Application of current knowledge to the management of bleeding events during immune tolerance induction

The development of inhibitors to factor VIII is the most serious adverse event associated with the treatment of haemophilia A, predisposing patients to uncontrollable haemorrhage, disability and premature death. Eradication of inhibitors via immune tolerance induction (ITI) is effective in the majority of patients, but may require months to years to achieve success. In the interim, the treatment and prevention of acute bleeding episodes are primary foci of care. Regrettably, there is a paucity of information regarding management of bleeding episodes in inhibitor patients undergoing tolerization. Until specific data from ongoing clinical trials are available to provide more guidance in this patient group, it is reasonable and useful to rely on the broader base of medical literature pertaining to patients not being tolerized to deduce strategies for controlling acute and perioperative bleeding episodes in inhibitor patients during ITI.

Depressed mothers' speech to their infants and its relation to infant gender and cognitive development

The speech of depressed and well mothers during play with their infants at two months was compared on dimensions of structure and semantics. No differences between maternal groups were found on measures of complexity and syntax. However, the speech of depressed women expressed more negative affect, was less focused on infant experience, and tended to show less acknowledgement of infant agency. Speech style of depressed women also varied according to infant gender. Regression analyses indicated that the quality of maternal communication with the infant, and particularly the focus of speech, mediated the association between depression and infant cognitive development in the first 18 months.