Altered morphokinetics and differential reproductive outcomes associated with cell exclusion events in human embryos.

RESEARCH QUESTION: Can embryos harbouring cell exclusion and their reproductive outcomes be classified based on morphokinetic profiles? DESIGN: A total of 469 time-lapse videos of embryos transferred between 2013 and 2019 from a single clinic were analysed. Videos were assessed and grouped according to the presence or absence of one or more excluded cells before compaction. Cell division timings, intervals between subsequent cell divisions and dynamic intervals were analysed to determine the morphokinetic profiles of embryos with cell exclusion (CE+), compared with fully compacted embryos without cell exclusion or extrusion (CE-). RESULTS: Transfer of CE+ embryos resulted in lower proportions of fetal heartbeat (FHB) and live birth compared with CE- embryos (both, P < 0.001). CE+ embryos were associated with delays in t2 (P = 0.030), t6 (P = 0.018), t7 (P < 0.001), t8 (P = 0.001), tSC (P < 0.001) and tM (P < 0.001). Earlier timings for t3 (P = 0.014) and t5 (P < 0.001) were positively associated with CE+; CE+ embryos indicated prolonged S2, S3, ECC3, cc2 and cc4. Logistic regression analysis revealed that t5, tM, S2 and ECC3 were the strongest predictive indicators of cell exclusion. Timings for S2 and ECC3 were useful in identifying increased odds of FHB when a cell exclusion event was present. CONCLUSION: Embryos harbouring cell exclusion indicated altered morphokinetic profiles. Their overall lower reproductive success was associated with two morphokinetic parameters. Morphokinetic profiles could be used as adjunct indicators for reproductive success during cycles producing few, low-quality embryos. This may allow more objective identification of cell exclusion and refinement of embryo ranking procedures before transfer.

Parental alienation - a valid experience?

BACKGROUND: The phenomenon of 'parental alienation' is controversial and little explored in the Nordic countries. We wanted to investigate whether parental alienation is a valid concept and how it is perceived in a Nordic context. MATERIAL AND METHOD: The study was based on an online survey where the participants were self-recruited. We received responses from 1212 participants. Bivariate and multivariate models were used to test the associations between parental alienation and gender, other intimate partner violence, depressive health problems and reduced well-being. RESULTS: Visitation sabotage and parental alienation are realities for both fathers and mothers. It was most frequently directed at fathers, but such behaviour is not gender specific. Eight different alienation strategies have high internal reliability, and all items contribute to high Cronbach's alpha. Construct validity was confirmed by the fact that parental alienation is strongly associated with visitation sabotage and with other forms of destructive relational behaviour. Visitation sabotage and false accusations increase gradually with the degree of parental alienation. The construct validity of parental alienation was also confirmed by dose-response associations with both mental ill-health and impaired well-being in adjusted analyses. CONCLUSIONS: The phenomenon of parental alienation is recognized among parents as a form of harmful behaviour where both mothers and fathers suffer. The construct validity was supported in this study. Such behaviour should be recognized as a form of domestic violence by professional communities in health and social services and be subject to legal action.

The Significance of Inter-Eye Osmolarity Difference in Dry Eye Diagnostics.

Purpose: The purpose of this study was to evaluate the diagnostic value of inter-eye osmolarity differences in relation to dry eye symptoms and other non-osmolar signs of dry eye disease. Patients and Methods: One hundred ninety one participants who attended a larger interventional study of dry eye disease prior to and after cataract surgery were analyzed for dry eye disease (DED). Dry eye diagnostics were performed for all subjects according to the DEWS II criteria: tear osmolarity was collected from both eyes with the TearLab system, non-invasive Tear film break up time (NIKBUT) was obtained on the test eye with Keratograph and ocular surface staining (OSS) was evaluated using the Oxford schema. The Ocular Surface Disease Index (OSDI) questionnaire was used to assess symptoms. Inter-eye osmolarity greater than 8, which is considered as a sign of DED according to the TearLab user manual, was evaluated and compared with other non-osmolar signs of DED. Results: The 191 subjects were divided into three groups according to osmolarity measurements. Sixty-five subjects had normal osmolarity (below 308 mOsmol/L in both eyes and less than 9 mOsmol/L difference between the eyes), 107 had high osmolarity (308 mOsmol/L or higher in one of the eyes) and 19 had an inter-eye difference >8 mOsmol/L or higher, with neither eye having osmolarity higher than 307 mOsmol/L. Signs and symptoms in this last group were not correlated with the high osmolarity group or the normal group, though they appeared more similar to the normal group. Conclusion: The diagnostic value of inter-eye osmolarity difference in predicting symptoms or other non-osmolar signs of dry eyes appears weak. Our study suggests that the criterion of an inter-eye difference of 8 mOsmol/L is not a useful cut-off for diagnosing dry eyes based on osmolarity.

Self-rated health in adolescence as a predictor of 'multi-illness' in early adulthood: A prospective registry-based Norwegian HUNT study.

Self-rated health (SRH) is a marker of future health and a possible predictor of future multimorbidity, which is a major challenge for population health and health care. There is a lack of studies on adolescent SRH and patterns of health problems across the transitional period from adolescence to early adulthood. Therefore, this study aimed to identify groups of people with similar health problems in early adulthood and explore the predictive value of adolescent SRH on the group classification after a period of 10-19 years. Data from 8828 adolescents participating in the Young HUNT-1 survey (1995-1997) were linked to the Norwegian registry of general practitioner (GP) claims, which includes diagnoses recorded in GP consultations in 2006-2014. We used latent class analysis (LCA) to identify groups of patients with similar health problems in early adulthood and explored SRH as a predictor of class membership using latent class regression, adjusting for baseline chronic disease, frequency of health care attendance, sex and age. The mean age at baseline was 16 years, and 50% of the participants were female. SRH was reported as very good by 28%, good by 61% and not good by 11%. We identified five groups of patient classification (classes): Healthy (35%), Infections and general problems (26%), Musculoskeletal problems (21%), Psychological problems (6%) and Multi-illness (13%). We found a gradual increase in the probability of belonging to the Healthy class with better SRH, and an inverse pattern for the Psychological and Multi-illness classes. This pattern remained after adjusting for baseline variables. In conclusion, there is a clear association between adolescent SRH and the risk of having multi-illness in early adulthood, seen as a proxy for later multimorbidity. This finding warrants greater attention to SRH in adolescence as a possible indicator in targeted prevention of future health problems.

Adolescent self-rated health predicts general practice attendance in adulthood: Results from the Young-HUNT1 survey.

AIMS: Self-rated health (SRH) is a predictor of future health. However, the association between SRH in adolescence and health problems and health care utilization in adulthood has rarely been investigated. The aim of this study was to examine adolescent SRH as a predictor of general practitioner consultations in adulthood. METHODS: SRH was registered in the Young-HUNT1 survey in 1995-1997 ( N=8828, mean age 16 years, 88% participation rate). General practitioner consultations during 2006-2014 were obtained from a national claims database. The predictive value of adolescent SRH on general practitioner consultations in adulthood was analysed by regression models estimating the relative risks (RR) for the total number of consultations and consultations for psychological, gastrointestinal, musculoskeletal or respiratory problems. Age, sex and baseline measures of chronic disease and health care attendance were used as the adjusting variables. RESULTS: SRH was reported as 'very good' by 28.4%, 'good' by 60.6% and 'not good' by 11.0% of the respondents. The increases in consultation rates were 21% (RR 1.21, 95% CI 1.15-1.27) and 52% (RR 1.52, 95% CI 1.40-1.64) when comparing respondents with 'very good' SRH to those with 'good' and 'not good' SRH, respectively. We also demonstrated a dose-response association between adolescent SRH and general practitioner consultations for psychological, gastrointestinal, musculoskeletal or respiratory problems. CONCLUSIONS: SRH in adolescence is a predictor for general practitioner consultations in adult life. Previous research shows that SRH is influenced by factors such as well-being, health behaviour, functional status and body satisfaction. Intervention studies are needed to evaluate whether population-based and clinical interventions can improve SRH by improving these factors among adolescents.

Body size perceptions and preferences favor overweight in adult Saharawi refugees.

BACKGROUND: Culture affects body image and body size perceptions from an early age and in many African countries, overweight has been associated with richness, health, strength, and fertility. The present study investigated body size perceptions and preferences in an African refugee population. METHODS: The cross-sectional study was comprised of 180 and 175 randomly selected Saharawi women and men, respectively, between 18 and 80 years. Stunkard's body figure scale was used to identify self-perceived body size, desired body size and desired body size in the opposite gender. RESULTS: Approximately half of the participants had a correct self-perceived body size; among them 70% did not have a desire to have a smaller body size. Among women who preferred a body size corresponding to overweight in men, 77% also had a desired body size corresponding to overweight; compared to 43% for men. The youngest participants (18-25 years) were the least likely to overestimate their body size in comparison to the older participants (26-45 years and 46-80 years). CONCLUSION: We found an overall preference for an overweight body size, and a significant difference in body size perception associated with age.

Type and severity of new-onset urinary incontinence in middle-aged women: the Hordaland Women's Cohort.

AIMS: To determine the natural history of new-onset urinary incontinence by type and severity in middle-aged women. METHODS: In 1997-1999 2229 randomly selected women aged 41-45 agreed to participate in the Hordaland Women's' Cohort, and six identical postal questionnaires were sent them during the following ten years. Response rate was 95.7% at inclusion and has remained 87% to 93% in subsequent waves. A total of 1274 women were continent at baseline and used as source population for this paper. Distribution of type and severity of new-onset urinary incontinence and changes in these variables during four years follow-up (two checkpoints) were measured. RESULTS: Among 1274 continent women, 514 (40.3%) reported new-onset urinary incontinence during 10 years. Type distribution was 49.8%, 18.3% and 20.3% for stress, urgency and mixed incontinence, respectively. A majority of women (89.3%) started with slight urinary incontinence and none reported severe new-onset urinary incontinence. During four years follow-up of 337 women, 212 (62.9%) reported transient and 125 (37.1%) women reported persistent urinary incontinence. In the latter group 74.6% had the same type of urinary incontinence and 62.4% reported slight grade of incontinence in all reports. CONCLUSIONS: Our study demonstrates that in middle-aged women new-onset urinary incontinence is mainly of stress type and of slight severity. One third of the women developed persistent incontinence, with low tendency of shifting type and severity over several years. Mixed urinary incontinence is not a final stage of incontinence in this age group.

The Hordaland Women's Cohort: prevalence, incidence, and remission of urinary incontinence in middle-aged women.

INTRODUCTION AND HYPOTHESIS: The aim of study is to prospectively investigate the prevalence, incidence, and remission of urinary incontinence (UI) in a cohort of middle-aged women. METHODS: In 1997-1999, 2,229 randomly selected women aged 41-45 agreed to participate in the Hordaland Women's Cohort, and six almost identical postal questionnaires were sent them during the following 10 years. Response rate was 95.7% at inclusion and has remained 87% to 93% in subsequent waves; 64.1% answered all six questionnaires. UI variables include type, amount, frequency, and severity. RESULTS: Prevalence of UI increased by age until a peak in age group 51-52 years for any (50.3%) and significant (10.0%) UI. There was then a decrease in prevalence caused by a decrease in incidence and decrease in remission. Stress UI was the major type and most UI was of low severity. CONCLUSION: Prevalence of any UI is high in middle-aged women but reaches a peak followed by a decrease.

The Hordaland Women's Cohort: a prospective cohort study of incontinence, other urinary tract symptoms and related health issues in middle-aged women.

BACKGROUND: Urinary incontinence (UI) is a prevalent symptom in middle-aged women, but data on incidence is limited and rarely reported. In order to analyze incidence, remission, or development patterns of severity and types of UI, we have established a 15-year prospective cohort (1997-2012). METHODS: The Cohort is based on the national collection of health data gathered from county studies (CONOR). Hordaland Health Study (HUSK) is one of them from Hordaland County. Each of the county studies may have local sub-studies and our Cohort is one of them. The Cohort included women aged 40-45 in order to have a broad approach to women's health including UI and other lower urinary tract symptoms (LUTS). A one fifth random sampling from HUSK was used to create the Cohort in 1997-1999. For the necessary sample size a preliminary power calculation, based on a 70% response rate at inclusion and 5% annual attrition rates was used. The Cohort is planned to collect data through questionnaires every second year for the 15-year period from 1997-2012. DISCUSSION: The Cohort represents a relatively large random sample (N = 2,230) of about 15% of the total population of women born between 1953-57 in the county of Hordaland. Our data shows that the cohort population is very similar to the source population. The baseline demographic, social and medical characteristics of the Cohort are compared with the rest of women in HUSK (N = 7,746) and there were no significant differences between them except for the level of education (P = 0.001) and yearly income (P = 0.018), which were higher in the Cohort population. Urological characteristics of participants from the Cohort (N = 1,920) were also compared with the other participants (N = 3,400). There were no significant statistical differences except for somewhat more urinary continence (P = 0.04), more stress incontinence (P = 0.048) and smaller amount of leakage (P = 0.015) in the Cohort. In conclusion, the Cohort is population-based, with little selection bias, and thus is a rather unique study for investigating UI and LUTS in comparison with many other projects with similar purposes.