An Empowerment-Based Physical Activity Intervention for Older People with Advanced Age-Related Macular Degeneration: An Exploratory Qualitative Case Study Design.

Background: Age-related macular degeneration (AMD) is the most common cause of incurable visual impairment and impacts daily life. There are benefits of physical activity for people who are affected with AMD; however, living with AMD is associated with lower levels of physical activity and social isolation. The aim of this study was to explore how older people with AMD in Sweden experienced participation in a 6-month empowerment-based physical activity intervention and how it influenced their physical abilities. Methods: The participants were nine individuals with AMD aged 70-87 years. The intervention comprised physical and social activities in a group twice a week and individual health coaching on three occasions. The study was based on an exploratory qualitative case study design. Results: The findings showed two themes: created meaningfulness in life and creative and playful ways to develop body movements. The findings also showed improved muscle strength after the intervention. Conclusions: The findings showed that participants had increased social connectedness, improved physical self-efficacy and physical ability, as well as improved muscle strength. The empowerment process of the intervention was appreciated by the participants and challenged them to participate in physical activity offered by the municipality for older individuals.

Effects of weight loss intervention on anxiety, depression and quality of life in women with severe obesity and polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women that is associated with an increased risk of anxiety and depression and with a lower health-related quality of life (HRQoL). PCOS is closely associated with obesity, which per se can lead to symptoms of anxiety and depression and lower HRQoL. The first-line treatment for PCOS is weight loss through lifestyle intervention, which has been shown to improve all symptoms of the syndrome. The aim of this study was to investigate symptoms of anxiety and depression and HRQoL in women with severe obesity (BMI ≥ 35) with and without PCOS, and to evaluate the effect of a one-year structured weight loss intervention. A total of 246 women with severe obesity (PCOS n = 63, non-PCOS n = 183) were included. The comprehensive psychopathological rating scale self-rating scale for affective symptoms (CPRS-S-A) and the short form-36 (SF-36) were used to assess symptoms of anxiety and depression and HRQoL. In total 72 women of the 246 women with severe obesity completed a one-year weight loss programme and were followed up and compared with baseline data. In women with severe obesity, there were no differences in symptoms of anxiety and depression and HRQoL between women with and without PCOS at baseline. Clinically relevant anxiety symptoms were present in 71.3% (PCOS) and 65.6% (non-PCOS), and depression symptoms were present in 56.4% (PCOS) and 52.2% (non-PCOS). Significant weight loss improved physical HRQoL in all women, but reduced symptoms of anxiety and depression only in women without PCOS. There were no differences when comparing the changes between the groups. Women with severe obesity are severely affected by symptoms of anxiety and depression, independent of PCOS. Weight loss improved symptoms of anxiety and depression in women without PCOS, but there were no differences between groups in change from baseline to follow-up.Trial registration number: Clinical trial.gov: NCT01319162, March 18, 2011. Date of registration and enrolment of the first subject September 2011.

Androgens Modulate the Immune Profile in a Mouse Model of Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is associated with a low-grade inflammation, but it is unknown how hyperandrogenism, the hallmark of PCOS, affects the immune system. Using a PCOS-like mouse model, it is demonstrated that hyperandrogenism affects immune cell populations in reproductive, metabolic, and immunological tissues differently in a site-specific manner. Co-treatment with an androgen receptor antagonist prevents most of these alterations, demonstrating that these effects are mediated through androgen receptor activation. Dihydrotestosterone (DHT)-exposed mice displayed a drastically reduced eosinophil population in the uterus and visceral adipose tissue (VAT). A higher frequency of natural killer (NK) cells and elevated levels of IFN-γ and TNF-α are seen in uteri of androgen-exposed mice, while NK cells in VAT and spleen displayed a higher expression level of CD69, a marker of activation or tissue residency. Distinct alterations of macrophages in the uterus, ovaries, and VAT are also found in DHT-exposed mice and can potentially be linked to PCOS-like traits of the model. Indeed, androgen-exposed mice are insulin-resistant, albeit unaltered fat mass. Collectively, it is demonstrated that hyperandrogenism causes tissue-specific alterations of immune cells in reproductive organs and VAT, which can have considerable implications on tissue function and contribute to the reduced fertility and metabolic comorbidities associated with PCOS.

Bearing the burden of spill-over effects: Living with a woman affected by symptomatic pelvic organ prolapse after vaginal birth - from a partner's perspective.

INTRODUCTION: Symptomatic pelvic organ prolapse (sPOP) can have a negative impact on a woman's health. While research exists about the impact of sPOP on women, little is known about the effect on their partners. Therefore, this study aimed to explore, from the partner's perspective, what it means to live with a woman with symptomatic pelvic organ prolapse after vaginal birth. METHODS: A qualitative explorative design with a constructed grounded theory approach was taken to analyse the interviews of 13 partners who experienced living with a woman who had sPOP after vaginal birth. RESULTS: "The theory of bearing the burden of spill-over effects" was constructed based on a core category: "Facing a new restricted life", with related categories "Giving up valued activities"; "Struggling with added demands"; "Changing intimate behaviour" and "Redefining future family planning". The theory also contains factors constraining and enabling adjustment to the new reality. While the shortcomings of healthcare constrained the process of adjustment, getting competent treatment and the feeling of love for the family enabled it. CONCLUSION: This study demonstrated that women's sPOP had an apparently negative impact on partners' health behaviours, sexual health, relationship harmony, and psychological well-being. The partners indicated they were unprepared for post-birth adversities and distressed by the lack of treatment options. There is a need to develop prenatal information highlighting the potential risks of sPOP which may be accompanied by levator ani muscle injury, implement guidelines for the prevention and management of these conditions, and offer targeted support to partners if needed.

Transgenerational transmission of reproductive and metabolic dysfunction in the male progeny of polycystic ovary syndrome.

The transgenerational maternal effects of polycystic ovary syndrome (PCOS) in female progeny are being revealed. As there is evidence that a male equivalent of PCOS may exists, we ask whether sons born to mothers with PCOS (PCOS-sons) transmit reproductive and metabolic phenotypes to their male progeny. Here, in a register-based cohort and a clinical case-control study, we find that PCOS-sons are more often obese and dyslipidemic. Our prenatal androgenized PCOS-like mouse model with or without diet-induced obesity confirmed that reproductive and metabolic dysfunctions in first-generation (F1) male offspring are passed down to F3. Sequencing of F1-F3 sperm reveals distinct differentially expressed (DE) small non-coding RNAs (sncRNAs) across generations in each lineage. Notably, common targets between transgenerational DEsncRNAs in mouse sperm and in PCOS-sons serum indicate similar effects of maternal hyperandrogenism, strengthening the translational relevance and highlighting a previously underappreciated risk of transmission of reproductive and metabolic dysfunction via the male germline.

Transcriptomic survey of key reproductive and metabolic tissues in mouse models of polycystic ovary syndrome.

Excessive androgen production and obesity are key to polycystic ovary syndrome (PCOS) pathogenesis. Prenatal androgenized (PNA), peripubertal androgenized, and overexpression of nerve growth factor in theca cells (17NF) are commonly used PCOS-like mouse models and diet-induced maternal obesity model is often included for comparsion. To reveal the molecular features of these models, we have performed transcriptome survey of the hypothalamus, adipose tissue, ovary and metaphase II (MII) oocytes. The largest number of differentially expressed genes (DEGs) is found in the ovaries of 17NF and in the adipose tissues of peripubertal androgenized models. In contrast, hypothalamus is most affected in PNA and maternal obesity models suggesting fetal programming effects. The Ms4a6e gene, membrane-spanning 4-domains subfamily A member 6E, a DEG identified in the adipose tissue in all mouse models is also differently expressed in adipose tissue of women with PCOS, highlighting a conserved disease function. Our comprehensive transcriptomic profiling of key target tissues involved in PCOS pathology highlights the effects of developmental windows for androgen exposure and maternal obesity, and provides unique resource to investigate molecular mechanisms underlying PCOS pathogenesis.

A consensus document on definition and diagnostic criteria for orthorexia nervosa.

PURPOSE: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with "correct" eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. METHODS: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A-Definition, Clinical Aspects, Duration; B-Consequences; C-Onset; D-Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. RESULTS: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. CONCLUSIONS: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. LEVEL OF EVIDENCE: Level V: opinions of expert committees.

Favorable Adaptation during SARS-CoV-2-Pandemic as Told by Student-Athletes-A Longitudinal and Behavioral Study.

(1) Background: The aim was to explore the impact of adaptive responses (resilience factors) on student-athletes' behaviors during a stressful period of life during the SARS-CoV-2-pandemic of 2020 and 2021. (2) Methods: A constructivist-based grounded theory (CGT) was used guided by a biopsychosocial approach. Based on purposeful sampling, 22 male and female student-athletes were divided into four focus group interviews (FGI) seven months after the outbreak of the SARS-CoV-2-pandemic (October 2020) and 18 of these were followed up by FGI seven months later (May 2021). The mean age was 17.65 and they represented golf and handball. (3) Results: The CGT contained four main categories seven months after the SARS-CoV-2-pandemic outbreak: Social support, Self-discipline, Physical practice and recovery and Management of everyday life. Fourteen months after the SARS-CoV-2-pandemic outbreak, four additional main categories emerged: More extensive social support, Belief in the future, Self-awareness and Responsibility and problem-solving. (4) Conclusions: The CTG suggests that student-athletes' favorable adaptations to the stressful SARS-CoV-2-pandemic period 2020-2021 are based on a gradually developed ability to take responsibility for one's own actions, insight into the importance of deepened social interaction, belief in a positive post-COVID future and increased awareness of physical activity and its relation to perceived health.

Circulating Anti-Müllerian hormone in a cohort-study of women with severe obesity with and without polycystic ovary syndrome and the effect of a one-year weight loss intervention.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) have high circulating anti-Müllerian hormone (AMH) levels which is correlated with antral follicle count and polycystic ovarian morphology and negatively correlated with body mass index (BMI). Moreover, diet-induced weight loss in women with PCOS and overweight or obesity, reduce or normalize AMH-levels. There is, however, no previous study investigating the circulating AMH levels in women with severe obesity and how a structured diet-induced weight loss program affects circulating AMH levels in these women. Therefore, this study aims to investigate circulating AMH levels in a population of women with severe obesity (BMI ≥ 35 kg/m2) with and without PCOS, as diagnosed by the NIH-criteria, and to investigate the effect of a one-year weight loss program with a very low-energy diet (VLED) on circulating levels of AMH. METHODS: In a prospective cohort-study, were 246 women with severe obesity were screened for PCOS diagnosis with the NIH-criteria, circulating AMH and anthropometry were measured at baseline and after a 12-month weight loss intervention with very low-energy diet (VLED). RESULTS: Mean BMI was 39.9 ± 4.7 (PCOS), 39.6 ± 4.3 (non-PCOS) P = 0.960. Circulating AMH was higher in women with PCOS (5.47 ± 4.89 µg/L) compared with non-PCOS (2.66 ± 3.71 µg/L) P < 0.001 and was positively correlated with circulating total testosterone in both groups. Next, we performed ROC-analyses, and show that circulating AMH could not discriminate women with PCOS and severe obesity from non-PCOS women with severe obesity. Finally, a one-year weight reduction program does not affect circulating AMH levels despite significant weight loss neither in women with PCOS, nor without PCOS and severe obesity. CONCLUSION: Women with severe obesity and PCOS have elevated levels of circulating AMH compared to women without the syndrome. AMH-levels could not discriminate women with PCOS from non-PCOS because of low sensitivity and specificity. Significant weight loss was not associated with changes in circulating AMH levels, neither in women with, nor without PCOS and severe obesity. These results imply that in women with severe obesity, a greater weight loss may be needed to improve reproductive features, independent of PCOS diagnosis. TRIAL REGISTRATION NUMBER: Clinical trial.gov: NCT01319162.

"This Group is Like a Home to Me:" understandings of health of LGBTQ refugees in a Swedish health-related integration intervention: a qualitative study.

BACKGROUND: When large numbers of asylum seekers immigrate to a country, civil society is encouraged to contribute to their integration. A subgroup of asylum seekers comprising lesbian, gay, bisexual, transgender, or queer (LGBTQ) refugees are specifically deemed vulnerable to developing health and integration problems due to the double stigma of being a sexual/gender minority and a refugee. The Swedish Federation for LGBTQ Rights (RFSL) is a civil societal organization that has established the support group "RFSL Newcomers," a health-related integration intervention that targets such refugees. The aim of the present study is reconstructing the subjective understanding of health of LGBTQ refugees. METHODS: Eleven participants in Newcomers and eight organizers were interviewed about LGBTQ refugees' experiences of migrating and participating in RFSL Newcomers. Qualitative content analysis was used to reconstruct subjective understandings of health that were constructed in these narratives. As the data did not originally concentrate on exploring understandings of health, a broad theoretical approach was used as a heuristic for the analysis, which focused on the common everyday approach of conceptualizing health as wellbeing. RESULTS: The narratives revealed three interconnected, interdependent categories of understanding health in which tensions occur between wellbeing and ill-being: belonging versus alienation, security and safety versus insecurity, and recognition versus denial. The categories contribute to an overarching theme of health as framed freedom - i.e., freedom framed by conditions of society. CONCLUSIONS: For our participants, belonging, recognition, and security/safety are conceptual elements of understanding health, not its social determinants. Thus, these understandings emphasize relational and existential meanings of health (theoretical implication). As for practical implications, the understandings of health were connected to being either inside or outside the Newcomers group and a new society, depending on whether LGBTQ refugees comply with social requirements. As a significant actor that is representative of the cultural majority and a facilitator of LGBTQ refugees' resettlement process, RFSL provides LGBTQ refugees with crucial orientations for becoming a "good migrant" and a "good LGBTQ person," yet a "bad bio-citizen." Generally, organizers of interventions may enhance the effectiveness of their interventions when relational, existential, and biomedical understandings of health are all incorporated.

From Hell to Heaven? Lived experiences of LGBTQ migrants in relation to health and their reflections on the future.

This paper explores the lived experiences of LGBTQ migrants participating in a civil society group in Sweden during the migration process and their reflections on the future. Eleven migrants who self-identified as LGBTQ (seven male/gay, one female/lesbian, one female/bi-sexual, and two transgender/gay persons) from three local support groups for LGBTQ migrants agreed to be interviewed. Participants came from Guinea, Iraq, Kurdistan, North Macedonia, Nigeria, Nicaragua, Pakistan, the Russian Federation, Syria, Uganda and Ukraine. Interpretative-phenomenological analysis resulted in three themes: Past: from daily stress to the fear of being killed; Present: safety, belonging and resources to support the transition to a new life; and Future: making a positive difference or being afraid of what's ahead. Participants' health-related journeys and reflections about the future were complex in terms of favourable and unfavourable lived experiences, which become resources and risks for personal development. Study findings offers an enhanced awareness of the complex landscape of, and interaction between, vulnerability and potentiality. Based on the findings, we suggest the adoption of a health promoting approach focusing on the LGBTQ migrants' strengths and personal resources.

Empowerment-Based Physical Activity Intervention for People with Advanced Dry Age-Related Macular Degeneration: Mixed-Methods Protocol.

Age-related macular degeneration (AMD) is the most common cause of incurable visual impairment and impacts daily life. These impacts include loss of social activities, decreased functional independence, and reduced physical activity. This protocol aims to describe a prospective, mixed-methodology for studying a population with AMD before, during, and after an empowerment-based physical activity intervention (EPI). A study framework was also developed for EPI. The intervention will include 20 older individuals (age 65+ years) with AMD recruited in Sweden. The intervention period is six months and comprises adapted physical activity and social activities in a group twice a week and individual health coaching on three occasions. The quantitative pre-test and three follow-ups include physical functional tests, an accelerometer that monitors physical activity continuously for one week, and questionnaires. Individual and focus-group interviews and ethnographic observations will explore the experience of living with AMD and what it means to participate in the EPI for individuals with AMD. The chosen methodology offers a structured way for researchers to explore the experiences and factors that may provide insights into the potential of creative supervised, adapted physical activity in groups, health coaching, and socialising that are significant to enable well-being among older individuals with AMD.

Health-related integration interventions for migrants by civil society organizations: an integrative review.

Purpose: Migrants are a vulnerable group concerning health and integration. Civil society organizations are deemed important for the integration and health of migrants and have been encouraged to help. This study explored health and acculturation, as expressed in research into health-related integration interventions for migrant groups provided by civil society organizations.Methods: Databases, journal websites and reference lists were searched in an integrative review. Thirteen articles were found and analysed using concepts of health strategies/perspectives and of acculturation with regard to general and health culture.Results: Studies were divided between two primary spectrums: 1) assimilation-integration and 2) integration-separation spectrum. Spectrum 1 interventions tend to promote assimilation into the present host culture and into a Western view of health. They are mostly driven by representatives of the host culture. Spectrum 2 interventions are characterized by a greater openness concerning the home-culture understandings of health, alongside an appreciation of the home culture in general. They are mostly migrant-driven.Conclusions: The different acculturating approaches in migrant and native-driven civil society organizations call for an awareness of their guiding health and acculturation assumptions and their applied perspectives and strategies. This awareness is considered crucial in order to achieve desired health and acculturation outcomes.

'Don't abandon me': Young people's experiences of child and adolescent psychiatric inpatient care supporting recovery described in blogs.

Child and adolescent psychiatric (CAP) inpatient care has the potential to support or hinder young people's mental-health recovery. Research describing inpatient care from the perspective of young people is rare. Personal blogs provide an opportunity to further understand how inpatient care relates to young people's recovery processes. This study aimed to explore young people's experiences of CAP inpatient care supporting mental-health recovery. The study is reported in accordance with the COREQ guidelines. Data were created during 2018 from twenty-seven personal blogs describing first-hand experiences of being a patient in a CAP inpatient care facility in Sweden and analysed using a method for interpretive description. Information in blogs suggests they were written by women, a majority of which had experienced eating disorders. Findings describe young people's experiences of CAP inpatient care supporting mental-health recovery in an interpretive explanation with one theme, 'Don't abandon me', and three sub-themes: 'Listen to me', 'Believe in me', and 'Allow me to feel safe'. This study adds to the growing body of empirical work suggesting the importance of the concept of recovery in young people's mental health. To support recovery, CAP inpatient care needs to focus on developing the content of care rather than minimizing the length of the stay. User experience should be at the heart of efforts aimed at improving services.

Personal trainers' health advice in the fitness gym space from a gender perspective.

Purpose: This study aimed to describe and problematize the advice on exercise and diet that personal trainers (PTs) provide to their clients from a gender perspective.Method: The present study had an explorative design, and the interviews were analysed using an interpretative qualitative approach. Seven focus group discussions were conducted with 19 PTs (aged 23-47 years).Results: The findings indicated that the PTs had a gender-neutral health advice approach to both women and men, guiding them towards a relaxed attitude to exercise and diet, prioritizing and rationalizing their exercise and diet and eating a natural diet. PTs also had a gendered health advice approach as regards women who showed unhealthy exercise and eating behaviours; advising them to eat more and exercise less, to focus on performance rather than appearance and to avoid heavy weightlifting. Some PTs acted evasively and did not give advice to men.Conclusions: Both approaches include advice that reflect health as control and health as release. From a gender perspective, PTs health advice both challenged and reproduced the stereotypical male norm in the fitness gym space. However, PTs gendered health advice may create different opportunities for men and women to promote their health and well-being in the fitness gym.

Excess of ovarian nerve growth factor impairs embryonic development and causes reproductive and metabolic dysfunction in adult female mice.

Nerve growth factor (NGF) is critical for the development and maintenance of the peripheral sympathetic neurons. NGF is also involved in the ovarian sympathetic innervation and in the development and maintenance of folliculogenesis. Women with the endocrine disorder, polycystic ovary syndrome (PCOS), have an increased sympathetic nerve activity and increased ovarian NGF levels. The role of ovarian NGF excess in the PCOS pathophysiology and in the PCOS-related features is unclear. Here, using transgenic mice overexpressesing NGF in the ovarian theca cells (17NF mice), we assessed the female embryonic development, and the reproductive and metabolic profile in adult females. Ovarian NGF excess caused growth restriction in the female fetuses, and a delayed gonocyte and primary oocyte maturation. In adulthood, the 17NF mice displayed irregular estrous cycles and altered ovarian expression of steroidogenic and epigenetic markers. They also exhibited an increased sympathetic output with increased circulating dopamine, and metabolic dysfunction reflected by aberrant adipose tissue morphology and function, impaired glucose metabolism, decreased energy expenditure, and hepatic steatosis. These findings indicate that ovarian NGF excess leads to adverse fetal development and to reproductive and metabolic complications in adulthood, mirroring common features of PCOS. This work provides evidence that NGF excess may be implicated in the PCOS pathophysiology.

Electroacupuncture Mimics Exercise-Induced Changes in Skeletal Muscle Gene Expression in Women With Polycystic Ovary Syndrome.

CONTEXT: Autonomic nervous system activation mediates the increase in whole-body glucose uptake in response to electroacupuncture but the mechanisms are largely unknown. OBJECTIVE: To identify the molecular mechanisms underlying electroacupuncture-induced glucose uptake in skeletal muscle in insulin-resistant overweight/obese women with and without polycystic ovary syndrome (PCOS). DESIGN/PARTICIPANTS: In a case-control study, skeletal muscle biopsies were collected from 15 women with PCOS and 14 controls before and after electroacupuncture. Gene expression and methylation was analyzed using Illumina BeadChips arrays. RESULTS: A single bout of electroacupuncture restores metabolic and transcriptional alterations and induces epigenetic changes in skeletal muscle. Transcriptomic analysis revealed 180 unique genes (q < 0.05) whose expression was changed by electroacupuncture, with 95% of the changes towards a healthier phenotype. We identified DNA methylation changes at 304 unique sites (q < 0.20), and these changes correlated with altered expression of 101 genes (P < 0.05). Among the 50 most upregulated genes in response to electroacupuncture, 38% were also upregulated in response to exercise. We identified a subset of genes that were selectively altered by electroacupuncture in women with PCOS. For example, MSX1 and SRNX1 were decreased in muscle tissue of women with PCOS and were increased by electroacupuncture and exercise. siRNA-mediated silencing of these 2 genes in cultured myotubes decreased glycogen synthesis, supporting a role for these genes in glucose homeostasis. CONCLUSION: Our findings provide evidence that electroacupuncture normalizes gene expression in skeletal muscle in a manner similar to acute exercise. Electroacupuncture might therefore be a useful way of assisting those who have difficulties performing exercise.

Prenatal androgen exposure and transgenerational susceptibility to polycystic ovary syndrome.

How obesity and elevated androgen levels in women with polycystic ovary syndrome (PCOS) affect their offspring is unclear. In a Swedish nationwide register-based cohort and a clinical case-control study from Chile, we found that daughters of mothers with PCOS were more likely to be diagnosed with PCOS. Furthermore, female mice (F0) with PCOS-like traits induced by late-gestation injection of dihydrotestosterone, with and without obesity, produced female F1-F3 offspring with PCOS-like reproductive and metabolic phenotypes. Sequencing of single metaphase II oocytes from F1-F3 offspring revealed common and unique altered gene expression across all generations. Notably, four genes were also differentially expressed in serum samples from daughters in the case-control study and unrelated women with PCOS. Our findings provide evidence of transgenerational effects in female offspring of mothers with PCOS and identify possible candidate genes for the prediction of a PCOS phenotype in future generations.

Voices from Pupil Participation in the Health Promotion Intervention "Pulse for Learning and Health [PuLH]" in Primary and Middle School.

In order to improve the learning conditions and health of schoolchildren, the Pulse for Learning and Health [PuLH] program in Sweden has introduced additional mandatory moderate to vigorous physical activity [MVPA] that lasts for 30 min three times a week. The PE teachers used a child-centered coaching approach to support all pupils. The aim of this study was to explore pupils' perception and experience of PuLH that has been implemented in primary and middle schools in Sweden. We have taken into account children's rights perspectives and adopted an exploratory and interpretive approach. In total, 73 pupils (34 girls, 39 boys, grades 4-9) were recruited through purposive sampling. 13 focus group interviews (n = 71) and individual interviews (n = 2) were carried out. All interviews were analyzed using qualitative content analysis. The analysis resulted in three major themes: 'promotes academic performance and a learning school environment', 'promotes health and well-being', and 'individual and structural barriers'. From children's perspective, the results highlight the importance of teachers and principals taking into account the interests and needs of all pupils, to have a well-planned MVPA intervention and to deal with issues regarding body ideals.