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The cells of humans and other animals have likely evolved to reduce the chance of triggering cancers and other diseases, according to research published in the journal Science.
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Closely Supervised Foster Care Linked With Reduced Pregnancy Rates For Delinquent Teens, Study Says
Teenage girls with a history of delinquency who were placed in individualized foster care programs were less likely than their peers to become pregnant, according to a study in the June issue of the Journal of Consulting and Clinical Psychology, HealthDay/Forbes reports. Teen girls in foster care have an elevated risk for pregnancy, according to HealthDay/Forbes. For example, an earlier survey of teens in three states found that nearly half of girls in the foster care system reported a pregnancy by age 19, according to David Kerr, an assistant professor of psychology at Oregon State University and lead author of the new study.For the study, researchers followed 166 girls ages 13 to 17 with court orders to receive treatment for criminal behavior in either specialized foster care or a group-care facility. The specialized programs, known as Multidimensional Treatment Foster Care, were created in the 1980s. Under the programs, foster parents who are trained in behavioral management provide one-on-one care to severely delinquent youths, and the parents receive consultation, support and crisis intervention services from program supervisors. One of the most important aspects of the program is that, unlike group care, the teens are isolated from other troubled youths. There are 51 such programs in the U.S.After two years, 26% of the girls in MTFC became pregnant, compared with almost 47% of those in group care, according to the study. The MTFC group also showed lower levels of criminal activity and arrests, and increased school engagement. Kerr said, "One of the most interesting aspects of this research is that the MTFC program was created to reduce crime, not pregnancy." He added, "It specifically targeted changing the girl"s environment: her home, her peers and her school experience. The focus was on giving her lots of supervision, support for responsible behavior, and consistent, non-harsh consequences for negative behavior" (HealthDay/Forbes, 6/17).
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Induction Of Labour After 37 Weeks Recommended For Women With Gestational Hypertension/Mild Pre-Eclampsia (Hypitat Study)

Pregnant women with mild hypertensive disorders such as high blood pressure/mild pre-eclampsia^ should have their labour induced once they complete 37 weeks of their pregnancy. This is the conclusion of the HYPITAT study, published in an Article Online First and in an upcoming edition of The Lancet, written by Dr Corine M Koopmans, Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Netherlands, and colleagues. About 6-8% of pregnancies are complicated by hypertensive disorders such as gestational hypertension (high blood pressure) and mild pre-eclampsia. Such disorders in pregnancy make a substantial contribution to maternal and neonatal morbidity and mortality worldwide. In the Netherlands these disorders are the primary cause of maternal mortality. Most hypertensive disorders present after 36 weeks" gestation. For the management of women with gestational hypertension or mild pre-eclampsia at term, evidence for selection of induction of labour versus expectant monitoring^^ is scarce. In the USA and other developed countries, induction of labour is already clinical practice in women with gestational hypertension or mild pre-eclampsia, but, until this study, this treatment was not based on the results of randomised clinical trials. However, in The Netherlands, expectant monitoring is the protocol in most hospitals. This study looked at 756 pregnant women from 38 centres in The Netherlands, all with singleton pregnancies and at 36-41 weeks" gestation, and all of whom had gestational hypertension or mild pre-eclampsia. They were randomised in a 1:1 ratio to induced labour or expectant monitoring. The primary outcome was any of a variety of measures of poor maternal outcome-death, eclampsia, HELLP syndrome*, pulmonary oedema**, thrombembolic disease, placental abruption***, progression to severe high blood pressure or proteinuria****, and major post-birth bleeding (of 1.0 litres or more). 397 women refused randomisation but allowed use of their medical records. The researchers found that, of the remaining women, 31% of those who were induced developed poor maternal outcome, compared with 44% who had expectant monitoring. Put another way, women who were induced had a 29% lower relative risk of developing poor maternal outcome than those who had expectant monitoring. No cases of maternal or newborn deaths were recorded in either group. Surprisingly, fewer caesarean sections were needed in the induction group than in the expectant monitoring group. This result is of major importance, because women with a previous caesarean section are at increased risk of developing a uterus scar rupture in a next pregnancy. This can be life-threatening for both mother and child. Furthermore, women with a previous caesarean section will have a higher risk of caesarean section in the next pregnancy. Women with a caesarean section also need a longer recovery time with higher costs as compared to women with a spontaneous delivery. And quality of life is better in women who have a spontaneously delivery as compared to women who undergo a caesarean section. The authors say: "The results of our trial are important for both developed countries in which induction of labour in women with hypertensive disease beyond 36 weeks" gestation has been controversial, and for developing countries in which maternal morbidity and mortality rates are substantially increased. Our finding that induction of labour was associated with a reduced risk of severe hypertension or HELLP syndrome and subsequent reduced need for caesarean section, emphasises the importance of frequent blood pressure monitoring during the concluding weeks of pregnancy." They conclude: "We believe that induction of labour should be advised for women with gestational hypertension and a diastolic blood pressure of 95 mm Hg or higher or mild pre-eclampsia at a gestational age beyond 37 weeks." In an accompanying Comment, Dr Donna D Johnson, Medical University of South Carolina, Charleston, USA, says: "Inclusion of less serious pregnancy outcomes makes this trial even more clinically relevant. Is the goal of managing mild hypertensive disease at term to prevent rare serious maternal and fetal events, or to prevent overall deterioration of maternal health? The latter-the health of the mother-should be the goal of the obstetrician." She concludes: "Severe hypertension and use of antihypertensive drugs were less common in the group of patients that had induction of labour. Thus this group had a lower probability of developing complications associated with severe hypertension. Therefore it is reasonable to treat mild hypertensive disease definitively with delivery rather than allow pregnancy to progress and blood pressure to increase if maternal caesarean section rate and neonatal morbidity are indeed unchanged." Link to Article The Lancet


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