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Women are conferred with greater immunologic and survival benefits compared to men. Female sex steroids contribute to this sexual dimorphism. Furthermore, during human pregnancy when female sex hormones are elevated, neutrophil apoptosis is delayed. This study examines the specific effects of estradiol and progesterone on neutrophil apoptosis and function in healthy adult men and women. We also examined the contribution of these hormones to the persistence and resolution of an inflammatory response. Spontaneous apoptosis was significantly decreased in women compared with men. Physiologic doses of estradiol and progesterone caused a further delay in spontaneous apoptosis in both men and women but did not diminish Fas antibodyinduced apoptosis. The delay in apoptosis was mediated at the level of the mitochondria with decreased release of cytochrome c, which may alter caspase cleavage and activity. There were no associated alterations in neutrophil CD11b, but production of reactive oxygen intermediates (ROIs) in women was increased. Thus, female sex hormones mediate delayed neutrophil apoptosis in both sexes and enhance female intracellular production of ROIs. Modulating hormonal responses may be an effective therapeutic tool in combating inflammatory diseases. IntroductionFrom conception to senescence, women have a significant survival advantage. 1 Men are more susceptible to sepsis and subsequent morbidity and mortality than women of reproductive age. [2][3][4] The incidence of sepsis in postmenopausal women increases to levels almost equal to those seen in age-matched men. 5,6 The exact mechanism mediating this sexual dimorphism is unclear. However, female sex hormones have been implicated because they modulate the immune system under normal and stress conditions. 7 Following trauma or hemorrhage, female mice maintain their immune function, whereas male mice have significantly depressed responses. 8 Estradiol has been shown to be protective in organ ischemia-reperfusion injury and shock by preventing androgeninduced immunosuppression in male animals. 9-12 Thus, female sex hormones may be a useful adjunct in preventing trauma-induced immunosuppression and the associated increased susceptibility to sepsis. 13 Estrogen treatment, testosterone depletion, and testosterone receptor antagonists improve outcome in male animals following trauma and sepsis. 14 The exact role of changes in the estradiol-testosterone ratio in immune function requires further clarification. Estrogens are also cited as having a protective role in neurodegenerative and cardiac diseases through a variety of mechanisms including blockade of oxidation, antagonism of nitric oxide synthase activity, 15 and interference with the apoptotic process in a variety of cell systems.Altered neutrophil apoptosis has been implicated in the pathogenesis of several inflammatory conditions. 16,17 Excessively delayed neutrophil apoptosis is associated with the systemic inflammatory response syndrome (SIRS). This syndrome is also characterized by activated neutro...

The WHO (2001) recommends exclusive breast-feeding and delaying the introduction of solid foods to an infant's diet until 6 months postpartum. However, in many countries, this recommendation is followed by few mothers, and earlier weaning onto solids is a commonly reported global practice. Therefore, this prospective, observational study aimed to assess compliance with the WHO recommendation and examine weaning practices, including the timing of weaning of infants, and to investigate the factors that predict weaning at # 12 weeks. From an initial sample of 539 pregnant women recruited from the Coombe Women and Infants University Hospital, Dublin, 401 eligible mothers were followed up at 6 weeks and 6 months postpartum. Quantitative data were obtained on mothers' weaning practices using semi-structured questionnaires and a short dietary history of the infant's usual diet at 6 months. Only one mother (0·2 %) complied with the WHO recommendation to exclusively breastfeed up to 6 months. Ninety-one (22·6 %) infants were prematurely weaned onto solids at # 12 weeks with predictive factors after adjustment, including mothers' antenatal reporting that infants should be weaned onto solids at #12 weeks, formula feeding at 12 weeks and mothers' reporting of the maternal grandmother as the principal source of advice on infant feeding. Mothers who weaned their infants at # 12 weeks were more likely to engage in other sub-optimal weaning practices, including the addition of non-recommended condiments to their infants' foods. Provision of professional advice and exploring antenatal maternal misperceptions are potential areas for targeted interventions to improve compliance with the recommended weaning practices.

Objective: To assess breast-feeding initiation and prevalence from birth to 6 months in a sample of mothers in Dublin, and to determine the factors associated with breast-feeding initiation and 'any' breast-feeding at 6 weeks in a sample of Irish-national mothers. Design: This prospective cross-sectional study involved the recruitment of women during the antenatal period, with subsequent follow-up of mothers who delivered healthy, term singleton infants, at 6 weeks and 6 months postpartum. Setting: Participants were recruited from antenatal clinics in the Coombe Women and Infants University Hospital, Dublin. Subjects: In all, 401 Irish-national and forty-nine non-Irish-national mothers met the criteria for inclusion in the present study. Results: Breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47 % and 79?6 %, respectively. Factors that were significantly (P 5 0?000) associated with both breast-feeding initiation and 'any' breast-feeding at 6 weeks included mothers who were $35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breastfeeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation. Conclusions: Breast-feeding initiation and prevalence rates of the Irish-national population remain low and lag considerably behind national and international targets. Inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland. Public health campaigns that focus on increasing the social acceptability of breastfeeding may prove effective in addressing this cultural barrier.

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BackgroundThe objective was to develop a risk scoring tool which predicts respiratory syncytial virus hospitalisation (RSVH) in moderate‐late preterm infants (32‐35 weeks’ gestational age) in the Northern Hemisphere.MethodsRisk factors for RSVH were pooled from six observational studies of infants born 32 weeks and 0 days to 35 weeks and 6 days without comorbidity from 2000 to 2014. Of 13 475 infants, 484 had RSVH in the first year of life. Logistic regression was used to identify the most predictive risk factors, based on area under the receiver operating characteristic curve (AUROC). The model was validated internally by 100‐fold bootstrapping and externally with data from a seventh observational study. The model coefficients were converted into rounded multipliers, stratified into risk groups, and number needed to treat (NNT) calculated.ResultsThe risk factors identified in the model included (i) proximity of birth to the RSV season; (ii) second‐hand smoke exposure; and (iii) siblings and/or daycare. The AUROC was 0.773 (sensitivity: 68.9%; specificity: 73.0%). The mean AUROC from internal bootstrapping was 0.773. For external validation with data from Ireland, the AUROC was 0.707 using Irish coefficients and 0.681 using source model coefficients. Cut‐off scores for RSVH were ≤19 for low‐ (1.0%), 20‐45 for moderate‐ (3.3%), and 50‐56 (9.5%) for high‐risk infants. The high‐risk group captured 62.0% of RSVHs within 23.6% of the total population (NNT 15.3).ConclusionsThis risk scoring tool has good predictive accuracy and can improve targeting for RSVH prevention in moderate‐late preterm infants.

There is a need to comprehensively examine why mothers in Ireland discontinue breastfeeding early and to explore the factors influencing duration of breastfeeding during the first 6 months postpartum. Findings from this study provide valuable direction for future strategies and interventions aimed at increasing breastfeeding duration rates in Ireland.

Educational efforts are still necessary to convince women of Irish nationality, in particular, of the adverse effects of smoking and alcohol consumption on fetal outcome. Women <25 years should be specifically targeted in smoking cessation and FA promotional campaigns.