Invitation to grief in the family context

Grief is a family affair, yet it is commonly viewed as an individual phenomenon. As an international, interdisciplinary team, we explore grief within a family context across theoretical, research, practice, and educational domains. Families are complex and working with this complexity is challenging but necessary for a holistic view of grief. We therefore encourage an increased focus on theorizing, researching, practicing, and educating using innovative approaches to address the complexities of grief within the context of families. Learnings from within each domain will affirm and enhance the development of family-level thinking and approaches

Development of Animal Models to Test the Fundamental Basis of Gene–Environment Interactions

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93738/1/oby.2008.513.pd

Changing patient mindsets about non–life-threatening symptoms during oral immunotherapy: a randomized clinical trial

Background: Oral immunotherapy (OIT) can lead to desensitization to food allergens, but patients can experience treatment-related symptoms of allergic reactions that cause anxiety and treatment dropout. Interventions to improve OIT for patients are needed. Objective: To determine whether fostering the mindset that non–life-threatening symptoms during OIT can signal desensitization improves treatment experience and outcomes. Methods: In a randomized, blinded, controlled phase II study, 50 children/adolescents (28% girls, aged 7-17 years, M = 10.82, standard deviation = 3.01) completed 6-month OIT for peanut allergies. Patients and their parent(s) had monthly clinic visits at the Sean N. Parker Center for Allergy and Asthma Research between January 5, 2017, and August 3, 2017. All families received identical symptom management training. In a 1:1 approach, 24 patients and their families were informed that non–life-threatening symptoms during OIT were unfortunate side effects of treatment, and 26 patients and their families were informed that non–life-threatening symptoms could signal desensitization. Families participated in activities to reinforce these symptom mindsets. Results: Compared with families informed that symptoms are side effects, families informed that symptoms can signal desensitization were less anxious (B = −0.46, 95% confidence interval [CI]: −0.76 to −0.16; P = .003), less likely to contact staff about symptoms (5/24 [9.4%] vs 27/154 [17.5%] instances; P = .036), experienced fewer non–life-threatening symptoms as doses increased (BInteraction = −0.54, 95% CI: −0.83 to −0.27; P < .001), less likely to skip/reduce doses (1/26 [4%] vs 5/24 [21%] patients; P = .065), and showed a greater increase in patient peanut-specific blood IgG4 levels (BInteraction = 0.76, 95% CI: 0.36 to 1.17; P < .001). Conclusions: Fostering the mindset that symptoms can signal desensitization improves OIT experience and outcomes. Changing how providers inform patients about non–life-threatening symptoms is a promising avenue for improving treatment

The Role of Gender in Nurse-Resident Interactions: A Mixed-methods Study

Introduction: The role of gender in interprofessional interactions is poorly understood. This mixed-methods study explored perceptions of gender bias in interactions between emergency medicine (EM) residents and nurses.Methods: We analyzed qualitative interviews and focus groups with residents and nurses from two hospitals for dominant themes. An electronic survey, developed through an inductive-deductive approach informed by qualitative data, was administered to EM residents and nurses. Quantitative analyses included descriptive statistics and between-group comparisons. Results: Six nurses and 14 residents participated in interviews and focus groups. Key qualitative themes included gender differences in interprofessional communication, specific examples of, and responses to, gender bias. Female nurses perceived female residents as more approachable and collaborative than male residents, while female residents perceived nurses’ questions as doubting their clinical judgment. A total of 134 individuals (32%) completed the survey. Females more frequently perceived interprofessional gender bias (mean 30.9; 95% confidence interval {CI}, 25.6, 36.2; vs 17.6 [95% CI, 10.3, 24.9). Residents reported witnessing interprofessional gender bias more frequently than nurses (58.7 (95% CI, 48.6, 68.7 vs 23.9 (95% CI, 19.4, 28.4). Residents reported that gender bias affected job satisfaction (P = 0.002), patient care (P = 0.001), wellness (P = 0.003), burnout (P = 0.002), and self-doubt (P = 0.017) more frequently than nurses. Conclusion: Perceived interprofessional gender bias negatively impacts personal wellbeing and workplace satisfaction, particularly among female residents. Key institutional stakeholders including residency, nursing, and hospital leadership should invest the resources necessary to develop and integrate evidence-based strategies to improve interprofessional relationships that will ultimately enhance residency training, work climate, and patient care

Feasibility and Acceptability of Accelerometer Measurement of Physical Activity in Pregnant Adolescents

During pregnancy, physical activity relates to better maternal and child mental and physical health. Accelerometry is thought to be effective for assessing free-living physical activity, but the feasibility/acceptability of accelerometer use in pregnant adolescents has not been reported. In this short communication, we conducted secondary analysis of a small pilot study to describe the feasibility/acceptability of accelerometry in pregnant adolescents and the preliminary results of physical activity characteristics. Participants were recruited from a multidisciplinary adolescent perinatal clinic. Physical activity was assessed with wrist-worn accelerometers. Feasibility was described as median days of valid wear (≥10 h of wear/day) for the total sample and the number/percentage of participants with ≥4 days of valid wear. Sensitivity analyses of wear time were performed. Acceptability ratings were collected by structured interview. Thirty-six pregnant (14.6 ± 2.1 gestational weeks) adolescents (17.9 ± 1.0 years) participated. Median days of valid wear were 4 days. Seventeen participants (51.5%) had ≥4 days of valid wear. There were no differences in characteristics of adolescents with vs. without ≥4 days of valid wear. Twenty participants (60.6%) had ≥3 days of valid wear, 24 (72.7%) ≥2 valid days, and 27 (81.8%) ≥1 valid wear day. Acceptability ratings were neutral. Assessing physical activity with accelerometry in pregnant adolescents was neither feasible nor acceptable with the current conditions. Future research should investigate additional incentives and the potential utility of a lower wear-time criterion in pregnant adolescents

N-acetylcysteine Targets 5 Lipoxygenase-Derived, Toxic Lipids and Can Synergize with PGE2 to Inhibit Ferroptosis and Improve Outcomes Following Hemorrhagic Stroke in Mice

OBJECTIVES: N-acetylcysteine (NAC) is a clinically approved thiol-containing redox modulatory compound currently in trials for many neurological and psychiatric disorders. Although generically labeled as an antioxidant , poor understanding of its site(s) of action is a barrier to its use in neurological practice. Here, we examined the efficacy and mechanism of action of NAC in rodent models of hemorrhagic stroke. METHODS: Hemin was used to model ferroptosis and hemorrhagic stroke in cultured neurons. Striatal infusion of collagenase was used to model intracerebral hemorrhage (ICH) in mice and rats. Chemical biology, targeted lipidomics, 5-lipoxygenase (ALOX5) knockout mice and viral-gene transfer were used to gain insight into the pharmacological targets and mechanism of action of NAC. RESULTS: NAC prevented hemin-induced ferroptosis by neutralizing toxic lipids generated via arachidonate dependent ALOX5 activity. NAC efficacy required increases in glutathione and is correlated with suppression of reactive lipids by glutathione dependent enzymes such as glutathione-S-transferase. Accordingly, its protective effects were mimicked by chemical or molecular lipid peroxidation inhibitors. NAC delivered post-injury reduced neuronal death and improved functional recovery at least 7 days following ICH in mice, and can synergize with clinically-approved prostaglandin E2 (PGE2 ). INTERPRETATION: NAC is a promising, protective therapy for ICH, which acted to inhibit toxic arachidonic acid (AA) products of nuclear ALOX5 that synergized with exogenously delivered protective PGE2 in vitro and in vivo. The findings provide novel insight into a target for NAC, beyond the generic characterization as an antioxidant, resulting in neuroprotection and offer a feasible combinatorial strategy to optimize efficacy and safety in dosing of NAC for treatment of neurological disorders involving ferroptosis such as ICH. This article is protected by copyright. All rights reserved