Transition readiness in adolescents with blood disorders: the importance of family functioning and parent-adolescent communication style

Bleeding disorders, including hemophilia, an X-linked recessive disorder of blood coagulation, and von Willebrand disease (VWD), a more common inherited blood disorder, both result in prolonged bleeding and can involve similar treatment components (Kazazian, 1993; Kelley, 1996; Lemanek, Buckloh, Woods, & Butler, 1995; Paper & Kelley, 2002). While a majority of children with blood disorders (90% of children with hemophilia) are expected to live into adulthood, very little research has evaluated the variables thought to predict readiness for transition or successful transition from pediatric to adult health care in young adults with blood disorders (Blum et al., 1993; Gortmaker & Sappenfield, 1984). The purpose of the current study was to evaluate factors proposed by Holmbeck and Shapera (1999), including demographics, parenting-adolescent interaction, and family functioning, that are thought to predict successful adjustment in adolescence. The study also examined differences between adolescents with hemophilia and those with VWD, explored how factors predict adjustment during adolescent transition to adult health care and assessed factors thought to predict readiness for transition. Results from the study suggest few differences between adolescents with VWD and those with hemophilia and partial support for the Holmbeck and Shapera (1999) model. Demographic variables were found to play a significant role in predicting transition outcome. Results should be interpreted cautiously given the small sample size of the study and low power. Findings suggest that male adolescents and those from a low socioeconomic background may be more likely to experience poorer family functioning and increased maladjustment. Results provided support for a multi-tiered intervention program that provides minimal services to well-functioning families surrounding transition to adult care, but provides more intensive services to families that have multiple risk factors.Ph.D., Clinical Psychology -- Drexel University, 200

Looking Through a Community Lens: Innovative Ways to Integrate Community Health Nursing Competencies into All Settings of Care

Community nursing is not a new. In fact, nursing practice in the home and community is the oldest form of nursing care. Yet, nursing education's move to the university from hospital-based programs coupled with advances in health care technology located in hospitals has contributed to community nursing being overshadowed by the perceived need for nursing students to spend more clinical time in an acute-care setting. In the 1980s, the introduction of Diagnostic Related Groups (DRGs) in the acute care setting resulted in community nursing being viewed as a vital part of the healthcare continuum. Nonetheless, in today's schools of nursing, community health nursing is viewed by some faculty members as a practice that takes place solely outside the walls of the hospital and one that requires less nursing skill and knowledge—or at least less than a student needs to be successful on the National Council Licensure (NCLEX) licensure examination. Nursing students will occasionally say community health nursing is a waste of time since “it is not even on the Boards.” This viewpoint fails to recognize the competencies of nursing practice in the community and sets the stage for a us-versus-them attitude between nursing faculty who teach in medical-surgical hospital settings and those who teach in community settings

Protease Activated Receptor Signaling Is Required for African Trypanosome Traversal of Human Brain Microvascular Endothelial Cells

Human African trypanosomiasis, or sleeping sickness, occurs when single-cell trypanosome protozoan parasites spread from the blood to brain over the blood-brain barrier (BBB). This barrier is composed of brain microvascular endothelial cells (BMECs) especially designed to keep pathogens out. Safe drugs for treating sleeping sickness are lacking and alternative treatments are urgently required. Using our human BMEC BBB model, we previously found that a parasite protease, brucipain, induced calcium activation signals that allowed this barrier to open up to parasite crossing. Because human BMECs express protease-activated receptors (PARs) that trigger calcium signals in BMECs, we hypothesized a functional link between parasite brucipain and BMEC PARs. Utilizing RNA interference to block the production of one type of PAR called PAR-2, we hindered the ability of trypanosomes to both open up and cross human BMECs. Using gene-profiling methods to interrogate candidate BMEC pathways specifically triggered by brucipain, several pathways that potentially link brain inflammatory processes were identified, a finding congruent with the known role of PAR-2 as a mediator of inflammation. Overall, our data support a role for brucipain and BMEC PARs in trypanosome BBB transmigration, and as potential triggers for brain inflammation associated with the disease

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Emerging markets in the post-liberalization period: Evidence from the raw milk market in rural Kenya.

This chapter examines how the raw milk market in western and central Kenya has developed after the dairy sector liberalization in 1992 by using panel data of 862 rural households. From the late 1990s to 2004, the proportion of households that sold milk to traders more than doubled, while it declined from 29% to 12% for those who sold milk to dairy cooperatives. To examine this change in the milk market, we use the price differentials between the farm gate and retail prices as a proxy for the functioning of the market. Our empirical analyses clearly show that the functioning of the market improved between the late 1990s and 2004

Emerging markets in the post-liberalisation period: evidence from the raw milk market in rural Kenya

Have recent reforms improved market functioning in African economies? This article examines how the raw milk market in western and central Kenya has developed after the dairy sector liberalisation in 1992 by using panel data of 862 rural households. From the late 1990s to 2004, the proportion of rural households who sold milk increased from 37 to 51%. During the same period, the proportion of households who sold milk to traders more than doubled, while it declined from 29 to 12% for those who sold milk to dairy cooperatives. On the basis of the price differentials between the farm gate and retail prices, we find that the functioning of the market improved between the late 1990s and 2004; in turn, the development of the milk market has increased the adoption of improved cows, resulting in higher milk sales