Scandinavian Cases Research Articles

Action researchers as “orchestrators” of co-innovation: a theoretical and methodological framework

BackgroundWith the increasing complexity of health care services, more comprehensive and integrated services need to be designed. Action researchers are encouraged to facilitate multiactor participation and user-centered approaches to initiate service development. However, “orchestrating” co-innovation, in which actors have diverse attitudes, agendas, positions of power, and horizons of understanding, is challenging, and a framework that supports action researchers in co-innovation studies lack. The purpose of this article was to explore how action researchers can facilitate multiactor engagement and handle possible challenges and stimulate creativity among diverse stakeholders.MethodsWe have studied and discussed two Scandinavian cases of rehabilitation innovation (for cancer patients and persons with acquired brain injury) where two research teams with action research approaches have acted in an orchestrating role to create co-innovation.ResultsWe identified four themes that are essential for action researchers to facilitate collaborative and creative co-innovation processes: (1) relational power reflexibility, (2) resource integration, (3) joint understanding, and (4) the facilitation of creativity. These mutually dependent themes constitute a theoretical and methodological framework for of co-innovation.ConclusionsThis paper offers a contribution that supports action researchers in orchestrating diverse actors and their contributions in co-innovation processes.

The HLA region in ANCA-associated vasculitis: characterisation of genetic associations in a Scandinavian patient population

ObjectiveThe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are inflammatory disorders with ANCA autoantibodies recognising either proteinase 3 (PR3-AAV) or myeloperoxidase (MPO-AAV). PR3-AAV and MPO-AAV have been associated with distinct loci...

The Internationalization of the Newspaper Industry 1989–2002: Three Scandinavian Cases

In the 1990s, three Scandinavian news media companies, Bonnier, Kinnevik, and Schibsted, internationalized their newspapers. Despite doing this during the same period, competing in the same industry and institutional environment, being exposed to the same opportunities by the opening of the Eastern European markets, and all belonging to a smaller language area, they differed in their internationalization models as well as in their outcomes. Despite initial successes, Bonnier and Kinnevik eventually discontinued their newspapers in the new markets, in many cases following significant losses, while Schibsted fared better. The main explanation for using different internationalization models was differences in business models, basically striving to do business internationally in a similar way as domestically. That is, they did not choose a specific internationalization model but sought to simply expand their business models internationally. Consequently, this article finds that when researching internationalization, more focus should be placed on business models.

Stratified genetic analysis reveals sex differences in MPO-ANCA-associated vasculitis.

To identify and genetically characterize subgroups of patients with ANCA-associated vasculitides (AAV) based on sex and ANCA subtype. A previously established SNP dataset derived from DNA sequencing of 1853 genes and genotyping of 1088 Scandinavian cases with AAV and 1589 controls was stratified for sex and ANCA subtype and analysed for association with five top AAV SNPs. rs9274619, a lead variant at the HLA-DQB1/HLA-DQA2 locus previously associated with AAV positive for myeloperoxidase (MPO)-ANCA, was analysed for association with the cumulative disease involvement of ten different organ systems. rs9274619 showed a significantly stronger association to MPO-ANCA-positive females than males [P = 2.0 × 10-4, OR = 2.3 (95% CI 1.5, 3.5)], whereas proteinase 3 (PR3)-ANCA-associated variants rs1042335, rs9277341 (HLA-DPB1/A1) and rs28929474 (SERPINA1) were equally associated with females and males with PR3-ANCA. In MPO-ANCA-positive cases, carriers of the rs9274619 risk allele were more prone to disease engagement of eyes [P = 0.021, OR = 11 (95% CI 2.2, 205)] but less prone to pulmonary involvement [P = 0.026, OR = 0.52 (95% CI 0.30, 0.92)]. Moreover, AAV with both MPO-ANCA and PR3-ANCA was associated with the PR3-ANCA lead SNP rs1042335 [P = 0.0015, OR = 0.091 (95% CI 0.0022, 0.55)] but not with rs9274619. Females and males with MPO-ANCA-positive AAV differ in genetic predisposition to disease, suggesting at least partially distinct disease mechanisms between the sexes. Double ANCA-positive AAV cases are genetically similar to PR3-ANCA-positive cases, providing clues to the clinical follow-up and treatment of these patients.

Identification and functional characterization of a novel susceptibility locus for small vessel vasculitis with MPO-ANCA.

ObjectiveTo identify and characterize genetic loci associated with the risk of developing ANCA-associated vasculitides (AAV).MethodsGenetic association analyses were performed after Illumina sequencing of 1853 genes and subsequent replication with genotyping of selected single nucleotide polymorphisms in a total cohort of 1110 Scandinavian cases with granulomatosis with polyangiitis or microscopic polyangiitis, and 1589 controls. A novel AAV-associated single nucleotide polymorphism was analysed for allele-specific effects on gene expression using luciferase reporter assay.ResultsPR3-ANCA+ AAV was significantly associated with two independent loci in the HLA-DPB1/HLA-DPA1 region [rs1042335, P = 6.3 × 10−61, odds ratio (OR) 0.10; rs9277341, P = 1.5 × 10−44, OR 0.22] and with rs28929474 in the SERPINA1 gene (P = 2.7 × 10−10, OR 2.9). MPO-ANCA+ AAV was significantly associated with the HLA-DQB1/HLA-DQA2 locus (rs9274619, P = 5.4 × 10−25, OR 3.7) and with a rare variant in the BACH2 gene (rs78275221, P = 7.9 × 10−7, OR 3.0), the latter a novel susceptibility locus for MPO-ANCA+ granulomatosis with polyangiitis/microscopic polyangiitis. The rs78275221-A risk allele reduced luciferase gene expression in endothelial cells, specifically, as compared with the non-risk allele.ConclusionWe identified a novel susceptibility locus for MPO-ANCA+ AAV and propose that the associated variant is of mechanistic importance, exerting a regulatory function on gene expression in specific cell types.

Organisational cultures of two successful Scandinavian handball talent development environments: a comparative case study

ABSTRACT The study explores the organisational cultures of two successful Scandinavian cases in handball to better understand how talent development environments can be different yet successful in developing international elite players within the same sport and sociocultural contexts. A professional club and a volunteer-based club recognised by the national federations for their talent development were selected for the study. Empirical data from four weeks of fieldwork in different settings (e.g., training, school, residence), and semi-structured interviews with different social actors (e.g., players, coaches and managers) were explored and compared through the principles of thematic analysis. Using Schein’s conceptualisation of organisational culture as the theoretical lens for the research, we identified similarities and differences of the talent development structure and culture. Specific for the professional club, coaches selected players who “fitted into their system”, collaborated with the schools to organise the players’ everyday life, the club took responsibility for the players’ wellbeing and established daily routines for the players. In the volunteer-based club, the players took responsibility for their own wellbeing and daily routines and stressed that success is achieved through autonomous decisions, and the coaches’ awareness of player differences was a means for facilitating talent development.

X-chromosome variants are associated with aldosterone producing adenomas

Aldosterone-producing adenomas (APAs) are a major cause of primary aldosteronism (PA) and are characterized by constitutively producing aldosterone, which leads to hypertension. Several mutations have been identified in ion channels or ion channel-associated genes that result in APAs. To date, no studies have used a genome-wide association study (GWAS) approach to search for predisposing loci for APAs. Thus, we investigated Scandinavian APA cases (n = 35) and Swedish controls (n = 60) in a GWAS and discovered a susceptibility locus on chromosome Xq13.3 (rs2224095, OR = 7.9, 95% CI = 2.8–22.4, P = 1 × 10–7) in a 4-Mb region that was significantly associated with APA. Direct genotyping of sentinel SNP rs2224095 in a replication cohort of APAs (n = 83) and a control group (n = 740) revealed persistently strong significance (OR = 6.1, 95% CI = 3.5–10.6, p < 0.0005). We sequenced an adjacent gene, MAGEE1, of the sentinel SNP and identified a rare variant in one APA, p.Gly327Glu, which is complementary to other mutations in our primary cohort. Expression quantitative trait loci (eQTL) were investigated on the X-chromosome, and 24 trans-eQTL were identified. Some of the genes identified by trans-eQTL point towards a novel mechanistic explanation for the association of the SNPs with APAs. In conclusion, our study provides further insights into the genetic basis of APAs.

Leadership in low- and underperforming schools—two contrasting Scandinavian cases

ABSTRACT In this paper, we investigate how professional cultures and situated, material and external contexts relate to dynamic low- and underperforming schools in Scandinavia, particularly how the leadership is constructed through the leader, the followers and the situation. The first school studied was a low-performing school in Norway called ‘Toppen’, which has shown improved student outcomes. The other school, Seaside, is a Swedish school that is considered underperforming because student outcomes are lower than expected based on the contextual prerequisites. Our results show that Toppen can be described as a turnaround school and Seaside can be described as a cruising school. Analysis reveals that, at Toppen, the principal has been developing a culture that can be described in terms of community and motivation. At Seaside, on the other hand, the culture can be described in terms of individuality and conservatism. From this analysis, we can detect how different contexts impact two low- and underperforming schools and how they are affected by different prerequisites linked to the situated, material, external and professional contexts. However, the development of a collective professional culture with a shared sense of commitment seems to be an important tool to plan and communicate organizational improvement strategies.

Community and Society: The Thing at the Edge of Europe

This article addresses the question of how vast societies were created by increased interaction among smaller communities through judicial cooperation. This process is explored through two case studies of the law provinces of (1) Gulathing and (2) Hålogaland, Norway, covering a time span of nearly a millennium, from the 3rd to 13th century. Central to the discussion of the early phase, during the 3rd–10th centuries, are the courtyard sites of Åse and Bjarkøy, Hålogaland, providing key materials to these developments in a northern European context. This material is supplemented by a case study of the Gulathing law area, which is one of only a few Scandinavian cases where the development can be more securely traced from the 11th to the 13th centuries. In addition, population size and the number of delegates present at the representative thing are considered.

Formal Rules in Product Development: Sensemaking of Structured Approaches*

Many scholars consider the use of formal structured approaches to manage product development as very significant for successful product innovation. Others consider them a predictor of the likely outcome of the processes. Structured approaches can be considered management technologies for product development. Prior research has addressed the design of structured approaches and has measured how different types or generations of these are related to different processes and outcomes in different ways. However, only limited research has addressed how managers and employees actually understand and makes sense of these methods. This paper investigates how structured approaches are translated through a number of interpretations into daily practices. The research draws on research in sociology and management accounting to analyze structured approaches for product development as a managerial technology that consists of rules that individuals must understand (i.e., make sense of). The paper presents arguments for building a model of factors that influence the sensemaking of structured approaches for product development based on Scandinavian cases. First, structured approaches are presented as a type of managerial technology that consists of rules. Second, a framework to classify structured approaches for product development according to their degree of elaborateness and exhaustiveness is derived. This helps to identify the types of rule systems in companies—and how these influence everyday practices. The sensemaking from rules to practice is implemented through a number of translations, based on the context, the history, and the authorized statements and feedback processes. Empirical findings show that structured approaches differ both with respect to their degree of elaborateness and exhaustiveness. Additionally, firms differ greatly in terms of how rigorously they enforce the rules. Furthermore, the importance assigned to them by functional managers and project managers differ greatly. Even companies with extensive and elaborate rule regimes enforce the rules in a flexible manner, and rules are often applied at the discretion of project managers. Practices are influenced by the interpretation, use, and feedback from senior managers. Observations make it possible to develop a model for the sensemaking processes that influences how a specific structured approach through sensemaking is altered, modified, and sometimes even cut off from influencing innovation processes. The sensemaking of rules might reverse elaborate and exhaustive rules into quite flexible systems in practice. One implication of this is that individual sensemaking of structured approaches for product development thus needs to be analyzed to understand managerial practices. Another implication is that it cannot be assumed, a priori that formal approaches are the same as exercised practices.

Collective expertise: Ways of organizing expert work in collective settings

AbstractTwo gaps appear in the theory of ‘expertise’: expert work as an individual endeavor; and, researchers and managers understanding little of expert practice. To bridge these gaps, ‘collective expertise’ can describe ways of organizing professional expert work in collective settings. This study analyzes ‘collective expertise’ in three Scandinavian cases using ethnographic methods: a product development process at Volvo; a description of computer programmers' work; and an analysis of nano physicists' organizing practices. The empirical results are used to build a ‘collective expertise’ theory, based on seven factors identified as contributing to collective expertise: concrete work routines, minimal structure, generosity and gift giving, narratives and story-telling, aesthetic capabilities, room for individuality, and mixed practice zone.

Collective expertise: Ways of organizing expert work in collective settings

AbstractTwo gaps appear in the theory of ‘expertise’: expert work as an individual endeavor; and, researchers and managers understanding little of expert practice. To bridge these gaps, ‘collective expertise’ can describe ways of organizing professional expert work in collective settings. This study analyzes ‘collective expertise’ in three Scandinavian cases using ethnographic methods: a product development process at Volvo; a description of computer programmers' work; and an analysis of nano physicists' organizing practices. The empirical results are used to build a ‘collective expertise’ theory, based on seven factors identified as contributing to collective expertise: concrete work routines, minimal structure, generosity and gift giving, narratives and story-telling, aesthetic capabilities, room for individuality, and mixed practice zone.

Formal Rules in Product Development: Sensemaking of Structured Approaches

Many scholars consider the use of formal structured approaches to manage product development as very significant for successful product innovation. Others consider them a predictor of the likely outcome of the processes. Structured approaches can be considered management technologies for product development. Prior research has addressed the design of structured approaches and has measured how different types or generations of these are related to different processes and outcomes in different ways. However, only limited research has addressed how managers and employees actually understand and makes sense of these methods. This paper investigates how structured approaches are translated through a number of interpretations into daily practices. The research draws on research in sociology and management accounting to analyze structured approaches for product development as a managerial technology that consists of rules that individuals must understand (i.e., make sense of). The paper presents arguments for building a model of factors that influence the sensemaking of structured approaches for product development based on Scandinavian cases. First, structured approaches are presented as a type of managerial technology that consists of rules. Second, a framework to classify structured approaches for product development according to their degree of elaborateness and exhaustiveness is derived. This helps to identify the types of rule systems in companies — and how these influence everyday practices. The sensemaking from rules to practice is implemented through a number of translations, based on the context, the history, and the authorized statements and feedback processes. Empirical findings show that structured approaches differ both with respect to their degree of elaborateness and exhaustiveness. Additionally, firms differ greatly in terms of how rigorously they enforce the rules. Furthermore, the importance assigned to them by functional managers and project managers differ greatly. Even companies with extensive and elaborate rule regimes enforce the rules in a flexible manner, and rules are often applied at the discretion of project managers. Practices are influenced by the interpretation, use, and feedback from senior managers. Observations make it possible to develop a model for the sensemaking processes that influences how a specific structured approach through sensemaking is altered, modified, and sometimes even cut off from influencing innovation processes. The sensemaking of rules might reverse elaborate and exhaustive rules into quite flexible systems in practice. One implication of this is that individual sensemaking of structured approaches for product development thus needs to be analyzed to understand managerial practices. Another implication is that it cannot be assumed, a priori that formal approaches are the same as exercised practices.

THE ENLIGHTENMENT AND THE REDEFINITION OF POLITICAL LOYALTIES

This article discusses the study of modernization in the conceptions of political identities and loyalties in Scandinavia in the late 18th century. Opening with a review of recent Scandinavian research on political cultures, the language of politics and emerging nationalism in the 18th century, it locates the ensuing case studies in this burgeoning field and also in a wider, European and comparative context. The construction of identities and loyalties among the nobility, the clergy, burghers, civil servants and peasants is examined. The author argues that, despite much of apparent continuity of values, there was a surprising degree of potential for innovation within Scandinavian political cultures in the Age of the Enlightenment. He emphasizes the need to study past political thought in the appropriate contexts of entire realms and North‐Western Europe as a whole and not just in the context of present‐day nation states. He also suggested that – due to the common traditions of representative government, unusually well‐preserved archival sources and the intensity of scholarly work on the 18th century in Scandinavia – Scandinavian cases should more frequently be used as objects of comparison in international studies of 18th‐century political cultures.

Book Review: Employment Miracles: a Critical Comparison of the Dutch, Scandinavian, Swiss, Australian and Irish Cases versus Germany and the United States

Book Review: Employment Miracles: a Critical Comparison of the Dutch, Scandinavian, Swiss, Australian and Irish Cases versus Germany and the United States

NEUROLOGICAL OUTCOME AND LONG-TERM COURSE IN GLUTARIC ACIDEMIA TYPE I

Glutaric aciduria type I (GA1) is one of several organic acidurias affecting basal ganglia integrity and function. Presentation may either be acute catastrophic, slowly insidious or even asymptomatic. Follow up of all diagnosed Scandinavian cases (n=28) showed that acute onset correlated significantly with severe motor impairment, dystonia and dysphasia/dysatrhria but not cognition. The median follow-up time was 14 years. Intense acute management may have averted deterioration in a few cases. Morphological changes were most prominent in the basal ganglia and perisylvian areas. Cortical atrophy occurred in severe cases. Neurological signs did not change over time and treatment with riboflavine, carnitine and diet did not reverse established neurological signs. At 10 years of age the cumulated survival rate was 89% and at 35 years 44%. Mortality was in some cases associated with non-septicaemic hyperthermic reactions. The onset and course of GA1 give rise to hypotheses of acute metabolic stroke rather than chronic toxic effects. High energy demands may target the basal ganglia for the metabolic effects of GA1 and some other organic acidurias such as methylmalonic and propionic aciduria, and mitochondrial disorders.

Genetically heterogeneous selective intestinal malabsorption of vitamin B12: founder effects, consanguinity, and high clinical awareness explain aggregations in Scandinavia and the Middle East.

Selective intestinal malabsorption of vitamin B(12) causing juvenile megaloblastic anemia (MGA; MIM# 261100) is a recessively inherited disorder that is believed to be rare except for notable clusters of cases in Finland, Norway, and the Eastern Mediterranean region. The disease can be caused by mutations in either the cubilin (CUBN; MGA1; MIM# 602997) or the amnionless (AMN; MIM# 605799) gene. To explain the peculiar geographical distribution, we hypothesized that mutations in one of the genes would mainly be responsible for the disease in Scandinavia, and mutations in the other gene in the Mediterranean region. We studied 42 sibships and found all cases in Finland to be due to CUBN (three different mutations) and all cases in Norway to be due to AMN (two different mutations), while in Turkey, Israel, and Saudi Arabia, there were two different AMN mutations and three different CUBN mutations. Haplotype evidence excluded both CUBN and AMN conclusively in five families and tentatively in three families, suggesting the presence of at least one more gene locus that can cause MGA. We conclude that the Scandinavian cases are typical examples of enrichment by founder effects, while in the Mediterranean region high degrees of consanguinity expose rare mutations in both genes. We suggest that in both regions, physician awareness of this disease causes it to be more readily diagnosed than elsewhere; thus, it may well be more common worldwide than previously thought.

A screening for superoxide dismutase-1 D90A mutation in Italian patients with sporadic amyotrophic lateral sclerosis.

The Aspartate-90-Alanine (D90A) mutation on SOD-1 gene, the only known change causing recessive familial amyotrophic lateral sclerosis (FALS), is associated with a uniform phenotype characterized by slowly ascending paresis and long survival. Originally reported in Scandinavian cases, it has also been detected in patients from other countries. A common haplotype, probably of Scandinavian origin, has been demonstrated in D90A recessive pedigrees. In this study we screened the SOD-1 gene for the D90A mutation in 56 Italian patients from north-west Tuscany with sporadic ALS in order to evaluate the occurrence of this mutation and its genotype-phenotype correlation in Italy. We found the homozygous D90A mutation in one patient (1.8%), harboring the classical phenotype related to this mutation. No other mutations were detected in any of the five SOD-1 exons in our group. Our results confirm that recessive D90A mutation is present in Italy and it is associated with the phenotype already described A screening for that mutation, easily made by RFLP, should be made in sporadic ALS patients, especially where clinical investigation indicates its presence.

Risk Factors for Male Breast Cancer?A Case-Control Study from Scandinavia

We report a population-based case-control study on risk factors for male breast cancer. Data on a broad range of previously suggested risk factors were collected in a set of Scandinavian breast cancer cases and matched controls. Incident cases (n = 282) with histologically verified carcinomas of the breast were identified from notification to the cancer registries of Denmark, Norway and Sweden over a 4-year period 1987-1991 and of these cases, 156 men could be approached and responded. Controls were identified through national central population registers and were matched individually for country, sex and year of birth. Controls with a diagnosis of breast cancer were excluded; 468 of 780 controls responded. Data on risk factors were collected by self-administered questionnaires mailed to the cases between 1and 2 years after diagnosis and to controls during the same period. The findings were compatible with an increased risk associated with family history of breast cancer (odds ratio (OR) = 3.3, 95% confidence interval (CI) 2.0-5.6), obesity 10 years before diagnosis (OR = 2.1, 95% CI 1.0-4.5) for BMI > 30, diabetes (OR = 2.6, 95% CI 1.3-5.3) and the use of digoxin and methyldopa (OR = 2.0 and 2.1, respectively). The association with family history of breast cancer has been repeated in several studies, while the relation to anthropometric measures has been equivocal. We could not substantiate some associations seen in other studies; namely those with high education, fertility, marital status, testicular injury, liver disease and religion. The detailed questions about gynaecomastia indicated that many cases reported signs of breast cancer as a gynaecomastia. This type of misunderstanding may explain the strong association with gynaecomastia seen in other studies. Several patients died before contact. Thus, risk factors related to a more aggressive male breast cancer or related to high risk of dying (e.g. liver cirrhosis, heavy smoking) may have been missed.

PRENATAL TREATMENT OF CONGENITAL ADRENAL HYPERPLASIA (CAH) DUE TO 21-HYDROXYLASE DEFICIENCY: EUROPEAN EXPERIENCE IN 223 PREGNANCIES AT RISK

In the aim to prevent the in utero virilization of CAH affected females a prenatal treatment (Rx) has first been attempted by David and Forest in 1979; later these authors reported their first results and proposed a therapeutic protocol (J. Pediatr. 1984; 104: 799-803). Except for the experience of the French multicentric study in 42 pregnancies at risk (Endocr. Res.1989;15:277-301), prenatal Rx of CAH using therapeutic protocols quite similar to the above, and subsequently reported in the literature were concerned with a limited number of cases. Indeed, prenatal Rx of CAH is not frequently instituted. Nevertheless, a number of experiences have not been reported. This is why, we decided to collect a maximum of data from European Pediatricians. A questionnaire was constructed to enquire about the effects of prenatal Rx on the fetus on one hand (therapeutic protocols, prenatal diagnosis (Dg), results on the external genitalia of CAH female fetuses, effects if any on the development of the fetus or child) and on the mother on the other hand (follow-up, compliance and tolerance of Rx, course of pregnancy, short and long term effects or side-effects in the mothers). Informations were obtained in a total of 223 treated pregnancies: 75 cases from the French multicentric study (M.G. Forest, M.David), 58 German cases (collected by H.G. Dorr and W.G. Sippell in cooperation with the APE), and 27 Scandinavian cases coordinated by E.M. Ritzen. The questionnaire was also sent to the other European ESPE Members and to date data were collected on 63 additional cases. There was no prenatal Dg in 20 cases (not available or refused). Prenatal Dg was first made on HLA typing and/or steroid measurement in the amniotic fluid. An earlier prenatal Dg was subsequently made by HLA typing on chorion villus sampling (CVS). On the whole, steroid measurement was safe (if Rx interrupted) except in 2 cases and HLA serological typing helpful, but at least 8 false prenatal Dg were recorded. For the last 2-4 years, DNA studies are performed on CVS (HLA RFLP, C4-CYP21 genes) with increasing safety. Prenatal Rx was with dexamethasone (Dex) or Dex acetate (France in particular), usually at a dose of 0.5 mg, 2 to 3 times a day. The Dex dose was more rarely adapted to maternal body weight (20 μg/kg, as advocated by Forest et al (above ref). Among the 38 CAH treated females, 37 were born, with normal (9) or slightly virilized genitalia (17); none of them would need surgery. Prenatal Rx was not successful (stage III/IV) for apparently logical reasons (late start of Rx, insufficient Dex dose, early interruption, lack of compliance) in 9 CAH females but not explained in 2 others. There was a remarkable lack of side-effects in fetuses or children, except for a severe hydrocephalus in a male fetus (treated for 7 wks) and 2 deaths in utero near term while Rx was stopped for several months (both not attributed to Dex Rx by specialists), and an unexplained failure to thrive in a CAH girl treated until term. Maternal acceptance of Rx was said to be good to excellent. Maternal compliance was usually good (as judged by low maternal levels of cortisol, DHAS or estriol). Maternal side-effects were reported in some but not all mothers. In the mothers where Rx was stopped in mid-pregnancy (unaffected cases) there was often no complaint or that of an excessive weight gain (reasonably controlled by salt and caloric restriction in the French study), observed more often in the mothers given 1.5 mg of Dex, and always resuming after delivery. When treatment was continued until term (n = 53), more serious side-effects were observed in some mothers : marked weight gain (n=15), edema (n =3), increased blood pressure (n= 5). In addition, Rx tolerance was poor in 7 mothers (weight gain, edema, fatigue, feeling of exhaution, or hypertension, or gestational diabetes mellitus) leading twice to interrupting Rx despite prenatal Dg of a CAH female fetus. This is why a more detailed follow-up of the maternal well-being is undertaken. In conclusion, prenatal Rx of CAH appears effective, providing a good rationale in the Rx protocol. Observations made in a large number of pregnancies show that short term Rx (started at 4-7 wks, and stopped after a prenatal Dg based on DNA studies on CVS, at about 12 wks) is usually well tolerated. Tolerance of long term Rx seems to be a problem in some mothers. These findings lead us to propose that Dex Rx should be adapted to maternal size in all mothers (20 μg/kg), then Dex dose should or could eventually be decreased by 50% from mid-pregnancy to term in those mothers who bear a CAH female fetus.