Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Factors Influencing Acculturative Stress Among International Students in the United States

The purpose of this study was to determine the factors influencing acculturative stress among international students from the international student perspective. This study explored how acculturative stressors, social support and stress are related. In addition the study examined the significant socio-cultural and demographic predictors of acculturative stress. The Berry\u27s acculturation stress research framework and Bronfenbrenner\u27s ecological perspective were used to guide this study. Data was collected using an online survey from international students across a cohort of eleven U.S universities. Of the 986 students who took the survey, only complete data from 606 students were included in the current study. Descriptive statistics, univariate and multivariate statistical analyses were employed to summarize and test the proposed hypotheses. The findings indicated that students who were experiencing increased levels of difficulty with the acculturative stressors were more likely to experience higher levels of stress. In addition international students who reported high levels of collective social support were more likely to display less impact of acculturative stressors on acculturative stress. However, the unique moderating influences of various types of social support (family, friends and important others) on the relationship between acculturative stressor and stress was not supported. The findings on the socio-cultural and demographic predictors of acculturative stress suggested that using the assimilation mode and identifying marital status in the others category was indicative of lower stress. Lower income and self identified lower social class prior and during acculturation were predictive of higher acculturative stress levels. Findings highlight the fundamental role of the international student\u27s social context and its impact on his/her acculturation process and outcomes. The findings have implications for professionals and scholars who work with international students in practice, education and policy. Suggestions for future research are also included

Factors Influencing Acculturative Stress Among International Students in the United States

The purpose of this study was to determine the factors influencing acculturative stress among international students from the international student perspective. This study explored how acculturative stressors, social support and stress are related. In addition the study examined the significant socio-cultural and demographic predictors of acculturative stress. The Berry\u27s acculturation stress research framework and Bronfenbrenner\u27s ecological perspective were used to guide this study. Data was collected using an online survey from international students across a cohort of eleven U.S universities. Of the 986 students who took the survey, only complete data from 606 students were included in the current study. Descriptive statistics, univariate and multivariate statistical analyses were employed to summarize and test the proposed hypotheses. The findings indicated that students who were experiencing increased levels of difficulty with the acculturative stressors were more likely to experience higher levels of stress. In addition international students who reported high levels of collective social support were more likely to display less impact of acculturative stressors on acculturative stress. However, the unique moderating influences of various types of social support (family, friends and important others) on the relationship between acculturative stressor and stress was not supported. The findings on the socio-cultural and demographic predictors of acculturative stress suggested that using the assimilation mode and identifying marital status in the others category was indicative of lower stress. Lower income and self identified lower social class prior and during acculturation were predictive of higher acculturative stress levels. Findings highlight the fundamental role of the international student\u27s social context and its impact on his/her acculturation process and outcomes. The findings have implications for professionals and scholars who work with international students in practice, education and policy. Suggestions for future research are also included

Factors Influencing Acculturative Stress among International Students

This book reports the findings of a study conducted to determine the factors influencing acculturative stress among international students in the United States. The study explored how acculturative stressors, social support and stress are related. In addition, the study examined the significant socio-cultural and demographic predictors of acculturative stress. The major findings indicate that students who experience increased levels of difficulty with the acculturative stressors are more likely to experience higher levels of stress. In addition, students who report high levels of collective social support are more likely to display less impact of acculturative stressors on acculturative stress. However, the unique moderating influences of various types of social support (family, friends and important others) on the relationship between acculturative stressor and stress was not supported. These findings highlight the fundamental role of the student’s social context and also have implications for professionals and scholars who work with international students in practice, education and policy development. Suggestions for future research are discussed

A Discussion of HIV /Aids Family Interventions: Implications for Family‐Focused Nursing Practice

Aim This article presents a discussion on the role of family interventions in HIV /AIDS disease prevention and care. Background Although HIV /AIDS epidemic and its impact on the society traditionally has been measured in terms of individual risk behaviours and individual‐level HIV prevention, HIV /AIDS family‐focused prevention and management strategies are increasingly becoming a priority. However, little is known as to what constitutes a HIV /AIDS family intervention. Data sources The search was limited to English and published literature starting in the year 1983 to date. CINAHL and PubMed were emphasized using a combination of text words and subject headings. Cochrane Library, PsycInfo, Scopus, and the ISI Web of Science databases were also searched using keywords and in the case of PsycInfo, subject headings were used. The main keywords were ‘nurse’, or ‘nursing’, ‘HIV /AIDS ’, ‘family interventions’, ‘family support’ and ‘family education’, and/or ‘family subsystems’. Discussion The process of theorizing about ‘family interventions’ and ‘HIV /AIDS ‐family interventions’ is critical for putting forth essential components unique for designing culturally specific HIV /AIDS family interventions. In addition, any proposed design of HIV /AIDS family intervention should consider the impact of HIV /AIDS on the family across the family life span, disease trajectory, and from an interdisciplinary perspective. Conclusion Training needs of family nurses should be met when designing multidisciplinary HIV /AIDS ‐FI s. Furthermore, nurses should be proactive in advocating for HIV /AIDS family intervention and HIV /AIDS family policies to improve outcomes in family functioning, processes, and relationships. More needs to be done in regard to research on families, family interventions, effectiveness, and cost of family‐focused approaches

Factors Influencing Acculturative Stress among International Students

This book reports the findings of a study conducted to determine the factors influencing acculturative stress among international students in the United States. The study explored how acculturative stressors, social support and stress are related. In addition, the study examined the significant socio-cultural and demographic predictors of acculturative stress. The major findings indicate that students who experience increased levels of difficulty with the acculturative stressors are more likely to experience higher levels of stress. In addition, students who report high levels of collective social support are more likely to display less impact of acculturative stressors on acculturative stress. However, the unique moderating influences of various types of social support (family, friends and important others) on the relationship between acculturative stressor and stress was not supported. These findings highlight the fundamental role of the student’s social context and also have implications for professionals and scholars who work with international students in practice, education and policy development. Suggestions for future research are discussed