Maternal pre-pregnancy obesity and timing of puberty in sons and daughters: a population-based cohort study.

BackgroundIn many countries, an increased prevalence of obesity in pregnancy has coincided with a declining pubertal age. We aimed to explore the potential effect of maternal pre-pregnancy overweight and obesity on timing of puberty in sons and daughters.MethodsBetween 2012 and 2018, 15 819 of 22 439 invited children from the Danish National Birth Cohort, born 2000-03, provided half-yearly information from the age of 11 years on the pubertal milestones: Tanner stages, voice break, first ejaculation, menarche, acne and axillary hair. We estimated adjusted mean monthly differences (with 95% confidence intervals) in age at attaining the pubertal milestones for children exposed to maternal pre-pregnancy obesity [body mass index (BMI) ≥30.0 kg/m2] or overweight (BMI 25.0 to 29.9 kg/m2) with normal weight (BMI 18.5 to 24.9 kg/m2) as reference. In mediation analysis, we explored whether childhood BMI at age 7 years mediated the associations.ResultsMaternal pre-pregnancy obesity was associated with earlier age at attaining most pubertal milestones in sons, and pre-pregnancy overweight and obesity were associated with earlier age at attaining all pubertal milestones in daughters. When combining all pubertal milestones, pre-pregnancy obesity [sons: -1.5 (-2.5, -0.4) months; daughters: -3.2 (-4.2, -2.1) months] and overweight [daughters only: -2.6 (-3.3, -1.8) months] were associated with earlier timing of puberty. The associations in sons were completely mediated by higher childhood BMI and partly so in daughters.ConclusionsMaternal pre-pregnancy obesity appears to lower timing of puberty through childhood obesity in sons and mainly through other mechanisms in daughters

Sexual health in parous women with a history of polycystic ovary syndrome:A national cross-sectional study in Denmark

Objective: To examine associations between polycystic ovary syndrome (PCOS) and sexual health in midlife. Methods: We included 31 645 mothers from the Danish National Birth Cohort who participated in a Maternal Follow up in 2013–14. A lifetime PCOS diagnosis was self-reported. Sexual health was assessed by specific sexual problems including reduced sexual desire, insufficient lubrication, difficulty in obtaining orgasm, vaginismus and pain during intercourse within the past year. We also generated a combined outcome which was positive if the women reported one or more sexual problems. Logistic regression was used to estimate adjusted odds ratios (aOR) for sexual problems with 95% confidence intervals (CI). Results: Participants were on average 44 years old, and 920 women (2.9%) had ever had PCOS. One or more sexual problems were more often reported in women with PCOS compared with other women (42.6% versus 36.3%, aOR 1.29, 95% CI 1.13–1.48). Especially reduced sexual desire (25.6% versus 21.0%, aOR 1.29, 95% CI 1.10–1.50) and dyspareunia (11.4% versus 8.7%, aOR 1.34, 95% CI 1.09–1.66) were more frequent in women with PCOS. These associations were slightly weakened when further adjusting for mental and somatic health problems. Conclusion: Our data suggest that PCOS is linked to long-term impaired sexual health, especially reduced sexual desire and dyspareunia.</p

Managing Change of EHR Systems

This article analyzes the associations between four leadership styles, the implementation of renewed ElectronicHealth Record (EHR) systems in hospitals and performance. The four leadership styles are taken from the literature on change management and are: mobilize, guide, involve and adapt. The performance measure is inspired by the Technology Acceptance Model (TAM). The empirical context is the implementation of a new EHR system in a Danish multi-site hospital in 2015. We apply a mixed-method approach combining qualitative and quantitative data. Using a Structural Equation Model (SEM) combined with focus group interviews we find evidence for significant impact on performance of all four leadership styles

Managing Change of EHR Systems

This article analyzes the associations between four leadership styles, the implementation of renewed ElectronicHealth Record (EHR) systems in hospitals and performance. The four leadership styles are taken from the literature on change management and are: mobilize, guide, involve and adapt. The performance measure is inspired by the Technology Acceptance Model (TAM). The empirical context is the implementation of a new EHR system in a Danish multi-site hospital in 2015. We apply a mixed-method approach combining qualitative and quantitative data. Using a Structural Equation Model (SEM) combined with focus group interviews we find evidence for significant impact on performance of all four leadership styles

Managing Change of EHR Systems

This article analyzes the associations between four leadership styles, the implementation of renewed ElectronicHealth Record (EHR) systems in hospitals and performance. The four leadership styles are taken from the literature on change management and are: mobilize, guide, involve and adapt. The performance measure is inspired by the Technology Acceptance Model (TAM). The empirical context is the implementation of a new EHR system in a Danish multi-site hospital in 2015. We apply a mixed-method approach combining qualitative and quantitative data. Using a Structural Equation Model (SEM) combined with focus group interviews we find evidence for significant impact on performance of all four leadership styles

Genome-wide association and HLA fine-mapping studies identify risk loci and genetic pathways underlying allergic rhinitis

Allergic rhinitis is the most common clinical presentation of allergy, affecting 400 million people worldwide, with increasing incidence in westernized countries1,2. To elucidate the genetic architecture and understand the underlying disease mechanisms, we carried out a meta-analysis of allergic rhinitis in 59,762 cases and 152,358 controls of European ancestry and identified a total of 41 risk loci for allergic rhinitis, including 20 loci not previously associated with allergic rhinitis, which were confirmed in a replication phase of 60,720 cases and 618,527 controls. Functional annotation implicated genes involved in various immune pathways, and fine mapping of the HLA region suggested amino acid variants important for antigen binding. We further performed genome-wide association study (GWAS) analyses of allergic sensitization against inhalant allergens and nonallergic rhinitis, which suggested shared genetic mechanisms across rhinitis-related traits. Future studies of the identified loci and genes might identify novel targets for treatment and prevention of allergic rhinitis

Investigating the causal effect of smoking on hay fever and asthma: a Mendelian randomization meta-analysis in the CARTA consortium

AbstractObservational studies on smoking and risk of hay fever and asthma have shown inconsistent results. However, observational studies may be biased by confounding and reverse causation. Mendelian randomization uses genetic variants as markers of exposures to examine causal effects. We examined the causal effect of smoking on hay fever and asthma by using the smoking-associated single nucleotide polymorphism (SNP) rs16969968/rs1051730. We included 231,020 participants from 22 population-based studies. Observational analyses showed that current vs never smokers had lower risk of hay fever (odds ratio (OR) = 0·68, 95% confidence interval (CI): 0·61, 0·76; P &lt; 0·001) and allergic sensitization (OR = 0·74, 95% CI: 0·64, 0·86; P &lt; 0·001), but similar asthma risk (OR = 1·00, 95% CI: 0·91, 1·09; P = 0·967). Mendelian randomization analyses in current smokers showed a slightly lower risk of hay fever (OR = 0·958, 95% CI: 0·920, 0·998; P = 0·041), a lower risk of allergic sensitization (OR = 0·92, 95% CI: 0·84, 1·02; P = 0·117), but higher risk of asthma (OR = 1·06, 95% CI: 1·01, 1·11; P = 0·020) per smoking-increasing allele. Our results suggest that smoking may be causally related to a higher risk of asthma and a slightly lower risk of hay fever. However, the adverse events associated with smoking limit its clinical significance.</jats:p

The effect on the birth experience of women and partners of giving birth in a “birth environment room”:A secondary analysis of a randomised controlled trial

Objective: To evaluate women and partners' experience of birth in a "birth environment room" compared to a standard birth room. Design: A single centre parallel randomised controlled trial. Women and partners were enrolled during a 3-year period (May 2015 to March 2018). Setting: The Department of Obstetrics and Gynaecology at Herning Hospital, Denmark. Participants and intervention: A total of 680 Danish speaking nulliparous women, more than 18 years old, with a singleton pregnancy in cephalic presentation, and a spontaneous onset of labour, and their partners were randomly assigned to give birth in a “birth environment room” (n = 340) or in a standard birth room (n = 340) on arrival at the birth unit. Measurements and findings: Outcomes were the overall birth experience and overall satisfaction with care, measured on a Likert scale, obtained in the postpartum questionnaire sent to the women 6 weeks after birth and to their partners 1/2 weeks after birth. Other outcomes were “staff support for partner”, “undisturbed contact with new-born”, “feeling of being listened to”, “level of information”, “attention to psychological needs”, “suggestions for pain-relief”, “participation in decision-making”, “midwife present when wanted”, “support from midwife”, “birth wishes were met”, “loss of internal control” (only women), “loss of external control”, “support from partner” (partners: “being supportive for partner”), “importance of physical environment for birth” and “importance of physical environment for staff´s ability to involve the women” (only women). All outcomes were prespecified. We applied Mann Whitney U test for comparing the two groups. Data were collected from 326 women and 236 partners in the intervention group and from 315 women and 209 partners in the control group. The intention-to-treat analysis revealed no difference in the overall experience of birth for women or partners (p 0.81 and p 0.17, respectively). Partners in the intervention group reported more overall satisfaction with care compared to partners in the control group (p 0.048). In the intervention group, fewer women and partners responded they had not had the opportunity for undisturbed contact with their new-born in the first hours after birth (RR 0.19 (95% CI 0.04-0.87) and OR 0.00 CI (0.00–0.83), respectively). Otherwise, there were no differences between groups. The thematic analysis revealed that many women and partners felt they were not able to benefit from the features in “the birth environment room” in the most intense hours of birth. Key conclusion and implications for practice: "The birth environment room" did not improve the overall experience of birth for women and partners. Partners in the intervention group were overall more satisfied with care. These findings are of importance in the developing of physical birth environments that support the mental/emotional process of labour.</p

The influence of transmitted and non-transmitted parental BMI-associated alleles on the risk of overweight in childhood

Overweight in children is strongly associated with parental body mass index (BMI) and overweight. We assessed parental transmitted and non-transmitted genetic contributions to overweight in children from the Danish National Birth Cohort by constructing genetic risk scores (GRSs) from 941 common genetic variants associated with adult BMI and estimating associations of transmitted maternal/paternal and non-transmitted maternal GRS with child overweight. Maternal and paternal BMI (standard deviation (SD) units) had a strong association with childhood overweight [Odds ratio (OR): 2.01 (95% confidence interval (CI) 1.74; 2.34) and 1.64 (95% CI 1.43; 1.89)]. Maternal and paternal transmitted GRSs (SD-units) increased odds for child overweight equally [OR: 1.30 (95% CI 1.16; 1.46) and 1.30 (95% CI 1.16; 1.47)]. However, both the parental phenotypic and the GRS associations may depend on maternal BMI, being weaker among mothers with overweight. Maternal non-transmitted GRS was not associated with child overweight [OR 0.98 (95% CI 0.88; 1.10)] suggesting no specific influence of maternal adiposity as such. In conclusion, parental transmitted GRSs, based on adult BMI, contribute to child overweight, but in overweight mothers other genetic and environmental factors may play a greater role.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.WT104150/Wellcome Trust (Wellcome)published version, accepted version, submitted versio