RESUMEN
PROBLEM: Migration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden. BACKGROUND: Migrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives' perspectives in this context is crucial to address maternal health inequities. AIM: To explore midwives' experiences conveying information about fetal movement to migrant women in antenatal healthcare settings. METHODS: Semi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis. FINDINGS: The midwives' efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures. DISCUSSION: Our findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy. CONCLUSION: To reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman's needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.
Asunto(s)
Movimiento Fetal , Entrevistas como Asunto , Partería , Atención Prenatal , Investigación Cualitativa , Migrantes , Humanos , Femenino , Embarazo , Suecia , Atención Prenatal/métodos , Adulto , Migrantes/psicología , Enfermeras Obstetrices/psicología , Consejo/métodos , Relaciones Enfermero-Paciente , Actitud del Personal de Salud , Servicios de Salud MaternaRESUMEN
OBJECTIVE: To explore how Swedish Somali migrant women perceive fetal movements, process information about fetal movements, and take actions if decreased fetal activity occurs. DESIGN: A qualitative study based on individual semi-structured interviews. The interviews were analysed using content analysis. SETTING: The study was conducted in Sweden. PARTICIPANTS: Swedish Somali migrant women (n=15) pregnant in their third trimester or recently given birth. FINDINGS: The analysis led to the main category: tailored information about fetal movements enhances the possibility to seek care if the movements decrease. The results are described in the generic categories: explanatory models determine action; and understand and interpret information. KEY CONCLUSIONS: Miscommunication on fetal movements can be a hurdle for Swedish Somali migrant women that may have impact on stillbirth prevention and the quality of care. Improved communication and information tailored to individual needs is essential to achieve equality for women and their newborns. IMPLICATIONS FOR PRACTICE: The midwife can be used as a hub for reassuring that adequate information about fetal movements reaches each individual woman in antenatal care. Individualised information on fetal movements based on the women's own understanding is suggested to increase the possibility that the pregnant woman will seek care if the movements decrease. Somali women's verbal communication can be used to spread accurate information in the Somali community on the importance of seeking care if fetal movements decrease.
Asunto(s)
Movimiento Fetal , Migrantes , Embarazo , Femenino , Recién Nacido , Humanos , Suecia , Somalia , Investigación Cualitativa , ComunicaciónRESUMEN
The birthing room is a major workplace for midwives but how it influences them in practice is not enough investigated.Purpose: This study aimed to explore midwives´ experiences of how the birthing room affects them in their work to promote a normal physiological birth.Methods: A phenomenological reflective lifeworld research approach was used and included individual interviews with 15 midwives working at four different hospitals in western Sweden, and of which two also assisted at homebirths. The analysis focused on the meanings of the study phenomenon.Results: A birthing room can by its design either support a normal physiological birth or support a risk approach to childbirth. Four opposing constituents complete the essential meaning of the birthing rooms, and to which the midwives need to relate in their roles as guardians for normal birth: i) a private or a public room; ii) a home-like or hospital-like room; iii) a room promoting activity or passivity; iv) a room promoting the midwife´s presence or absence.Conclusions: The birthing room mirrors a pathogenic-oriented care approach. A presupposition for the work to keep the birth bubble intact is to protect the mother from disturbing elements both inside and outside the room.
Asunto(s)
Partería , Parto Obstétrico , Femenino , Humanos , Parto , Embarazo , Investigación Cualitativa , SueciaRESUMEN
Preclinical studies have shown that the amino acid taurine is of importance for the dopamine elevating properties of ethanol. Taurine intake has escalated over the last decade due to increased consumption of taurine-containing energy drinks and dietary supplements. Whether long-term intake of large amounts of taurine induces adaptations affecting ethanol-induced dopamine elevation is not clear. Thus the aim of the present studies was to explore the impact of repeated administration of large amounts of taurine on ethanol-induced behavior and dopamine neurotransmission. Repeated daily systemic administration of taurine increased taurine-induced locomotor activity and rearing. Acute administration of taurine and ethanol in naïve animals produced an additive effect on extracellular taurine but no alteration of the ethanol-induced dopamine elevation, as measured by in vivo microdialysis. Sub-chronic administration of taurine did not modify the taurine- or dopamine-elevating properties of ethanol. Daily taurine treatment also failed to change the mRNA expression of the taurine transporter and GABAA- and glycine-receptor subunits, as measured by qPCR in nucleus accumbens tissue. We conclude that systemic administration of taurine may have long lasting central effects, here displayed as behavioral sensitization. However, repeated daily exposure to taurine does not appear to influence the dopamine elevating properties of ethanol.
Asunto(s)
Dopamina/metabolismo , Etanol/administración & dosificación , Núcleo Accumbens/efectos de los fármacos , Núcleo Accumbens/metabolismo , Taurina/administración & dosificación , Taurina/metabolismo , Animales , Locomoción/efectos de los fármacos , Locomoción/fisiología , Masculino , Microdiálisis/métodos , Ratas , Ratas WistarRESUMEN
Excessive alcohol use causes considerable morbidity and mortality worldwide. Changes in the mesolimbic dopamine system have been postulated as a neurobiological underpinning of excessive alcohol consumption, and recent research also suggests that the amino acid taurine plays a central role in ethanol-induced dopamine elevation. The aim of this study was to further outline the role of dopamine and taurine in regulating alcohol consumption. In this study, a choice between ethanol (20%) and water was administered to Wistar rats in an intermittent manner (three times/week) for seven consecutive weeks. In vivo microdialysis was used to explore baseline levels as well as ethanol-induced increases of extracellular dopamine and taurine, in the nucleus accumbens (nAc) of Wistar rats voluntarily consuming large or small amounts of ethanol. Basal levels of taurine were also measured in cerebrospinal fluid (CSF) and serum in a subset of rats. Ethanol-induced increases in nAc dopamine and taurine did not differ between alcohol-consuming and naïve rats. However, when categorized based on ethanol intake, rats consuming larger amounts of ethanol exhibited a lower dopamine tone in the nucleus accumbens and responded to ethanol with a slower elevation of extracellular taurine levels, as compared with low-consuming animals. Basal levels of taurine in nAc, CSF, or serum did not differ between ethanol high- and low-consuming rats. Our data support previous studies claiming an association between low endogenous dopamine levels and excessive alcohol intake.
Asunto(s)
Consumo de Bebidas Alcohólicas/metabolismo , Depresores del Sistema Nervioso Central/administración & dosificación , Dopamina/metabolismo , Etanol/administración & dosificación , Núcleo Accumbens/metabolismo , Taurina/metabolismo , Animales , Conducta Animal , Líquido Cefalorraquídeo/química , Microdiálisis , Ratas , Ratas Wistar , AutoadministraciónRESUMEN
Due to the highly addictive properties of nicotine, a low percentage of users successfully maintain cessation for longer periods of time. This might be linked to neuroadaptations elicited by the drug, and understanding progressive changes in neuronal function might provide critical insight into nicotine addiction. We have previously shown that neurotransmission in the nucleus accumbens (nAc), a key brain region with respect to drug reinforcement and relapse, is suppressed for as long as seven months after a brief period of nicotine treatment. Studies were therefore performed to define the temporal properties of these effects, and to assess behavioral correlates to altered neurotransmission. Ex vivo electrophysiology revealed progressive depression of synaptic efficacy in the nAc of rats previously receiving nicotine. In addition, following three months of nicotine withdrawal, the responses to GABAA receptor modulating drugs were blunted together with downregulation of several GABAA receptor subunits. In correlation to reduced accumbal neurotransmission, a reduced anxiety-like behavior; assessed in the elevated plus-maze and marble burying tests, were identified in animals pre-treated with nicotine. Lastly, to test the causal relationship between suppressed excitability in the nAc and reduced anxiety-like behavior, rats received local administration of diazepam in the nAc while monitoring behavioral effects on the elevated plus-maze. These results show that nicotine produces long-lasting changes in the GABAergic system, which are observed first after extended withdrawal. Our data also suggest that nicotine produces a progressive suppression of accumbal excitability, which could result in behavioral alterations that may have implications for further drug intake.
Asunto(s)
Ansiedad/etiología , Nicotina/efectos adversos , Núcleo Accumbens/fisiología , Síndrome de Abstinencia a Sustancias/complicaciones , Transmisión Sináptica/fisiología , Animales , Ansiolíticos/uso terapéutico , Ansiedad/tratamiento farmacológico , Cuerpo Estriado/efectos de los fármacos , Cuerpo Estriado/metabolismo , Espinas Dendríticas/efectos de los fármacos , Espinas Dendríticas/patología , Diazepam/uso terapéutico , Modelos Animales de Enfermedad , Potenciales Evocados/efectos de los fármacos , Potenciales Postsinápticos Excitadores/efectos de los fármacos , Locomoción/efectos de los fármacos , Locomoción/fisiología , Masculino , Neuronas/efectos de los fármacos , Neuronas/fisiología , Neuronas/ultraestructura , Núcleo Accumbens/citología , Núcleo Accumbens/efectos de los fármacos , Técnicas de Placa-Clamp , Ratas , Ratas Wistar , Receptores de GABA/genética , Receptores de GABA/metabolismo , Transmisión Sináptica/efectos de los fármacosRESUMEN
The subthalamic nucleus (STN) is a key area of the basal ganglia circuitry regulating movement. We identified a subpopulation of neurons within this structure that coexpresses Vglut2 and Pitx2, and by conditional targeting of this subpopulation we reduced Vglut2 expression levels in the STN by 40%, leaving Pitx2 expression intact. This reduction diminished, yet did not eliminate, glutamatergic transmission in the substantia nigra pars reticulata and entopeduncular nucleus, two major targets of the STN. The knockout mice displayed hyperlocomotion and decreased latency in the initiation of movement while preserving normal gait and balance. Spatial cognition, social function, and level of impulsive choice also remained undisturbed. Furthermore, these mice showed reduced dopamine transporter binding and slower dopamine clearance in vivo, suggesting that Vglut2-expressing cells in the STN regulate dopaminergic transmission. Our results demonstrate that altering the contribution of a limited population within the STN is sufficient to achieve results similar to STN lesions and high-frequency stimulation, but with fewer side effects.