Die vorliegende Arbeit beschäftigt sich mit der mechanischen Untersuchung des menschlichen Fersenfettpolsters (FP) in Abhängigkeit von Alter und Geschlecht. Das menschliche FP stellt evolutionsgeschichtlich eine Anpassung an den aufrechten Gang dar. Durch Aufrichtung des Oberkörpers im Zweibeingang kam es zur Ganglinienverlängerung in Richtung Ferse und folglich zu einer Mehrbelastung des Rückfußes. Sie prägten die Funktion des FP, die Kräfte beim Aufsetzen der Ferse zu reduzieren. Das FP, das ein spezielles Unterhautfettgewebe ist und sich aus straffem und lockerem Bindegewebe zusammensetzt, kann die Kräfte durch Verteilen und Absorbieren vermindern. Bekannt ist, dass sich das mechanische Verhalten der Haut zwischen Mann und Frau unterscheidet. Da das FP ein Bestandteil der Haut ist, stellt sich als ein Schwerpunkt dieser Arbeit die Frage: Unterscheidet sich das FP mechanisch zwischen Mann und Frau? Aus naturwissenschaftlicher Sicht ist Altern ein natürlicher Mechanismus, der die Lebenskraft des Organismus durch Zellalterung und –tod reduziert. Aus evolutionärer Sicht wurde zugelassen, dass sich bestimmte Zellen bzw. Gewebe, welche hohen endogenen und exogenen Faktoren ausgesetzt sind, vollständig aber begrenzt regenerieren dürfen. Es wird als primäres Altern gekennzeichnet. Das primäre Altern kann positiv oder negativ durch äußere Einwirkungen auf den Organismus („Sekundäres Altern“) beeinflusst werden. Bindegewebe, welches hohen exogenen Faktoren ausgesetzt ist, sind insbesondere Schnittstellen zwischen „Biologischem System“ und „Umwelt“ (z.B. beim Menschen das Gewebe der Hautinnenfläche oder der Fußsohle). Es wird erwartet, dass das FP dem Alterungsprozess stark unterworfen ist, da es alltäglich mechanisch beansprucht wird. Folglich kann es zu einem mechanischen Funktionsverlust des FP kommen, das sich negativ auf die Belastbarkeit des Rückfußes auswirken kann. Die Entwicklung von altersbedingten Verschleißerkrankungen kann nicht ausgeschlossen werden. Als ein zweiter Schwerpunkt dieser Arbeit stellt sich die Frage: Unterscheidet sich das FP mechanisch zwischen Jung und Alt? Es gibt hinsichtlich der Thematik dieser Dissertation wenige Untersuchungen. Die Autoren kommen zum Teil zu unterschiedlichen Ergebnissen und Schlussfolgerungen, dass möglicherweise auf die unterschiedlich verwendete Methodik zurückzuführen ist. Die Vor- und Nachteile der bisher durchgeführten Experimente machen es schwierig, Stellungnahme zu beziehen, welche der Tests die zuverlässigsten Ergebnisse liefern. Seit den letzten 10-15 Jahren wurde immer häufiger Ultraschall als zusätzliche Informationsquelle in mechanischen Messplätzen integriert, um innere Kenndaten zum mechanischen Verhalten des FP abzuleiten. Allerdings waren die quasi-statischen Messungen und die geringen Kontaktkräfte der limitierende Faktor um das mechanische Verhalten valide zu charakterisieren. Mit einem eigens entwickelten Messplatz sollte dieser methodische Ansatz überholt werden. Der instrumentierte Belastungsschlitten ermöglicht die Aufnahme von dynamischen Ultraschallbildsequenzen unter mindestens 10-fach höheren Kontaktkräften bei fast doppelter Fersenkontaktgeschwindigkeit gegenüber den bisher bekannten Ultraschallexperimenten in der Literatur. Mögliche geschlechts- und altersspezifische Unterschiede im mechanischen Verhalten des FP sind grundlegend für die Orthopädie-Technik, die klinische Forschung und die Biogerontologie. Die Orthopädie-Technik benötigt insbesondere die Erkenntnisse zum mechanischen Verhalten der Haut an unterschiedlichen Stellen der unteren Extremität in Abhängigkeit von Alter und Geschlecht, um den Tragekomfort und die Bewegungseffizienz von Prothesen und Orthesen zu bessern. In der klinischen Forschung zeigt sich das Interesse an den altersspezifischen mechanischen Kenndaten, um im Zusammenhang zu klinischen Parametern die Entwicklung von orthopädischen Erkrankungen zu erforschen. Für die Biogerontologie wäre diese Art von Forschung relevant, um Zusammenhänge zu histologischen Parametern zu überprüfen, die direkt am Alterungsprozess des Bindegewebes beteiligt sind. Sie könnten zur Entschlüsselung des Mechanismus „Altern“ beitragen.

Background: Neonates born with low birth weight or preterm are at an increased risk of long-term adverse health outcomes. Research studies on the association of fish consumption during pregnancy and birth outcomes, have led to inconsistent conclusions. Maternal dietary intakes during pregnancy have a significant impact on foetal development and growth. The aim of this project is to determine levels of maternal fish intake at <18 weeks during pregnancy and to determine the association with birth outcomes in pregnant women from Johannesburg, South Africa. Methods: This Master‘s study is nested in a larger study with a longitudinal observational research design was conducted on 250 pregnant women in Johannesburg, South Africa. For this Master‘s study, data from the first 102 participants were used. Data for this study were collected early in pregnancy (<18 week‘s gestation) and at birth. The birth data were collected by the study mid-wife. Maternal fish consumption during early pregnancy was measured using a Quantitative Food Frequency Questionnaire (QFFQ). Correlation analysis was used to examine the association between maternal fish consumption during early pregnancy and neonatal anthropometry (birth weight, crown heel length and head circumference) and gestational age at birth. Results: Majority (88.1%) of the mothers were black South Africans between the ages of 18 and 39 with a mean age of 28 ± 5 years. At enrolment, the mean BMI of the women was 27.8±5.8kg/m2 having a mean height of 158.8±6.7cm and a mean weight of 70.4±15.2kg. Most of them were unmarried (45.4%), living in households of 2 – 5 members (86.3%), wage-earning (44.6%) and had Grade 11 or 12 schooling (58.4%). Most (76.5%) of the pregnant women consumed fish rarely (once a month) and the overall median fish intake was 4.8g/day (0; 25). In the study sample 12.5% of new-borns had a low birth weight (<2500g), the percentages of preterm births were 1.0% - extremely preterm (<28 weeks), 2.0% - very preterm (28 – <32 weeks) and 10.0% - moderate to late preterm (32 – 37 weeks). The mean birth weight was 2999.2±624.4g with boys having a mean birth weight of 3157.3±571g and girls at 2819±671g. The new-borns‘ mean gestational age at birth was 38.8±2.4weeks (271.6days). The percentage of new-born head circumference ≤ 31.49cm was 9.2% and the mean head circumference was 34.3±3.6cm with the boys having a mean head circumference of 34.5±2.4cm and the girls 34.1±4.3cm. In this study sample, 3.7% of new-borns were born with crown heel length of 31 – 40cm and the mean crown heel length mean was 49.5±4.6cm with the boys having a mean crown heel length of 49.8±4.9cm and the girls having mean crown heel length of 49.3±4.3cm. In this study, there were no statistically significant associations between fish consumption at early pregnancy and birth outcomes such as gestational age at birth (r=0.051; p=0.625), birth weight (r=-0.043; p=0.695) and crown heel length (r=0.008; p=0.943). There was a positive association between maternal fish consumption in early pregnancy and head circumference of the new-born which tended towards statistical significance (r=0.193; p=0.079). Conclusions: In this study of pregnant women living in Johannesburg, a few women consumed fish at early pregnancy compared with women who did not consume fish during pregnancy. We found no statistically significant association in this study between fish consumption at early pregnancy and birth outcomes. / Life and Consumer Sciences / MCS (Consumer Science)

Les nouveau-nés prématurés sont soumis à de nombreuses procédures douloureuses lors de leur hospitalisation à l’unité néonatale, où la plus fréquente est le prélèvement sanguin au talon. La douleur répétée et non traitée entraîne des conséquences à long terme pour les nouveau-nés prématurés. L’utilisation des interventions de soulagement de la douleur, tant pharmacologiques que non pharmacologiques, est limitée chez cette population. Nous avons donc vérifié la faisabilité et l’effet d’une nouvelle intervention pour le soulagement de la douleur, soit l’odeur du lait maternel. Cette étude pilote visait à évaluer la faisabilité et l’acceptabilité d’une intervention de stimulation olfactive avec du lait maternel pour diminuer la réponse à la douleur des nouveau-nés prématurés, nés entre 28 et 34 semaines de gestation, lors d’un prélèvement sanguin au talon. L’étude pilote a été menée auprès d’un groupe de 12 nouveau-nés prématurés (présence de jumeaux), 11 mères et 20 infirmières dans une unité néonatale de niveau III, soit de soins intensifs. L’odeur du lait maternel a été combinée aux soins standards au moment du prélèvement sanguin au talon et la douleur a été mesurée à l’aide du Premature Infant Pain Profile Revised. Ensuite, les mères et les infirmières ont complété des questionnaires concernant la faisabilité et l’acceptabilité de l’intervention de stimulation olfactive. Des questionnaires auto-administrés remis aux mères (n=11) et aux infirmières (n=20) après l’intervention ont permis de confirmer la faisabilité et l’acceptabilité de l’intervention qui étaient de plus de 80% pour les mères et les infirmières. Les effets observés ont indiqué que plus la compresse imbibée de lait maternel était proche du nez du nouveau-né prématuré plus il semblait y avoir un effet sur la diminution de la réponse à la douleur lors d’un prélèvement sanguin au talon ainsi qu’un retour au calme après le prélèvement plus rapide. L’odeur du lait maternel est une intervention non pharmacologique de soulagement de la douleur qui est peu coûteuse et facilement réalisable par les mères et les infirmières. Les résultats de l’étude pilote confirment la faisabilité et l’acceptabilité de l’intervention et soutiennent la méthodologie d’un essai clinique randomisé à plus large échelle. / Preterm neonates experience many painful procedures during their hospitalisation in the Neonatal Intensive Care Unit (NICU) where heel prick is the most frequent painful intervention. Repeated and untreated pain has long term consequences for preterm neonates. The use of pharmacological and non-pharmacological pain management interventions is limited for preterm neonates. Therefore, it is essential to investigate new pain management interventions such as breast milk odor. This pilot study aimed to evaluate the feasibility and acceptability of an olfactive stimulation intervention to manage procedural pain of preterm neonates, born between 28 and 34 weeks of gestation, during heel prick. A pilot study was conducted with 12 preterm neonates, 11 mothers and 20 nurses in a level III NICU. The study group was familiarised with breast milk odor for nine hours preceding blood sampling. Breast milk odor was combined with standard care during heel prick and pain was measured by the Premature Infant Pain Profile-Revised. Self-reported questionnaires administered to mothers (n = 11) and nurses (n = 20) confirmed the feasibility and acceptability of the intervention, with a proportion of over 80% for both of these items. Observed effect indicated that the closer the compress with the breast milk odor was to the preterm neonates’ nose (n=12), the shorter time to return to baseline after the painful procedure was and the lower the pain score was on the PIPP-R. Breast milk odor is a non-pharmacological pain management intervention which is non-expensive and feasible for mothers and nurses. Findings of this pilot study guide the methodology of a randomized controlled trial.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.