Orientador: Renata Cunha Matheus Rodrigues Garcia / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-26T11:36:14Z (GMT). No. of bitstreams: 1 Vilanova_LarissaSoaresReis_D.pdf: 8785126 bytes, checksum: 61a40f7b2a2d6cfcf4b66db5fb9b6d01 (MD5) Previous issue date: 2014 / Resumo: Disfunções temporomandibulares (DTM) são condições orofaciais patológicas comuns caracterizadas por dor na articulação temporomandibular e/ou nos músculos da mastigação. A DTM é uma condição comum de dor, especialmente em mulheres durante a fase reprodutiva. Desta maneira os objetivos dessa tese foram (1) avaliar se as flutuações hormonais ocorridas durante o ciclo menstrual alteram a sensibilidade dolorosa (SD), força máxima de mordida (FMM) e performance mastigatória (PM) de voluntárias com DTM, (2) avaliar se os movimentos mandibulares e a qualidade do sono alterariam com o tratamento com placas oclusais estabilizadoras e (3) comparar o diagnóstico baseado no Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) avaliando a confiabilidade e calibração entre o treinamento formal em relação a autoinstrução com documentos e filme. Para tanto, cinquenta voluntárias foram selecionadas e divididas em dois grupos de 25 participantes: (1) voluntárias com DTM e ciclos menstruais regulares e (2) voluntárias com DTM e utilizando contraceptivos orais. Foram analisados a sensibilidade dolorosa (SD) por meio da escala visual analógica, força máxima de mordida (FMM) por meio de sensores e performance mastigatória (PM) por meio do peneiramento. Essas variáveis foram avaliadas durante o período de quatro fases de um ciclo menstrual completo. As mesmas 50 voluntárias diagnosticados com SD participaram do segundo estudo, que foram analisadas a intensidade da dor (escala visual analógica), qualidade do sono (Escala de Sonolência Epworth (ESS) e Índice de Qualidade de Sono de Pittsburgh (PSQI), e movimentos mandibulares ¿ amplitude de movimento e movimentos mastigatórios (cinesiografia) antes e depois de dois meses do tratamento com placa estabilizadora. Medidas repetidas GLIMMIX foram utilizados para a análise de dados seguido pelo teste de Tukey (P ? 0,05). Para o terceiro estudo foi utilizada uma amostra diferente, um total de 32 indivíduos (27 pacientes com DTM e 9 assintomáticos) foram examinados por meio do DC/TMD. Seis examinadores foram divididos em dois grupos com diferentes tipos de treinamento, (1) treinamento formal e de calibração em um centro de treinamento para o DC/TMD e (2) autoinstrução com o uso de documentos e vídeo. Após a primeira avaliação o segundo grupo passou pelo treinamento formal, sendo considerado o grupo (3) Autoinstrução + curso. A avaliação da confiabilidade foi realizada ao longo de um dia inteiro compreendendo em um exame clínico em 16 pacientes para cada um dos três grupos. O coeficiente kappa foi utilizado para calcular a confiabilidade dos diagnósticos do DC/TMD. Em relação aos resultados, foram encontradas diferenças na SD entre a fase lútea (quarta avaliação) e ovulatória (terceira avaliação) (p = 0,01), de ambos os grupos. Não foram encontradas diferenças em FMM (P = 0,34) ou PM (P = 0,43), entre os grupos experimental e controle. Sensibilidade à dor foi reduzido após o tratamento (P = 0,0001). O tratamento melhorou a amplitude de movimento, aumentando a abertura bucal (P = 0,0001) e movimento ântero-posterior (P = 0,01), bem como a velocidade de abertura máxima (P = 0,0001) e de fechamento (P = 0,04) durante a mastigação, após o tratamento. Houve diferenças nos índices de qualidade de sono para PSQI (P = 0,0001) e ESS (P = 0,04) após o tratamento da dor miofacial. No terceiro estudo, a confiabilidade foi boa em todos os três grupos de examinadores para todos os diagnósticos, exceto para a mialgia local e dor miofascial com referência no grupo Autoinstrução + curso. O curso melhorou a confiabilidade para a mialgia e artralgia quando comparado com a auto-instrução. Desta maneira, flutuações de estrogênio pode influenciar a sensibilidade à dor de pacientes com DTM, mas não afeta a função mastigatória. O tratamento de indivíduos com dor miofascial com placas estabilizadoras foi eficaz reduzindo a dor, e esta opção de tratamento melhora a qualidade do sono e movimentação mandibular. A confiabilidade da calibração do DC/TMD por meio do treinamento formal e da auto-instrução são semelhantes, exceto para os subgrupos de Mialgia. A auto-instrução seguida de treinamento formal melhora a confiabilidade da calibração do DC/TMD / Abstract: Temporomandibular disorders (TMD) are common chronic orofacial pathology conditions characterized by pain in the temporomandibular joint and/or muscles of mastication. The TMD is a common pain condition, especially in women during their reproductive phase. Thus the objectives of this thesis were (1) to evaluate whether the hormonal fluctuations that occur during the menstrual cycle alter pain sensitivity (PS), maximum bite force (MBF) and masticatory performance (MP) to volunteers with TMD, (2) evaluate if jaw movements and sleep quality would change with treatment with stabilizing occlusal splint and (3) compare the diagnosis based on the Diagnostic Criteria for Temporomandibular Disorders (DC / TMD) to evaluate the reliability and calibration between formal training in relation to self-instruction with documents and film. For this purpose, fifty volunteers were selected and divided into two groups of 25 participants: (1) volunteers with regular menstrual cycles and TMD, and (2) voluntary with TMD and using oral contraceptives. Pain sensitivity (PS) by using a visual analog scale, maximum bite force (MBF) using sensors and masticatory performance (MP) through screening were analyzed. These variables were measured for a period of four phases of a complete menstrual cycle. The same 50 volunteers diagnosed with PS participated in the second study, pain intensity (visual analogue scale), quality of sleep (Epworth Sleep Scale (ESS) and Index of Pittsburgh Sleep Quality (PSQI) were analyzed, and mandibular movements - range of motion and chewing movements (kinesiography) before and after two months of treatment with stabilizing splints. Repeated measures GLIMMIX were used for data analysis followed by Tukey¿s test (P ? .05). For the third study a different sample was used, a total of 32 patients (27 patients with TMD and 9 asymptomatic) were examined using DC/TMD. Six examiners were divided into two groups with different training, (1) formal training and calibration at a DC/TMD training center and (2) self-instruction with the use of documents and video. After the first evaluation, the second group went through the formal training, considered the group (3) self-instruction + course. The reliability assessment was performed over a full day comprising in a clinical examination of 16 patients for each of the three groups. The Cohen's kappa coefficient was used to calculate the reliability of the DC/TMD diagnoses. Regarding the results, differences between the PS in luteal phase (Fourth evaluation) and ovulatory phase (third evaluation) were found (p = 0.01) in both groups. No differences in MBF (P = 0.34) or MP (P = 0.43) were found between the experimental and control groups. Sensitivity to pain was reduced after treatment (P = 0.0001). The treatment improved range of motion, increasing mouth opening (P = 0.0001) and anterior-posterior movement (P = 0.01) and the maximum opening speed (P = 0.0001) and closing (P = 0.04) during mastication after treatment. There were differences in the sleep quality scores for PSQI (P = 0.0001) and ESS (P = 0.04) after the treatment of myofascial pain. On the third study, the reliability was good in all three groups of examiners for all diagnoses, except for Myofascial pain with referral in the Self + course group. The course group improved reliability for myalgia and arthralgia compared to self-instruction. Thus, estrogen fluctuations may influence the pain sensitivity of TMD patients, but does not affect masticatory function. Treatment of MFP subjects with stabilized splints was effective reducing pain, and this treatment option improves sleep quality and jaw motion. The reliability of the calibration of DC / TMD through formal training and self-education are similar, except for subgroups of Myalgia. The self-instruction followed by formal training improves the reliability of the calibration of DC / TMD / Doutorado / Protese Dental / Doutora em Clínica Odontológica

The purpose of this research project was to examine the relationship between age at menarche and the development of behavior problems. The research was designed to determine if there is any significance to the hypothesis that early maturing girls engage in more problematic behaviors than their on-time or later maturing peer.

<p>Cilj ove teze bio je utvrđivanje polnih razlika<br />u mehanizmima vegetativne regulacije srčane<br />frekvencije, kao i utvrđivanje razlika u regulaciji srčane frekvencije kod žena po<br />fazama menstrualnog ciklusa. Kori&scaron;ćeni su<br />parametri varijabilnosti srčanog ritma (heart<br />rate variability) - HRV i oporavka srčane<br />frekvencije (heart rate recovery) - HRR.</p><p>Ispitivanje je obuhvatilo 90 ispitanika; 45<br />osoba mu&scaron;kog pola (20.4&plusmn;0.7 god., 184&plusmn;5.00<br />cm, 79.38&plusmn;9.42 kg, BMI 23.53&plusmn;2.83) i 45<br />osoba ženskog pola (20.5&plusmn;0.6 god., 168&plusmn;5.25<br />cm, 60.96&plusmn;6.93 kg, BMI 21.57&plusmn;2.23) -<br />studenata Univerziteta u Novom Sadu. Za<br />prikupljanje podataka kori&scaron;ćen je pulsmetar<br />(Polar, Finska). Ispitivanje je sprovedeno u<br />mirovanju, kao i u periodu oporavka posle<br />kratkotrajnog fizičkog opterećenja poznatog<br />intenziteta. U prvom modulu snimanje je<br />obavljano u miru, u sedećem poloţaju na<br />samom ergo-biciklu, stopala na platformi<br />ispred pedala, noge u fleksiji od 90&deg; u<br />kolenom zglobu, ruke na natkolenicama. U<br />drugom modulu snimanje je obavljeno u<br />priodu petominutnog oporavka posle<br />maksimalnog opteraćenja u trajanju od 30<br />sekundi (supramaksimalno opterećenje) -<br />Wingate protokol. U grupi mu&scaron;karaca<br />sprovedeno je jednokratno merenje, dok su za<br />grupu ţena isti moduli snimanja primenjeni u ri navrata: 1. U fazi menstrualnog krvarenja,<br />rana folikularna faza - najniži nivoi estrogena<br />i progesterona. 2. Kasna folikularna faza -<br />visok estrogen. 3. Srednja lutealna faza -<br />visok nivo progesterona i estrogena.<br />U miru kao i u poslednjem trominutnom<br />intervalu petominutnog oporavka određeni su<br />sledeći parametri varijabilnosti srčanog ritma:<br />srednja vrednost NN intervala - RRNN,<br />standardna devijacija NN intervala - SDNN,<br />kvadratni koren iz srednje vrednosti kvadrata<br />sukcesivnih razlika susednih NN intervala<br />(root mean square of successive differences) -<br />RMSSD, broj sucesivnih NN intervala koji<br />se razlikuju za vi&scaron;e od 50ms - NN50 i<br />procentualni udeo NN50 u ukupnom broju<br />NN intervala - pNN50. Od parametara<br />frekvencijskog domena, nakon brze Furijeove<br />transformacije analizirani su sledeći<br />parametri: snaga spektra niske frekvencije<br />(LF; 0,04-0,15Hz) i snaga spektra visoke<br />frekvencije (HF; 0,15-0,40Hz).<br />Oporavak srčane frekvencije u toku<br />petominutnog oporavka nakon<br />supramaksimalnog opterećenja na bicikl<br />ergometru procenjivan je pomoću sledećih parametara: 1. Apsolutna razlika između<br />vrednosti srčane frekvencije odmah po<br />zavr&scaron;etku opterećenja i frekvencije<br />registrovane nakon 60 sekundi oporavka -<br />HRR60. 2. Vremenska konstanta<br />kratkoročnog oporavka srčane frekvencije u<br />prvih 30 sekundi - T30. 3. Vremenska<br />konstanta opadanja srčane frekvencije u toku<br />petominutnog oporavka - T.<br />Utvrđeno je da mu&scaron;karci imaju veći pik snage<br />kao i prosečnu snagu pri supramaksimalnom<br />opterećenju u odnosu na grupu ţena bez<br />obzira na fazu menstrualnog ciklusa; dok su<br />bazalna i maksimalna srčana frekvencija bile<br />iste u obe grupe.<br />Postoje polne razlike u mehanizmima<br />vegetativne regulacije srčane frekvencije u<br />mirovanju. Najbolje su vidljive kroz<br />parametre frekvencijkog domena HRV-a (LF<br />i HF), odnosno prirodne logaritme ovih<br />vrednosti (lnLF i lnHF). Statistički značajne<br />razlike u vrednostima parametara<br />frekvencijskog domena HRV-a između grupe<br />mu&scaron;karaca i grupe ţena u sve tri faze<br />menstrualnog ciklusa potvrđene su i u fazi<br />oporavka posle supramaksimalnog opterećenja.<br />Postoje polne razlike u parasimpatičkoj<br />reaktivaciji posle supramaksimalnog<br />opterećenja koja je značajno brţa kod<br />mu&scaron;karaca. One se najbolje mogu proceniti<br />kroz matematičke modele oporavka srčane<br />frekvencije i vremensku konstantu opadanja<br />srčane frekvencije u prvih 30 sekundi<br />oporavka - T30.<br />Nisu utvrđene razlike u mehanizmima<br />vegetativne regulacije srčane frekvencije u<br />miru u grupi ţena po fazama menstrualnog<br />ciklusa; procenjeno kroz parametre<br />vremenskog i frekvencijskog domena HRVa.<br />Parametri vremenskog i frekvencijskog<br />domena HRV-a registrovani u mirovanju kao<br />i u fazi odmora posle supramaksimalnog<br />opterećenja nisu dovoljno osetljivi za<br />utvrđivanje razlika u vegetativnoj regulaciji<br />srčane frekvencije kod žena po fazama<br />menstrualnog ciklusa.<br />Nijedan od registrovanih parametara<br />oporavka srčane frekvencije (HRmax,<br />HRoporavak, HRR60, T i T30) nije se pokazao<br />dovoljno osetljivim za utvrđivanje promena u<br />parasimpetičkoj reaktivaciji kroz faze<br />menstrualnog ciklusa.</p> / <p>The aim of this study was to determine<br />gender differences in autonomic heart rate<br />control mechanisms, as well as to determine<br />heart rate control differences in women<br />during menstrual cycle. Heart rate variability<br />- HRV and heart rate recovery - HRR parameters were used.<br />The study included 90 participants; 45 males<br />(20.4&plusmn;0.7 yrs., 184&plusmn;5.00 cm, 79.38&plusmn;9.42 kg,<br />BMI 23.53&plusmn;2.83) and 45 females (20.5&plusmn;0.6<br />yrs., 168&plusmn;5.25 cm, 60.96&plusmn;6.93 kg, BMI<br />21.57&plusmn;2.23) - students of the University of<br />Novi Sad. Heart rate monitor (Polar,<br />Finland) was used for data collection.<br />Measurements were conducted while resting<br />as well as in a short recovery period after a<br />brief physical strain of known intensity. In<br />the first mode, heart rate monitoring was<br />conducted on relaxed subjects, in a sitting<br />position on an ergo-bike, feet on the<br />platform in front of the pedals, legs bent at<br />knees at 90&deg;, hands on thighs. In the second<br />mode heart rate monitoring was conducted in<br />a five-minute resting period after 30 seconds<br />of maximal exercise (supramaximal<br />exercise) - Wingate protocol. There was a<br />single monitoring in the male group, while in<br />the female group each monitoring mode was<br />conducted three times: 1. During the phase<br />of menstrual bleeding, early follicular phase<br />- the lowest levels of estrogen and<br />progesterone 2. Late follicular phase - high<br />estrogen. 3. Mid-luteal phase - high progesterone and estrogen.<br />While resting as well as in the last three<br />minutes of five-minute recovery period after<br />the exercise the following parameters of<br />heart rate variability were determined: the<br />mean value of NN intervals - RRNN, the<br />standard deviation of NN intervals - SDNN,<br />the square root of the mean of the squares of<br />the successive differences between adjacent<br />NN intervals (root mean square of<br />successive differences) - RMSSD, the<br />number of pairs of successive NN intervals<br />that differ by more than 50 ms - NN50 and<br />the proportion of NN50 divided by total<br />number of NN intervals pNN50. After the<br />fast Fourier transformation, following<br />frequency domain parameters were<br />analyzed: power spectrum of low frequency<br />(LF; 0,04-0,15Hz) and power spectrum of<br />high frequency (HF; 0,15-0,40Hz).<br />Heart rate recovery during the five-minute<br />resting period after the supramaximal<br />exercise on the ergo-bike was evaluated<br />through following parameters: 1. Absolute<br />difference between the heart rate<br />immediately after the exercise and the heart rate registered after 60 seconds of recovery -<br />HRR60. 2. Time constant of short-time heart<br />rate recovery in the first 30 seconds - T30. 3.<br />Time constant of heart rate decay<br />during the five-minute recovery period - T.<br />It was found that men had greater peak and<br />average power during supramaximal<br />exercise compared to a group of women<br />regardless of the phase of menstrual cycle;<br />while basal and maximal heart rate were the<br />same in both groups.<br />There are gender differences in autonomic<br />heart rate control mechanisms while resting.<br />These are best visible through frequency<br />domain HRV parameters (LF and HF), and<br />their natural logarithms (lnLF and lnHF).<br />Statistically significant differences in the<br />frequency domain HRV parameters between<br />the group of men and the group of women in<br />all three phases of the menstrual cycle, were<br />also found in recovery period after<br />supramaximal exercise.<br />There are gender differences in<br />parasympathetic reactivation after<br />supramaximal exercise which is significantly faster in men. These differences are best<br />assessed through mathematical models of<br />heart rate recovery and the time constant of<br />short-time heart rate recovery in the first 30<br />seconds - T30 .<br />No differences in autonomic heart rate<br />control mechanisms while resting in the<br />female group during three phases of<br />menstrual cycle were found; assessed<br />through the time and frequency domain<br />HRV parameters. The time and frequency<br />domain HRV parameters registered while<br />resting and during recovery period after<br />supramaximal еxеrcise were not sensitive<br />enough to determine differences in<br />autonomic heart rate control in women<br />through three phases of menstrual cycle.<br />None of the registered heart rate recovery<br />parameters (HRmax, HRR60, HRoporavak, T i<br />T30) were sensitive enough to determine<br />changes in parasympathetic reactivation<br />through a menstrual cycle.</p>

5 Abstract Products of major histocompatibility complex (MHC) plays key role in immune system of vertebrates. Prior studies on different vertebrate species show, that heterozygosity in MHC genes is linked to more efficient immune system and preferred in mate choice. Results of human studies are ambivalent, which can be due to the effect of some modulating factors like reproductive status. Therefore, our aim was to test heterozygosity related preferences in faces, odor and voice across menstrual cycle. Our sample consisted of 51 men and 52 women, from which 23 used hormonal contraception and 29 had natural cycle. They were genotyped in -A, -B and -DR alleles. All odor stimuli, face photos and voice records were rated on seven-point scale in both follicular and luteal phase. Repeated measures ANOVA was used for the analysis. Changes in ratings across the menstrual cycle and heterozygosity were most discernible on voice ratings. Voices of homozygous males were rated more attractive than voices of heterozygous males especially in follicular phase. Similar shift to higher ratings in follicular phase was manifested in ratings of homozygous male faces, but the difference between homozygous males and heterozygous males was not significant. Women with natural cycle also rated voices higher in their follicular phase...

Une fraction importante de la population est exposée à la pollution atmosphérique ; ses effets sur la mortalité et la morbidité cardiovasculaire et respiratoire sont connus, et un effet de l'exposition au cours de la grossesse sur le poids de naissance et la croissance fœtale est probable ; un effet sur le risque de naissance prématurée a aussi été suggéré par de nombreuses études, essentiellement en Amérique. En revanche, la capacité des couples à concevoir -fertilité- et les paramètres de la fertilité féminine ont été très peu étudiés en lien avec cette exposition.L’objectif de ce doctorat était de documenter un effet éventuel de la pollution atmosphérique sur la fonction de reproduction humaine et tout particulièrement sur les caractéristiques du cycle menstruel, la probabilité de survenue d’une grossesse (fertilité) et le risque de naissance prématurée.Nous nous sommes appuyés sur une cohorte de couples n’utilisant pas de méthode contraceptive (l’Observatoire de la fertilité en France) et sur treize cohortes de naissances européennes participant au projet ESCAPE (European Study of Cohorts for Air Pollution Effects).Nous avons observé un allongement de la durée de la phase folliculaire du cycle menstruel (période du cycle entre le début des règles et l’ovulation) avec l’exposition de la femme aux particules en suspension dans l’atmosphère (n=158, β=1,6 jour pour une augmentation de la concentration des particules de diamètre aérodynamique inférieur à 10 µm -PM10- de 10 µg/m3 dans le mois précédant le cycle, intervalle de confiance, IC à 95%, 0,3; 2,9). En utilisant deux designs d’étude en parallèle sur la même population, l’approche des durées en cours et l’approche de cohorte prévalente, nous avons mis en évidence une tendance à une diminution de la probabilité de grossesse en association avec l’exposition à la pollution atmosphérique pour la première approche (cohorte prévalente : n=468, risque relatif de grossesse, HR : 0,69 pour une augmentation des PM10 de 10 µg/m3 dans les 70 jours précédant l’inclusion, IC à 95%, 0,43;1,12) ; la tendance était similaire avec l’approche des durées en cours (n=516, durée médiane sans contraception multipliée par 1,29 pour une augmentation des PM10 de 10 µg/m3 dans les 70 jours précédant l’arrêt de la contraception, IC à 95%, 0,97;1,70).Le risque de naissance prématurée, analysé avec un modèle de survie en prenant en compte l’exposition comme une variable dépendant du temps, n’était pas associé à divers polluants atmosphériques dans les cohortes du projet ESCAPE (n=46 791, OR=0,97 pour une augmentation du niveau moyen de PM10 de 10 µg/m3 pendant la grossesse, IC à 95%, 0,87 ;1,07). Nous avons par ailleurs mis en évidence une augmentation du risque de naissance prématurée avec la pression atmosphérique pendant le premier trimestre de grossesse et avec la température moyenne pendant le premier trimestre, au moins dans l’intervalle entre -5°C et 10°C. Nous avons montré qu’une partie de la littérature en faveur d’une association entre particules fines et risque de naissance prématurée pourrait être sujette à un biais causé par des durées de fenêtres d’exposition différentes entre les enfants nés avant terme et ceux nés à terme.Dans l’ensemble, ce travail confirme la nécessité d’utiliser un modèle de survie avec variables dépendant du temps pour étudier le risque de naissance prématurité et appelle à poursuivre les recherches concernant des effets possibles des polluants atmosphériques sur le cycle menstruel et la fertilité, pour lesquels nos travaux font partie des premiers réalisés en population générale. / A large fraction of the population is exposed to atmospheric pollution, which has known effects on cardiovascular and respiratory mortality and morbidity and probable effect on birthweight and fetal growth. So far, the biological aptitude to conceive for couples -fecundity- and the female markers of fecundity have been seldom studied in relation with this environmental exposure.The aim of this PhD was to quantify the possible association between atmospheric pollution and specific health outcomes related to human reproduction: menstrual cycle characteristics, probability of pregnancy and preterm birth risk. We relied on a population of couples not using any contraceptive method (Observatory of Fecundity in France) and on 13 birth cohorts participating in the European Study of Cohorts for Air Pollution Effects.We observed that higher levels of atmospheric pollutants during the 30 days before the start of a menstrual cycle were associated with longer follicular phase (n=158, β=1.6 days per each increase by 10 µg/m3 in particulate matters with an aerodynamical diameter of less than 10 µm -PM10; 95% confidence interval: 0.3;2.9). In the population recruited in OBSEFF study, we observed a trend for an increased time to pregnancy with short-term NO2 and PM10 levels in an original approach relying on two seldom used study designs focusing on a marker of fecundity in parallel: the prevalent cohort approach (n=468, hazard ratio of pregnancy, HR: 0.69 per each increase by 10 µg/m3 in PM10 during the 70 days before the inclusion, with a 95% CI of 0.43;1.12) and the current duration approach (n=516, median current duration of unprotected intercourse multiplied by 1.29 per each increase by 10 µg/m3 in PM10 during the 70 days before the contraception stop, 95% CI: 0.97;1.70). In the cohorts included in ESCAPE, preterm delivery risk studied by a survival model with time-dependent exposures was not associated with atmospheric pollutants levels during pregnancy (n=46,791, OR=0.97 per each increase by 10 µg/m3 in PM10 during the whole pregnancy, 95% CI 0.87;1.7). We observed an increased risk of preterm birth with higher atmospheric pressure during the first trimester of pregnancy and to some extent with temperature between -5°C and 10°C during the first trimester of pregnancy. We additionally showed that using exposure windows with different durations between cases and non-cases is a source of a bias in preterm birth studies that may impact several studies in the literature.This work demonstrated that using a survival model with time-dependent exposures is crucial to study preterm delivery risk. It appeals for additional research on the possible adverse effects of atmospheric pollution on menstrual cycle and fecundity, as our studies are among the first ones conducted in a general population on those topics.

Prior research has found the female athlete triad in both female athletes and female non-athletes. This study consisted of 192 female participants attending Utah State University with 103 collegiate athletes and 89 non-athletes. The instruments used included the EAT-26, menstrual cycle history questionnaire, osteoporosis questionnaire, and time spent in exercise questionnaire. Results from the present study found a statistically significant difference between athletes and non-athletes being at risk for the triad with female athletes having a higher percentage (4.8%, 3.4%). No statistical significant correlation was found between the risk of the triad and excessive amounts of time spent in exercise in athletes (r=.113, p=.256) and non-athletes (r=-.041, p=.706). When athletes were divided into lean and non-lean athletes statistical significance was found with non-lean (17.4%) sport athletes (χ²(1,N=103)=83.971, p<.01) having a higher overall percentage of being at risk of the triad compared to the athletes involved in lean (5%) sports.

Bakgrundsfakta visar att flera studier har gjorts på hur menstruationscykeln påverkar prestation under träning, dock är resultatet inkonsekvent, där vissa menar att hormonfluktueringen under de olika faserna inte har någon påverkan på prestationen medan vissa menar att påverkan finns. Syftet var att undersöka hur fysisk aktiva kvinnor upplevde symtom och menstruationens påverkan på prestation under träning. Metoden inkluderade 27 kvinnor i åldrarna mellan 18 och 30 år som svarade på en enkät, bestående av 25 frågor, där de som inkluderades uppnådde antingen WHO:s styrketräning- eller konditionsträningsmål. Deltagarna kontaktades genom att ett informationsbrev skickades ut till Luleå Tekniska Universitets fysioterapeutstudenter, Elitidrottsvänligt lärosäte i Luleå samt via sociala medier. Svaren från enkäten analyserades med en deskriptiv analys och Spearman’s korrelationskoefficient med hjälp av JASP. Resultatet visade att deltagarna (96.3%) upplevde menstruationsrelaterade symtom. En måttlig korrelation mellan antalet upplevda symtom och upplevelsen av prestation under träning menstruationsveckan sågs (r = -0.399, p = 0.039). Prestationen upplevdes bättre veckan efter och sämre veckan under menstruation. Konklusionen är att resultatet indikerar att upplevelsen av prestation under träning påverkas av antalet symtom. Indikationen finns att upplevelsen av prestation ökar veckan efter menstruationen och att den är ‘neutral’ veckan innan. På grund av lågt antal deltagare i studien krävs ytterligare forskning i större skala för att få en evidensbaserad rehabilitering och för att få fram ett kliniskt användbart resultat. / Background information show previous studies that have looked at how the menstrual cycle affects performance during training, however this information is inconsistent, parts of the studies showed that the hormonal fluctuation during the different phases had no impact on training and others showed that there is an impact. The purpose of this study was to analyze how physically active women find the symptoms and menstrual cycles effect regarding performance during training. The method included 27 women between ages of 18 and 30, who answered a survey consisting of 25 questions. The women who were included in the study had to uphold either WHO:s strength or cardiovascular aims. The participants were contacted via an information letter sent out to physiotherapy students at Luleå University of Technology physiotherapy, Elitidrottsvänligt lärosäte in Luleå and through social media. Answers collected from the survey were analyzed by descriptive analysis and Spearman's correlation coefficient in JASP. The results showed that the participants (96.3%) experienced menstrual related symptoms. A moderate correlation was seen between the number of symptoms and the effect of performance during menses (r = -0.399, p = 0.039). There was a better effect on performance the week after menses and worse the week during menses. The Conclusion is that the result indicates that the experience of performance during training is affected by the number of symptoms the women experienced. The result also indicates that experience of performance was higher the week after menses and ‘neutral’ the week before. Due to low numbers of participants in this study further research is needed on a larger scale to obtain evidence based rehabilitation and to produce a clinically useful result.

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