The Health Care Encounters of Pregnant and Postpartum Women With Substance Use Disorders

Indiana University-Purdue University Indianapolis (IUPUI)Pregnant and postpartum women with substance use disorders (SUDs) are likely to experience adverse health care encounters that contribute to poor health outcomes for them and their infants. The purpose of this dissertation is to describe the health care encounters of pregnant and postpartum women with SUDs. This dissertation includes two studies. The first study is a metasynthesis of published qualitative studies using a metasummary approach to classify the types of health care encounters experienced by pregnant and postpartum women with SUDs. A taxonomy of health care encounters was developed. Five types of adverse encounters were identified and labeled as (a) judgmental, (b) disparaging, (c) scrutinizing, (d) disempowering, and (e) deficient care. Three types of beneficial encounters were identified and labeled as (a) recovery-based, (b) accepting, and (c) effective care. The second study was a qualitative descriptive study conducted to describe factors that influence the formation of trusting relationships between maternity nurses and pregnant and postpartum women with SUDs. Interviews with 15 maternity nurses and 10 pregnant and postpartum women with SUDs were conducted. Content analysis of the participant narratives revealed a number of characteristics of maternity nurses and pregnant and postpartum women with SUDs that helped or hindered trusting relationships. Six characteristics of maternity nurses were identified and labeled as (a) rapport-building with women, (b) demeanor toward women, (c) provision of care, (d) provision of information, (e) attitude toward substance use, and (f) addiction expertise. Five characteristics of the women were identified and labeled as (a) engagement with nurses, (b) demeanor toward nurses, (c) acceptance of care, (d) investment in recovery, and (e) bonding with infant. Adverse encounters were often associated with provider stigma related to substance use during pregnancy and limited provider knowledge related to addiction. The findings will contribute to the development of strategies to improve the health care encounters of this population by promoting stigma awareness and communication skills training

From Solos to Symphony: The Indianapolis Reggio Collaborative

In this NAREA Column, the founding members of the Indianapolis Reggio Collaborative share the development of their work together

Examining the Children’s Defense Fund Freedom Schools Model on Middle School Students’ Reading Achievement

In effort to curb summer learning loss, the Children’s Defense Fund Freedom Schools program identifies as a six-week summer literacy program for students in grades K-12. This study explored the impact of the Freedom School program on 128 middle school students’ reading achievement using Johns (2005) Basic Reading Inventory. Findings support the program’s effectiveness in increasing students’ reading outcomes, as demonstrated in the existent literature, but unlike other studies, data provided for both independent and instructional levels across three fluency indicators. In recognition of heightened state of summer learning loss for students with lack of access to quality enrichment summer programming, the study reveals the program\u27s positive impact and academic outcomes for student participants. Implications for future research that examine longitudinal impacts of the program and the value in utilizing multicultural literature are provided

Pharmacokinetic Variability of Mycophenolic Acid in Pediatric and Adult Patients with Hematopoietic Stem Cell Transplantation

The aim of this study was to evaluate the pharmacokinetic variations of mycophenolic acid (MPA), the active metabolite of mycophenolate mofetil (MMF), in both pediatric and adult patients following hematopoietic stem cell transplantation (HSCT). Twenty pediatric patients with a median age of 3 years (range 0.2-12 years) and 13 adult patients with a median age of 54 years (range 18-63 years) were enrolled. Blood samples were collected on days 0, 7, 14, 21, and 30 after allogeneic HSCT. Total and free (unbound) MPA as well as MPA 7-O-glucuronide (MPAG) were quantified using a validated LC-MS/MS assay. The plasma protein binding of MPA and MPAG did not change significantly in pediatric patients over the 1-month sampling period post-HSCT. However, it increased in adult patients from day 7 to day 30 post-HSCT, from 97.3 ± 0.8% to 98.3 ± 0.6% for MPA (P < .05), and 74.6 ± 9.4% to 82.9 ± 8.1% for MPAG (P < .05). The plasma protein binding of MPA was significantly higher in males compared to females in both pediatric (98.3 ± 1.1% vs 97.4 ± 1.1%) and adult (98.1 ± 0.7% vs 97.4 ± 1.2%) patients (P < .05). The MPAG/MPA ratios on a milligram-per-kilogram dose basis in adult patients were significantly higher than those in pediatric patients (4.3 ± 3.4 vs 2.4 ± 2.6; P < .05). Time-dependent plasma protein binding and age-related differences in MPA metabolism at least in part impact the reported large intra- and interindividual variability in MPA pharmacokinetics. These patient and pharmacologic factors, if incorporated into MMF regimen design and modification, may contribute to the rational dose selection of MMF in HSCT patients

PREGMED: Indiana University Center for Pharmacogenetics and Therapeutics Research in Maternal and Child Health

poster abstractMany illnesses occur in pregnant women and children that can significantly impact health. These conditions require drug therapy but the clinical pharmacology and pharmacogenomics of most medications used during pregnancy and childhood are poorly characterized. This compromises the effective and individualized treatment of multiple conditions specific to these populations such as nausea and vomiting of pregnancy, preterm labor, diabetes, and depression in pregnant women and childhood cancers in pediatric patients. Furthermore, drug disposition in these populations is known to be different from that observed in non-pregnant adults. We have developed PREGMED a unique center whose central mission is to improve the pharmacotherapy for women and children using a personalized medicine approach that builds on the strengths of Indiana University in the areas of pharmacogenomics and clinical obstetrics and pediatrics. The center’s multidisciplinary activities focus on developing new paradigms for the treatment of the multiple important conditions that affect pregnant women and children

Higher Education Liaisons for Students Experiencing Homelessness: Role Preparation and Professional Development Needs

Homelessness among college students is an increasing concern on campuses across the U.S. Homelessness during college is associated with food insecurity, mental health concerns, and academic challenges including dropped classes, low GRE, and delayed degree completion. Homeless education liaisons—a role often filled by financial aid officers—are tasked with assisting students experiencing homelessness as the students navigate systems of support for basic needs while pursuing their degrees. Little is known about the perspectives or experiences of these professionals in terms of their role as a liaison. Our aim was to inform efforts to support these professionals by gaining an understanding of the knowledge and experiences of liaisons and their professional development preferences and needs. Based on survey data collected from 49 liaisons in four states, we identified gaps in understanding of college student homelessness, such as underestimates of the rate of student homelessness. We pinpointed areas of potential professional development including methods to identify and reach all students at risk for or experiencing homelessness and approaches for collaboration with community partners. We found that liaisons welcomed professional development and preferred online training and peer support as approaches to gain knowledge and skills to fulfill their critical roles

First Results from SPARO: Evidence for Large-Scale Toroidal Magnetic Fields in the Galactic Center

We have observed the linear polarization of 450 micron continuum emission from the Galactic center, using a new polarimetric detector system that is operated on a 2 m telescope at the South Pole. The resulting polarization map extends ~ 170 pc along the Galactic plane and ~ 30 pc in Galactic latitude, and thus covers a significant fraction of the central molecular zone. Our map shows that this region is permeated by large-scale toroidal magnetic fields. We consider our results together with radio observations that show evidence for poloidal fields in the Galactic center, and with Faraday rotation observations. We compare all of these observations with the predictions of a magnetodynamic model for the Galactic center that was proposed in order to explain the Galactic Center Radio Lobe as a magnetically driven gas outflow. We conclude that the observations are basically consistent with the model.Comment: 11 pages, 2 figures, 1 table, submitted to ApJ Let

Identifying Genetic Variants in Adolescents With Oppositional Defiant Disorders and/or Conduct Disorders: A Brief Report

PROBLEM To add to diversity in our state biobank, we explored the feasibility of collecting genetic material from adolescents with oppositional defiant disorder (ODD) and/or conduct disorder (CD) and their family members. We also preliminarily explored genetic factors associated with ODD and/or CD by comparing participant data to 1000 Genome Project data on minor allele frequencies. METHODS Adolescents with ODD and/or CD and family members provided saliva samples for genetic testing. We evaluated five single-nucleotide polymorphisms (SNPs), respectively, in the dopamine receptor subtype D2, dopamine receptor subtype D3, dopamine beta-hydroxylase, dopamine transporter gene SLC6A3, and alpha-2-adrenergic receptor genes. Fisher's exact tests were used to examine differences in minor allele frequencies for each SNP. FINDINGS Thirty-one viable samples were genotyped from 15 affected adolescents and 16 unaffected family members; the 60% consent rate reflected high feasibility. Compared with the 1000 Genome Project frequencies, affected adolescents had higher frequencies of the genetic variant in the dopamine receptor subtype D2 (p = .05) and dopamine beta-hydroxylase (p = 0.03), but not of the other three SNPs examined. CONCLUSIONS Collecting genetic materials from an ethnically diverse sample of affected adolescents and their families is feasible. We offer practical suggestions to strengthen the integrity of future research studies

Raising the Level of Nursing Involvement in the National Precision Medicine Initiative: An Example

PURPOSE The Precision Medicine Initiative (PMI) goal of ushering in a new and more effective era of health care that benefits all Americans requires two critical and interdependent components: a cohort assembly of 1 million or more Americans who reflect the diversity of the United States of America and an interdisciplinary workforce that includes nursing. The purpose of this article is to provide an example of nursing involvement in PM, specifically as related to gathering biospecimens (saliva) from vulnerable, understudied adolescents with disruptive behavior disorders and their family members. SOURCE(S) First, we provide a brief description of important concepts related to PM as well as current roles of nurses in PM. Then, we share lessons learned from our feasibility study aimed at increasing the diversity of our statewide cohort assembly that has provided biospecimens for the Indiana Biobank. CONCLUSION Nurses can definitely contribute to biobanks in support of the PMI. This article is a call to action for nurses to take their rightful place in PM