Treatment Adherence in Children with Sickle Cell Disease: Disease-Related Risk and Psychosocial Resistance Factors

To identify disease-related risk factors and psychosocial resistance factors that impact adherence to prescribed treatment in the context of admission to a Hematology Acute Care Unit (HACU) designed to provide acute care for children with sickle cell disease (SCD) presenting with pain or fever. A total of 73 primary caregivers and 24 children (if age 8 or older) completed standardized forms during the HACU admission. Treatment adherence variables (medical staff rating, SCD-related care activities, percentage of agreement between treatment recommendations made and care activities, and attendance at hematology clinic) indicated moderate-to-high adherence. Based on regression analyses, the risk variable of disease-related stress and the resistance variables of family flexibility and less reliance on passive coping accounted for significant portions of the variance in treatment adherence. Empirical evaluation of interventions designed to improve communication regarding expectations for the care of children with SCD and to support active family problem solving during times of SCD-related stress must be ongoing.     

A Self-Management Program for Adolescents and Children with Renal Transplantation

This paper describes the development and implementation of a self-management program designed to address noncompliance in adolescents with renal transplants. Transplantation provides the best treatment alternative for End-Stage Renal Disease (ESRD), but is a procedure that subsequently demands recipients follow a life-long medication regimen. Nonadherance to medical therapy is a serious problem for adolescents; it is one of the most common causes of chronic graft rejection in this population. To improve compliance rates for this population, a self-management program was designed: (1) to provide social support; (2) to review information about medications and transplant management; and (3) to both teach and provide transplantation patients the opportunity to practice self-management skills. Details about the program, including recruitment issues and session content, are provided. Evaluations by participants indicated that the program was effective in creating a supportive environment for both patients and their parents, and in addressing health-related concerns.     

Presurgical Coping, Depression, and Quality of Life in Persons with Parkinson's Disease

This study describes utilization of coping strategies and evaluates the interaction between coping strategies, depression, and quality of life (QOL) in patients with Parkinson's disease (PD) who are being considered for neurosurgical intervention. Eighty patients (mean age 61.7 years) with PD being evaluated for possible deep brain stimulation completed self-report instruments of coping strategies (Coping Responses Inventory), depression (Beck Depression Inventory), and disease-specific QOL (Parkinson's Disease Questionnaire-39). Analyses showed that patients with PD cope with the acute stressor of approaching neurosurgery through a variety of strategies, but particularly avoidant and behavioral strategies. When the correlated but apparently opposing effects of cognitive and behavioral strategies were teased apart, greater use of cognitive strategies was associated with more severe depressive symptomatology (and poorer QOL), while greater use of behavioral strategies appeared to be associated with less depression. Depressive symptomatology, in turn, was associated with poorer QOL. However, coping had minimal direct association with QOL. From this it was concluded that patients with advanced PD generate a variety of coping responses to an acute stressor such as surgery, and the use of behavioral strategies, in particular seeking of alternative enjoyable activities, may be associated with better mood if salutary effects are not overwhelmed by less helpful cognitive coping techniques. The minimization of depressive symptomatology, in turn, is associated with better QOL.     

Some Hindu Insights on a Global Ethic in the Context of Diseases and Epidemics

As we develop a global ethic in the context of diseases, we need to reconsider the wisdom of the religious traditions, for there is more to ailments than their material causes. In the Hindu framework, aside from the Ayurvedic system, which is based on herbal medicines and a philosophical framework, there is the insight that much of what we experience is a direct consequence of our karma (consequential actions). Therefore, here one emphasizes self–restraint and self–discipline in contexts that are conducive to self–hurting behavior.     

"The Plague Of Blood": HIV/AIDS and Ethics of the Global Health–Care Challenge

In this essay I explore the heuristic value of the concept of ethics of complexity, chaos, and contingency by applying its framework to the analysis of the HIV/AIDS pandemic. Everyday human moral choices are outcomes of a moral impulse, and such an impulse is grounded in moral competence shaped by moral literacy. This literacy is constructed on the basis of a body of knowledge of culture, social context, environment, and the universe. It also includes the knowledge of religions and religious and secular ethical codes. I also distinguish between the social and cultural aspects of ethical systems. Both societies and cultures provide resources and constraints for the development of literacy and competence. An intentionally developed multifaith and multidisciplinary coalition may help us move away from various forms of social speciation and toward sociological mindfulness. This could help us remake the world into one that has more courage to care.     

The value of stress-management interventions in life-threatening medical conditions

Emotional stress has been associated with the development and progression of several chronic medical conditions. Recently, researchers have assessed the impact of stress-management interventions on patients' psychological functioning, quality of life, and various disease outcomes, including survival. This review summarizes the value of stress-management techniques in the treatment of two important, life-threatening conditions: coronary heart disease and cancer. Results from randomized clinical trials indicate that psychological interventions can improve patients' psychological functioning and quality of life. However, there is limited evidence to suggest that these interventions significantly reduce morbidity and mortality.     

异体造血干细胞移植问题、发展与思考

异体造血干细胞移植(Allo-HSCT)已成为治疗恶性血液病及其他各种疾病的有效方法之一。在Allo-HSCT中由于供体和受体免疫屏障的存在。从而一开始就是一个供受体矛盾的对立统一的过程。对其中矛盾的研究和解决充满了辩证唯物的哲学思想。也促使Allo-HSCT技术不断发展。新的方法和理念不断出现。使Allo-HSCT治疗白血病的疗效不断提高。     

The link between knowledge and remembering in Alzheimer’s disease

Current research on the influence of cognitive support (e.g., activation of task-relevant prior knowledge, item organizability, retrieval cues) on episodic remembering in normal aging and Alzheimer’s disease (AD) is reviewed. Examining the effects of cognitive support on memory may shed light on the relationship between knowledge and remembering, and also provides relevant information pertaining to the development of cognitive intervention procedures. A series of studies from our own and other laboratories reveal a number of interesting empirical regularities. First, AD results in problems in utilizing cognitive support for improving memory. Conceivably, this reduction in cognitive reserve capacity is due to both the overall severity of the episodic memory impairment in AD, as well as to dementia-related deficits in the semantic network that guides encoding and retrieval of information. Nevertheless, AD patients are able to utilize cognitive support in episodic memory tasks, although they typically need more support than their healthy aged counterparts to show memory facilitation. Specifically, it is critical to provide support at both encoding and retrieval in order to demonstrate performance gains in AD. Moreover, successful utilization of retrieval support in this disease is most likely to occur when the encoding requirements force the individual to engage in elaborative cognitive activity (e.g., generation of task-relevant knowledge, categorical organization). Finally, a reduction in cognitive reserve capacity occurs later in the pathogenesis of AD than a generalized episodic memory impairment. This observation reflects the insidious nature of AD, and suggests that the transition from normal aging to AD may be continuous rather than discrete.     

Community member perceptions of influences on teenage pregnancies

This exploratory qualitative study aimed to provide insight into the factors contributing to the high prevalence rate of teenage pregnancy in South African communities. Focus group were conducted with 193 community members (females = 44.6%; adults = 50.8%, teenagers/youth = 44.0%) and followed by thematic content analysis to interpret the data. Several overarching themes regarding the increasingly common occurrence of teenage pregnancy emerged from the data. These included: (1) the increased acceptability of teenage pregnancy to families and communities for economic and material gain; (2) the influence of social pressure; and (3) the lack of sexual knowledge and provision of sex education. Community members perceived teenage pregnancy as an increasingly common occurrence in their communities. Community members perceived teenage pregnancy to be driven by multiple factors and to require holistic interventions at the individual, family and community level.     

Walking impairs cognitive performance among people with multiple sclerosis but not controls

People with multiple sclerosis (MS) complain of problems completing two tasks simultaneously; sometimes called ‘dual-tasking’ (DT). Previous research in DT among people with MS has focused on how adding a cognitive task interferes with gait and few have measured how adding a motor task could interfere with cognition. We aimed to determine the extent to which walking affects a concurrent working memory task in people with MS compared to healthy controls. We recruited MS participants (n = 13) and controls (n = 10) matched by age (±3 years), education (±3 years) and gender. Participants first completed the cognitive task (subtracting 7’s from the previous number) and then again while walking on an instrumented walkway. Although there were no baseline differences in cognition or walking between MS participants and controls, MS participants demonstrated a 52% decrease in number of correct answers during DT (p < 0.001). Mental Tracking Rate (% correct answers/min) correlated strongly with MS-related disability measured using the Expanded Disability Status Scale (EDSS; r(11) = −0.68, p < 0.01). We propose that compromised mental tracking during walking could be related to limited neural resource capacity and could be a potentially useful outcome measure to detect ecologically valid dual tasking impairments.