Depression improvement and parenting in low-income mothers in home visiting

Research on older children and high resource families demonstrates that maternal improvement in depression often leads to parallel changes in parenting and child adjustment. It is unclear if this association extends to younger children and low income mothers. This study examined if In-Home Cognitive Behavioral Therapy (IH-CBT), a treatment for depressed mothers participating in home visiting programs, contributes to improvements in parenting and child adjustment

Predictors of Condom Use among Peer Social Networks of Men Who Have Sex with Men in Ghana, West Africa

Ghanaian men who have sex with men (MSM) have high rates of HIV infection. A first step in designing culturally relevant prevention interventions for MSM in Ghana is to understand the influence that peer social networks have on their attitudes and behaviors. We aimed to examine whether, in a sample of Ghanaian MSM, mean scores on psychosocial variables theorized to influence HIV/STI risk differed between peer social networks and to examine whether these variables were associated with condom use. We conducted a formative, cross-sectional survey with 22 peer social networks of MSM (n = 137) in Ghana. We assessed basic psychological- needs satisfaction, HIV/STI knowledge, sense of community, HIV and gender non-conformity stigmas, gender equitable norms, sexual behavior and condom use. Data were analyzed using analysis of variance, generalized estimating equations, and Wilcoxon two sample tests. All models were adjusted for age and income, ethnicity, education, housing and community of residence. Mean scores for all psychosocial variables differed significantly by social network. Men who reported experiencing more autonomy support by their healthcare providers had higher odds of condom use for anal (AOR = 3.29, p \u3c 0.01), oral (AOR = 5.06, p \u3c 0.01) and vaginal (AOR = 1.8, p \u3c 0.05) sex. Those with a stronger sense of community also had higher odds of condom use for anal sex (AOR = 1.26, p \u3c 0.001). Compared to networks with low prevalence of consistent condom users, networks with higher prevalence of consistent condom users had higher STD and HIV knowledge, had norms that were more supportive of gender equity, and experienced more autonomy support in their healthcare encounters. Healthcare providers and peer social networks can have an important influence on safer-sex behaviors in Ghanaian MSM. More research with Ghanaian MSM is needed that considers knowledge, attitudes, and norms of their social networks in the development and implementation of culturally relevant HIV/STI prevention intervention strategies

Spiritual Struggle in Parents of Children with Cystic Fibrosis Increases Odds of Depression

Objective. Spiritual struggle (SS) is associated with poorer health outcomes including depression. The study’s main objectives were to characterize change in depression over time, examine longitudinal associations between SS and depression, and determine the extent to which experiencing SS at baseline was predictive of developing depression at follow-up. Methods. A two-site study collected questionnaire responses of parents (N=112; 72% female) of children with cystic fibrosis followed longitudinally. Generalized linear mixed effects modeling examined the association between depression and SS over time and assessed potential mediators, moderators, and confounders. Results. Prevalence of depression increased from baseline to follow-up (OR: 3.6, P<0.0001), regardless of degree of SS. Parents with Moderate/Severe SS were more likely to have depressive symptoms, compared to parents without SS (OR: 15.2, P=0.0003) and parents who had Mild SS (OR: 10.2, P=0.0001). Being female and feeling less “at peace” also significantly predicted increased depression (OR: 2.5, P=0.0397, and OR: 1.15, P=0.0419, resp.). Experiencing SS at baseline was not predictive of having depression subsequently at follow-up. Conclusions. Parents experiencing SS were significantly more likely to report depressive symptoms. Interventions to reduce SS have shown efficacy and may be considered

Evaluation of Target Attainment of Vancomycin Area Under the Curve in Children With Methicillin-Resistant Staphylococcus Aureus Bacteremia.

BACKGROUND: Vancomycin is often required to treat methicillin resistant Staphylococcus aureus (MRSA) bacteremia in children. Treatment failure occurs in up to 50% of adults and is associated with a 24 hour area under the curve/minimum inhibitory concentration (AUC(24h)/MIC) <400. We sought to identify patient factors associated with vancomycin AUC and whether AUC(24h)/MIC <400 was predictive of treatment failure in children. METHODS: Hospitalized children <18 years of age with MRSA bacteremia receiving vancomycin were included in a retrospective cohort study. AUC(24h) was calculated using a validated PK model. Factors such as age, gender, underlying conditions, presence of foreign bodies, patient site of infection, and markers of illness severity were examined for an association with vancomycin AUC, and AUC(24h)/MIC was evaluated for an association with treatment failure. RESULTS: Subjects requiring intensive care (ICU) support were significantly more likely to have higher vancomycin AUC(24h) and AUC(avg) than those subjects not needing ICU support. While vancomycin serum trough concentrations are predictive of vancomycin AUC, sub-optimal exposure of vancomycin occurred in almost 20% of subjects despite trough concentrations within the target range. A relationship between vancomycin AUC(24h)/MIC and treatment failure could not be established. CONCLUSIONS: To ensure optimal AUC/MIC pharmacodynamic index, especially in critically ill patients, estimation of the AUC is critical

Hypertriglyceridemia Induced Pancreatitis: Inpatient Management at a Single Pediatric Institution

Objectives Hypertriglyceridemia-induced pancreatitis is an important cause of acute pancreatitis (AP) in children, which lacks established guidelines. The aim of this study was to review management approaches at a single pediatric center. Methods This retrospective study included all inpatients younger than 21 years with AP and triglycerides (TG) of 1000 mg/dL or greater. A linear mixed effect model was used to calculate drop in TGs. The patient\u27s diet, intravenous fluid (IVF) rate, insulin, and plasmapheresis were included in the model. Results Seventeen admissions were identified among 8 patients, average age 15 years (range, 6-19 years). Fifty percent had recurrent AP and 29% of admissions had complications including 1 death. The population was primarily female (75%), white (75%), and overweight, and 63% had diabetes. The median stay was 5.4 days. There were 14 approaches used with variations in IVF rates, insulin, plasmapheresis, and nill per os (NPO) versus feeds. Variables that reduced TG\u27s were NPO, higher IVF rates, plasmapheresis, and insulin (P \u3c 0.05). Importantly, NPO reduced TGs faster than those who started early nutrition. Conclusions Hypertriglyceridemia is an important cause of pancreatitis in children. This study shares a management algorithm from a single institution. Larger studies are needed for more evidence-based guidelines

Nomogram predicts risk of perineural invasion based on serum biomarkers for pancreatic cancer

Abstract Background Pancreatic cancer is a fatal tumor, and the status of perineural invasion (PNI) of pancreatic cancer was positively related to poor prognosis including overall survival and recurrence-free survival. This study aims to develop and validate a predictive model based on serum biomarkers to accurately predict the perineural invasion. Materials and methods The patients from No.924 Hospital of PLA Joint Logistic Support Force were included. The predictive model was developed in the training cohort using logistic regression analysis, and then tested in the validation cohort. The area under curve (AUC), calibration curves and decision curve analysis were used to validate the predictive accuracy and clinical benefits of nomogram. Results A nomogram was developed using preoperative total bilirubin, preoperative blood glucose, preoperative CA19-9. It achieved good AUC values of 0.753 and 0.737 in predicting PNI in training and validation cohorts, respectively. Calibration curves showed nomogram had good uniformity of the practical probability of PNI. Decision curve analyses revealed that the nomogram provided higher diagnostic accuracy and superior net benefit compared to single indicators. Conclusion The present study constructed and validate a novel nomogram predicted the PNI of resectable PHAC patients with high stability and accuracy. Besides, it could better screen high-risk probability of PNI in these patients, and optimize treatment decision-making