PeerJ Preprints: Women's Healthhttps://peerj.com/preprints/index.atom?journal=peerj&subject=7300Women's Health articles published in PeerJ PreprintsEvolutionary-rooted models for denial of pregnancy, concealment of pregnancy and pseudocyesishttps://peerj.com/preprints/269792018-06-062018-06-06Patrick SandozJens Wessel
Women in denial of pregnancy remain unaware of their gravid state. Typically women in labor present to emergency units while attributing their pain to unrelated causes. In higher risk cases, women experience unassisted delivery in a non-hospital setting. In concealment of pregnancy, the woman knows about her pregnancy but keeps it secret for diverse reasons. This induces also a lack of prenatal care and increased perinatal risks for mother and child. Such cases are very challenging to clinicians because of increased medical risk and psychological needs. Better understanding of these psychosomatic disorders is necessary to address the public-health issues raised.
In regard to denial and concealment of pregnancy, in which a pregnant woman thinks or says she is not pregnant, pseudocyesis corresponds to the opposite configuration in which a non-pregnant woman believes, claims and presents objective signs to be pregnant. Pseudocyesis takes therefore place in the same psychosomatic issue to be addressed. This paper aims to explain satisfactorily these psychosomatic disorders of gravida status.
We consider human reproduction in regard to evolution with emphasis on the various forms of parenting existing among sexually reproducing species. This evolutionary study highlights that for some pregnant women, the forthcoming maternal status may be internally appraised as psychologically-unacceptable because of diverse personalized causes. The ongoing pregnancy enters then into conflict with the intense fears triggered by the promise of motherhood. From this perspective, denial and concealment of pregnancy are satisfactorily explained as transitory means to cope with such an internal conflict by pursuing pregnancy while containing associated fears. In the absence of conflict resolution, the avoidance means is protracted over time, sometimes until an unexpected delivery.
Conversely, pseudocyesis is explained as an attempt to obtain a psychologically-indispensable maternal status in the absence of actual pregnancy. Specific conflict formulations are elucidated for each type of psychosomatic disorder of gravida status considered. These formulations, related to subjective internal appraisals, comply with the huge diversity of causative events reported in literature and specific to each woman concerned.
These explanations will help clinicians in caring those high-demanding patients and in exploring individualized causative events of such challenging experiences.
Women in denial of pregnancy remain unaware of their gravid state. Typically women in labor present to emergency units while attributing their pain to unrelated causes. In higher risk cases, women experience unassisted delivery in a non-hospital setting. In concealment of pregnancy, the woman knows about her pregnancy but keeps it secret for diverse reasons. This induces also a lack of prenatal care and increased perinatal risks for mother and child. Such cases are very challenging to clinicians because of increased medical risk and psychological needs. Better understanding of these psychosomatic disorders is necessary to address the public-health issues raised.In regard to denial and concealment of pregnancy, in which a pregnant woman thinks or says she is not pregnant, pseudocyesis corresponds to the opposite configuration in which a non-pregnant woman believes, claims and presents objective signs to be pregnant. Pseudocyesis takes therefore place in the same psychosomatic issue to be addressed. This paper aims to explain satisfactorily these psychosomatic disorders of gravida status.We consider human reproduction in regard to evolution with emphasis on the various forms of parenting existing among sexually reproducing species. This evolutionary study highlights that for some pregnant women, the forthcoming maternal status may be internally appraised as psychologically-unacceptable because of diverse personalized causes. The ongoing pregnancy enters then into conflict with the intense fears triggered by the promise of motherhood. From this perspective, denial and concealment of pregnancy are satisfactorily explained as transitory means to cope with such an internal conflict by pursuing pregnancy while containing associated fears. In the absence of conflict resolution, the avoidance means is protracted over time, sometimes until an unexpected delivery.Conversely, pseudocyesis is explained as an attempt to obtain a psychologically-indispensable maternal status in the absence of actual pregnancy. Specific conflict formulations are elucidated for each type of psychosomatic disorder of gravida status considered. These formulations, related to subjective internal appraisals, comply with the huge diversity of causative events reported in literature and specific to each woman concerned.These explanations will help clinicians in caring those high-demanding patients and in exploring individualized causative events of such challenging experiences.Prospective abuse and intimate partner violence surgical evaluation (PRAISE-2 pilot): Statistical analysis plan for a pilot prospective cohort studyhttps://peerj.com/preprints/269182018-05-072018-05-07Kim MaddenDiane Heels-AnsdellSheila SpragueHerman JohalMichelle GhertMohit BhandariLehana Thabane
Background. Intimate partner violence (IPV) is a prevalent social issue that affects the health and well-being of women globally. In orthopaedics, the prevalence of women who have experienced abuse in the past year is as high as 1 in 6. PRAISE-2 is a multi-centre pilot prospective cohort study of 250 women with musculoskeletal injuries to determine how IPV experiences affect injury-related outcomes, and how patterns of IPV change over a 12 month period of time following a musculoskeletal injury. The current report is a description of the statistical analysis plan for the PRAISE-2 pilot study. Methods. This study is a pilot multicentre prospective cohort study to primarily assess feasibility of our recruitment, retention and data collection strategies, and to collect preliminary data on orthopaedic outcomes after experiencing IPV, as well as changes in IPV patterns following an injury. Included participants will be adult females presenting to participating fracture clinics for a fracture and/or dislocation requiring orthopaedic care. Participants will be followed for one year. The primary analysis will be descriptive. We will report recruitment, missed visits, out of window visits, participant completion data, and completed form data as counts and percentages with 95% confidence intervals. Based on the primary analyses, we will report whether the feasibility criteria have been met, and recommend modifications to the protocol for any planned definitive studies, if needed. All secondary (clinical) analyses are exploratory. Discussion. In order for surgeons to be as effective as possible in assisting and advocating for women who have experienced abuse, we need more information on how IPV experiences are associated with musculoskeletal outcomes. Both the feasibility and clinical information gained from this pilot study will be instrumental in informing future observational and interventional IPV studies. By reporting our statistical analysis plan before the study ends, we hope to improve the transparency, integrity, and reproducibility of our study findings. Trial registration. This study is registered on clinicaltrials.gov NCT02529267 on 20 August 2015, before the first participant was enrolled
Background. Intimate partner violence (IPV) is a prevalent social issue that affects the health and well-being of women globally. In orthopaedics, the prevalence of women who have experienced abuse in the past year is as high as 1 in 6. PRAISE-2 is a multi-centre pilot prospective cohort study of 250 women with musculoskeletal injuries to determine how IPV experiences affect injury-related outcomes, and how patterns of IPV change over a 12 month period of time following a musculoskeletal injury. The current report is a description of the statistical analysis plan for the PRAISE-2 pilot study. Methods. This study is a pilot multicentre prospective cohort study to primarily assess feasibility of our recruitment, retention and data collection strategies, and to collect preliminary data on orthopaedic outcomes after experiencing IPV, as well as changes in IPV patterns following an injury. Included participants will be adult females presenting to participating fracture clinics for a fracture and/or dislocation requiring orthopaedic care. Participants will be followed for one year. The primary analysis will be descriptive. We will report recruitment, missed visits, out of window visits, participant completion data, and completed form data as counts and percentages with 95% confidence intervals. Based on the primary analyses, we will report whether the feasibility criteria have been met, and recommend modifications to the protocol for any planned definitive studies, if needed. All secondary (clinical) analyses are exploratory. Discussion. In order for surgeons to be as effective as possible in assisting and advocating for women who have experienced abuse, we need more information on how IPV experiences are associated with musculoskeletal outcomes. Both the feasibility and clinical information gained from this pilot study will be instrumental in informing future observational and interventional IPV studies. By reporting our statistical analysis plan before the study ends, we hope to improve the transparency, integrity, and reproducibility of our study findings. Trial registration. This study is registered on clinicaltrials.gov NCT02529267 on 20 August 2015, before the first participant was enrolled Candida albicans cell wall glycosidases DFG5 and DCW1 are required for biofilm formation and Hog-1 signalinghttps://peerj.com/preprints/265262018-02-152018-02-15Ryan MancusoJennifer ChinniciCharlene TsouSujay BusarajanAbhiram Maddi
Background. Candida albicans is a commensal fungus that inhabits the oral mucosal surface and causes oral and systemic candidiasis. Oral candidiasis most commonly occurs in patients with AIDS, denture wearers and newborn children. Systemic candidiasis occurs mainly in immunocompromised patients and patients admitted to hospitals for prolonged periods. The C. albicans homologous genes, DFG5 and DCW1, encode for two closely related cell wall proteins with putative glycosyltransferase enzyme activity and C-terminal GPI-anchors. Past studies have shown that individual DFG5 and DCW1 mutations are viable but simultaneous deletion of DFG5 and DCW1 in C. albicans results in lethality. However, the exact functions of these cell wall based enzymes, which represent ideal drug targets, are not understood.
Methods. C. albicans DFG5/DCW1 heterologous and conditional double mutant strains, ES1 and ES195 respectively, were assessed for growth and biofilm formation in comparison to wild type and parental strains. Cell wall, osmotic and heat stress susceptibility of the mutant and control strains was assessed using agar spotting assays. Western Blot analysis of mutant strains and control strains was performed to assess Hog-1 phosphorylation status.
Results. Growth in planktonic cultures and biofilm formation was found to be affected in the DFG5/DCW1 double mutants as compared to control strains. The mutant strains were also less resistant to cell wall, osmotic and heat stresses as compared to control strains. Hog-1 phosphorylation was affected in the mutant strains.
Conclusions. These data indicate that Candida albicans DFG5 and DCW1 play critical roles in biofilm formation and Hog-1 signaling pathway.
Background. Candida albicans is a commensal fungus that inhabits the oral mucosal surface and causes oral and systemic candidiasis. Oral candidiasis most commonly occurs in patients with AIDS, denture wearers and newborn children. Systemic candidiasis occurs mainly in immunocompromised patients and patients admitted to hospitals for prolonged periods. The C. albicans homologous genes, DFG5 and DCW1, encode for two closely related cell wall proteins with putative glycosyltransferase enzyme activity and C-terminal GPI-anchors. Past studies have shown that individual DFG5 and DCW1 mutations are viable but simultaneous deletion of DFG5 and DCW1 in C. albicans results in lethality. However, the exact functions of these cell wall based enzymes, which represent ideal drug targets, are not understood.Methods. C. albicans DFG5/DCW1 heterologous and conditional double mutant strains, ES1 and ES195 respectively, were assessed for growth and biofilm formation in comparison to wild type and parental strains. Cell wall, osmotic and heat stress susceptibility of the mutant and control strains was assessed using agar spotting assays. Western Blot analysis of mutant strains and control strains was performed to assess Hog-1 phosphorylation status.Results. Growth in planktonic cultures and biofilm formation was found to be affected in the DFG5/DCW1 double mutants as compared to control strains. The mutant strains were also less resistant to cell wall, osmotic and heat stresses as compared to control strains. Hog-1 phosphorylation was affected in the mutant strains.Conclusions. These data indicate that Candida albicans DFG5 and DCW1 play critical roles in biofilm formation and Hog-1 signaling pathway.Robotic Olympics: A novel robotic surgical training experience for residents in an obstetrics and gynecology residency programhttps://peerj.com/preprints/35102018-01-072018-01-07Malte RenzEric LibermanBrian DanielsSara IsaniDennis Y KuoNicole Nevadunsky
Background: Resident experience and opinions regarding robotic surgical training as part of the formal obstetrics and gynecology curriculum has not been reported.
Objective: To evaluate residents’ experience with the newly introduced Robotic Olympics and a robotic surgical trainings curriculum in general, especially in correlation with future career goals.
Methods: All residents of the Obstetrics and Gynecology Residency Program at the Montefiore Medical Center, who participated in the Robotic Olympics 2014, a team-based simulation competition, completed a de-identified pre- and post-Olympics survey.
Results: For the participating 31 residents, the mean number of bedside-assistant robotic and console cases was 8 (0-50) and 4 (0-30), respectively. Both were positively associated with postgraduate level. The majority of residents (89%) reported that they were best trained in open surgery. Only 52% anticipated using robotic surgery in their future practice. Anticipated use of the robot and interest in robotic training were correlated with surgical subspecialty career goals. 100% of residents aspiring a career in gynecologic oncology and none interested in maternofetal medicine anticipated future use of robotic surgery. However, all residents desired the Robotic Olympics to be integral part of resident education.
Conclusions: The majority of residents welcomed the addition of the Robotic Olympics to the robotic-surgical curriculum. However, the residents’ interest in robotic surgical training in general was disparate and correlated with the anticipated use of the robot in the residents’ future career. This data suggests the need for directed robotic surgical training for residents interested in surgical sub-specialties to focus resources early on.
Background: Resident experience and opinions regarding robotic surgical training as part of the formal obstetrics and gynecology curriculum has not been reported.Objective: To evaluate residents’ experience with the newly introduced Robotic Olympics and a robotic surgical trainings curriculum in general, especially in correlation with future career goals.Methods: All residents of the Obstetrics and Gynecology Residency Program at the Montefiore Medical Center, who participated in the Robotic Olympics 2014, a team-based simulation competition, completed a de-identified pre- and post-Olympics survey.Results: For the participating 31 residents, the mean number of bedside-assistant robotic and console cases was 8 (0-50) and 4 (0-30), respectively. Both were positively associated with postgraduate level. The majority of residents (89%) reported that they were best trained in open surgery. Only 52% anticipated using robotic surgery in their future practice. Anticipated use of the robot and interest in robotic training were correlated with surgical subspecialty career goals. 100% of residents aspiring a career in gynecologic oncology and none interested in maternofetal medicine anticipated future use of robotic surgery. However, all residents desired the Robotic Olympics to be integral part of resident education.Conclusions: The majority of residents welcomed the addition of the Robotic Olympics to the robotic-surgical curriculum. However, the residents’ interest in robotic surgical training in general was disparate and correlated with the anticipated use of the robot in the residents’ future career. This data suggests the need for directed robotic surgical training for residents interested in surgical sub-specialties to focus resources early on.Divergence of HPV16 variants reflects loci undergoing inter-host positive selection, potentially immunologic selectionhttps://peerj.com/preprints/30702017-07-032017-07-03Chase W. NelsonApurva NarechaniaRobert D. BurkMark SchiffmanMichael CullenJoseph F. BolandZigui ChenNicolas WentzensenQi YangJason MitchellDavid RobertsonSara BassLaurie BurdettTina Raine-BennettThomas LoreyMeredith YeagerLisa Mirabello
Human papillomavirus type 16 (HPV16) is the most carcinogenic HPV, causing >50% of cervical cancers. Its unique oncogenicity is unsolved, e.g., the second most carcinogenic type (HPV18, causing ~16% of cancers) is relatively distantly related to HPV16. Mirabello et al. recently reported on viral genome data from 3,215 HPV positive specimens from women undergoing cervical cancer screening at Kaiser Permanente Northern California in the Persistence and Progression (PaP) cohort. Results demonstrated profound differences in disease risk by histologic subtype among the HPV16 sublineages (e.g., A1), with over 100-fold risk differences. Here, we expanded this analysis to examine the genetic and evolutionary underpinnings of HPV16 carcinogenicity through an exhaustive analysis of viral nucleotide distance. The HPV16 genome displays significant evidence of purifying selection (dN/dS = 0.267; P<0.001). However, within the A1 and A2 sublineages, one of the two oncogenes (E6) does not differ from neutrality, while the other oncogene (E7) is significantly more constrained in cases (dN/dS = 0.049) than in controls (dN/dS = 0.27; P<0.001). Thus, benign viral infections exhibit less constraint, implying a nonsynonymous mutational burden. Using an unsupervised sliding window approach, we next identified genomic regions exhibiting strong evidence of inter-host positive selection. Within A1, 14 regions were identified, with dN/dS values up to 59.44. Twelve (12) of these regions overlap phylogenetic sublineage-defining residues, and 9 match known HPV epitope sequences obtained from the Immune Epitope Database and/or the Human Papillomavirus T Cell Antigen Database. In particular, two regions of E6 were identified independently in cases and controls: codons 20-27 and codons 75-90, both of which overlap with experimentally verified HLA epitopes, and the second of which overlaps known antibody epitopes. Moreover, the 75-90 region exhibits a dN/dS ratio of 59.44 in cases and 28.05 in controls, shows substantial case vs. control divergence (between – within group dN/dS of 55.60), and includes a L83V variant that has been reported to contribute to persistence in European populations. We conclude that diversifying positive selection likely played a key role in the historical divergence of HPV16 variants, possibly as the result of inter-host environmental heterogeneity based on host immune genotype. Moreover, since our data imply that positive selection is targeted to many of the same loci that are diagnostic as sublineage-defining residues, it is likely that similar evolutionary pressures have operated throughout the evolutionary diversification of HPV16. In particular, we suggest that host immune genotype (e.g., HLA) may play a key role in disease outcome, and must be prioritized in future studies of HPV evolution and its link to cervical cancer.
Human papillomavirus type 16 (HPV16) is the most carcinogenic HPV, causing >50% of cervical cancers. Its unique oncogenicity is unsolved, e.g., the second most carcinogenic type (HPV18, causing ~16% of cancers) is relatively distantly related to HPV16. Mirabello et al. recently reported on viral genome data from 3,215 HPV positive specimens from women undergoing cervical cancer screening at Kaiser Permanente Northern California in the Persistence and Progression (PaP) cohort. Results demonstrated profound differences in disease risk by histologic subtype among the HPV16 sublineages (e.g., A1), with over 100-fold risk differences. Here, we expanded this analysis to examine the genetic and evolutionary underpinnings of HPV16 carcinogenicity through an exhaustive analysis of viral nucleotide distance. The HPV16 genome displays significant evidence of purifying selection (dN/dS = 0.267; P<0.001). However, within the A1 and A2 sublineages, one of the two oncogenes (E6) does not differ from neutrality, while the other oncogene (E7) is significantly more constrained in cases (dN/dS = 0.049) than in controls (dN/dS = 0.27; P<0.001). Thus, benign viral infections exhibit less constraint, implying a nonsynonymous mutational burden. Using an unsupervised sliding window approach, we next identified genomic regions exhibiting strong evidence of inter-host positive selection. Within A1, 14 regions were identified, with dN/dS values up to 59.44. Twelve (12) of these regions overlap phylogenetic sublineage-defining residues, and 9 match known HPV epitope sequences obtained from the Immune Epitope Database and/or the Human Papillomavirus T Cell Antigen Database. In particular, two regions of E6 were identified independently in cases and controls: codons 20-27 and codons 75-90, both of which overlap with experimentally verified HLA epitopes, and the second of which overlaps known antibody epitopes. Moreover, the 75-90 region exhibits a dN/dS ratio of 59.44 in cases and 28.05 in controls, shows substantial case vs. control divergence (between – within group dN/dS of 55.60), and includes a L83V variant that has been reported to contribute to persistence in European populations. We conclude that diversifying positive selection likely played a key role in the historical divergence of HPV16 variants, possibly as the result of inter-host environmental heterogeneity based on host immune genotype. Moreover, since our data imply that positive selection is targeted to many of the same loci that are diagnostic as sublineage-defining residues, it is likely that similar evolutionary pressures have operated throughout the evolutionary diversification of HPV16. In particular, we suggest that host immune genotype (e.g., HLA) may play a key role in disease outcome, and must be prioritized in future studies of HPV evolution and its link to cervical cancer.Supply-side barriers to maternal health care utilization at health sub-centres in Indiahttps://peerj.com/preprints/23622016-08-162016-08-16Aditya Singh
Introduction: There exist several barriers to maternal health service utilization in developing countries. Most of the previous studies conducted in India have focused on demand-side barriers, while only a few have touched upon supply-side barriers. None of the previous studies in India have investigated the factors that affect maternal health care utilization at Health Sub-Centers (HSC) in India, despite the fact that these institutions, as the nearest available public healthcare facilities in rural areas, play a significant role in providing affordable maternal health care. Therefore, this study aims to examine the supply-side determinants of maternal service utilization at HSCs in rural India.
Data and Methods: This study uses health facility data from the nationally representative District-Level Household Survey, which was collected in 2007–2008 to examine the effect of supply-side variables on the utilization of maternal healthcare services across HSCs in rural India. Since the dependent variables (the number of antenatal registrations, in-facility deliveries, and postnatal care services) are count variables with considerable dispersion, the data has been analyzed using negative binomial regression instead of Poisson regression.
Results: The results show that those HSCs run by a contractual auxiliary nurse midwife (ANM) are likely to offer a lower volume of services when compared to those run by a permanent ANM. The availability of obstetric drugs, weighing scale, blood pressure equipment is associated with the increased utilization of antenatal and postnatal services. The unavailability of labor/examination table and bed screen is associated with a reduction in the number of safe deliveries and postnatal services. The utilization of services is expected to increase if essential facilities, such as water, telephone, toilet, and electricity, are available at HSCs. Monitoring of an ANM’s work by the Village Health and Sanitation Committee (VHSC) and the in-service training of ANMs appear to have a positive impact on the utilization of services. The distance of an ANM’s actual residence from the sub-center village where she works is negatively associated with the utilization of delivery and postnatal services. These findings are robust to the inclusion of several demand-side factors.
Conclusion: To improve maternal healthcare utilization at sub-centers, the government should ensure the availability of basic infrastructure, drugs, and equipment at all sub-centers. Monitoring of ANMs’ work by VHSCs could play an important role in improving healthcare utilization at the HSCs; therefore, it is important to establish VHSCs in each sub-center village. The issue of the relatively low utilization of maternity services in the HSCs that are run solely by contractual ANMs needs to be investigated further.
Introduction: There exist several barriers to maternal health service utilization in developingcountries. Most of the previous studies conducted in India have focused on demand-side barriers, while only a few have touched upon supply-side barriers. None of the previous studies in India have investigated the factors that affect maternal health care utilization at Health Sub-Centers (HSC) in India, despite the fact that these institutions, as the nearest available public healthcare facilities in rural areas, play a significant role in providing affordable maternal health care. Therefore, this study aims to examine the supply-side determinants of maternal service utilization at HSCs in rural India.Data and Methods: This study uses health facility data from the nationally representativeDistrict-Level Household Survey, which was collected in 2007–2008 to examine the effect of supply-side variables on the utilization of maternal healthcare services across HSCs in rural India. Since the dependent variables (the number of antenatal registrations, in-facility deliveries, and postnatal care services) are count variables with considerable dispersion, the data has been analyzed using negative binomial regression instead of Poisson regression.Results: The results show that those HSCs run by a contractual auxiliary nurse midwife (ANM) are likely to offer a lower volume of services when compared to those run by a permanent ANM. The availability of obstetric drugs, weighing scale, blood pressure equipment is associated with the increased utilization of antenatal and postnatal services. The unavailability of labor/examination table and bed screen is associated with a reduction in the number of safe deliveries and postnatal services. The utilization of services is expected to increase if essential facilities, such as water, telephone, toilet, and electricity, are available at HSCs. Monitoring of an ANM’s work by the Village Health and Sanitation Committee (VHSC) and the in-service training of ANMs appear to have a positive impact on the utilization of services. The distance of an ANM’s actual residence from the sub-center village where she works is negatively associated with the utilization of delivery and postnatal services. These findings are robust to the inclusion of several demand-side factors.Conclusion: To improve maternal healthcare utilization at sub-centers, the government shouldensure the availability of basic infrastructure, drugs, and equipment at all sub-centers. Monitoring of ANMs’ work by VHSCs could play an important role in improving healthcare utilization at the HSCs; therefore, it is important to establish VHSCs in each sub-center village. The issue of the relatively low utilization of maternity services in the HSCs that are run solely by contractual ANMs needs to be investigated further.Hierarchical multistate models from population data: An application to parity statuseshttps://peerj.com/preprints/21282016-06-152016-06-15Robert Schoen
Hierarchical models are characterized by having N living states connected by N–1 rates of transfer. Demographic measures for such models can be calculated directly from counts of the number of persons in each state at two nearby points in time. Exploiting the ability of population stocks to determine the flows in hierarchical models expands the range of demographic analysis.
The value of such analyses is illustrated by an application to childbearing, where the states of interest reflect the number of children a woman has born. Using Census data on the distribution of women by age and parity, a parity status life table for U.S. Women, 2005-2010, is constructed. That analysis shows that nearly a quarter of American women are likely to remain childless, with a 0-3 child pattern replacing the 2-4 child pattern of the past.
Hierarchical models are characterized by having N living states connected by N–1 rates of transfer. Demographic measures for such models can be calculated directly from counts of the number of persons in each state at two nearby points in time. Exploiting the ability of population stocks to determine the flows in hierarchical models expands the range of demographic analysis.The value of such analyses is illustrated by an application to childbearing, where the states of interest reflect the number of children a woman has born. Using Census data on the distribution of women by age and parity, a parity status life table for U.S. Women, 2005-2010, is constructed. That analysis shows that nearly a quarter of American women are likely to remain childless, with a 0-3 child pattern replacing the 2-4 child pattern of the past.Preventing Zika virus infection during pregnancy by timing conception seasonallyhttps://peerj.com/preprints/18182016-05-152016-05-15Micaela E Martinez-Bakker
It has come to light that Zika virus (ZIKV) infection during pregnancy can result in trans-placental transmission to the fetus along with fetal death, congenital microcephaly and/or Central Nervous System (CNS) malformations. There are projected to be > 9, 200, 000 births annually in countries with ongoing ZIKV transmission. In response to the ZIKV threat, the World Health Organization (WHO) is strategically targeting prevention of infection in pregnant women and funding contraception in epidemic regions. I propose that the damaging effects of ZIKV can be reduced by timing pregnancy seasonally to minimize maternal exposure. Like other acute viral infections—including the related flavivirus, dengue virus (DENV)—the transmission of ZIKV is anticipated to be seasonal. By seasonally planning pregnancy, this aspect of pathogen ecology can be leveraged to align sensitive periods of gestation with the low-transmission season.
It has come to light that Zika virus (ZIKV) infection during pregnancy can result in trans-placental transmission to the fetus along with fetal death, congenital microcephaly and/or Central Nervous System (CNS) malformations. There are projected to be > 9, 200, 000 births annually in countries with ongoing ZIKV transmission. In response to the ZIKV threat, the World Health Organization (WHO) is strategically targeting prevention of infection in pregnant women and funding contraception in epidemic regions. I propose that the damaging effects of ZIKV can be reduced by timing pregnancy seasonally to minimize maternal exposure. Like other acute viral infections—including the related flavivirus, dengue virus (DENV)—the transmission of ZIKV is anticipated to be seasonal. By seasonally planning pregnancy, this aspect of pathogen ecology can be leveraged to align sensitive periods of gestation with the low-transmission season.What are the possible determinants of urinary incontinence during pregnancy? Results of a pilot studyhttps://peerj.com/preprints/18982016-03-252016-03-25Nejat DemircanÜlkü ÖzmenFürüzan KöktürkHamdi KüçükŞevket AtaMüge Harmaİnan İlker Arıkan
Objectives: This study was conducted to determine the frequency, predisposing factors and impact of urinary incontinence (UI)during pregnancyon quality of life (QOL). Materials and Method: A preliminary cross-sectional survey was carried out among pregnant women from January to June of 2014. A total of 132 pregnant women were enrolled. We used a questionnaire form for sociodemographic features, ICIQ-SF-Turkish version to determine the occurrence and characteristics of UI and Wagner’s Quality of Life scale to assess impact on QOL. Results: Urinary incontinence was present in 56 out of 132 pregnant women (42.4%); these women were referred to as the UI-present group. The remaining 76 women comprised the UI-absent group. The overall mean age was 27.5 ± 5.1 y (p=0.780), median height in UI-present group was 160 cm (min-max: 153-176, p=0.037 <0.05) and median BMI was 28.7 kg/m2(min-max: 22.4-50.0, p=0.881).For women in the UI-present group, urine leakage occurred once a week (n=18, 32.1%) to twice or thrice a week (n=8, 14.3%), few times a day (n=14, 25%), once a day (n=5, 8.9%) and always (n=8, 14.3%). The pregnant women in the UI-present group mainly reported a small amount of urine leakage (n=33, 58.9%) or a moderate amount of leakage (n=4, 7.1%). There were statistically significant relationships between QOL scores and frequency of UI (p=0.002 <0.05) as well as the amount of leakage (p=0.002 <0.05). Impact on QOL scores ranged from mild (n=33, 58.9%) or moderate (n=4, 7.1%) to severe (n=4, 7.1%) levels. QOL has ‘mildly deteriorated’. The following features were found to favour the onset of UI: age of pregnant woman (OR= 0.845, 95% CI 0.268-2.669), occupational status (OR=1.800, 95% CI 0.850-3.810), anaemia (OR=0.939, 95% CI 0.464-1.901), parity (OR=0.519, 95% CI 0.325-0.829), miscarriage in previous pregnancies (OR=1.219, 95% CI 0.588-2.825) and living in rural vs urban settlement (OR=1.800, 95% CI 0.887-3.653).Heigt (p= 0,037<0.05), educational status (p=0.016 <0.05), miscarriage, parity and place of living (p=0.002, p=0.006, p=0.020 <0.05 respectively)were significant in favour of UI-present. Conclusions: Urinary incontinence was frequently encountered among pregnant women (42.1%). Urinary incontinence distorted the QOL in pregnant women at a mild level and caused life style changes. Frequency and amount of UI were the significant factors in deterioration. Age, parity, miscarriage, being housewife, place of living (rural) and anaemia were the factors in favour of onset of UI during pregnancy. Among them, height, educational status (primary-intermediate school graduate), place of living (rural), miscarriage and parity were statistically significant predictors. It is necessary to pay attention to UI and its impact on women’s health during pregnancy.
Objectives: This study was conducted to determine the frequency, predisposing factors and impact of urinary incontinence (UI)during pregnancyon quality of life (QOL). Materials and Method: A preliminary cross-sectional survey was carried out among pregnant women from January to June of 2014. A total of 132 pregnant women were enrolled. We used a questionnaire form for sociodemographic features, ICIQ-SF-Turkish version to determine the occurrence and characteristics of UI and Wagner’s Quality of Life scale to assess impact on QOL. Results: Urinary incontinence was present in 56 out of 132 pregnant women (42.4%); these women were referred to as the UI-present group. The remaining 76 women comprised the UI-absent group. The overall mean age was 27.5 ± 5.1 y (p=0.780), median height in UI-present group was 160 cm (min-max: 153-176, p=0.037 <0.05) and median BMI was 28.7 kg/m2(min-max: 22.4-50.0, p=0.881).For women in the UI-present group, urine leakage occurred once a week (n=18, 32.1%) to twice or thrice a week (n=8, 14.3%), few times a day (n=14, 25%), once a day (n=5, 8.9%) and always (n=8, 14.3%). The pregnant women in the UI-present group mainly reported a small amount of urine leakage (n=33, 58.9%) or a moderate amount of leakage (n=4, 7.1%). There were statistically significant relationships between QOL scores and frequency of UI (p=0.002 <0.05) as well as the amount of leakage (p=0.002 <0.05). Impact on QOL scores ranged from mild (n=33, 58.9%) or moderate (n=4, 7.1%) to severe (n=4, 7.1%) levels. QOL has ‘mildly deteriorated’. The following features were found to favour the onset of UI: age of pregnant woman (OR= 0.845, 95% CI 0.268-2.669), occupational status (OR=1.800, 95% CI 0.850-3.810), anaemia (OR=0.939, 95% CI 0.464-1.901), parity (OR=0.519, 95% CI 0.325-0.829), miscarriage in previous pregnancies (OR=1.219, 95% CI 0.588-2.825) and living in rural vs urban settlement (OR=1.800, 95% CI 0.887-3.653).Heigt (p= 0,037<0.05), educational status (p=0.016 <0.05), miscarriage, parity and place of living (p=0.002, p=0.006, p=0.020 <0.05 respectively)were significant in favour of UI-present. Conclusions: Urinary incontinence was frequently encountered among pregnant women (42.1%). Urinary incontinence distorted the QOL in pregnant women at a mild level and caused life style changes. Frequency and amount of UI were the significant factors in deterioration. Age, parity, miscarriage, being housewife, place of living (rural) and anaemia were the factors in favour of onset of UI during pregnancy. Among them, height, educational status (primary-intermediate school graduate), place of living (rural), miscarriage and parity were statistically significant predictors. It is necessary to pay attention to UI and its impact on women’s health during pregnancy.Behavior of biomarkers during pregnancy and lactation through a biological multi-paradigm model. BECOME study protocolhttps://peerj.com/preprints/18782016-03-202016-03-20María José Aguilar-CorderoLaura Baena-GarcíaRaquel Rodríguez-BlanqueJuan Carlos Sánchez-GarcíaManuel Isidoro Capel-TuñónAntonio Manuel Sánchez-López
Background Despite of advances in research, at the moment, various points related to the physiology of gestation and the etiology of severe diseases that can be developed in the course of it remain unknown. One of those aspects is the behavior of biomarkers (triglycerides, prolactin, glucose and cholesterol) during pregnancy, which experience a gradual increase in their levels until they reach the peak of hypertriglyceridemia, a few days before delivery. Several studies have reported that biomarkers experience a higher elevation in diabetic and obese pregnant women and in those women who suffer preeclampsia. The description of their behavior in different population of pregnant women (healthy women and women at risk) would identify the relation of these with some of the alterations that occurs more frequently during pregnancy. Objective The aim of this study is to develop a multi-paradigm biological model of systems to determine triglyceride, prolactin, glucose and cholesterol levels during pregnancy and its relation with lactogenesis in healthy and risk pregnant women. Methods A prospective cohort study will take place with women during pregnancy and lactation. Participating women will be divided into two groups. One group will be integrated by healthy women and the other group by pregnant women with a risk medical history. The personal, family and a detailed medical history will be collected in each group. A study of all the variables which influence the level of the mentioned biomarkers (triglycerides, cholesterol, glucose and prolactin) will be done. The universe consists in 4,300 women, who constitute the historical average deliveries during the semester in the city of Granada (Spain). The sample collection will be made in medical office’s pregnancy control in Granada’s hospitals, in their respective health centers and during the second half of 2015. The sample will be stratified and probabilistic. Peculiarities of pregnant women will be taken into account when calculating the size of the study sample. This sample will be made up of 224 women who comply with the inclusion criteria and that have signed the informed consent. To achieve the project objectives an organization comprising six theoretical and practical phases enabling the scientific development of the project. During the first phase, the technical and administrative preparation of the project is constructed. Thereafter, the work is divided into two action areas which encompass the collection and data modeling. The creation of a biological multi-paradigm computer simulation model of the levels of biomarkers in different months of pregnancy and in the various pathologies of pregnant women can be very effective to know the risks that involve high levels of lipids for the mother and for the baby.
Background Despite of advances in research, at the moment, various points related to the physiology of gestation and the etiology of severe diseases that can be developed in the course of it remain unknown. One of those aspects is the behavior of biomarkers (triglycerides, prolactin, glucose and cholesterol) during pregnancy, which experience a gradual increase in their levels until they reach the peak of hypertriglyceridemia, a few days before delivery. Several studies have reported that biomarkers experience a higher elevation in diabetic and obese pregnant women and in those women who suffer preeclampsia. The description of their behavior in different population of pregnant women (healthy women and women at risk) would identify the relation of these with some of the alterations that occurs more frequently during pregnancy. Objective The aim of this study is to develop a multi-paradigm biological model of systems to determine triglyceride, prolactin, glucose and cholesterol levels during pregnancy and its relation with lactogenesis in healthy and risk pregnant women. Methods A prospective cohort study will take place with women during pregnancy and lactation. Participating women will be divided into two groups. One group will be integrated by healthy women and the other group by pregnant women with a risk medical history. The personal, family and a detailed medical history will be collected in each group. A study of all the variables which influence the level of the mentioned biomarkers (triglycerides, cholesterol, glucose and prolactin) will be done. The universe consists in 4,300 women, who constitute the historical average deliveries during the semester in the city of Granada (Spain). The sample collection will be made in medical office’s pregnancy control in Granada’s hospitals, in their respective health centers and during the second half of 2015. The sample will be stratified and probabilistic. Peculiarities of pregnant women will be taken into account when calculating the size of the study sample. This sample will be made up of 224 women who comply with the inclusion criteria and that have signed the informed consent. To achieve the project objectives an organization comprising six theoretical and practical phases enabling the scientific development of the project. During the first phase, the technical and administrative preparation of the project is constructed. Thereafter, the work is divided into two action areas which encompass the collection and data modeling. The creation of a biological multi-paradigm computer simulation model of the levels of biomarkers in different months of pregnancy and in the various pathologies of pregnant women can be very effective to know the risks that involve high levels of lipids for the mother and for the baby.