<p><strong>Bakgrund:</strong> Sexualitet hos äldre är precis som hos yngre en viktig del av livskvaliteten. Den sexuella förmågan och de sexuella behoven fortsätter långt upp i åren. Ett aktivt sexualliv har visat sig vara bra för välbefinnandet.</p><p><strong>Syfte: </strong>Syftet var att undersöka vilka faktorer som har en positiv påverkan på äldre kvinnors sexuella välbefinnande.</p><p><strong>Metod: </strong>En kvantitativ metod har används på ett redan insamlat datamaterial. Detta material består av omfattande enkäter som samlades in under åren 2000-2003. Huvudvariabel sexuellt välbefinnande har testats mot flera relevanta variabler. Analysmetoderna som användes var Chi-square test, univariat analys och slutligen en multivariat analys. Vi har valt att titta på den positiva odds kvoten, det vill säga vad som påverkar det sexuella välbefinnandet positivt.</p><p><strong>Resultat:</strong> Av den undersökta populationen skattade 25 % av kvinnorna att de hade ett bra sexuellt välbefinnande. Studien visade ett starkt samband mellan att känna sig uppskattad i hemmet och att vara nöjd med sitt sexuella välbefinnande. Att vara nöjd med sin kropp var en positiv faktor för det sexuella välbefinnandet. Signifikans fanns också för att ha ett bra humör, att vara icke rökare och att inte ha passerat menopaus.</p> / <p><strong>Background</strong>: Sexuality among older persons are just as important to quality of life as it is to younger people. The sexual ability and sexual needs will continue up in years. An active sex life is good for the sexual satisfaction.</p><p><strong>Objective:</strong> The objective was to examine factors that have a positive impact on older women's sexual satisfaction.</p><p><strong>Method:</strong> A quantitative method was used on already collected material, consisting of extensive surveys collected during the years of 2000-2003. The main variable sexual satisfaction has been tested against several relevant variables. The analytical methods used were chi-square test, univariate analysis and finally a multivariate analysis. We chose to examine the positive odds ratio, (POR), that affects the sexual satisfaction positively. <strong>Results:</strong> Among the respondents 25% estimated that they had very good sexual satisfaction. The results indicates to be appreciated at home and happy with ones own body affected the sexual satisfaction positively. Having a good mood and not have passed menopause also have a positive affect of the older womens sexual satisfaction.</p>

Assisted reproductive technology (ART) uses advanced techniques such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) to combat human infertility. However, the success rate of ART is poor and can, at least in part, be attributed to detrimental (iatrogenic) damage incurred by gametes and embryos during laboratory treatment or manipulation, thus compromising their functional role and reducing the chances of fertilisation. The sperm plays two fundamental roles upon gamete fusion: (1) to deliver paternal genomic DNA of optimal integrity into the oocyte, and (2) to activate the oocyte to initiate embryogenesis. Protamine and phospholipase C zeta (PLC&zeta;) are two critical sperm proteins fundamentally responsible for facilitating these two key roles, respectively. The essential role of these sperm proteins with regards to male fertility, and fertilisation outcome following ART treatment, has been widely reported. This thesis was predominantly designed to investigate the potential effects of cryopreservation and sperm immobilisation via polyvinylpyrrolidone (PVP) upon the abundance and localisation of protamine and PLC&zeta; in mouse and human sperm, respectively. Deficiency of these proteins could lead to reduced sperm DNA integrity and oocyte activation ability, respectively. An immunofluorescent quantitative assay was first designed and optimised for the determination of protamine 1 (P1) and 2 (P2) levels in sperm. This assay demonstrated that the total levels of P1 and P2, but not the P1:P2 ratio, were significantly reduced (by approximately 50%) in mouse sperm following cryopreservation. This novel assay may represent a useful clinical tool to predict DNA integrity and help select sperm with the best quality DNA. Clinical screening of PLC&zeta; was also carried out in the largest dataset reported to date and confirmed that total levels of PLC&zeta; in human sperm varied significantly between samples (P &le; 0.05). Cluster analysis led to the development of a PLC&zeta; scoring system with significant potential as a clinical prognostic and diagnostic assay. Regression models also correlated fertilisation rate and PLC&zeta; content in a total of 30 clinical samples. Collectively, these novel tools show significant promise as predictors of oocyte activation ability. Specific case studies involving vasectomy, oocyte activation deficiency (OAD), and globozoospermia, were identified and shown to be associated with significantly reduced levels of PLC&zeta; (P &le; 0.05). In two of these case studies, a single nucleotide polymorphism (SNP) was identified in the PLC&zeta; promoter region, potentially indicating a novel mechanism for PLC&zeta; expression in human sperm. Another case of OAD suggested the apparent deficiency of a crucial interacting factor in the oocyte, emphasising that OAD is not exclusively linked to sperm abnormalities. For the first time, efforts were made to assess whether PLC&zeta; expression was linked to male age; total levels and the proportion of sperm exhibiting PLC&zeta; were found not to differ significantly amongst a total of 46 males. Furthermore, in a pilot experiment, levels of PLC&zeta; were significantly reduced (by 23% to 89%) in PVP-treated sperm from 9 controls and 3 infertile patients, with patient sperm showing higher susceptibility to the effects of PVP compared to controls. However, a more robust experiment featuring sperm from 16 fertile donors, failed to show any significant effect of PVP upon PLC&zeta;. Collectively, data arising from this thesis generated a series of potential clinical tools to quantify protamine and PLC&zeta; in sperm, provides strong evidence that levels of protamine are significantly reduced by cryopreservation, and has provided at least some evidence that PVP may cause detrimental effect upon the level of PLC&zeta; in human sperm. Further work on the effects of vasectomy and the relative functional importance of the SNP detected in the PLC&zeta; promoter are highly warranted. Further investigation and clinical translation of these findings may help to improve the success rate of ART.

The use of intraperitoneal (i.p.) adenovirus virotherapy of ovarian cancer is currently limited by insufficient efficacy and high toxicity. Both factors are associated with adenovirus serotype 5 (Ad5) in this setting and may be serotype-specific. Low levels of uptake receptors (CAR and αV integrins) on ovarian tumour cells and widespread immunity against Ad5 among patients appear to restrict efficacy and intraperitoneal inflammatory responses against Ad5 were among the reasons for the termination of a phase II/III clinical trial in ovarian cancer. This thesis sought to overcome these obstacles by investigating the alternative adenovirus serotypes Ad3 and Ad11. For these viruses lower pre-existing antiviral immunity and utilisation of different uptake receptors have been reported. Furthermore, virus cloaking with novel polymers which could impart enhanced protection from neutralisation was examined. In vitro, wild-type Ad3, Ad5 and Ad11 displayed differential oncolytic activity in a panel of ovarian cancer cell lines which partly correlated to uptake receptor expression and virus internalisation. However, some cell lines displayed lysis resistance in a serotype-specific manner. While the inflammatory response six hours after i.p. administration of Ad11 in CD46-transgenic mice did not differ from Ad5, in long-term studies of repeated administration Ad5 induced significantly more severe pathologic effects in the form of adhesions and liver toxicity than Ad11 or mock-treatment. Oncolysis inhibition assays using malignant exudate samples demonstrated greater neutralisation of Ad3 and Ad5 in comparison to Ad11 at low concentrations of samples. Notably, 10-fold less Ad11 than Ad5 was required for oncolytic efficacy at a sample concentration of 10%. In an ex vivo model of ascites from ovarian cancer patients Ad5 modified with novel polymer formulations achieved at least 50% cell kill in six of eight samples, in contrast to two of eight samples for non-modified Ad5. These data suggest that virotherapy using Ad11 might be advantageous over Ad3 or Ad5. The lack of strong inflammation and the possibility to decrease treatment doses due to less neutralisation of Ad11 might result in considerably improved patient safety. Chemical modification of Ad with novel polymers presents an exciting advancement in overcoming treatment neutralisation in adenovirus virotherapy.

The aim of this thesis was to investigate the effect of antihypertensive therapy on vascular function and placental markers in hypertensive disorders in pregnancy (HTD). We prospectively studied 208 women at the Homerton and University College London Hospitals. Vascular and serum markers were measured in 80 with HTD [51 pre-eclampsia (PE), 29 gestational hypertension (GH)] and 80 normotensive controls. The same markers were measured in placental samples from another 48 women (14 PE, 10 GH, 24 controls). Pulse wave analysis indices [augmentation pressure (AP) and augmentation index at heart rate 75/minute (Aix-75)], serum and placental concentrations of soluble fms-like tyrosine-kinase-1 (sFlt-1), soluble endoglin (sEng), placental growth factor (PIGF), vascular endothelial growth factor (VEGF), inhibin A, activin A, and uterine artery Doppler were measured before, and 24-48 hours after, initiating antihypertensive therapy. The three study groups were compared using ANOVA multiple comparisons with Bonferroni post hoc testing. Marker levels before and after antihypertensives were compared using paired t-test. In both pre-eclampsia (P < 0.0001) and gestational hypertension (P < 0.05), serum sFlt-1 was increased and PIGF reduced (P < 0.001) compared to controls. Serum sEng levels were also increased in pre-eclampsia. Placental sFlt-1 and sEng were significantly higher (P < 0.0001), and PIGF lower (P = 0.008), in pre-eclampsia compared to controls and gestational hypertension. Antihypertensive therapy was associated with a significant fall in serum and placental sFlt-1 and sEng in pre-eclampsia only (P < 0.05). In pre-eclampsia, but not gestational hypertension, treatment was associated with significantly (P < 0.05) lower serum and placental inhibin A and activin A. In women with pre-eclampsia or gestational hypertension, both AP (P < 0.0001 and P < 0.05) and Aix-75 (P < 0.0001 and P < 0.001) were significantly higher than controls. Antihypertensive therapy resulted in a significant fall in both AP and Aix-75 in pre-eclampsia only (P < 0.0001). Anti hypertensive drugs may have an effect on the pathophysiology of pre-eclampsia other than their known anti hypertensive action.

This poststructuralist qualitative study explored the discourses constructing women’s choice for a caesarean section in the absence of clinical indications, in the talk and texts of women, midwives, an obstetrician, professional journals and the media publications. The study affirms inscriptions surrounding choice in childbirth are shaped discursively through a multiplicity of discourses underpinned by social and institutional practices. With advances in technology, childbearing women have a greater variety of options from which to choose. Controversial, is the option of a caesarean section, regardless of clinical need. The issue is depicted in both professional and popular discourse as contentious, complex and contradictory. Its momentum into the 21st century, as a new object of obstetric discourse, has been played out on a number of platforms. In this thesis I draw from the theoretical ideas of French philosopher Michel Foucault, to examine this complex debate. I argue there is a volatile moment in the history of childbirth in which an explosion of discourses have sculptured choice for a caesarean, in the absence of clinical indications, out of a repartee of autonomy, convenience, desire, fear and risk. In this precarious moment, new meanings joust with the old on a shifting terrain awash with rhetoric that co-opts, competes, and contradicts to bring about a caché of mutable ‘truths’. Whether caesarean, as an optional extra, can be explained in terms of a libertarian imperative, an embodiment of lifestyle, the satiation of desire, the attenuation of fear or the avoidance of risk, the democratisation of this choice has exposed a pathologising paradox, whereupon the normal emerges as the abnormal, and the abnormal emerges as the normal. The deconstruction of choice through a poststructuralist lens has enabled insight into how contradiction and contest befall the ‘order of things ’ and in so doing, provides new openings for contemplating the discursive positioning of women through the competing discourses of childbirth.

This thesis was funded by the Department of Human Services (South Australia) to test the acceptability of nicotine patches to pregnant women and to assess the safety of nicotine patches for pregnant women, at least in terms of overall exposure to nicotine. The study was conducted in the antenatal clinics at the Women's and Children's Hospital, Adelaide and was a pilot for a planned larger study. If the pilot indicated that the nicotine patches could be used safely by this group of women, the larger study would examine the effectivemess of patches in a smoking cessation program. Four focus groups, three with pregnant women and one with their care providers, were used to elucidate issues for pregnant women related to smoking and the use of nicotine patches to aid cessation.

Testicular function is stimulated from the pituitary gland by the gonadotrophic hormones FSH and LH. The testis in turn regulates gonadotrophin secretion by negative feedback. The agents of feedback are steroids, and in addition, probably a protein hormone, which has been given the name inhibin. A method capable of detecting inhibin-like activity in bull seminal plasma (bSP) was developed. Administration of bSP at the time of castration to five-week old male rats inhibited the post-castration rise of serum concentrations of FSH and LH otherwise seen 24 h later. The degree of inhibition depended on the dose; 0.5 ml bSP or the equivalent amount of bSP-extract always suppressed FSH and LH to levels typical of intact rats. The rats' sensitivity to 0.2 ml bSP varied with the time of year, possibly reflecting seasonal changes in the onset of puberty. The time-course of action of bSP-extract was studied in intact rats. Serum FSH was suppressed 12, 24 and 48 h after a single injection, but not at 3 or 6 h. LH was suppressed at 6, 12, 24 and possibly 48 h.

<p>Hysterektomi är ett kirurgiskt ingrepp där man opererar bort livmodern på kvinnor där en genital rubbning uppkommit. Syftet med detta arbete var att ge en klarare bild om hur kvinnor upplever detta ingrepp samt hur vårdpersonalen skall bemöta och kunna ge kvinnan stöd om så skulle behövas. Syftet med studien var att genom en litteraturstudie belysa kvinnors upplevelser av hysterektomi samt behov av stöd. En systematisk litteraturstudie gjordes där tretton vetenskapliga studier har inkluderats. Resultatet presenteras i två huvudkategorier, kvinnors upplevelser vid hysterektomi samt kvinnors behov av stöd. Båda kategorierna innefattade underkategorier vilka var livskvalitet, sexualitet, stöd samt information. Resultatet visade på att större delen av kvinnorna som genomgått hysterektomi var nöjda med ingreppet, då ett stort handikapp de dragits med en lång tid lättade eller försvann helt. Kvinnorna saknade information om tiden efter operationen. Information har en stor betydelse av hur kvinnorna upplever hysterektomi. Sammanfattningsvis är det viktigt att sjukvårdspersonal har den kunskapen att ge rätt information vid rätt tillfälle. För att hjälpa de kvinnor som skall genomgå hysterektomi bör vårdpersonalen även kunna vara ett stöd, så att sjukhusvistelsen blir en god upplevelse för dessa kvinnor.</p>

<p>Amniocentesis (AC) and chorionic villus sampling (CVS) are the principal methods for fetal karyotyping. The aim of this thesis was to evaluate psychological reactions and risks associated with the procedures.</p><p>A semi-randomised study was made on 321 women, where AC (147) and CVS (174) at 10-13 weeks’ gestation were done trans-abdominally. Spontaneous fetal loss occurred in 6.8% and 1.7% of the women in the AC and CVS groups, respectively. Repeat testing was required more often in the AC (19.0%) than in the CVS (5.2%) group.</p><p>A subgroup of 94 women answered a questionnaire prior to the procedure. Anxiety was stated as reason for invasive testing in 38% of the women. Mean scores according to the Hospital Anxiety and Depression Scale for anxiety and depression were low. Likewise, mean scores for the Impact of Event Scale, evaluating the psychological distress evoked by the procedure, were low. Yet, a number of women had higher scores, indicating a risk of clinical anxiety and depression or psychological distress. The women worried most about miscarriage, fetal injury by the procedure and waiting for the result.</p><p>Fetal, infant and maternal outcomes were evaluated in a cohort of 71 586 women aged 35 to 49 years old, with single births in Sweden during 1991 to 1996. Altogether, 21 748 were exposed to AC and 1984 to CVS. Women exposed to AC and CVS were compared with non-exposed. Outcomes were extracted from the Swedish Medical Birth Register, the Swedish Hospital Discharge Register, and the Swedish Malformation Register. An increased risk of musculo-skeletal deformities, such as club foot (OR=1.45) and hip dislocation (OR=1.22), and respiratory disturbances such as neonatal pneumonia (OR=1.29), was found for infants born in the AC group. Risk increased with earlier gestation at the procedure. Fewer women in the AC group had a normal delivery and more had a Caesarean section. Complications related to the amniotic cavity and membranes (OR=1.15), hypotonic uterine dysfunction (OR=1.12) and instrumental vaginal deliveries (OR=1.11) were more common in the AC group. No significant differences were found for the CVS group.</p><p>CVS is the method of choice for prenatal karyotyping in the first trimester. AC should not be performed before 15 weeks’ gestation. Further research to develop methods to better identify women at increased risk of chromosomal abnormal pregnancies and to develop non-invasive tests for prenatal diagnosis is needed. Thereby, the number of women exposed to invasive procedures and the adverse effects caused by these procedures can be minimised.</p>

<p>The overall aims of the study were to determine the prevalence of anaemia in women of reproductive age and to investigate the underlying causes, as well as assess the effectiveness of antenatal care (ANC) interventions for anaemia prevention. Consecutive pregnant women booking for ANC (n=2235) were screened for anaemia, followed up and screened again late in pregnancy. Basic ANC interventions included iron and folate supplementation, malaria chemoprophylaxis and referral of severe anaemia cases, and in addition staff training and education for the women and the community at the study clinic. Non-pregnant women (n=504), adolescents: pregnant (n=76), non-pregnant (n=130), and boys (n=101) were also screened for anaemia. Haematological and biochemical investigations were made on anaemic cases.</p><p>The prevalences of anaemia and severe anaemia in pregnant women were 60% and 3.8%, respectively. The adolescent pregnant women were more anaemic, with an overall prevalence of anaemia of 76%. In the non-pregnant women the prevalence was 49%. Anaemia was more prevalent in adolescent girls than in boys, and iron deficiency was the main underlying cause in all groups. In the anaemic pregnant women, malaria and other infections were more common, and Serum ferritin therefore underestimates iron deficiency.</p><p>ANC interventions achieved a significant reduction in the prevalence of severe and moderate anaemia but only a moderate reduction in overall prevalence of anaemia. Time for treatment of anaemia during pregnancy is inadequate to correct pre-existing nutritional deficiencies, and all the underlying factors are not addressed. Anaemia control must include all women of reproductive age, starting with adolescents to build up their iron stores before pregnancy. ANC supplementation should include other nutrients, and there is also a need to identify and treat infections during pregnancy. Training of ANC providers and supervision as well as improvement in the logistics and supply supplements to the clinics needs reinforcement.</p>