Satisfaction in life among fathers following fertility treatment

Objective: The study aimed at (a) gaining a better understanding of how fertility history (ART/spontaneous) is associated with life satisfaction among new fathers; and (b) identifying personal and interpersonal risk factors for lower satisfaction in life during the transition to fatherhood.

Design: This cross-sectional study comprised 172 Israeli fathers (76 who became fathers following ART and 96 following spontaneous pregnancy), who completed a series of self-report questionnaires 5–18 months after the birth of their first child.

Results: No differences were found in life satisfaction between fathers in the two fertility history groups. Regression analysis indicated that younger age and higher economic status, as well as lower attachment anxiety and avoidance and better marital relationship, were associated with a higher level of life satisfaction among new fathers.

Conclusion: Although the life satisfaction of new fathers does not appear to be affected by their fertility history, it may be hampered by personal and interpersonal risk factors. These results have practical implications for professionals who come into contact with this population.     

Childhood obesity complicating the differential diagnosis of maturity-onset diabetes of the young and type 2 diabetes

OBJECTIVE: To describe a proband with features of type 2 diabetes who was found to have concomitant maturity-onset diabetes of the young (MODY) and the consequent multigeneration genetic analysis. DESIGN: Familial genetic analysis. SETTING: Tertiary university medical center. PARTICIPANTS: The proband was a 13.5-yr-old boy with marked non-ketotic hyperglycemia, obesity, systolic hypertension, and insulin resistance. His mother, maternal aunt, grandmother, and great grandmother had diabetes; his father was obese and had early ischemic heart disease. INTERVENTIONS: Clinical examination, laboratory work-up, and DNA study. Outcome measures: Mutation in hepatocyte nuclear factor-1alpha gene, the most common cause of MODY. Results: The proband showed elevated C-peptide level and was negative for beta-cell antibodies. On genetic analysis for MODY, the 291fsinsC mutation was identified in all affected family members. A younger sister who was obese but had no signs of impaired glucose tolerance was also tested on the basis of these findings and was found to have the same mutation. CONCLUSIONS: The patient, who presented with apparent type 2 diabetes, had concomitant MODY 3, inherited from his mother's side, and some features of type 2 diabetes secondary to marked obesity. This combination probably caused an earlier and more severe presentation of the disease and had significant implications for medical management. A search for MODY mutations should be considered in patients with a history of diabetes in three generations of one side of the family, even those in whom the clinical picture resembles type 2 diabetes.     

Neuroprotective effect of memantine in different retinal injury models in rats

PURPOSE: To evaluate the neuroprotective effect of memantine, an NMDA receptor channel blocker, in two retinal ganglion cell (RGC) injury models in rats. METHODS: Neuroprotective effect of memantine was tested in partial optic nerve injury and chronic ocular hypertensive models. In the optic nerve injury model, memantine (0.1 - 30 mg/kg) was injected intraperitoneally immediately after injury. Two weeks later, optic nerve function was determined by measuring compound action potential and surviving RGC was determined by retrograde labeling with dextran tetramethyl rhodamine. Chronic ocular hypertension was attained by laser photocoagulation of episcleral and limbal veins. Memantine (5 or 10 mg/kg) was administered continuously each day with an osmotic pump, either immediately after or 10 days after first laser photocoagulation, for 3 weeks, after which RGC survival was determined. RESULTS: Two weeks after partial optic nerve injury, there was approximately 80% reduction in RGC number. Memantine (5 mg/kg) caused a twofold increase in compound action potential amplitude and a 1.7-fold increase in survival of RGCs, respectively. In the chronic ocular hypertension model there was 37% decrease in RGCs after 3 weeks of elevated intraocular pressure. Memantine (10 mg/kg daily) reduced ganglion cell loss to 12% when applied immediately after first laser photocoagulation, and prevented any further loss when applied 10 days after first laser photocoagulation. CONCLUSION: The protective effect of memantine suggests that excessive stimulation of NMDA receptors by glutamate is involved in causing cell damage in these RGC injury models.     

Aggregometry in the settings of thrombocytopenia,thrombocytosis and antiplatelet therapy

A variety of laboratory tests have been developed, which can diagnose a number of both congenital and acquired disorders of platelet function. Many tests of platelet function measure the ability of platelets to adhere to each other, forming platelet aggregates, which represent the major constituents of hemostatic plugs and of arterial thrombi. Light transmission aggregometry (LTA) is still considered the gold standard of platelet aggregation tests, but other platelet aggregation-based tests are also available. Among them, the flow cytometry-based methods may be more convenient than LTA for the study of patients with very low or very high platelet counts. The use of platelet aggregation tests has also been advocated to monitor the treatment with antiplatelet agents (mostly the P2Y₁₂ antagonist clopidogrel) of patients with thrombotic arterial occlusions, with the aim of improving their efficacy and safety. However, randomized clinical trials failed to show any advantage of this strategy; as a consequence, international guidelines now recommend against laboratory monitoring of antiplatelet therapy.     

The comparison of the effects and side effects of local anesthetic and opioid combinations in epidural patient controlled analgesia

The aim of this study was to retrospectively evaluate the efficacy and side effects of local anesthetic and opioid combinations in 457 patients who have received epidural patient-controlled analgesia (EPCA). Hemodynamic parameters, numeric rating scale, sedation scores, the degree of motor and sensory blockage, the presence of side effects, the parameters of PCA device were recorded from the postoperative pain records. 253 patients received 0.1 % bupivacaine + 3 microg/ml fentanyl (Group B1F3), 80 patients received 0.125 % bupivacaine + 3 microg/ml fentanyl (Group B12F3), 43 patients received 0.125 % bupivacaine + 4 microg/ml fentanyl (Group B12F4), 46 patients received 0.1 % bupivacaine + 0.1 mg/ml morphine (Group B1M1) and 35 patients received 0.125 % bupivacaine + 0.1 mg/ml morphine (Group B12M1). Nausea was significantly higher in group B1M1 compared to B12F3, in group B12M1 compared to B1F3 and B12F3 (p<0.05), vomiting was significantly higher in group B1M1 and B12M1 (p<0.05) compared to B12F3, pruritus was significantly higher in group B12F4 compared to B12F3 and B1F3, in group B1M1 compared to B1F3 and B12F3 and in group B12M1 compared to B1F3 and B12F3 (p<0.05). As a result, in EPCA, the combination of bupivacaine and fentanyl provides as effective analgesia as the combination of bupivacaine and morphine and 3 mg/ml fentanyl admixture may be preferred with less side effects such as nausea, vomiting and pruritus.     

“Dis-able bodied” or “dis-able minded”: stakeholders’ return-to-work experiences compared between physical and mental health conditions

Purpose: This study aimed to explore if and why the return-to-work (RTW) experiences of various workplace stakeholders in the Netherlands and Denmark differ between physical and mental health conditions, and to understand the consequences of potentially different experiences for the RTW process in both health conditions.

Methods: We studied 21 cases of long-term sickness absence, and held a total of 61 semi-structured interviews with the various actors involved in these cases.

Results: Physical cases were seen as “easy” and mental cases as “difficult” to manage, based on the visibility and predictability of health complaints. On this ground, assessing work ability and following required RTW actions were perceived as more urgent in mental than in physical cases. Despite these perceptions, in practice, the assessment of work ability seemed to impair the RTW process in mental cases (but not in physical ones), and the (non-)uptake of RTW actions appeared to have similar results in both mental and physical cases.

Conclusions: With these outcomes, the effectiveness of a differential approach is questioned, and the relevance of a bidirectional dialog on work ability and a phased RTW plan is highlighted, regardless of the absence cause. Our study also demonstrates how policymakers need to strike a balance between obligatory and permissive legislation to better involve workplaces in RTW issues.

• Implications for rehabilitation

• Both physically and mentally sick-listed employees could benefit from a bidirectional dialog on work ability as well as from a phased RTW plan.

• A greater role for employers in the RTW process should be accompanied with a support for sick-listed employees, in both physical and mental sickness absence cases.

• Dutch and Danish RTW legislation could be improved by carefully balancing obligatory and permissive rules and regulations to involve workplaces in RTW matters.