Preventing deaths due to the hypertensive disorders of pregnancy:Ending Preventable Maternal and Newborn Deaths

In this chapter, taking a life cycle and both civil society and medically oriented approach, we will discuss the contribution of the hypertensive disorders of pregnancy (HDPs) to maternal, perinatal and newborn mortality and morbidity. Here we review various interventions and approaches to preventing deaths due to HDPs and discuss effectiveness, resource needs and long-term sustainability of the different approaches. Societal approaches, addressing sustainable development goals (SDGs) 2.2 (malnutrition), 3.7 (access to sexual and reproductive care), 3.8 (universal health coverage) and 3c (health workforce strengthening), are required to achieve SDGs 3.1 (maternal survival), 3.2 (perinatal survival) and 3.4 (reduced impact of non-communicable diseases (NCDs)). Medical solutions require greater clarity around the classification of the HDPs, increased frequency of effective antenatal visits, mandatory responses to the HDPs when encountered, prompt provision of life-saving interventions and sustained surveillance for NCD risk for women with a history of the HDPs

Parental employment and child behaviors: Do parenting practices underlie these relationships?

This study examined whether hours of parental employment were associated with child behaviors via parenting practices. The sample included 2,271 Australian children aged 4-5 years at baseline. Two-wave panel mediation models tested whether parenting practices that were warm, hostile, or characterized by inductive reasoning linked parent\u27s hours of paid employment with their child\u27s behavior at age 6-7 years. There were significant indirect effects linking mother employment to child behavior. No paid employment and full-time work hours were associated with more behavioral problems in children through less-warm parenting practices; few hours or long hours were associated with improved behavioral outcomes through less-hostile parenting practices. These findings may have implications for developing policies to enable parents to balance work and family demands

Smooth values of polynomials

Given $f\in \mathbb{Z}[t]$ of positive degree, we investigate the existence of auxiliary polynomials $g\in \mathbb{Z}[t]$ for which $f(g(t))$ factors as a product of polynomials of small relative degree. One consequence of this work shows that for any quadratic polynomial $f\in\mathbb{Z}[t]$ and any $\epsilon > 0$, there are infinitely many $n\in\mathbb{N}$ for which the largest prime factor of $f(n)$ is no larger than $n^{\epsilon}$

Sociodemographic, social influence, and psychological variables as predictors of alcohol-related attitudes and behaviours in a university sample.

Respondents in the current study were 183 first-year undergraduate students at the University of Windsor who participated for research credit. They answered questions about their sociodemographic characteristics, their drinking attitudes and behaviours, and their perceptions of the drinking attitudes and behaviours of peers and parents. Participants also completed several self-report measures that assessed alcohol dependence, expectancies associated with alcohol consumption, achievement anxiety, and problem-solving skills. Results indicated that sociodemographic variables account for less variance in college students\u27 alcohol consumption than social influence and psychological variables. Peer and parental attitudes toward alcohol and personal tension-reduction alcohol expectancies accounted for 56% of the variance in students\u27 attitudes toward alcohol. Living arrangements, perceived quantity of alcohol consumption by friends, and tension-reduction expectancies accounted for 61% of the variance in participants\u27 quantity of consumption. Estimated quantity of consumption by close friends, and frequency of drinking on weekends and weekdays, accounted for 68% of the variance in respondents\u27 frequency of alcohol consumption. Finally, living arrangements, estimated attitudinal ratings of mothers, estimated alcohol consumption by close friends, and tension-reduction expectancies accounted for 35% of the variance in respondents\u27 alcohol dependence. These results replicate past research that peers are more influential than parents on college students\u27 drinking behaviour. The results of the current study also support the possibility of a relationship between tension-reduction expectancies and heavier, more frequent alcohol consumption. (Abstract shortened by UMI.)Dept. of Psychology. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis1993 .M266. Source: Masters Abstracts International, Volume: 32-02, page: 0725. Adviser: Cheryl Thomas. Thesis (M.A.)--University of Windsor (Canada), 1993

Hypertension

Defining hypertension in pregnancy is challenging because blood pressure levels in pregnancy are dynamic, having a circadian rhythm and also changing with advancing gestational age. The accepted definition is a sustained systolic (sBP) of ≥140 mmHg or a sustained diastolic blood pressure (dBP) ≥90 mmHg, by office (or in-hospital) measurement. Measurement of blood pressure in pregnancy should follow standardised methods, as outside pregnancy. Blood pressure measurement may occur in three types of settings, which will dictate in part, which measurement device(s) will be used. The settings are (1) health care facility; and two types of settings outside the facility: (2) ‘ambulatory’ blood pressure measurement (ABPM); and (3) home blood pressure measurement (HBPM). Furthermore, blood pressure can be measured using auscultatory (mercury or aneroid devices) or automated methods. Factors to consider when selecting a blood pressure measurement device include validation, disease specificity, observer error and the need for regular recalibration. The accuracy of a device is repeatedly compared to two calibrated mercury sphygmomanometers (the gold standard), by trained observers, over a range of blood pressures and for women with different hypertensive disorders of pregnancy; only a few devices have been validated among women with pre-eclampsia. This chapter discusses the advantages and/or disadvantages of the various settings and devices. Low- and middle-income countries (LMICs) bear a disproportionate burden of maternal morbidity and mortality from the hypertensive disorders of pregnancy. While regular blood pressure monitoring can cost-effectively reduce this disparity, LMIC-health systems face unique challenges that reduce this capacity. Assessment of service gaps and programmatic responses to ensure access to blood pressure measurement are a priority, supported where appropriate by implementation research.Publisher PD

Pediatric Transplantation in the United States, 1996–2005

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73448/1/j.1600-6143.2007.01780.x.pd

Hypertensive Disorders of Pregnancy:A Systematic Review of International Clinical Practice Guidelines

Background Clinical practice guidelines (CPGs) are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy) to inform clinical practice. Methodology & Principal Findings MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of Abstracts of Reviews of Effects (Ovid interface), Grey Matters, Google Scholar, and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13) in English, French, Dutch, or German. Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3–1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ≧80% on every domain of the AGREE II, a tool for assessing guideline methodological quality; two CPGs did so for 5/6 domains. Consistency was seen for (i) definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii) pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii) antihypertensive treatment of severe hypertension; (iv) MgSO4 for eclampsia and severe pre-eclampsia; (v) antenatal corticosteroids a

Less-tight versus tight control of hypertension in pregnancy.

BACKGROUND: The effects of less-tight versus tight control of hypertension on pregnancy complications are unclear. METHODS: We performed an open, international, multicenter trial involving women at 14 weeks 0 days to 33 weeks 6 days of gestation who had nonproteinuric preexisting or gestational hypertension, office diastolic blood pressure of 90 to 105 mm Hg (or 85 to 105 mm Hg if the woman was taking antihypertensive medications), and a live fetus. Women were randomly assigned to less-tight control (target diastolic blood pressure, 100 mm Hg) or tight control (target diastolic blood pressure, 85 mm Hg). The composite primary outcome was pregnancy loss or high-level neonatal care for more than 48 hours during the first 28 postnatal days. The secondary outcome was serious maternal complications occurring up to 6 weeks post partum or until hospital discharge, whichever was later. RESULTS: Included in the analysis were 987 women; 74.6% had preexisting hypertension. The primary-outcome rates were similar among 493 women assigned to less-tight control and 488 women assigned to tight control (31.4% and 30.7%, respectively; adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.77 to 1.35), as were the rates of serious maternal complications (3.7% and 2.0%, respectively; adjusted odds ratio, 1.74; 95% CI, 0.79 to 3.84), despite a mean diastolic blood pressure that was higher in the less-tight-control group by 4.6 mm Hg (95% CI, 3.7 to 5.4). Severe hypertension (≥160/110 mm Hg) developed in 40.6% of the women in the less-tight-control group and 27.5% of the women in the tight-control group (P<0.001). CONCLUSIONS: We found no significant between-group differences in the risk of pregnancy loss, high-level neonatal care, or overall maternal complications, although less-tight control was associated with a significantly higher frequency of severe maternal hypertension. (Funded by the Canadian Institutes of Health Research; CHIPS Current Controlled Trials number, ISRCTN71416914; ClinicalTrials.gov number, NCT01192412.)