The HELLP syndrome: clinical issues and management. A Review

Background: The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence. Methods: Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases. Results and conclusion: About 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L), AST (≥ 70 U/L), and platelets < 100·109/L. The Mississippi Triple-class HELLP System further classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (≥ 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. If the cervix is unfavourable, it is reasonable to induce cervical ripening and then labour. In gestational ages between 24 and 34 weeks most authors prefer a single course of corticosteroid therapy for foetal lung maturation, either 2 doses of 12 mg betamethasone 24 hours apart or 6 mg or dexamethasone 12 hours apart before delivery. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. High-dose treatment and repeated doses should be avoided for fear of long-term adverse effects on the foetal brain. Before 34 weeks' gestation, delivery should be performed if the maternal condition worsens or signs of intrauterine foetal distress occur. Blood pressure should be kept below 155/105 mmHg. Close surveillance of the mother should be continued for at least 48 hours after delivery

Can job insecurity be managed? Evaluating an organizational-level intervention addressing the negative effects of restructuring

Although downsizing and reorganisation are recognised as serious threats to the psychological well-being of employees, intervention strategies for addressing these events are limited. This study evaluated the effects of a participatory organisational-level intervention in which employees and managers chose to address the psychosocial consequences, specifically job insecurity, of restructuring. The intervention was conducted among postal service letter carriers in Denmark and was evaluated based on quantitative and qualitative data. Using interviews (N = 24) and observations, the programme theory of the intervention and to what extent the intervention had been implemented were assessed. Using survey data (N = 238), repeated measures ANOVAs were conducted to test for differences in the development of job insecurity between the intervention group and a comparison group. The results indicate that the intervention group had a significantly smaller increase in one dimension of job insecurity as compared to the comparison group. Therefore, we conclude that employees’ experiencing of job insecurity, which typically follows in the wake of restructuring, can be addressed by planned efforts at the workplace level

Caracterización de la localidad de El Soberbio como centro estratégico turístico de la región "De Los Saltos del Moconá"

El presente trabajo toma como caso de estudio una localidad de la provincia de Misiones para analizar en el marco de su región de pertenencia las potencialidades que presenta para el desarrollo local a través de la Planificación Estratégica del Sector Turismo. Se trata de la localidad de El Soberbio, que representa el portal de acceso a una de las áreas turísticas más importantes de la provincia, la de los Saltos del Moconá. Esta área contiene un gran potencial, e integra en la actualidad una de las regiones estratégicas de la planificación turística provincial; sin embargo, presenta también importantes carencias que debe superar. Aquí se analizan estas potencialidades y carencias.Fil: Barreto, Miguel Angel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Nordeste. Facultad de Arquitectura y Urbanismo; ArgentinaFil: Abildgaard, Evelyn. Universidad Nacional del Nordeste. Facultad de Arquitectura y Urbanismo; Argentin