Sickness absence among mothers caring for a child with disability: Examining the impact of mechanical and psychosocial occupational exposures

Background

Sickness absence is more prevalent among mothers caring for children with disability compared to those caring for non-disabled children. Working in a poor working environment may worsen the impact of care burden on health outcomes among mothers of children with disabilities.

Objective

The study investigated how sickness absences are associated with mechanical and psychosocial occupational exposures among mothers caring for children with and without disabilities.

Methods

The study included children born between 2005 and 2013 and their respective mothers (N = 147, 507). Using register data from Statistics Norway, a Zero-Inflated Negative Binominal Regression was fitted to estimate the relationship between mechanical and psychosocial occupational exposures and sickness absence among employed mothers.

Results

Mothers caring for children with disability had higher levels of sickness absences, even after adjusting for psychosocial and mechanical occupational exposures, and other possible confounding factors. When the occupational exposures analysed separately, both mechanical and psychosocial indices had a significant positive main effect on the number of sick days. The main effect of psychosocial exposure was no more significant in a simultaneous analysis, but mechanical exposure maintained its significant positive effect. However, we found no statistically significant differences in the number of sick absence days between mothers of children with and without disability based on their levels of psychosocial or mechanical job exposures.

Conclusions

The findings emphasize the need of providing support to mothers caring for children with disability that help them manage occupational health risks.

The health of mothers caring for a child with a disability: a longitudinal study

BACKGROUND

Raising a child with disabilities requires a significant parental investment that is greater than that required by typically developing children. Previous studies have shown that parents caring for a child with a disability experience a range of health problems, particularly the mothers. However, few of these studies have controlled for maternal health prior to birth.

METHODS

This study used a sample from the Norwegian administrative register that comprised all children born between 2009 and 2015. We followed the mothers and their children for 11 years, between 2009 and 2019. The outcome variable was the mothers' physical and mental health, which was assessed using specific ICD-10 diagnoses recorded in the Norwegian Patient Register (NPR). The data included information on the mothers' health before and after the birth of their first child, enabling us to control for maternal health prior to birth in our analysis, in addition to socio-demographic characteristics. The analyses of maternal health were performed using multiple logistic regression, and the results are presented on both a relative scale (odds ratio [OR]) and an absolute scale (average marginal effect [AME]), both with 95% confidence intervals.

RESULTS

Mothers caring for a child with a disability have higher odds of having a diagnosis of a musculoskeletal disorder, depression, anxiety, sleeping disorder or migraines than mothers of children without a disability. The differences between the two groups of mothers decrease after adjusting for the characteristics of the children, mothers and families, but remain significant for musculoskeletal disorder, depression, anxiety and sleeping disorder, although the absolute differences are modest.

CONCLUSION

The findings suggest that mothers caring for a child with a disability are more likely to have health problems than mothers of children without a disability after controlling for maternal health prior to birth. Providing more support for mothers of children with a disability might help to improve their health.

Educational achievement among children with a disability: do parental resources compensate for disadvantage?

We examined the impact of child disability on Grade Points Average (GPA) using all children aged 15-16 years who completed their lower secondary education and registered with a GPA score in the period from 2016 to 2020 in Norway (n = 247 120). We use registry data that contain information on the child's main diagnosis, such as physical-, neurological- and neurodevelopmental conditions, and the severity of the condition, additional to the child's family characteristics. First, we examined whether the impact of the child's disability on the GPA scores varied by diagnosis and the severity of the child's condition. Second, we examined whether higher parental socioeconomic status (SES) buffers against the negative impact of child disability on GPA scores. Using longitudinal register data with the school fixed-effect model, the results showed that children with neurological and neurodevelopmental disabilities obtained lower GPA scores than their typically developing peers without chronic conditions, however children with asthma and diabetes had comparable GPA scores. These associations were most evident for neurodevelopmental conditions, such as ADHD and autism but also notable for neurological conditions such as epilepsy. In general, a severe condition impacts GPA scores more negatively than a less severe condition. Moreover, our analysis revealed that children of highly educated parents obtained higher GPA scores than children who had parents with short education. This applied to both disabled and typically developing peers, except children with autism and epilepsy, among whom buffering due to the parent's education did not seem to apply.

'Struggling to participate in everyday life': emerging adults' experiences of living with long-term health challenges

AIM

To gain a deeper understanding of the experiences of participation in the everyday life of emerging adults living with long-term health challenges and how this influences their own quality of life.

METHODS

Using an explorative study design, data were collected through in-depth interviews with a sample of 12 young people aged 18-29 years living with long-term health challenges in Norway.

FINDINGS

The analysis identified one overarching theme of struggling to participate in everyday life, and four subthemes: the notion of being independent but also dependent, experiencing mismatch between needs and support, experiencing deprivation of spontaneity and feeling uncertain about the future. The emerging adults experienced difficulties with participation in key areas of life such as education, employment and leisure activities. Associated symptoms of their diagnosis, limited physical abilities and lack of sufficient support made it hard to participate in everyday life the way they aspired to.

CONCLUSION

The challenges of living with a long-term health challenge as an emerging adult contributed to limitations in participation in different areas of life that was perceived as important for their quality of life.

Impact of growing up with somatic long-term health challenges on school completion, NEET status and disability pension: a population-based longitudinal study

Background

Young adulthood is an important transitional life phase that can determine a person’s educational and employment trajectories. The aim of this study was to examine the impact of somatic long-term health challenges in adolescence on upper secondary school completion, not in education, employment or training (NEET status) and receiving disability pension in early adulthood. Additional disparities in educational and employment achievements were also investigated in relation to socioeconomic background.

Methods

The sample consisted of all young adults born in the period 1990 to 1996, (N = 421,110). Data were obtained from the Norwegian Patient Registry which is linked to the Central Population Register, education and income registries and the Historical Event Database in Statistics Norway. These data sources provide longitudinal population data. Statistical analyses were performed using multiple logistic regression and computed average marginal effects after the multiple logistic regression.

Results

The results showed that, compared to young adults without long-term health challenges, young adults with the diagnoses inflammatory bowel disease, epilepsy, diabetes, sensory impairment, spinal muscular atrophy (SMA), spina bifida (SB) and cerebral palsy (CP) had lower odds of completing upper secondary education. Moreover, young adults with long-term health challenges had higher odds of NEET status by age 21 compared to those without a long-term health challenge. As for the odds of NEET status by age 21, the results showed that young adults with epilepsy, SMA, SB and CP in particular had the highest odds of receiving disability pension compared to young adults without long-term health challenges.

Conclusions

This longitudinal study revealed that on average young adults with long-term health challenges, compared to those without, struggle to participate in education and employment. The findings highlight the need for preventive measures especially in relation to young adults with neurological conditions such as epilepsy, SMA, SB, and CP.

Young people with long-term health challenges experiences in transition to adulthood: A qualitative metasynthesis

AIMS

The aim of this study was to describe the experiences of the transition to adulthood for young people with long-term health challenges.

DESIGN

The metasynthesis approach was based on the guidelines by Sandelowski and Barroso for synthesizing qualitative research.

DATA SOURCES

Seven electronic databases: CINAHL, Medline, Embase, PsycINFO, Web of Science, Scopus, and SocIndex were searched on 6-10 February 2020.

REVIEW METHODS

Studies were critically appraised using the Joanna Briggs critical appraisal tool. Qualitative data were extracted, meta-summarised, then meta-synthesized.

FINDINGS

Nineteen qualitative studies were included in this review. Six themes illustrated experiences in the transition to adulthood: wishing for an 'ordinary' life, significance of close network, working towards independence, in need of systemic resources and services, psychosocial challenges and keeping a positive attitude.

CONCLUSION

Young people with long-term health challenges wished for as 'ordinary' a life as possible in the future. In the transition to adulthood, they gradually gained more competence in self-management skills and knowledge and strived to become more independent. By having a positive attitude and using other coping strategies, young people can work on some of the difficulties they experience in this phase. However, to achieve and maintain independence young people with long-term health challenges are dependent on the support of a close network and systemic support and services.

IMPACT

The findings highlight the need to help alleviate the fears and worries of young people with long-term health challenges and create opportunities for successful transition to adulthood by increased awareness and interventions from policy-makers and professionals in the health and social system.

Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials

AIMS/HYPOTHESIS

Individuals of South Asian origin have a high risk of type 2 diabetes and of dying from a diabetes-attributable cause. Lifestyle modification intervention trials to prevent type 2 diabetes in high-risk South Asian adults have suggested more modest effects than in European-origin populations. The strength of the evidence of individual studies is limited, however. We performed an individual participant data meta-analysis of available RCTs to assess the effectiveness of lifestyle modification in South Asian populations worldwide.

METHODS

We searched PubMed, EMBASE, Cochrane Library and Web of Science (to 24 September 2018) for RCTs on lifestyle modification interventions incorporating diet and/or physical activity in South Asian adults. Reviewers identified eligible studies and assessed the quality of the evidence. We obtained individual participant data on 1816 participants from all six eligible trials (four from Europe and two from India). We generated HR estimates for incident diabetes (primary outcome) and mean differences for fasting glucose, 2 h glucose, weight and waist circumference (secondary outcomes) using mixed-effect meta-analysis overall and by pre-specified subgroups. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to rate the quality of evidence of the estimates. The study is registered with the International Prospective Register of Systematic Reviews ([PROSPERO] CRD42017078003).

RESULTS

Incident diabetes was observed in 12.6% of participants in the intervention groups and in 20.0% of participants in the control groups. The pooled HR for diabetes incidence was 0.65 (95% CI 0.51, 0.81; I² = 0%) in intervention compared with control groups. The absolute risk reduction was 7.4% (95% CI 4.0, 10.2), with no interactions for the pre-specified subgroups (sex, BMI, age, study duration and region where studies were performed). The quality of evidence was rated as moderate. Mean difference for lifestyle modification vs control groups for 2 h glucose was -0.34 mmol/l (95% CI -0.62, -0.07; I² = 50%); for weight -0.75 kg (95% CI -1.34, -0.17; I² = 71%) and for waist -1.16 cm (95% CI -2.16, -0.16; I² = 75%). No effect was found for fasting glucose. Findings were similar across subgroups, except for weight for European vs Indian studies (-1.10 kg vs -0.08 kg, p = 0.02 for interaction).

CONCLUSIONS/INTERPRETATION

Despite modest changes for adiposity, lifestyle modification interventions in high-risk South Asian populations resulted in a clinically important 35% relative reduction in diabetes incidence, consistent across subgroups. If implemented on a large scale, lifestyle modification interventions in high-risk South Asian populations in Europe would reduce the incidence of diabetes in these populations.

Sickness absence in pregnancy and sedentary behavior: a population-based cohort study from Norway

Background

Sickness absence in pregnancy accounts for a large part of sickness-related absenteeism among women. Exercise in pregnancy is associated with a lower level of sickness absence, however little is known about how sedentary behaviour is related to sickness absence in pregnancy. In the current study, we hypothesize a positive association between sedentary hours/day and the risk of long-term sickness absence.

Methods

Population-based cohort study of pregnant women attending three Child Health Clinics in Groruddalen, Oslo, 823 Women (74% of those eligible) were included between 2008 and 2010. Questionnaire data were collected at gestational weeks 10–20 (visit 1) and 28 (visit 2). Sedentary time and physical activity were objectively recorded at visit 1 with the multi-sensor SenseWear™ Pro3 Armband (SWA). Long-term sickness absence was self-reported at visit 2. We explored the association between sedentary time and long-term sickness absence in pregnancy using multiple logistic regression analysis.

Results

The odds of long-term sickness absence was significantly increased per one-hour increase in daily sedentary time (odds ratio 1.45 [95% confidence interval 1.13–1.84]), providing support for our hypothesis that sedentary time is positively associated with long-term sickness absence.

Conclusions

Pregnant women with a sedentary lifestyle have a higher risk of long-term sickness absence from work. Reducing sedentary time in pregnancy may improve health, and may, in turn reduce sickness absence in pregnancy.

Reporting of pain by people with chronic obstructive pulmonary disease (COPD): comparative results from the HUNT3 population-based survey

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is often associated with chronic pain, but pain in COPD remains poorly understood, particularly in comparison to pain in other groups. We compared the pain reported by people with COPD with that reported by arthritis, heart disease, diabetes, and those not reporting any disease, while adjusting for the effects of selected sociodemographic and lifestyle factors, comorbidities, anxiety, and depression.

METHODS

Using cross-sectional data from a population-based health survey in Norway (HUNT3; n = 50,807), we included participants with COPD (n = 1199), participants without COPD, but with arthritis (n = 8582), heart disease (n = 4109), or diabetes (n = 1254), and participants without any disease (n = 18,811). Logistic and linear regression analyses were performed to estimate the probability of reporting chronic pain and the level of pain intensity in the different groups adjusting for other relevant factors.

RESULTS

Approximately half (51.8%) of people with COPD reported chronic pain, which was a significantly higher rate than in the diabetes and non-disease groups, and similar to the heart disease group. People with arthritis had a chronic pain rate of 75.4%, which was higher than all other groups, including COPD. Analyses of pain intensity yielded similar findings, with the COPD group having higher pain intensity than the diabetes and non-disease groups, similar pain intensity as the heart disease group, and less pain intensity than the arthritis group. The likelihood of chronic pain and the intensity of pain were generally higher among women, people employed in occupations with low educational requirements, smokers, and those with comorbidity. Chronic pain rates and pain intensity increased with age and higher anxiety and depression scores, and were inversely related to physical activity.

CONCLUSIONS

People with COPD are at increased risk for chronic pain and higher pain intensity, second only to those with arthritis among the disease groups included in this study. The findings indicate a close relationship between pain and anxiety and depression. The relationships between pain and socioeconomic and lifestyle factors (e.g., smoking and exercise) suggest the need for efforts at the societal level to reduce inequality in health.

Long-time sickness absence among parents of pre-school children with cerebral palsy, spina bifida and down syndrome: a longitudinal study

Background

Taking care of a child with special needs can be draining and difficult and require a lot of parental time and resources. The present study investigated the long-term sickness absence of parents who have children with spina bifida, cerebral palsy and Down syndrome compared to that of parents without a child with special needs.

Methods

The sample consisted of primiparae women who gave birth between 2001 and 2005 and the fathers of the children (N = 202,593). Data were obtained from the Medical Birth Registry of Norway (MBRN), which is linked to the Central Population Register, education and income registries and Historical Event Database (FD-Trygd) of Statistics Norway (SSB). The linkage data provide longitudinal data, together with annual updates on children and their parents. Statistical analyses were performed using difference-in-difference (DD) study design.

Results

Caring for a child with special needs affected maternal sickness absence, particularly in the first year after the birth. The level of sickness absence of mothers caring for a child with spina bifida and cerebral palsy was greater than that of mothers caring for a child with Down syndrome. In contrast, the sickness absence of fathers caring for a child with special needs was, on average, comparable to that of fathers without a special-needs child in the post-birth period.

Conclusions

Caring for a child with special needs affected the long-term sickness absence of mothers but not fathers. The findings indicate that the burden of care in the case of children with special needs falls especially on the mother.

On duty all the time: health and quality of life among immigrant parents caring for a child with complex health needs

AIMS AND OBJECTIVES

To provide knowledge about how immigrant parents of children with complex health needs manage their family lives and how this affects their own health and quality of life.

BACKGROUND

Caregivers of children with complex health needs have additional risk for general health problems and mental health problems and immigrant parents may be more vulnerable to mental distress and failing health and quality of life.

DESIGN

This qualitative study used an exploratory design with individual and focus group interviews. Data collection and analysis followed phenomenological hermeneutic guidelines.

METHODS

Individual and group interviews with 27 parents: 18 mothers and 9 fathers from Pakistan, Poland and Vietnam.

RESULTS

Immigrant parents of children with complex health needs experience their own health and quality of life challenges. They described the burden of dealing with their child's needs and special care, which affects their sleep and physical and mental health. Single mothers are particularly vulnerable.

CONCLUSION

Parents reported positive and negative effects of their caregiving experience that may affect their health and quality of life. Mothers were the primary caregivers and reported more health problems than did fathers. The lack of respite care, social networks and support impacted maternal health. Immigrant parents struggle to access resources for their child with complex health needs.

RELEVANCE TO CLINICAL PRACTICE

Hospital nurses, schools and community health care can play a valuable role in supporting the parents of children with complex health needs. It is important that parents are informed about their rights and receive a coordinator and interdisciplinary group to ensure that their needs are met with assistance and respite care. That maternal health was worse in this sample implies that health care professionals should pay more attention to reducing stress among these caregivers.

Health and educational success in adolescents: a longitudinal study

Background

Health in childhood and adolescence is a matter of contention. This article examines how infant and adolescent health act together with parental SES, health-related behaviour and academic factors to generate differences in the early life course with regard to later enrolment in higher education.

Methods

We used a questionnaire on health, The Oslo Health Study, which was linked to register data that provided detailed information on educational outcomes over time; and the Medical Birth Registry of Norway, which provided information on health at birth.

Results

It was found in the unadjusted results that infant health measures had a positive association with enrolment in higher education. After adjustment for adolescent health, there was still evidence that infant health are associated with enrolment in higher education. However, this association disappeared when parental socio-economic status (SES) was included in the model. Health in adolescents remains a significant and strong predictor of enrolment in higher education after adjusting for parental SES. However, the relationship between adolescent health and enrolment in higher education was reduced and became nonsignificant when adjustments were made to the health behaviour of the adolescents and their relationship with their families. Future educational expectations and good grades in grade 10 are strong predictors of enrolment in higher education.

Conclusions

There are lower odds of enrolment in higher education for infants of low birthweight. However, this result seems to reflect the fact that parental SES correlate with both infant health and enrolment in higher education. Adolescent health are associated with enrolment in higher education, even after adjusting for parental SES. However, a considerable proportion of this association seems to be attributable to health-related behaviour and the relationship of the adolescent with his or her family.

Doctor-certified sickness absence in first and second trimesters of pregnancy among native and immigrant women in Norway

AIMS

The authors sought to estimate differences in doctor-certified sickness absence during pregnancy among immigrant and native women.

METHODS

Population-based cohort study of pregnant women attending three Child Health Clinics in Groruddalen, Oslo, and their offspring. Questionnaire data were collected at gestational weeks 10-20 and 28. The participation rate was 74%. A multivariate Poisson regression was used to analyse differences in sickness absence in pregnancy between immigrant and native women.

RESULTS

A total of 573 women who were employed prior to their pregnancies were included, 51% were immigrants. After adjusting for age, years of education, marital status, number of children, occupation, part-time/full-time work, health status, severe pregnancy-induced emesis and language proficiency, the immigrant/native differences in number of weeks with sickness absence decreased from 2.0 to 1.2 weeks. Part-time/full-time work, health status, severe pregnancy-induced emesis and language proficiency were significant predictors of sickness absence.

CONCLUSION

Immigrant women had higher sickness absence than native women during pregnancy. The difference in average number of weeks between native and immigrant women was partly explained by poorer health status prior to pregnancy, severe pregnancy-induced emesis and poorer proficiency in the Norwegian language among the immigrant women.

Experience with cyclosporine in 1519 kidney transplantations from living donors in a national transplant programme, 1983-2002

Following the introduction of cyclosporine as basic immunosuppression in our national transplant programme in 1983, the pool of grafts from living donors (LDs) was expanded 2 years later by also accepting LDs mismatched for 2 HLA haplotypes and living unrelated donors (LURDs), mostly spouses. A policy of approaching family members to promote donation was consistently pursued. During 1983 through 2002, nephrectomy was performed on 1519 LDs without mortality. From 1983 through 1988, our learning phase in managing cyclosporine-immunosuppression, 382 patients received first grafts from LDs. One-year graft survival (GS) rates were 94.4%, 90%, 89%, and 82% in 71 HLA identical, 260 haploidentical, 18 2-haplotypes disparate, and 33 LURD graft recipients, respectively. Corresponding half-lives were 15.8, 10.3, 11, and 9.1 years, respectively. Results improved in 1028 patients receiving first LD grafts from 1989 through 2002. Corresponding 1-year GS rates were 96.6% (n=117), 93.5% (n=650), 90.4% (n=73), and 88.8% (n=188), and half-lives were 30, 13.3, 13.5, and 12.3 years, respectively. Similar GS rates were observed in 109 recipients of repeat grafts from LDs. LDs contributed 44% and 21.6% of all first and repeat grafts transplanted, providing grafts to 11 patients (in 1983) increasing to 23 patients (in 2002) per million population per year (pmp/y). When added to grafts from cadaveric donors, 40 to 48 pmp/y were provided with a first or repeat graft since 1990, thus covering at least 65% of the national need for kidney transplantations.

Determinants of satisfactory rigidity after intracavernosal injection with prostaglandin E1 in men with erectile failure

The study examines the erectile response of intracavernosal injection with increasing doses of prostaglandin E1 (PGE) and papaverine/phentolamine (PP) in 516 men with erectile failure. The response was correlated to age, the duration of erectile failure, the quality of spontaneous erections, tobacco consumption and medicine use. In addition, the erectile response was related to penile brachial index (PBI) the free testosterone index and various hormonal parameters. Over 60% of the subjects obtained satisfactory rigidity of at least 30 min duration with 7-15 micrograms PGE. A further 15% (PGE non-responders at the doses tested) obtained rigidity with PP. The average dose necessary to achieve rigidity was 8.8 micrograms for PGE and 0.94 ml (papaverine: 15 mg/ml; phentolamine 0.5 mg/ml) for PP. The average duration of rigidity was 2.2 h and 2.3 h for PGE and PP, respectively. Tobacco consumption, the duration of erectile failure and the age of the subject did not influence the response to intracavernosal injection. Moreover the PBI, the free testosterone index or libido of the subject, did not appear to be generally important for obtaining satisfactory rigidity. In contrast, chronic medication, especially antihypertensive drugs, was associated with significantly higher numbers of poor responders, a shorter duration of erection in the responders and higher doses of PGE necessary to achieve a satisfactory response. The combination of increasing age and antihypertensive medication was predictive for a poor intracavernosal response. In general, a reduced incidence of morning erections was predictive of a weaker response to PGE. The proportion of men with a PBI lower than 0.75 increased with age. These subjects more often took chronic medication, had a lower frequency of morning erections and exhibited a significantly weaker reaction to PGE than subjects with higher PBI. In summary, a large number of men with erectile failure can obtain satisfactory rigidity with intracavernosal injection. In men taking antihypertensive medication, especially in higher age groups, the dose of the intracavernosal medication had to be increased. A reduced sensitivity to intracavernosal medication could be predicted from a lower PBI and a reduced frequency of spontaneous erections.

Provocation testing of human sperm motility using energy substrates and activators of the cyclic nucleotide system: II. Studies on sperm from asthenozoospermic subjects

OBJECTIVE

To find differences in effect on sperm motility of agents that increase intracellular cAMP: manganese ion, methyl-isobutyl-xanthine (MIX), 2-deoxyadenosine, glucose, and Mn-MIX and Mn-glucose.

DESIGN

Nine men with asthenozoospermia vs. fertile donors.

METHODS

Sperm was washed in Hepes-buffered saline, motility tested by laser-Doppler technique.

RESULTS

Best activation was obtained with Mn and 2-deoxyadenosine; generally poor response to MIX or glucose.

CONCLUSIONS

Usually, poor endogenous stimulation of adenylyl cyclase, and probably not limited energy supply, is the cause of impaired motility.

Provocation testing of human sperm motility using energy substrates and activators of the cyclic nucleotide system. I. Establishment of conditions for response testing

In order to establish a series of provocation tests to evaluate the integrity of the sperm cAMP pathway, manganese (Mn), 2-deoxyadenosine (DEA) (via adenylyl cyclase), and methyl-isobutyl-xanthine (MIX) (via phosphodiesterase) were tested for their capacity to activate the progressive motility of human sperm. Optimal responses were obtained using washed sperm previously incubated for 3 hours in substrate-poor medium (Hepes-buffered saline). Longer periods of incubation required the presence in addition of an energy substrate such as glucose. Exposure of sperm to seminal plasma for 24 hours prior to washing attenuated the responsiveness of the sperm to the different activators. Preliminary studies on the activation of the progressive motility of washed sperm from four normozoospermic men under fertility investigation, prepared under identical conditions, revealed differences in the pattern of response which may have pathophysiological relevance.

Epididymal secretory function in men with asthenoteratozoospermia

Epididymal function was evaluated in normozoospermic men and men with asthenoteratozoospermia using alpha-glucosidase as a secretory parameter. No difference was observed in the total quantity of the enzyme secreted into the ejaculate in spite of major differences between the two groups in the proportion of spermatozoa exhibiting progressive motility and normal morphology. In general, the secretion of alpha-glucosidase was positively correlated with the sperm concentration in the normozoospermic group, but not in asthenozoospermic subjects. The total enzyme contents of the ejaculate were significantly greater in men with asthenoteratozoospermia (sperm concentrations, greater than 35 x 10(6)/ml) than in subjects with severe oligoasthenoteratozoospermia (sperm concentrations less than 10 x 10(6)/ml, P less than 0.01) indicating a higher incidence of epididymal occlusion and/or dysfunction in the latter group. Within normozoospermic individuals, extremes in progressive motility or abnormal morphology could not be related to the quantities of enzyme when expressed per million sperm cells. It is concluded that if alpha-glucosidase is a reliable parameter of human epididymal secretory function, variation in the secretory function of the epididymis cannot explain the poor sperm quality observed in asthenoteratozoospermic individuals.

Effects of seminal plasma from normal and asthenozoospermic men on the progressive motility of washed human sperm

Human seminal plasma stimulated the progressive motility of human sperm in a dose- and time-related manner. Serum exhibited a similar capacity for stimulation. Seminal plasma from different normozoospermic men showed marked variation in its capacity to stimulate sperm motility. The stimulatory effect was maintained after heat-treatment, indicating the action of a low molecular weight substance or metal ion. No differences could be observed in the capacity for stimulation between seminal plasma from normozoospermic (n = 23) and asthenozoospermic (n = 22) men, when tested at the same dilution and under identical conditions. It is concluded that in general, differences in seminal plasma composition cannot account for the reduced sperm motility in asthenozoospermic men. Furthermore, the stimulatory effects of seminal plasma may be a property shared by other biological fluids.

[Kidney transplantation in Norway]

Twenty years ago, in 1969, a national kidney transplant program was established, based on uniform indications and preparations for transplantation. Since 1983, all transplants have been performed at one centre. We describe the organization, development, treatment policies and results of the program. The national transplant rate of 42 patients per million population per year (p.m.p.) keeps up with the demand. In contradiction to the international experience of rapidly expanding waiting lists and dialysis populations, a balance has been achieved in Norway, with a high transplant rate, a restricted and stable waiting list (mean 23 p.m.p.), waiting time (mean 5 months) and dialysis population. Approx. 80 per cent of all patients requiring long term renal replacement therapy actually receive a transplant, as against approx. 50% in Western Europe. Seventy-five to 100 per cent of the transplants function for more than a year, and 55-80 per cent for more than five years, depending on the donor and HLA compatibility. Other significant risk factors are age and HLA sensitization. Since 1983, 46 diabetics with renal failure have been treated by combined renal and pancreatic transplantation.

Effects of manganese and other divalent cations on progressive motility of human sperm

Manganese (Mn2+) stimulated the progressive motility of human washed sperm in a time- and dose-dependent manner. This confirmed previous data indicating a capacity for activating the adenylyl cyclase of sperm homogenates in vitro. A maintained response was best seen with doses 0.2-1.0 mM. After an initial stimulation, higher concentrations of up to 20 mM were associated with a decline in the response to control levels. Magnesium ions (Mg2+) stimulated motility in the same dose range but to less than 50% of the Mn2+ response. Other divalent cations such as zinc (Zn2+), strontium (Sr2+), and Calcium (Ca2+) also exerted stimulatory effects to varying degrees in descending order. Metal ion effects on sperm motility may be mediated through a common cation-binding site on the adenylyl cyclase.

Androgen interaction with the polyamine system of the rat prostate

The ventral and dorsal lobes of the rat prostate contain larger quantities of the aliphatic amines putrescine, spermidine and spermine and higher activities of the enzyme ornithine decarboxylase (ODC; EC 4.1.1.17) than other accessory sex glands. In contrast, the coagulating glands and the seminal vesicles contain only small quantities of the amines but the highest activities of the arginase (ARG; EC 3.5.3.1). Lineweaver-Burk plots indicated that the Km-values for ARG in the coagulating gland and ODC in the ventral prostate lobe were 20 mM and 0.2 mM, respectively. Castration decreased ODC and ARG activities to 3 and 50% of control levels, respectively, after 3 days, whilst the Km-values were unaffected. Daily administration of 3 mg dihydrotestosterone (DHT) prevented these castrational changes. Oestrogen treatment alone had no effect on the activities of the enzymes, but appeared to exert a synergistic effect with androgen on the ODC. Administration of androgen to intact rats for 7 days caused a dose-related alteration in the ratios of the various amines, particularly the spermine: putrescine ratio. A minor but significant decrease was also recorded in the activity of the ODC, which was mirrored by an increase in the levels of putrescine in the tissue. The data suggest that androgen control of the polyamine pathway is biphasic, first stimulatory and later inhibitory with lesions occurring at the ODC, possibly via short loop feedback of its product putrescine, but also at subsequent enzymic steps in spermidine and spermine biosynthesis.

Further observations on the autoregulation of the prolactin receptor in rat ventral prostate explants

In confirmation and extension of an earlier preliminary communication, ovine prolactin was found to elevate prolactin binding by approximately 100% in rat ventral prostate explants incubated for 20 h in vitro. A stimulation was observed with low doses of ovine hormone (150 micrograms/l) which, from available data on the relative biological potencies, could be considered equivalent to the upper limit of the physiological range of endogenous rat prolactin. The response was associated with a lag period of 3-6 h. The effect could be obtained with other lactogenic hormones, including human and rat prolactin and human growth hormone, but not with non-lactogenic hormones such as insulin, hCG, corticosterone, testosterone or oestradiol. The prostaglandin synthesis inhibitor, indomethacin, and the Ca2+-antagonist, verapamil, could not counteract the increase in prolactin binding induced by prolactin treatment, nor could dibutyryl cyclic AMP alone mimic the response. These data suggest that prostaglandins, Ca2+ or cAMP do not mediate the alteration in receptor binding. Furthermore, inhibition of lysosome activity by chloroquine could not alone increase the prolactin binding in the control tissues, suggesting that up-regulation does not simply reflect a protective action of prolactin on receptor degradation.

5 Alpha-reductase in the non-secretory cells of the rat ventral prostate epithelium

Kinetic constants for the 5 alpha-reductase were determined in freshly isolated epithelial cells from the rat ventral prostate. Studies were also performed on stromal tissue but not isolated stromal cells for comparison. Secretory and non-secretory epithelial cells were separated by centrifugation in a Percoll gradient. Both epithelial cell populations metabolized testosterone to predominantly 5 alpha-dihydrotestosterone (5 alpha-DHT), although when expressed per cell the capacity for conversion was 3-4-fold higher for secretory cells (7.4 pmol/min/10(6) cells) than for non-secretory cells (2.3 pmol/min/10(6) cells; P less than 0.01 in 4 separate studies). When compared per mg cytosol protein this difference became non-significant. Stromal tissue contained a 5 alpha-reductase Vmax (expressed) per mg protein) which was comparable to the non-secretory cell enzyme. Lineweaver-Burke plots revealed different Km values for the different cell populations (12.5, 5.9 and 4.7 microM for secretory, non-secretory and stromal cells, respectively) suggesting the presence of different isoforms of the enzyme, or differences in the intracellular concentrations of enzyme antagonists.

Homologous up-regulation of the prolactin receptor in rat prostatic explants

Exposure of explants of rat ventral prostates and a rat Leydig cell tumour to ovine prolactin for 20 h caused alterations of the subsequent membrane binding of 125I-human prolactin to an extent and in a direction dependent on the dose of hormone used. Low prolactin concentrations (1-10 micrograms/2 ml) were associated with an increase in binding (up-regulation) which was 75% in the case of the prostatic tissue and 500% in the case of the tumour tissue above control levels. Higher concentrations caused a dose-dependent decrease in binding to below control levels (down-regulation), alterations which could not be explained by receptor occupancy. Time studies with an up-regulatory dose of hormone (3 micrograms/2 ml) indicated that the effects of prolactin on its receptor did not begin to become manifest until after 6-12 h of culture. The results suggest that homologous up-regulation of prolactin binding may be a general feature of prolactin target organs and that explant cultures of prostatic tissue may provide a convenient model for exploring its mechanisms.

Circadian rhythms in accessory sex gland function in the male rat

Alterations in various parameters of accessory sex gland function were monitored during two separate 24 h periods in adult male rats, and compared to fluctuations in the circulating levels of testosterone, prolactin, corticosterone and LH. Bimodal circadian rhythms in ventral prostate prolactin binding, cytosolic oestrogen binding and seminal vesicle weight could be discerned which appeared to be related to a similar rhythmicity in circulating testosterone levels, but with a phase shift of 3 h. Prostatic membrane bound adenylyl cyclase activities (basal and hormone stimulated) and prostatein concentrations followed different patterns possibly correlated to other endocrine changes.

Properties and regulation of GnRH receptors in the anterior pituitary and the testis of the rat: different response of Leydig cell LH and GnRH receptors to hormonal treatments

The properties (association and dissociation rates, affinity and specificity) of GnRH receptors in the rat pituitary and the Leydig cells are very similar. In addition, in vivo administration for 5 or 11 days of 10 micrograms of GnRH to adult rats resulted in an increase (p less than 0.01) in both Leydig cell and pituitary GnRH receptors. In contrast, the same treatment caused a significant decrease (p less than 0.01) of Leydig cell LH receptor number. Furthermore, testosterone propionate (500 micrograms/day), which had no effect on Leydig cell LH receptors, caused a significant increase (p less than 0.01) of testicular GnRH receptors but a decrease (p less than 0.01) of pituitary GnRH receptors. Estradiol 17 beta valerate (5 micrograms/day) reduced (p less than 0.01) both testicular (5 days) and pituitary (5 and 11 days) GnRH receptors. Such treatment for 5 days also decreased (p less than 0.05) the Leydig cell LH receptors. No effect of dexamethasone and 17-hydroxyprogesterone was seen after 5 or 11 days of treatment. Thus, although pituitary and Leydig cell receptors appear similar, their regulation by exogenous hormone treatments is different. Furthermore, the regulation of Leydig cell GnRH and LH receptors also appears very different, suggesting different roles of the receptors in the control of the Leydig cell function.

Thyrotropin-releasing hormone (TRH) activates the adenylyl cyclase of nonsecretory cells in the rat ventral prostate

Prostatic secretory and basal or stem cells were isolated from rat ventral prostate lobes by collagenase dispersion and density centrifugation in a Percoll gradient. The membrane-bound adenylyl cyclase of secretory cells could be activated in a dose-dependent manner by vasoactive intestinal peptide (VIP ED50 10(-7)M) but not thyrotropin-releasing hormone (TRH). Conversely, only TRH could significantly stimulate the adenylyl cyclase in basal cell membranes (ED50 5 X 10(-7). In two separate studies enzyme activity was stimulated seven- and 13-fold by this peptide. This action of TRH on prostatic basal cells supports previous reports that high levels of immunologically active TRH have been found in prostate tissue and that TRH stimulates the growth of prostatic cancer cells in vitro.

Effects of castration, sex steroids, LHRH and glucocorticoids on LHRH binding in the anterior pituitary of male rats

In the present study we have examined the effects of gonadotrophin releasing hormone (LHRH), sex steroids and glucocorticoids on the binding of LHRH to receptors in the pituitary of male intact and castrated rats. In intact rats, LHRH (10 microgram/day) treatment for 11 days caused a significant increase in LHRH binding, whereas testosterone (500 microgram/day) or oestradiol (50 microgram/day) were inhibitory. 17-hydroxyprogesterone and dexamethasone were without effects. In castrated rats, LHRH caused a marginal decrease in LHRH binding. Much greater inhibition was observed with testosterone and oestradiol. 17-hydroxyprogesterone reduced binding to that of intact controls, whereas dexamethasone was ineffective. When different doses of sex steroids were tested, both oestradiol, testosterone and 5 alpha-dihydrotestosterone inhibited LHRH in a dose-dependent manner. The lowest doses of steroids causing significant inhibition of LHRH binding in castrated animals were 0.5, 50 and 500 microgram/day for oestradiol, 5 alpha-dihydrotestosterone and testosterone, respectively. The present study shows that pituitary receptors for LHRH are regulated both by sex steroids and LHRH itself.

Cofactor dependency of soluble 3 alpha-hydroxysteroid oxidoreductases in rat testis, prostate, and epididymis

The present paper demonstrates the presence of at least two 3-hydroxysteroid oxidoreductases (3-HSO) in rat testis, prostate, and epididymis cytosol preparations. The enzymes were either NADH or NDAPH dependent. Further investigation by Sephadex G-200 chromatogrphy revealed the presence of enzyme activities in the void volume (peak 1) and also eluting close to the methyl-carbonic anhydrase standard (mol wt, 34,000; peak 2). Enzyme activity in peak 1 was predominantly stimulated by NADH and that in peak 2 was stimulated mainly by NADPH. Both 3 alpha- and 3 beta-HSO activities were observed in testicular eluates from 1; 3 beta-Adiol accounted for up to 50% of the 5 alpha-androstanediols formed. In peak 2,3 alpha-HSO constituted more than 90% of the enzyme activity. In contrast, the prostatic and epididymal eluates revealed only 3 alpha-HSO activity; 3 beta-Adiol constituted less than 5% of the 5 alpha-androstanediols formed in either peak 1 or 2. The apparent Km values for enzyme activation reveal differences in sensitivity to cofactors for enzymes in peaks 1 and 2 and also among testis, epididymis, and prostate. NADH caused a very similar activation of enzyme activity in peak 1 or the prostate and epididymis (Km 50-100 micro M), whereas the enzyme in the testis was activated by much lower cofactor concentration (Km approximately 5 microM). It is possible that this enzyme activity may represent microsomal contamination. The enzyme activity in peak 2 revealed very similar sensitivity to NADPH in all three organs (Km, 0.6-1.7 microM), confirming previous studies from our laboratory that the soluble. NADPH-dependent enzymes in all three tissues are very similar, if not identical.

Physico-chemical characterization of the soluble 3 alpha-hydroxysteroid oxidoreductase in the rat testis and prostate

The present paper describes some physiocochemical properties of the soluble 3 alpha-oxidoreductases in the rat testis and prostate, and comparison with rat epididymal 3 alpha-oxidoreductase, published previously (Hastings & Hansson 1979). The testicular enzyme shows properties very similar to that in the epididymis (size, stability, pH optium) except for minor differences in charge (iso-electric point). The prostatic enzyme revealed a slightly higher molecular weight, and was more sensitive to heating than those in the testis and epididymis, whereas the iso-electric point was the same as that in the testis (pI-5.25). The enzymes in all tissues exhibit very similar shapes (f/fo 1.14-1.17). The similar properties of the testicular and prostate 3 alpha-oxidoreductases to those previously reported for that in the epididymis may indicate that these enzymes represent identical peptide chains. The small differences observed in size, temperature stability and change may be due to their presence in different environments.

Renal allograft rupture

In the present material of 448 consecutive renal transplants the incidence of allograft rupture was 3.6%. Among 389 first transplants there were two ruptures in the living donor group (126 patients, 1.5%) and 12 ruptures in the cadaveric donor group (263 patients, 4.6%). Only one ruptured kidney (living donor) achieved long term function. Four patients with first graft rupture were retransplanted with early loss of the kidney in all, in two because of rupture. Two of these patients received a 3rd cadaveric graft, of which one is functioning well after two years. All ruptures occurred within three weeks after transplantation, 14 kidneys ruptured during the first week. The clinical course and the operative findings suggested that rejection was the cause of rupture in all cases. This was confirmed by light and immunofluorescent microscopy of specimens from 15 kidneys, while one kidney only demonstrated extensive intrarenal vessel thrombosis. It is concluded that renal allograft rupture signals a strong immunological response in the recipient with poor graft prognosis. The chance of a successful retransplantation is small.