Caught in the eye of the storm: a qualitative study of views and experiences of planned drug holidays from methylphenidate in child and adolescent ADHD treatment

Background: Attention deficit hyperactivity disorder (ADHD) can be treated with stimulant medication such as methylphenidate. Although effective, methylphenidate can cause serious side-effects, including suppressed appetite, growth retardation and sleep problems. A drug holiday is a deliberate interruption of pharmacotherapy for a defined period of time and for a specific clinical purpose, for example for appeasing side-effects. Whilst some international guidelines recommend introducing drug holidays in ADHD treatment, this is not practised routinely. Our aim was to examine the views and experiences of planned drug holidays from methylphenidate with adults who have responsibility for treatment decisions in children and adolescents with ADHD. Method: In-depth interviews were carried out. Child and Adolescent Mental Health Services (CAMHS) practitioners (n=8), General Practitioners (n=8), teachers (n=5), and mothers of children with ADHD (n=4) were interviewed in a UK setting. Interview transcripts were analysed using grounded theory. Results: Methylphenidate eases the experience of the child amid problems at home and at school and once started is mostly continued long-term. Some families do practise short-term drug holidays at weekends and longer-term ones during school holidays. The decision to introduce drug holidays is influenced by the child’s academic progress, the parents’ ability to cope with the child, as well as medication beliefs. Trialling a drug holiday is thought to allow older children to self-assess their ability to manage without medication when they show signs of wanting to discontinue treatment prematurely. Conclusions: Planned drug holidays could address premature treatment cessation by enabling adolescents to assess repercussions under medical supervision.

"When I go to bed hungry and sleep, I'm not hungry": children and parents' experiences of food insecurity

Evidence demonstrates food insecurity has a detrimental impact on a range of outcomes for children, but little research has been conducted in the UK, and children have rarely been asked to describe their experiences directly. We examined the experiences of food insecure families living in South London. Our mixed-methods approach comprised a survey of parents (n = 72) and one-to-one semi-structured interviews with children aged 5-11 years (n = 19). The majority of parents (86%) described their food security during the preceding year as very low. Most reported they had often or sometimes had insufficient food, and almost all had worried about running out of food. Two thirds of parents had gone hungry. Most parents reported they had been unable to afford a nutritionally balanced diet for their children, and just under half reported that their children had gone hungry. Four themes emerged from the interviews with children: sources of food; security of food, nutritional quality of food, and experiences of hunger. Children's descriptions of insufficient food being available indicate that parents are not always able to shield them from the impact of food insecurity. The lack of school-meals and after-school clubs serving food made weekends particularly problematic for some children. A notable consequence of food insecurity appears to be reliance on low-cost takeaway food, likely to be nutritionally poor.

Vascular endothelial growth factor (VEGF) and VEGF-receptor expression in placenta of hyperglycemic pregnant women

Hyperglycemia occurs in a variety of conditions such as overt diabetes, gestational diabetes and mild hyperglycemia, all of which are generally defined based on the oral glucose tolerance test and glucose profiles. Whereas diabetes has received considerable attention in recent decades, few studies have examined the mechanisms of mild hyperglycemia and its associated disturbances. Mild gestational hyperglycemia is associated with macrosomia and a high risk of perinatal mortality. Morphologically, the placenta of these women is characterized by an increase in the number of terminal villi and capillaries, presumably as part of a compensatory mechanism to maintain homeostasis at the maternal-fetal interface. In this study, we analised the expression of VEGF and its receptors VEGFR-1 (Flt-1) and VEGFR-2 (KDR) in placentas from mildly hyperglycemic women. This expression was compared with that of normoglycemic women and women with gestational and overt diabetes. Immunohistochemistry revealed strong staining for VEGF and VEGFR-2 in vascular and trophoblastic cells of mildly hyperglycemic women, whereas the staining for VEGFR-1 was discrete and limited to the trophoblast. The pattern of VEGF and VEGF-receptor reactivity in placentas from women with overt diabetes was similar to that of normoglycemic women. In women with gestational diabetes, strong staining for VEGFR-1 was observed in vascular and trophoblastic cells whereas VEGF and VEGFR-2 were detected only in the trophoblast. The expression of these proteins was confirmed by western blotting, which revealed the presence of an additional band of 75 kDa. In the decidual compartment, only extravillous trophoblast reacted with all antibodies. Morphological analysis revealed collagen deposition around large arteries in all groups with altered glycemia. These findings indicate a placental response to altered glycemia that could have important consequences for the fetus. The change in the placental VEGF/VEGFR expression ratio in mild hyperglycemia may favor angiogenesis in placental tissue and could explain the hypercapillarization of villi seen in this gestational disturbance. (C) 2010 Elsevier Ltd. All rights reserved.

Collagen fibril organization in the pregnant endometrium of decorin-deficient mice

In the pregnant mouse endometrium, collagen fibrillogenesis is characterized by the presence of very thick collagen fibrils which are topographically located exclusively within the decidualized stroma. This dynamic biological process is in part regulated by the small leucine-rich proteoglycans decorin and biglycan. In the present study we utilized wild-type (Dcn+/+) and decorin-deficient (Dcn-/-) time-pregnant mice to investigate the evolution of non-decidualized and decidualized collagen matrix in the uterine wall of these animals. Ultrastructural and morphometric analyses revealed that the organization of collagen fibrils in the pregnant endometrium of both non-decidualized and decidualized stroma showed a great variability of shape and size, regardless of the genotype. However, the decidualized endometrium from Dcn-/- mice contained fibrils with larger diameter and more irregular contours as compared to the wild-type littermates. In the Dcn-/- animals, the proportion of thin (10-50 nm) fibrils was also higher as compared to Dcn+/+ animals. On day 7 of pregnancy, biglycan was similarly localized in the decidualized endometrium in both genotypes. Lumican immunostaining was intense both in decidualized and non-decidualized stroma from Dcn-/- animals. The present results support previous findings suggesting that decorin participates in uterine collagen fibrillogenesis. In addition, we suggest that the absence of decorin disturbs the process of lateral assembly of thin fibrils, resulting in very thick collagen fibrils with irregular profiles. Our data further suggest that decorin, biglycan and lumican might play an interactive role in collagen fibrillogenesis in the mouse endometrium, a process modulated according to the stage of pregnancy.

Chronic action of association of zidovudine, lamivudine and ritonavir on pregnant rats. A biologic assay

Purpose: To evaluate at term the effects of a highly active antiretroviral (HAAR) drug association administered during the entire period of rat pregnancy. Methods: Three groups (n = 10 each) of adult pregnant rats were treated with an oral solution of HAAR (Exp 1 = 10/5/20 mg/kg b.w.; Exp 2 = 30/15/60 mg/kg b.w.; Exp 3 = 90/45/180 mg/kg b.w.) from day ""0"" up to the 20th day of pregnancy. A fourth group served as a control. At term (20th day) the rats were killed under deep anesthesia and the number of implantations, resorptions, living fetuses, placentae and intrauterine deaths were recorded. Results: The highest HAAR doses caused lower maternal weight gain, lower litter weights, and lower placental weights compared to the control group. Conclusions: HAAR during the entire period of rat pregnancy can reduce maternal body weight gain and lower term placental weight.

Automatically linking live experiences captured with a ubiquitous infrastructure

Ubiquitous computing aims at providing services to users in everyday environments such as the home. One research theme in this area is that of building capture and access applications which support information to be recorded ( captured) during a live experience toward automatically producing documents for review (accessed). The recording demands instrumented environments with devices such as microphones, cameras, sensors and electronic whiteboards. Since each experience is usually related to many others ( e. g. several meetings of a project), there is a demand for mechanisms supporting the automatic linking among documents relative to different experiences. In this paper we present original results relative to the integration of our previous efforts in the Infrastructure for Capturing, Accessing, Linking, Storing and Presenting information (CALiSP). Ubiquitous computing aims at providing services to users in everyday environments such as the home. One research theme in this area is that of building capture and access applications which support information to be recorded (captured) during a live experience toward automatically producing documents for review (accessed). The recording demands instrumented environments with devices such as microphones, cameras, sensors and electronic whiteboards. Since each experience is usually related to many others (e.g. several meetings of a project), there is a demand for mechanisms supporting the automatic linking among documents relative to different experiences. In this paper we present original results relative to the integration of our previous efforts in the Infrastructure for Capturing, Accessing, Linking, Storing and Presenting information (CALiSP).

Kvinnors erfarenheter av framfödandet vid planerad hemförlossning

Background: The prevalence of sphincter rupture during childbirth has increased in Sweden from half percent to three percent from 1973 to 1993. Women who undergo planned home birth have sphincter injuries to a smaller extent than women who undergo planned hospital births. Objective: The purpose of this study was to describe women’s experience of the last stages of delivery during planned home birth. Design: Inductive content analysis of 150 randomly selected delivery reports. The delivery reports were gathered as a reply to an open question in a previously conducted survey.Findings: The woman´s confidence in the natural birthing process emerged as the overall theme of the delivery reports. Fourteen subcategories and five categories emerged during the analysis process: experience of support, physical experience, psychological experience, experience of birthplace and birth position and the woman’s awareness during birth. Conclusion: The support from the surrounding people was very important for the women and they felt calm and secure in the home environment. The women often gave birth in a birthing position that led to a reduced risk of perineal tears. Many risk factors for sphincter injuries were eliminated for the women who went thru planned home birth. For example the women often had experiences of prior deliveries and further no medical instruments were used during late stages of delivery in planned home births.

Vad kvinnor är mest nöjda med i samband med sin förlossning : Validering av instrumentet KUPP-I

AbstractThe aim: The aim of the study was to describe what women are most satisfied with in maternity care and if women´s childbirth experiences can be described by means of the QPP-I, who contains 32 statements related to maternity care. Design: The study is part of a national cross-sectional study which lasted for two weeks in Sweden in 2007. This paper analyzes one of the two questions with open answers, which reads: "What was the best with maternity care?”. Results: The results showed that out of a total of 735 responses 717 could be placed in the existing instrument QPP-I. Responses were analyzed by deductive content analysis and the majority 98% of the women's responses was about commitment, empathy and respect from the midwives. The responses (n = 18) who did not fit in QPP-I were then analyzed inductive and focused on team work and sense of coherence. Conclusion: The instrument QPP-I can be developed with additional statement to measure what it intends to measure, women's perceptions of maternity care.

We did it together : Fathers´ experiences of planned home birth in the Nordic countries

Sammanfattning: Bakgrund: för många pappor kan det vara en av livets största och bästa stund att närvara vid när deras barn föds. Det finns studier som beskriver pappors upplevelse av sjukhusförlossning, däremot finns det få studier som beskriver pappors upplevelse av planerad hemförlossning. Syftet med den här studien är att beskriva pappans upplevelser och erfarenheter av planerad hemförlossning. Metod: i denna studie medverkar 105 pappor från de nordiska länderna som har deltagit i planerad hemförlossning mellan 2009-2011. Materialet från en öppen enkätfråga analyserades med hjälp av deduktiv ansats. Den öppna frågan löd ”beskriv gärna förlossningen med egna ord”. Resultat: papporna upplevde den planerade hemförlossningen som lugn och säker, mycket tack vare den professionella barnmorskan och den välbekanta miljön. Att få vara hemma med sin partner och om så önskades, sin familj var högt skattat. Födelseprocessen hemma beskrevs av papporna som att ”vi gjorde det tillsammans” och ”det var vår egen förlossning”. Papporna uttryckte delaktighet i förlossningsflödet. De kände också att de fick ett barn och var en del av en vacker förlossning full av kärlek. Konklusion: att välkomna ett barn hemma i en lugn miljö där paret känner sig trygga och ostörda, kan underlätta en positiv och meningsfull förlossningsupplevelse.

Translation, Communication and 'Learning' : Experiences from teaching a master program in Viet Nam

In Vietnam, as in other Asian countries, co-operation with foreign universities plays an important role for the development of higher education. This paper is based on personal experiences from teaching a Swedish Master Programme in Education Science at Vietnam National University in Hanoi. Using theories developed by Lev Vygotsky and Donald Schon, the programme is explored as an inter-cultural learning process. Three aspects are focused upon. Firstly, the fact that communication between students and teachers is conducted with the help of translators who support both teachers and students in their attempt to understand and make themselves understood. Secondly, the expressed need to connect the ideas and techniques which are studied in the programme to the students´ professional worlds. Thirdly, the need to construct a framework wherein the students can inquire into their own situations and to encourage them to try new and more productive ways to deal with problems they are confronted with.

Förlossningsrädda kvinnors erfarenheter av Aurorasamtal ett till två år efter förlossning

Bakgrund: Av alla gravida kvinnor räknas omkring 5 % lida av svår förlossningsrädsla. Kvinnor med förlossningsrädsla löper högre risk för komplikationer under och efter graviditeten. I Sverige läggs idag mycket resurser på Auroraverksamhet för att hjälpa kvinnor med förlossningsrädsla. Det saknas omfattande utvärdering av Auroraverksamheten. Syfte: Syftet med detta fördjupningsarbete var att undersöka upplevelse och effekt av Aurorasamtal inför förlossning samt upplevelse av den efterföljande förlossningen bland först- och omföderskor. Metod: Studien har en retrospektiv studiedesign där datainsamling skedde via en enkätundersökning. Datamaterialet sammanställdes därefter i SPSS. Resultat: Majoriteten av kvinnorna upplevde att samtalen hjälpte dem till en mer positiv förlossningsupplevelse. Fler förstföderskor än omföderskor önskade planerat kejsarsnitt när de kom till Auroramottagningen. De flesta kvinnor som önskade vaginal förlossning blev vaginalt förlösta. Över hälften av kvinnorna som deltog i studien var mindre rädda för förlossning 1 – 2 år efter förlossningen än de upplevde att de var innan Aurorasamtalet och förlossningen. Konklusion: Aurorasamtal förefaller ha störst betydelse för omföderskor och för de kvinnor som önskar vaginal förlossning.