção & controle , Protocolos Clínicos , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Assunção de Riscos , Smartphone , Suécia/epidemiologia , Adulto Jovem
14.
Analyst ; 143(1): 224-231, 2017 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-29136068

RESUMO

Biomarkers are often present in complex biological fluids like blood, requiring multiple, slow sample preparation steps that pose limitations in simplifying analysis. Here we report integrated immunoaffinity extraction and separation devices for analysis of preterm birth biomarkers in a human blood serum matrix. A reactive polymer monolith was used for immobilization of antibodies for selective extraction of target preterm birth biomarkers. Microfluidic immunoaffinity extraction protocols were optimized and then integrated with microchip electrophoresis for separation. Using these integrated devices, a ∼30 min analysis was carried out on low nanomolar concentrations of two preterm birth biomarkers spiked in a human serum matrix. This work is a promising step towards the development of an automated, integrated platform for determination of preterm birth risk.


Assuntos
Biomarcadores/sangue , Eletroforese em Microchip , Dispositivos Lab-On-A-Chip , Nascimento Prematuro , Anticorpos Imobilizados , Feminino , Humanos , Recém-Nascido , Gravidez
15.
BMC Health Serv Res ; 17(1): 730, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29141635

RESUMO

BACKGROUND: Chlamydia trachomatis testing is offered to youth in Sweden, through a network of Youth Health Clinics, free at the point of care, in an attempt to bring down the prevalence and incidence of the infection. Nevertheless, infections rates have continued to rise during the past two decades and re-testing rates among youth for Chlamydia trachomatis has been reported to be high in Stockholm County. A few literature reports suggest that testing for sexually transmitted infections and the test result itself can have an undesirable impact on the sexual behaviour for the individual, i.e. increase sexual risk-taking. METHODS: This qualitative study aimed to explore the motives for repeated testing for Chlamydia trachomatis among youth using the services of the Youth Health Clinics in Stockholm, and how testing affects their subsequent risk-taking. We interviewed 15 repeat testers aging 18-22 years. RESULTS: Our main findings were that the fear of social stigma related to infecting a peer was a major driver of the re-testing process. The repetitive testing process, the test result, and the encounter with personnel did not decrease sexual risk-taking among this group. CONCLUSIONS: While testing and treatment services are an important part of Chlamydia trachomatis prevention it must not take the focus away from primary prevention strategies. Testing should be encouraged, but not to the exclusion of risk reduction measures. The testing services must be complemented with stronger emphasis on safe sex, especially for those who attend the clinics repeatedly, otherwise the easy accessible testing services risk counteracting its own purpose. Future research should focus on developing and evaluating youth appropriate interventions to increase condom use, taking into consideration factors which youth perceive as important to drive this behaviour change.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Parceiros Sexuais/psicologia , Sexo sem Proteção/psicologia , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/prevenção & controle , Busca de Comunicante , Cultura , Feminino , Humanos , Incidência , Masculino , Motivação , Grupo Associado , Prevalência , Pesquisa Qualitativa , Estigma Social , Suécia/epidemiologia , Adulto Jovem
16.
Bioorg Med Chem ; 24(16): 3752-7, 2016 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-27338657

RESUMO

Veratrum californicum, commonly referred to as corn lily or Californian false hellebore, grows in high mountain meadows and produces the steroidal alkaloid cyclopamine, a potent inhibitor of the Hedgehog (Hh) signaling pathway. The Hh pathway is a crucial regulator of many fundamental processes during vertebrate embryonic development. However, constitutive activation of the Hh pathway contributes to the progression of various cancers. In the present study, a direct correlation was made between the extraction efficiency for cyclopamine from root and rhizome by eight methods, and the associated biological activity in Shh-Light II cells using the Dual-Glo® Luciferase Assay System. Alkaloid recovery ranged from 0.39 to 8.03mg/g, with ethanol soak being determined to be the superior method for obtaining biologically active cyclopamine. Acidic ethanol and supercritical extractions yielded degraded or contaminated cyclopamine with lower antagonistic activity towards Hh signaling.


Assuntos
Alcaloides de Veratrum/farmacologia , Veratrum/química , Biomassa , Linhagem Celular , Cromatografia Líquida de Alta Pressão , Proteínas Hedgehog/antagonistas & inibidores , Proteínas Hedgehog/metabolismo , Transdução de Sinais/efeitos dos fármacos , Alcaloides de Veratrum/isolamento & purificação
17.
Gynecol Endocrinol ; 32(8): 625-628, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26891977

RESUMO

Corifollitropin, a long-acting follicle-stimulating hormone (FSH) analogue used for in vitro fertilization (IVF), does not allow individualization of dosage, and the ovarian response is similar to around 300 IU of daily recombinant FSH. This has raised concerns about the risk of ovarian hyperstimulation syndrome (OHSS) when used in standard patients. We administered corifollitropin selectively to patients with anticipated low to moderate ovarian response based on antimüllerian hormone levels in the lower quartile. The end points were oocyte distribution and occurrence of OHSS in women with AMH ≤15 pmol/L. The study included a cohort of 368 patients treated in 599 cycles. Post hoc the cohort was subdivided according to AMH. With increasing baseline AMH, the number of oocytes increased from a mean of 2.7 (range 0-8 with AMH <3 pmol/L) to 6.3 (range 0-15 with AMH 10-15 pmol/L) oocytes. Cancellations of retrievals and transfers decreased significantly with increasing AMH. Overall, the ongoing live pregnancy rate per started cycle was 15.2%. None developed OHSS. No cycles were cancelled or needed triggering of ovulation using a GnRH agonist due to risk of OHSS. Selective use of corifollitropin in patients with AMH in the lower quartile is a safe and appropriate way of optimising stimulation.


Assuntos
Hormônio Antimülleriano/sangue , Fertilização in vitro/métodos , Hormônio Foliculoestimulante Humano/uso terapêutico , Indução da Ovulação/métodos , Taxa de Gravidez , Adulto , Estudos de Coortes , Feminino , Hormônio Foliculoestimulante Humano/efeitos adversos , Humanos , Síndrome de Hiperestimulação Ovariana/induzido quimicamente , Gravidez , Resultado do Tratamento
18.
Memory ; 24(9): 1208-23, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-26401886

RESUMO

We here present the development and validation of the Verbal Affective Memory Test-24 (VAMT-24). First, we ensured face validity by selecting 24 words reliably perceived as positive, negative or neutral, respectively, according to healthy Danish adults' valence ratings of 210 common and non-taboo words. Second, we studied the test's psychometric properties in healthy adults. Finally, we investigated whether individuals diagnosed with Seasonal Affective Disorder (SAD) differed from healthy controls on seasonal changes in affective recall. Recall rates were internally consistent and reliable and converged satisfactorily with established non-affective verbal tests. Immediate recall (IMR) for positive words exceeded IMR for negative words in the healthy sample. Relatedly, individuals with SAD showed a significantly larger decrease in positive recall from summer to winter than healthy controls. Furthermore, larger seasonal decreases in positive recall significantly predicted larger increases in depressive symptoms. Retest reliability was satisfactory, rs ≥ .77. In conclusion, VAMT-24 is more thoroughly developed and validated than existing verbal affective memory tests and showed satisfactory psychometric properties. VAMT-24 seems especially sensitive to measuring positive verbal recall bias, perhaps due to the application of common, non-taboo words. Based on the psychometric and clinical results, we recommend VAMT-24 for international translations and studies of affective memory.


Assuntos
Afeto/fisiologia , Rememoração Mental/fisiologia , Testes Neuropsicológicos , Aprendizagem Verbal/fisiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Luminosa , Psicometria , Reprodutibilidade dos Testes , Adulto Jovem
19.
Health Care Women Int ; 37(4): 392-411, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-24850497

RESUMO

We interviewed 1,805 women in a rural setting in Vietnam with the aim of investigating women's knowledge regarding reproductive tract infections (RTIs) and their health-seeking behavior. We found that women's overall knowledge was poor. Furthermore, only one-third of the symptomatic women sought health care. RTIs affect millions of women globally each year. Most vulnerable are women in low- and middle-income countries where poverty and gender inequities affect their access to health care services. Findings from our study can be used in similar rural settings worldwide to understand and manage the widespread problem of RTIs.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Infecções do Sistema Genital/etnologia , Adolescente , Adulto , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Serviços de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pobreza , Prevalência , Pesquisa Qualitativa , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Vietnã/epidemiologia , Serviços de Saúde da Mulher/estatística & dados numéricos
20.
Eur J Clin Pharmacol ; 71(11): 1397-402, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26369536

RESUMO

PURPOSE: It is well documented that drug-drug interaction databases (DIDs) differ substantially with respect to classification of drug-drug interactions (DDIs). The aim of this study was to study online available transparency of ownership, funding, information, classifications, staff training, and underlying documentation of the five most commonly used open access English language-based online DIDs and the three most commonly used subscription English language-based online DIDs in the literature. METHODS: We conducted a systematic literature search to identify the five most commonly used open access and the three most commonly used subscription DIDs in the medical literature. The following parameters were assessed for each of the databases: Ownership, classification of interactions, primary information sources, and staff qualification. We compared the overall proportion of yes/no answers from open access databases and subscription databases by Fisher's exact test-both prior to and after requesting missing information. RESULTS: Among open access DIDs, 20/60 items could be verified from the webpage directly compared to 24/36 for the subscription DIDs (p = 0.0028). Following personal request, these numbers rose to 22/60 and 30/36, respectively (p < 0.0001). For items within the "classification of interaction" domain, proportions were 3/25 versus 11/15 available from the webpage (P = 0.0001) and 3/25 versus 15/15 (p < 0.0001) available upon personal request. CONCLUSION: Available information on online available transparency of ownership, funding, information, classifications, staff training, and underlying documentation varies substantially among various DIDs. Open access DIDs had a statistically lower score on parameters assessed.


Assuntos
Bases de Dados de Produtos Farmacêuticos , Interações Medicamentosas , Humanos , Algoritmos , Bases de Dados de Produtos Farmacêuticos/economia , Bases de Dados de Produtos Farmacêuticos/normas , Documentação , Administração Financeira , Capacitação em Serviço
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