What's known on the subject? and What does the study add? This is the first study examining FOXP3 expression in invasive urothelial urinary bladder cancer and in their tumour‐infiltrating lymphocytes (TILs). The relation of their respective immunohistological expression to survival adds new knowledge in the fields of tumour immunology and prognostic markers. OBJECTIVE • To investigate the possible impact of FOXP3 expression in T‐cells, as well as in tumour cells, on long‐term survival in patients with urinary bladder cancer (UBC) invading muscle. PATIENTS AND METHODS • In a retrospective study, tumour specimens from 37 patients cystectomized for T1–T4 UBC during 1999–2002 at the Karolinska University Hospital were examined by immunohistochemistry for tumour expression and/or infiltration of immune cells expressing FOXP3 as well as CD3. • The results obtained were correlated with clinicopathological parameters, where the primary and secondary outcomes investigated were overall survival and progression‐free survival, respectively. RESULTS • Infiltration of CD3+ and FOXP3+ lymphocytes (≥3 cells per high‐power field) were both correlated with better survival, and this relationship persisted throughout the whole study period (all P < 0.05). • Patients with FOXP3+ tumour cells had decreased long‐term survival compared to those patients with FOXP3− tumours (P < 0.05). • Despite a limited amount of patient material, the results of the present study indicate that FOXP3 expression, in both lymphocytes and tumour cells, is an important prognostic factor in UBC. CONCLUSIONS • FOXP3 expression in UBC cells is associated with decreased long‐term survival and thus may be a novel negative prognostic factor in UBC invading muscle. • By contrast, the presence of FOXP3+ tumour‐infiltrating lymphocytes was correlated with a positive prognosis. Because FOXP3 is up‐regulated upon activation in human T‐cells, FOXP3 may serve more as an activation marker than as a regulatory T‐cell indicator in this case. • These results support the need for larger prospective studies aiming to confirm the results obtained and to examine the underlying mechanisms in detail.

Lars Åke Persson and colleagues conduct a cluster randomised control in northern Vietnam to analyze the effect of the activity of local community-based maternal-and-newborn stakeholder groups on neonatal mortality. Please see later in the article for the Editors' Summary

Objective To estimate the intergenerational effects of preterm birth and reduced intrauterine growth.Design Population-based cohort study.Settings Mother-first-born offspring pairs recorded in the Swedish Medical Birth Registry.Population Children born before 2001 to 38 720 women born in 1973-75.Methods The relationships between the mother's and the child's birth characteristics were estimated using logistic regression analysis. Adjustments were made for smoking habits, body mass index (BMI), and current and childhood socio-economic conditions. Analyses were performed on all mother-offspring pairs and on the pairs for which information on neither of the included background variables was missing (n = 24 520).Main outcome measures Preterm birth (<37 weeks of gestation) and small for gestational age (SGA) (<-2 SD of the Swedish standard).Results Mothers who themselves had been born preterm were not significantly more likely to deliver their own children preterm, compared with those who had been born at term (adjusted OR 1.24, 95% CI 0.95-1.62). Also, preterm birth in the mothers did not influence the occurrence of SGA in the children. However, the odds ratio for giving birth to SGA and preterm children, respectively, was higher among SGA mothers (OR 2.68, 95% CI 2.11-3.41 and OR 1.30, 95% CI 1.05-1.61). Mothers whose intrauterine growth was moderately reduced but who did not meet the criterion of being born SGA were also at higher risk of giving birth to both preterm and SGA children, respectively. ConclusionsThe present study showed evidence of intergenerational effects of reduced intrauterine growth even when socio-economic factors as well as BMI and smoking were adjusted for. There was, however, no consistent intergenerational effect of preterm birth.

The primary aim of this study was to investigate whether women born prematurely or with impaired fetal growth have a reduced probability of giving birth. Using Swedish population-based registries, the authors identified 148,281 women born in 1973-1975 for follow-up until 2001. Of these women, 4.1% were born preterm and 0.32% very preterm, 0.29% were born with a very low birth weight, and 5.4% were small for gestational age. Outcome measures were the hazard ratios for giving birth during the study period. Adjustments were made for socioeconomic factors. Very-low-birth-weight women displayed a reduced probability of giving birth (hazard ratio = 0.74, 95% confidence interval: 0.60, 0.91), most apparent among women aged 25 or more years. There were also tendencies of reduced hazard ratios of giving birth among women born preterm or very preterm in this age interval. Women born small for gestational age (below -2 standard deviations) seemed to be more likely to have given birth (hazard ratio = 1.09, 95% confidence interval: 1.04, 1.14), but when a more extreme group of small-for-gestational-age women (below -3 standard deviations) was defined, the association was less evident (hazard ratio = 1.04, 95% confidence interval: 0.94, 1.16). The results suggest that very-low-birth-weight women and, possibly, women born preterm or very preterm have a reduced probability of giving birth, while the results regarding small for gestational age are less clear.

Word count for text only (exclusive of title, abstract, acknowledgements, references, and tables): 2,965 2 Abstract Context: Preterm birth and restricted foetal growth are related to symptoms of psychiatric disorder in childhood and early adulthood. However, psychiatric hospitalization has only been studied to a limited extent.Objective: To investigate possible relations between being born preterm and/or small for gestational age (SGA) and later psychiatric hospitalization.Design: A population-based registry study of psychiatric hospitalization. Registries allowed for inclusion of parental socioeconomic characteristics, pregnancy and delivery complications in the analyses. Preterm birth was defined as <37 weeks of gestation and SGA as a birth weight <-2.01 SD of the Swedish standard. Logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI 95% ). Results: The risk of hospitalization for all mental disorders was increased for: preterm SGA males (OR 2.19, CI 95% 1.49-3.21); at term SGA males (OR 1.55, CI 95% 1.34-1.79); at term SGA females (OR 1.31, CI 95% 1.15-1.50). Similarly, child psychiatric disorders and mental retardation were overrepresented among preterm males, preterm SGA males, at term SGA males, and at term SGA females. At term SGA males and females also suffered increased risk for anxiety and adjustment disorders (OR 1.70, CI 95% 1.18-2.45 and OR 1.49, CI 95% 1.14-1.94). For the males substance-related disorders were more common as well (OR 1.37, CI 95%1.11-1.71). Preterm, SGA males were also at risk for personality disorders (OR 3.30, CI 95% 3 1.16-9.41) and psychotic disorders (OR 4.36, CI 95% 1.85-10.30). SGA males were overrepresented in all hospitalization durations. Conclusions:The results show a relationship between being born SGA and later psychiatric hospitalization, where preterm birth and male gender seem to increase the risk.4

BackgroundThe gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose.MethodsThe development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries.ResultsThe tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge.ConclusionsAspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0305-2) contains supplementary material, which is available to authorized users.

BACKGROUND: There are few studies of couples that analyse satisfaction with treatment, adoption plans and relationships in couples after unsuccessful IVF. METHODS: ENRICH marital inventory was used to describe marital dynamics and to gain information about treatment and adoption plans. A specially designed questionnaire was used. Of the 51 couples without previous children who were asked to participate after their first failed IVF cycle, 45 participated. The next stage of the study was carried out when the couples had reached the 6 months point after the first IVF cycle, and the last stage after the couples had been through one to three treatments, 1 1 2 years after the last treatment. RESULTS: The couples displayed a stable relationship from the start as well as 1 year after the last IVF cycle. The vast majority of the couples had decided to go through with an adoption. Seventy-three per cent of the women were interested in more IVF treatment compared to 33% of the men. CONCLUSION: The stresses associated with IVF treatment did not have a negative impact on the couples' appreciation of their relationships during and after the treatment period. After treatment had been completed, the couples seemed to have reoriented themselves toward other solutions to childlessness.

BackgroundTargeted interventions to improve maternal and child health is suggested as a feasible and sometimes even necessary strategy to reduce inequity. The objective of this systematic review was to gather the evidence of the effectiveness of targeted interventions to improve equity in MDG 4 and 5 outcomes.Methods and FindingsWe identified primary studies in all languages by searching nine health and social databases, including grey literature and dissertations. Studies evaluating the effect of an intervention tailored to address a structural determinant of inequity in maternal and child health were included. Thus general interventions targeting disadvantaged populations were excluded. Outcome measures were limited to indicators proposed for Millennium Development Goals 4 and 5. We identified 18 articles, whereof 15 evaluated various incentive programs, two evaluated a targeted policy intervention, and only one study evaluated an intervention addressing a cultural custom. Meta-analyses of the effectiveness of incentives programs showed a pooled effect size of RR 1.66 (95% CI 1.43–1.93) for antenatal care attendance (four studies with 2,476 participants) and RR 2.37 (95% CI 1.38–4.07) for health facility delivery (five studies with 25,625 participants). Meta-analyses were not performed for any of the other outcomes due to scarcity of studies.ConclusionsThe targeted interventions aiming to improve maternal and child health are mainly limited to addressing economic disparities through various incentive schemes like conditional cash transfers and voucher schemes. This is a feasible strategy to reduce inequity based on income. More innovative action-oriented research is needed to speed up progress in maternal and child survival among the most disadvantaged populations through interventions targeting the underlying structural determinants of inequity.