Neonatal neutrophils: the good, the bad, and the ugly

Neonates are at considerable risk for bacterial and fungal infections,due in great part to a variety of age-related impairments in neutrophil function. In addition, evidence suggests that the tendency of the most immature neonates to develop chronic inflammatory disorders is also related to neutrophil dysfunction. This article provides an overview of specific functional deficiencies of neutrophils that have been reported in neonates.     

Birth plans: the good, the bad, and the future

A written birth plan encourages women to clarify desires and expectations and communicate with their providers to make a realistic plan for care during labor. Tension between health professionals and patients caused by birth plans reflects the larger problems with contemporary maternity care: conflicting beliefs about birth, what constitutes safe, effective care, and ethical issues related to informed consent and informed refusal. The focus of birth plans should be to answer three patient-focused questions: What will I do to stay confident and feel safe? What will I do to find comfort in response to my contractions? Who will support me through labor, and what will I need from them? In this article, the history and purposes of birth plans and approaches to resolving tensions will be discussed.     

Antenatal corticosteroids: the good,the bad and the unknown

PURPOSE OF REVIEW: The purpose of this review was to summarize recently published clinical and animal-based studies of antenatal corticosteroids, describe current recommendations for practice, and suggest priority areas for future research. RECENT FINDINGS: A single course of antenatal corticosteroids is known to improve newborn lung function after preterm birth and to reduce the risk of newborn death. Current evidence from animal and clinical studies suggests that additional numbers of courses do not further improve lung function and are associated with risks of adverse consequences. These risks principally include restricted intrauterine growth, altered brain development, postnatal insulin resistance and changes to the hypothalamic-pituitary-adrenal axis. SUMMARY: The research challenges in this field are now centred on uncovering the mechanisms by which cortisol is involved in programming the fetus for its future metabolic life, and discovering ways in which the effectiveness and safety of antenatal glucocorticoids can be enhanced.     

Adolescents and the internet: health and sexuality information

PURPOSE OF REVIEW: Adolescents are known to be frequent users of the Internet, but less is known about the frequency and nature of their searches for information about health and sexuality. In theory, the Internet offers adolescents unprecedented access to such information in a convenient and confidential way. In turn, this information may help them to seek medical care or advice. This article reviews new research relating to adolescents' uses of the Internet for health and sexuality information, including contextual adult population studies. RECENT FINDINGS: Adolescents are using the Internet in order to find health information on a range of subjects. Search engines are the primary strategy for such searches. The quality of the online experience is often limited by health/online literacy skills. The only reference to adolescents' quests for online information about sexuality was that they frequently sought this information from a Web site created primarily to provide information about sexually transmitted diseases. SUMMARY: Empirical research with adolescents on this subject is scarce. More research is needed regarding issues such as the impact of software filters on ability to access health information and the medium's potential to help and harm adolescents.     

Adolescent sexuality and pregnancy

The adolescent pregnancy rate has decreased throughout the USA. However, compared with other industrialized countries, US rates remain high. Efforts to decrease the number of teenage pregnancies are centered on sex education, postponing sexual activity, and safe sex practices.     

Adolescent sexuality and sexual behavior

PURPOSE OF REVIEW: Adolescence is a time of self-discovery and physical, as well as cognitive, development. It is within this context that adolescent sexual development and sexual behavior occur. While curiosity and experimentation are normal, sexual behaviors, both coital and non-coital, place adolescents at risk for undesired consequences including sexually transmitted disease acquisition and pregnancy. Trends in adolescent sexual behavior are changing, and health care professionals must be aware of these trends to provide necessary medical care and education to this population. RECENT FINDINGS: While the sexual activity of teenagers garners much attention, attention must also be directed at non-coital activities such as masturbation, mutual masturbation and oral sex, as the riskier of these behaviors appear to be increasing. The trends in sexual activity and contraceptive use are encouraging with a decrease in the proportion of adolescents reporting sexual activity, and an increase in the proportion reporting using contraception. These trends, however, are not shared equally among racial groups with the greatest decline reported in the in lowest risk groups. Sexual minority youth continue to report a higher prevalence of high-risk behaviors, both sexual and non-sexual, as compared to their heterosexual peers. SUMMARY: These findings highlight the multiple roles health care professionals can play in caring for this unique population: firstly as health care providers, offering age appropriate, confidential health care; secondly, as reproductive health care educators providing factual, balanced, and realistic information to both teenagers and the community; and thirdly, as advocates lobbying for greater education and services for this at-risk population.     

Adolescent sexuality,cultural sensitivity and the teachings of the Catholic Church

In recent years it has been increasingly recognized that physicians must be sensitive to the cultural beliefs of their patients. This is especially important for physicians who deal with sexuality, especially when dealing with adolescents. Despite this, many mainstream text-books and journal articles ignore the teachings of the largest single religious denomination in the United States, the Roman Catholic Church. The Church has clear teachings regarding sex education, masturbation, contraception and abortion. Physicians should be aware of these teachings and be sensitive to the needs of Catholic adolescents when dealing with these issues.     

Adolescent sexuality and issues in contraception.

The influence of physiologic, psychologic, and cultural influences on human sexuality is reviewed. These factors are considered in the exploration of how adolescents express their sexuality and the consequences of that expression.     

Why hypertension is good new and preeclampsia bad news-demonstrating the failure of prevention

Hypertensive disorders in pregnancy continue to be an intriguing and potentially lethal complication in humans and some other primates. In a simplistic way the current hypothesis is that the genesis of preeclampsia starts at 12 to 14 wk gestation with failure of trophoblast invasion in the spiral arteries, resulting in some degree of hypoxemia in the placenta. The hypoperfused placental tissue starts to secrete variable amounts of angiogenic and antiangiogenic factors which eventually cause endothelial damage all over the pregnant women’s body with one of the many signs of preeclampsia as the clinical endpoint. For some incomprehensible reason a major interest has existed for decades concerning the early prediction of preeclampsia, most commonly tested using uterine artery Doppler (the earlier the better) and various serum markers, alone or in combination. Any new model for detection has been welcomed enthusiastically, although nothing has changed in the outcome of women presenting with preeclampsia.     

Preventing the transmission of mitochondrial DNA disorders: selecting the good guys or kicking out the bad guys

Mitochondrial disorders represent the most common group of inborn errors of metabolism. Clinical manifestations can be extremely variable, ranging from single affected tissues to multisystemic syndromes. Maternally inherited mitochondrial DNA (mtDNA) mutations are a frequent cause, affecting about one in 5000 individuals. The expression of mtDNA mutations differs from nuclear gene defects. Mutations are either homoplasmic or heteroplasmic, and in the latter case disease becomes manifest when the mutation load exceeds a tissue-specific threshold. Mutation load can vary between tissues and in time, and often an exact correlation between mutation load and clinical manifestations is lacking. Because of the possible clinical severity, the lack of treatment and the high recurrence risk of affected offspring for female carriers, couples request prevention of transmission of mtDNA mutations. Previously, choices have been limited due to a segregational bottleneck, which makes the mtDNA mutation load in embryos highly variable and the consequences largely unpredictable. However, recently it was shown that preimplantation genetic diagnosis offers a fair chance of unaffected offspring to carriers of heteroplasmic mtDNA mutations. Technically and ethically challenging possibilities, such maternal spindle transfer and pronuclear transfer, are emerging and providing carriers additional prospects of giving birth to a healthy child.Mitochondrial disorders represent the most common group of inborn errors of metabolism. Clinical manifestations can be extremely variable, ranging from single affected tissues to multisystemic syndromes. Maternally inherited mutations in the mitochondrial DNA (mtDNA) are a frequent cause, affecting about one in 5000 individuals. The expression of mtDNA mutations differs from nuclear gene defects. Mutations are either homoplasmic (100% mtDNA mutated) or heteroplasmic (mixture wild-type and mutated mtDNA) and in the latter case disease become manifest when the mutation load exceeds a tissue-specific threshold. Mutation load can vary between tissues and in time, and often an exact correlation between mutation load and clinical manifestations is lacking. Because of the possible clinical severity, the lack of treatment and the high recurrence risk of affected offspring for carrier females, couples request to prevent transmission of mtDNA mutations. For many years, choices have been limited due to a segregational bottleneck, which makes the mtDNA mutation load in embryos highly variable and the consequences largely unpredictable. However, recently it was shown that preimplantation genetic diagnosis (or embryo selection) offers carriers of heteroplasmic mtDNA mutations a fair chance of unaffected offspring. New technically and ethically challenging possibilities, such as maternal spindle transfer and pronuclear transfer, in which the nuclear DNA is transferred from an oocyte or zygote containing mutated mitochondria into an enucleated oocyte or zygote containing normal mitochondria, are emerging at the horizon and are providing carriers with additional prospects of giving birth to a healthy child.VIDEO LINK: http://sms.cam.ac.uk/media/1400848     

Couple, sexuality and sexual health

Sexuality remained for a long time in the intimacy domain, judged worthy of a consultation reason only and yet as an illness cause or a male failure. Besides, dyspareunia and various women's illnesses took more time to be worthy of interest and care. And now it seems almost as if a turnaround were taking place. This mutation will probably induce some cultural changes. This paper focuses on the fifty-year-old man, in a world in which sexuality, from a universal right, becomes an obligation with the need for means and results, a requirement for performance. In order to discover how to approach these old problems with nowadays tools, we carried out a Medline review on sexuality and impotence, or erectile dysfunction (ED), which is a real problem in public health policy concerning more than 150 million men all over the world and more than 2 million in France. The analysis of the main papers associated with our own experience, allows us to better understand the changes in men/women relationship and the disclosure of male fragility, visible in the management of their well-being, their state of anxiety fowards this new women's control which probably influences their attitude in front of ageing and its consequences.     

Endorphins,oxytocin, sexuality and romantic relationships: An understudied area

Endorphins are the body’s natural opioids that are created and released by the central nervous system, hypothalamus and pituitary gland. Endorphins have a reputation for pain reduction, enhancing excitement or satisfaction, boosting confidence, enabling control of emotions and generating feelings of euphoria, and are involved in the natural reward cycle. There is also evidence in the literature suggesting the role of endorphins in sexuality (including sexual function and sexual behaviours), as they may regulate the release of sex hormones, prolactin and growth hormone, which are involved in sexual function and love. Endogenous oxytocin is another intrinsic hormone whose role in inducing labour contractions, the delivery of the baby and stimulating lactation has been well studied. However, the potential impact of endorphins and oxytocin on sexuality and romantic relationships is not well understood. This article reviews the research on endorphins and endogenous oxytocin and how they relate to human sexuality and romantic relationships. Some animal studies report the effect of endorphin and oxytocin on sex hormones and mating behaviours, but these findings have not been supported by research into human behaviour, indicating many gaps in knowledge relating to the association between these hormones and human sexuality.