Assessing Maternal Attachment: First Step Toward the Prevention of Child Abuse

Effective treatment of child abuse must be initiated long before abuse begins by identifying the potential child abuser. The obstetric nurse can initiate this process in the first crucial postpartum days by assessing maternal attachment. Through careful observation and interviewing she can identify families-at-risk, and she can then become instrumental in the development and implementation of an effective system of referral and follow-up care. As a result of her efforts such families can be assisted to cope adequately with the stresses of their parental roles, and in extreme cases, serious tragedy may be averted.     

Estimating the probability of spontaneous delivery conditional on time spent in the second stage

Summary. The duration of second stage labour was studied, retrospectively, among 410 primigravidas who received epidural analgesia in the first stage of spontaneous labour at term (>37 weeks). Survival analysis was used to investigate how the likelihood of a spontaneous delivery was related to time spent in the second stage, and how some maternal and fetal factors influenced this relationship. The proportion of spontaneous deliveries that had occurred by any given time was greatly influenced by maternal age and infant birthweight. However, the women who were least likely to have been delivered by any given time after full dilatation, were also the ones who were least likely to be delivered within any given subsequent time interval. If delivery had not occurred by 3h, the probability that it would take place in the next 3 h was well under 30% in most cases. We conclude that second stage labour in excess of 3 h is likely to be beneficial only if certain criteria, which are defined in the paper, are met.     

Prognostic factors in elderly acute lymphoblastic leukaemia

A retrospective study was performed on 46 unselected acute lymphoblastic leukaemia (ALL) elderly patients aged 60 years or more. Only 50% of these patients were included in the EORTC cooperative clinical trials, thus confirming the important selection bias in most of the published series on elderly ALL patients. 43% of the elderly patients achieved a complete remission (CR). The median survival was 10 months and the 5-year overall survival was only 7.6±4%. In multivariate analysis, W.H.O. performance status and peripheral blast counts at day 7 were found to significantly influence achievement of CR and survival. In patients with W.H.O. performance status 2, 35% died during induction treatment versus 4% in patients with W.H.O. performance status <2. Patients >70 years old showed a marked drop of the CR rate (27%) compared to those aged 60–69 (67%), and a very high death rate during the induction period (38% versus 4%). This suggests that ALL protocol treatments should be proposed until 70 years in patients with good-performance status, whereas less intensive treatment should be offered to elderly patients with performance status 2 and/or age 70. Peripheral blast counts at day 7 may help to adjust the treatment during induction phase.