LIMITED DOSES: HEALTH AND DEVELOPMENT IN LAOS, 1893-2000

Ph.DDOCTOR OF PHILOSOPH

Native Hawaiian Grandparents: Exploring Benefits and Challenges in the Caregiving Experience

Background: Increasingly, U.S. grandparents are raising their grandchildren. In Hawai‘i, 12% of Native Hawaiian grandparents live with grandchildren, compared to 7% of grandparents in all races combined in the state, and to 3.6% of grandparents in the total U.S. Although strong family-centric cultural values may provide Native Hawaiian grandparents with caregiving benefits, a generally poor health profile suggests they may also face challenges in this role. In this study, we talked to Native Hawaiian grandparents raising grandchildren (GRG) about the benefits and challenges of their caregiving experiences. Method: Three focus groups were conducted with Native Hawaiian grandparents (n=33) in Hawai‘i who were 55 years of age or older and caregivers to their grandchildren. Findings: The most prevalent themes voiced by grandparents spoke of the benefits of being a grandparent caregiver (the greatest being the experience of mutual, unconditional love) and the enjoyment of passing on “life lessons” to their grandchildren. Grandparents identified concrete examples of what they provided to grandchildren and also spoke of their role in transmission of Native Hawaiian cultural values, practices, and stories to their grandchildren. A number of challenges pertaining to grandparent caregiving were identified along with needed services—respite care, financial assistance, children’s programs, and information on grandparent legal rights. Despite these challenges, grandparents preferred to seek help from extended family rather than from formal supports. Our results support previous research on a number of universal GRG needs and services (i.e., legal rights of GRG) but also suggest potential directions to meeting the needs of Native Hawaiian GRG that are responsive to indigenous cultural values and preferences. Given the number of unmet needs expressed, further research is needed to design interventions for this population of grandparents raising grandchildren

How many human pathogens are there in Laos? An estimate of national human pathogen diversity and analysis of historical trends.

OBJECTIVE: The emergence of infectious diseases pose major global health threats. Estimates of total in-country human pathogen diversity, and insights as to how and when species were described through history, could be used to estimate the probability of new pathogen discoveries. Data from the Lao People's Democratic Republic (Laos) were used in this proof-of-concept study to estimate national human pathogen diversity and to examine historical discovery rate drivers. METHODS: A systematic survey of the French and English scientific and grey literature of pathogen description in Laos between 1874 and 2017 was conducted. The first descriptions of each known human pathogen in Laos were coded according to the diagnostic evidence available. Cumulative frequency of discovery across time informed the rate of discovery. Four distinct periods of health systems development in Laos were identified prospectively and juxtaposed to the unmodelled rate of discovery. A model with a time-varying rate of discovery was fitted to these data using a Markov-Chain- Monte-Carlo technique. RESULTS: From 6456 pathogen descriptions, 245 discoveries of known human pathogens in Laos, including repeat discoveries using different grades of evidence, were identified. The models estimate that the Laos human pathogen species diversity in 2017 is between 169 and 206. During the last decade, there has been a 33-fold increase in the discovery rate coinciding with the strengthening of medical research and microbiology. CONCLUSION: Discovery curves can be used to model and estimate country-level human pathogen diversity present in a territory. Combining this with historical assessment improves the understanding of the factors affecting local pathogen discovery. PROSPERO REGISTRATION NUMBER: A protocol of this work was registered on PROSPERO (ID:CRD42016046728)

Families Coping With Financial Loss Following the Deepwater Horizon Oil Spill

Objective: This study examines family strategies for coping and adaptation to social disruption from the 2010 Deepwater Horizon oil spill (DHOS) in south Louisiana. Background: The DHOS is a technological disaster of unprecedented scale and ongoing impact, including the socioeconomic disruption of families. Method: Using data from focus groups, grounded‐theory methods informed a thematic analysis of spill‐related economic loss and coping mechanisms among families in the spill‐affected region. Results: Key findings were as follows: (a) long‐term economic impacts persisted but were nuanced and differed across places; (b) for families living in multistressor environments, concerns about the DHOS spilled over into other aspects of social functioning and became enmeshed with perceptions of other environmental stressors; and (c) economic exposure after the DHOS affected families differently based on social position and community social structure. Conclusion: This study contributes to existing knowledge on technological disaster and family resilience in the face of environmental shocks and stressors, underscoring the utility of the conservation of resources model of stress in this area of research. Implications: This research offers information about family‐level response to oil spill impacts and may be of interest to policymakers and practitioners who work to support resilience in disaster contexts

The Economic Resource Receipt of New Mothers

U.S. federal policies do not provide a universal social safety net of economic support for women during pregnancy or the immediate postpartum period but assume that employment and/or marriage will protect families from poverty. Yet even mothers with considerable human and marital capital may experience disruptions in employment, earnings, and family socioeconomic status postbirth. We use the National Survey of Families and Households to examine the economic resources that mothers with children ages 2 and younger receive postbirth, including employment, spouses, extended family and social network support, and public assistance. Results show that many new mothers receive resources postbirth. Marriage or postbirth employment does not protect new mothers and their families from poverty, but education, race, and the receipt of economic supports from social networks do

Influenza Virus Infection of the Murine Uterus: A New Model for Antiviral Immunity in the Female Reproductive Tract

Secretory IgA (S-IgA) mediates local immunity to influenza virus in the murine upper respiratory tract and may play an important role in local immunity to various microorganisms in the female reproductive tract as well. Although the presence of IgA in cervicovaginal or uterine secretions has been correlated with immunity to a number of pathogens, there has been no direct demonstration of the mediation of uterine antiviral immunity by S-IgA. Influenza virus, although not a normal pathogen of the reproductive tract, was used to develop a model for the investigation of mucosal immunity in the uterus. PR8 (H1N1) influenza virus injected into the ovarian bursa of BALB/c mice grew well, with peak titers between days 3 and 5. Intravenous injection of polymeric IgA anti-influenza virus monoclonal antibody before or 30 min after viral challenge protected mice against viral infection. We believe this work to be the first direct demonstration of S-IgA-mediated antiviral uterine immunity. It provides a model for further investigation of immunity in the female reproductive tract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63226/1/vim.2006.19.613.pd

Deepwater Horizon Oil Spill Exposure, Industry Sector, and Child Health

The historic 2010 BP Deepwater Horizon Oil Spill (DHOS) led to public distress regarding potential impacts on children in nearby Gulf Coast communities. Using a community-based South Louisiana panel study of households with children, we examined the effect of fishing industry employment on changes in a subjective measure of general child health and whether economic and physical DHOS exposures played a mediating role. Fishing industry employment had a negative effect on child health compared to other industries. Economic exposure and physical exposure both mediated the effects of the fishing industry on child health, with economic exposure mediating a larger share (49.3%) of the relationship compared to physical exposure (40.5%). The importance of economic oil spill exposure in these findings highlights the significance of social determinants of health at the intersection of disasters and child vulnerability

Limiting prothrombin activation to meizothrombin is compatible with survival but significantly alters hemostasis in mice

Thrombin-mediated proteolysis is central to hemostatic function but also plays a prominent role in multiple disease processes. The proteolytic conversion of fII to α-thrombin (fIIa) by the prothrombinase complex occurs through 2 parallel pathways: (1) the inactive intermediate, prethrombin; or (2) the proteolytically active intermediate, meizothrombin (fIIa(MZ)). FIIa(MZ) has distinct catalytic properties relative to fIIa, including diminished fibrinogen cleavage and increased protein C activation. Thus, fII activation may differentially influence hemostasis and disease depending on the pathway of activation. To determine the in vivo physiologic and pathologic consequences of restricting thrombin generation to fIIa(MZ), mutations were introduced into the endogenous fII gene, resulting in expression of prothrombin carrying 3 amino acid substitutions (R157A, R268A, and K281A) to limit activation events to yield only fIIa(MZ). Homozygous fII(MZ) mice are viable, express fII levels comparable with fII(WT) mice, and have reproductive success. Although in vitro studies revealed delayed generation of fIIa(MZ) enzyme activity, platelet aggregation by fII(MZ) is similar to fII(WT). Consistent with prior analyses of human fIIa(MZ), significant prolongation of clotting times was observed for fII(MZ) plasma. Adult fII(MZ) animals displayed significantly compromised hemostasis in tail bleeding assays, but did not demonstrate overt bleeding. More notably, fII(MZ) mice had 2 significant phenotypic advantages over fII(WT) animals: protection from occlusive thrombosis after arterial injury and markedly diminished metastatic potential in a setting of experimental tumor metastasis to the lung. Thus, these novel animals will provide a valuable tool to assess the role of both fIIa and fIIa(MZ) in vivo

Sensitization in Transplantation: Assessment of Risk (STAR) 2017 Working Group Meeting Report

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144684/1/ajt14752_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144684/2/ajt14752.pd