The impact of treatment transitions between dialysis and transplantation on illness cognitions and quality of life - A prospective study

Objectives. Treatment transitions are frequent in end-stage renal disease (ESRD) but little is known about cognitive responses pre- to post-transplantation or after transplant failure. The purpose of this study was to examine changes in illness cognitions across treatment transitions between dialysis and transplantation and their impact on quality of life (QOL). Methods. In this longitudinal study, ESRD patients (N= 262) patients were followed up across treatment transitions over a 7-year observation window using the Illness Perceptions Questionnaire, the Illness Effects Questionnaire, and measures of QOL. Study sample comprised the patients from this cohort who switched treatment modality (N= 60 post-transplantation; N= 28 transplant failure). Data were collected while on dialysis or transplantation and at 6 months post-treatment change. Results. Significant changes in QOL and illness perceptions were found in treatment transitions with opposite patterns of either improvement or deterioration following transplantation or transplantation failure. Pre- to post-transplantation, QOL improves and patients report less symptoms, lower consequences, and illness intrusiveness, more acute timeline and stronger control beliefs (ps < .01). QOL is diminished following transplant failure and patients report more symptoms, consequences, illness disruptiveness, more chronic timeline, and lower control. Changes in cognitions are associated with changes in QOL (R(2) = .469-.789). Conclusions. Treatment transitions marked significant changes in illness perceptions that were associated with changes in QOL. Interventions to prepare patients for treatment transitions and prevent increasingly negative patterns of illness perceptions with transplant failure may serve towards maintaining or improving adjustment outcomes. STATEMENT OF CONTRIBUTION: WHAT IS ALREADY KNOWN ON THIS SUBJECT??: Illness cognitions have been shown to predict health outcomes and to change in response to changes in health status. Treatment transitions between dialysis and transplantation are frequent in end stage renal disease but their effect on illness representations has not been explored. WHAT DOES THIS STUDY ADD??: The paper described results of the first study to prospectively explore changes in illness cognitions across treatment transitions between dialysis and transplantation and their impact on QOL outcomes. The paper documents dynamic changes in illness cognitions when treatment modality is changed in line with the predictions of a dynamic reassessment of illness perceptions and coping behaviour as described in Leventhal's Common Sense Model of Illness Behaviour.     

Cognitive and behavioural correlates of non‐adherence to HIV anti‐retroviral therapy: Theoretical and practical insight for clinical psychology and health psychology

This cross‐sectional study identified variables associated with protease inhibitor (PI) non‐adherence in 179 patients taking anti‐retroviral therapy. Univariate analyses identified 11 variables associated with PI non‐adherence. Multiple logistic regression modelling identified three predictors of PI non‐adherence: low adherence self‐efficacy and seriousness of non‐adherence and HIV (p < .001), perceived absence of HIV associated illness (p < .01), and use of more than one type of recreational drug (p = .001). The model correctly classified 83.9% of the sample, offers psychologists insight into psychological barriers to treatment adherence to guide interventions for improving adherence, and supports a modified version of the reformulated health belief model.     

Illness representations of coronary artery disease: An empirical examination of the Illness Perceptions Questionnaire (IPQ) in patients undergoing surgery,angioplasty and medication

Background. This study sought to validate empirically, through factor analysis, the theoretically developed Illness Perceptions Questionnaire (IPQ) measure of illness representations, and investigated how illness representations varied within an illness condition between different treatments. Methods. Two hundred and fourteen coronary artery disease (CAD) patients, 70 of whom were undergoing medication, 71 to undergo angioplasty and 73 to undergo coronary artery bypass surgery (CABG), completed the New Zealand Heart Attack Recovery Project version of the IPQ. The core cognitive illness representation statement responses were subject to principal components analyses (PCA), with oblique rotation. Identity data were examined regarding symptom frequency. Subscales based on factor structures and frequency scores were utilized to investigate treatment group differences in illness beliefs through analysis of covariance (ANCOVA). Findings. PCA of the core components indicated four factors labelled: ‘illness impact’, ‘duration’, ‘control’, and ‘self‐image’, accounting for 46.5% of the variance. The most frequently experienced symptoms were fatigue, breathlessness and chest‐pain (angina). ANCOVAs showed significant treatment group differences in frequency of chest‐pain experienced (medication < CABG, p <.01) and differences on illness ‘duration’ beliefs (medication > revascularization groups, p <.001). Discussion. The results produced a modified structure for the IPQ, which appeared to reflect the nature of the illness under study and the possible fractionation of the core illness representation components. Responses on the subscales created were also related to the position within the ‘subjective experience with the illness’ that a patient had reached and the treatment being undertaken.     

Positivity in illness: Self‐delusion or existential growth?

Objectives: This study investigated the relationship between a measure of positivity in illness, the Silver Lining Questionnaire (SLQ), and measures of personality and spirituality/religious beliefs as a way of determining whether positivity in illness is a delusion or existential growth. Method: This is a cross‐sectional study comparing response to the SLQ, to the Eysenck Personality Questionnaire (EPQ‐R), breathlessness, illness type, and spiritual and religious beliefs in a final total sample of 194 respiratory outpatients. Results: The SLQ was associated positively with extraversion (r = .16, p< .05), unrelated to neuroticism (r = .11, n.s.) and repression (r = .10, n.s.) and was positively associated with spiritual and religious beliefs, F(2; 187) = 7.12, p < 001, as predicted by the existential growth but not the delusion interpretation. There was no relationship between positivity and age, r(194) = .09, n.s., or between positivity and gender t(192) = ?1.27, n.s., and nor were there relationships with type of illness, F(4, 188) = 2.17, n.s., or breathlessness, F (5, 173) = 0.42, n.s. Conclusions: The results suggest that positivity in illness is associated with existential growth, though the cross‐sectional nature of the study precludes a conclusion of causal direction. The non‐significant correlation between the SLQ and neuroticism is in the opposite direction predicted by the delusion explanation, but the non‐significant relationship between the SLQ and repression is in the predicted direction. We cannot rule out the possibility that some positivity is delusion.     

The perception of the Illness with Subsequent Outcome Measure in More Favorable in Continuos Peritoneal Dialysis vs Hemodialysis in the Framework of Appraisal Model of Stress

The aim of the study was to use the appraisal model of stress to compare hemodialysis (HD) and continuous peritoneal dialysis (CAPD) patients with special focus on the perception of end-stage renal disease and subsequent emotional profile and health related quality of life (HQoL) in. We hypothesize that different circumstances related to both modes of therapies will result in dissimilar perception of chronic illness with subsequent changes in emotional profile and heath related quality of life. The total of 88 patients with end stage renal disease (ESRD) enrolled in hemodialysis (n=52; HD) or continuous peritoneal dialysis (n=36; CAPD) were given a battery of psychological tests: The Profile of Mood States, The Nottingham Health Profile, The Stress Situation Assessment Questionnaire, The Social Appreciation Questionnaire and The Situation and Trait and Anxiety Inventory. All patients perceived ESRD in terms of a loss and a threat. Moreover, CAPD patients evaluated ESRD as a challenge. Despite different perception of ESRD no significant difference in the level of fear, anxiety or emotional profile was found. Both HD and CAPD patient were reported more fatigue/inertia and confusion/bewilderment than control groups. The main health related complaints were similar in both ESRD patients with major complaints of sleeping disturbances, motor limitations and lack of energy. From the psychological point of view, CAPD treatment seems more like challenge to the enrolled patient which is positive outcome. Despite different appraisal of stress mood and health related complaints were similar in both groups. This may be a result of optimal regulation of cognitive perception of the stress depending on the circumstances of therapy.     

Help‐seeking intentions for breast‐cancer symptoms: A comparison of the self‐regulation model and the theory of planned behaviour

Purpose: Delays in seeking help for symptoms have been found to be associated with poorer outcome in breast‐cancer patients. This study explores symptom perceptions and health beliefs as predictors of intentions to seek medical help in a general female population. The utility of the self‐regulation model of illness cognition and the theory of planned behaviour were examined in predicting help‐seeking intentions for potential symptoms of breast cancer in a general population sample. Methods: A general population sample of 546 women completed a postal questionnaire comprising items examining components of the self‐regulation model and the theory of planned behaviour. Help‐seeking intention was determined by asking participants to rate the likelihood of visiting their GP for a range of breast symptoms. Results: Hierarchical multiple regression analysis revealed that the cognitive component of the self‐regulation model accounted for approximately 22% of the variance in help‐seeking intention. Identity (β = 0.45, p < .001) emerged as a significant predictor of intention to seek help. Inclusion of the components of the theory of planned behaviour accounted for an additional 7% of the variance; the significant predictors were attitude to help‐seeking (β = 0.19, p <.001) and perceived behavioural control (β = 0.12, p <.01). Conclusions: Intention to seek medical help for a potential breast‐cancer symptom may be mediated, partly, by cognitive representations of the identity and consequences of breast cancer and by attitudes towards help‐seeking and perceived behavioural control. Although less than one‐third of the variance was accounted for, these results have important implications for future research (in terms of identifying which variables should be examined) and for the development of a model of help‐seeking behaviour in women with breast‐cancer symptoms.     

Is secondary hyperparathyroidism-related myelofibrosis a negative prognostic factor for kidney transplant outcome?

Secondary hyperparathyroidism (HP) presenting with hypocalcemia and subsequent increased parathormone (PTH), is mainly identified in patients with chronic renal failure, which has been associated with variable degrees of bone marrow fibrosis.For suitable patients with end-stage renal disease (ESRD), kidney transplantation is recognized as the therapy of choice, being superior to dialysis in terms of quality of life and long-term mortality risk; in this regard interesting data show that increased time on dialysis prior to kidney transplantation is associated with decreased graft and patient survival.In our opinion an important and until now underestimated determinant of graft survival is the proper activity of bone marrow because of the emerging role of hematopoietic stem cells (HSC) in repair of ischemia/reperfusion (IR) damage. We postulate that in ESRD patients, who usually undergo long dialytic treatment, a myelofibrosis caused by an overt secondary HP could drastically decrease the HSC potential for IR damage repair after kidney transplant; this could irremediably lead to a delay in graft function with all related complicances.If the curative role of bone marrow-derived stem cells was confirmed by more data obtained in experimental animal models, it could be possible to try a cellular-based therapeutic approach in the management of ESRD patients which are in waiting list for a kidney transplant.     

Risk factors of sensitization to human leukocyte antigen in end-stage renal disease patients

Background

Pre-sensitization to human leukocyte antigen (HLA) is closely related to the prognosis of renal transplantation. Concerning the risk factors for HLA sensitization, most studies focused only on selected transplant candidates.

Methods

All patients with end-stage renal disease (ESRD) in a single teaching hospital and a group of healthy subjects were enrolled for the tests of panel-reactive antibodies (PRA).

Results

A total of 1177 subjects were recruited, including 289 ESRD patients (140 hemodialysis, 98 peritoneal dialysis, and 51 pre-dialysis) and 888 healthy volunteers. The prevalence of PRA positivity (for either type I or II HLA) for ESRD patients was higher than for healthy subjects (23.2% vs. 12.8%, p = 0.000). Only pregnancy and transfusion showed independent correlations with PRA positivity, and not ESRD itself. The PRA-positive ESRD patients were prone to be female, have histories of pregnancy, transfusion, no hepatitis B, and use of graft shunt for dialysis. Multivariate analyses showed that pregnancy and time interval of the latest transfusion had independent correlations with PRA positivity. The time interval of less than 1 year had the highest odds ratio 10.06 (p = 0.000).

Conclusions

Pregnancy and recent transfusion, not ESRD itself or dialysis modality, remain the independent risk factors for HLA sensitization.     

Does perceived behavioural control mediate the relationship between power beliefs and intention?

Objectives: In order to determine whether the relationship between power beliefs (Σp) and health‐related behavioural intentions is mediated by perceived behavioural control (PBC) we used structural equation modelling of eight cross‐sectional data sets. Method: Eight studies that examined health‐related behaviours and employed representative samples totallingN = 4663 participants were analysed. All studies involved power belief items derived from pilot testing and employed standard multiitem measures of power beliefs, PBC and intention that were highly reliable. Results: Confirmatory factor analysis confirmed the discriminant validity of power beliefs, PBC and intention. Structural equation modelling of relevant paths indicated that PBC only partially mediated the relationship between power beliefs and intention (Z_Sobel = 5.15,p < .001;Z_Baron&Kenny = 5.16,p < .001). Power beliefs had a significant direct relationship with intention even after PBC had been taken into account. Conclusion: The findings undermine Ajzen's contention that PBC mediates the power beliefs‐intention relationship and suggests that it is important to employ measures of power beliefsin addition to measures of PBC in order to enhance the prediction of intentions to perform health‐risking, or health‐promoting, behaviours.     

Urinary haptoglobin,alpha‐1 anti‐chymotrypsin and retinol binding protein identified by proteomics as potential biomarkers for lupus nephritis

The study was aimed at identification by proteomics and validation by enzyme‐linked immunosorbent assay (ELISA) of potential urinary biomarkers for lupus nephritis. Study subjects comprised 88 systemic lupus erythematosus (SLE) patients and 60 controls (rheumatoid arthritis, diabetes mellitus and healthy individuals). Based on the SLE disease activity index (SLEDAI), patients were classified as active renal (AR), active non‐renal (ANR) or inactive disease (ID). Urinary proteins from a group of patients with AR or ID were resolved by two‐dimensional gel electrophoresis and identified by matrix‐assisted laser desorption ionization–time of flight–mass spectrometry (MALDI‐TOF‐MS/MS). The selected biomarkers were validated by ELISA using samples from all patients and controls. AR patients were followed‐up for 12 months after start of therapy. Three urinary proteins, alpha‐1 anti‐chymotrypsin (ACT), haptoglobin (HAP) and retinol binding protein (RBP), were detected in patients with AR and not ID. Upon validation, ACT levels were higher in AR patients than the other groups (P < 0·001) and showed good correlation with renal SLEDAI (r = 0·577, P < 0·001) as well as SLEDAI (r = 0·461, P < 0·001). Similarly, HAP levels were > 10‐fold higher in AR than other groups (P < 0·001) and correlated well with renal SLEDAI (r = 0·594, P < 0·001) and SLEDAI (r = 0·371, P < 0·01). RBP levels were also higher in AR patients than in other groups (P < 0·05), except diabetes, and showed moderate correlation with renal SLEDAI (r = 0·284, P < 0·008) and SLEDAI (r = 0·316, P < 0·003). Upon follow‐up with treatment, levels of all three proteins declined at 6 and 12 months (P < 0·01). Multiple logistic regression identified ACT as the best marker to differentiate AR from ANR. Urinary HAP, ACT and RBP are potential biomarkers for lupus nephritis activity.     

A text message programme designed to modify patients' illness and treatment beliefs improves self-reported adherence to asthma preventer medication

Objective. While effective preventative medication is readily available for asthma, adherence is a major problem due to patients’ beliefs about their illness and medication. We investigated whether a text message programme targeted at changing patients’ illness and medication beliefs would improve adherence in young adult asthma patients. Methods. Two hundred and sixteen patients aged between 16 and 45 on asthma preventer medication were recruited from pamphlets dispensed with medication and e‐mails sent to members of a targeted marketing website. Participants were randomized to receive individually tailored text messages based on their illness and medication beliefs over 18 weeks or no text messages. Illness and medication beliefs were assessed at baseline and at 18 weeks. Adherence rates were assessed by phone calls to participants at 6, 12, and 18 weeks and at 6 and 9 months. Results. At 18 weeks, the intervention group had increased their perceived necessity of preventer medication, increased their belief in the long‐term nature of their asthma, and their perceived control over their asthma relative to control group (all p's < .05). The intervention group also significantly improved adherence over the follow‐up period compared to the control group with a relative average increase in adherence over the follow‐up period of 10% (p < .001). The percentage taking over 80% of prescribed inhaler doses was 23.9% in the control group compared to 37.7% in the intervention group (p < .05). Conclusion. A targeted text message programme increases adherence to asthma preventer inhaler and may be useful for other illnesses where adherence is a major issue.     

Treatment beliefs and attending follow‐up visits in a lipid clinic

Objective. To explore the value of demographics, clinical parameters, and treatment beliefs in predicting attendance at follow‐up visits in a lipid clinic. Design. Prospective cohort study. Methods. A total of 104 consecutive patients, who attended the Meir Medical Center lipid clinic for the first time, were followed for an average of 14 months. During the first visit, demographic and clinical parameters were obtained and a treatment beliefs and a self‐rated health questionnaire were completed. Those who kept all scheduled follow‐up visits were categorized as attendees and those who were lost to follow up as non‐attendees. The two groups were compared on demographic and clinical parameters, as well as on treatment and health beliefs. Results. Lipid target level achievement was higher in attendees (p < .001). However, only 49 patients (47%) attended the scheduled clinic visits. None of the demographic or clinical parameters significantly predicted attendance. Both groups scored high on perceived risk‐to‐health of uncontrolled lipid levels and on perceived effectiveness and benefits of treatment. Non‐attendees reported significantly more perceived barriers and treatment misconceptions/disbeliefs, and lower self‐rated health. Conclusions. Beliefs concerning lipid‐lowering treatment should be identified so that they may be effectively addressed in order to improve patient attendance at follow‐up visits to a lipid clinic.     

Unexpected distribution of Hepatitis B genotypes in patients with kidney disease: Comparison with immunocompetent subjects

Hepatitis B virus (HBV) infection has a high prevalence among hemodialysis and renal transplant patients. Data regarding genotype distribution in these populations are scarce and are still under investigation. The aim of this study was to evaluate the distribution of HBV genotypes in end‐stage renal disease (ESRD)‐patients and renal transplant patients and to compare with the distribution observed in immunocompetent patients from the same geographic region. From a population of 213 patients evaluated initially, 120 patients with detectable HBV‐DNA were included in the study and submitted to genotype determination by amplification of S gene by nested PCR followed by sequencing method. Among 41 hemodialysis patients the most frequent genotype was D (83%), followed by genotype A (10%), C (5%), and F (2%). Genotype D was also the most prevalent (73%) among 33 renal transplant patients, followed by genotype A (18%), F (6%), and B (3%). This distribution was similar in these two groups of patients and for the comparative analysis they were considered in the kidney disease group. Compared to immunocompetents, patients with kidney disease (ESRD and renal transplant patients) showed a distinct distribution, with a higher prevalence of genotype D (78% vs. 17%, P < 0.001) whereas genotype A was the most prevalent among immunocompetent patients (70% vs. 14%, P < 0.001). In conclusion, the higher frequency of genotype A in immunocompetent patients and of genotype D in patients with renal disease suggest a higher capacity of environmental transmission or a better adaptability of this genotype in patients with a different pattern of immunologic response. J. Med. Virol. 84:1548–1552, 2012. © 2012 Wiley Periodicals, Inc.     

Alport syndrome: HLA association and kidney graft outcome

Alport syndrome (AS) is a genetic disease of type IV collagen involving non‐homogeneous patterns of inheritance characterized clinically by the presence of progressive haematuric nephritis leading to end‐stage renal disease (ESRD), hearing loss and/or ophthalmologic abnormalities. The aim of this study was to investigate, in a cohort of AS patients who had undergone a kidney graft (KG) or who were still on a waiting list for a KG, (a) whether there is a correlation between AS and HLA antigen expression, and (b) long‐term graft outcome in transplant patients. The AS cohort was represented by 34 ESRD patients, of whom 25 received a KG and the remaining nine were still on a waiting list. AS transplant patients represented 2.78% of 899 first KGs performed at our centre (Transplantation Department at S. Martino Hospital, Genoa) between 1983 and 2002. Grafts were procured from cadaveric donors in 18 cases and from living, related donors in seven cases. All AS transplant patients had a post‐transplant follow‐up period of at least 12 months. Results showed that: (i) the frequency of the HLA‐DRB1*16 antigen was significantly increased in the whole AS cohort as compared to 128 healthy subjects (HS) (corrected P‐value 0.0026; relative risk 7.20) as well as to 232 non‐AS ESRD patients on a waiting list for KG (corrected P‐values 0.0156; relative risk 4.67); (ii) 5‐ and 10‐year graft survivals in the AS transplant patients were 80 and 73%, respectively, and did not differ from those of a control group represented by 25 non‐AS KG recipients matched for sex, age, number of HLA mismatches and immunosuppressive treatment. Increased frequency of HLA‐DRB1*16 in AS patients may reflect a linkage disequilibrium with genes coding for collagen synthesis.     

Association between the polymorphism of HLA and ESRD in Dalian Han population located in north of China

Background: End-stage renal disease (ESRD), the last stage of chronic renal failure, is a global health problem. The number of ESRD patients worldwide is increasing faster than the number of kidneys available per year for renal transplantation. Most of the ESRD patients are awaiting renal transplantation. The immune response to the transplanted kidney is directed mainly against mismatched human leukocyte antigen (HLA) glycoproteins expressed on donor tissues. Thus, the analysis of HLA allele and haplotype polymorphisms is valuable not only for identifying ESRD susceptibility factors but also to improve graft survival. Methods: In this study, 163 Han ESRD patients were recruited to participate. The blood samples were genotyped by sequence-specific oligonucleotide method. A group of 14,529 healthy Chinese Han individuals registered at the Dalian Blood Center as bone marrow donors, living in the same region and of the same ethnicity, were used as controls. Results: We found that only one allele, HLA-DRB1*12, showed a positive association with ESRD (p = 0.004, p_c = 0.028, odds ratio = 1.530, 95% confidence interval = 1.147–2.041); A*02-B*40-DRB1*09, A*02-B*40-DRB1*12, A*24-B*15-DRB1*12, and B*40-DRB1*12 were significantly more frequent in ESRD patients after Bonferroni correction (p_c < 0.05). Conclusion: They were potentially valuable predictors for evaluating the risk of ESRD in the Dalian Han population.     

Dialysis access thrombosis in a family cohort

In 2004, 464,952 individuals were newly diagnosed with chronic renal insufficiency (CRI); 102,356 of those newly diagnosed patients required initiation of dialysis for end-stage renal disease (ESRD). Among the ESRD population, about one third is African American despite the fact that this population represent only about 12% of the total population in the United States (U.S. Renal Data System 2006). Familial aggregation of kidney disease disproportionately affects minorities. This paper describes the detection and management of dialysis access failure due to hypercoagulable states in a genetically related group. We also discuss the implications that associated familial disorders may have on the diagnoses, treatment and survival for this devastating illness.     

Clinical outcomes of current medical approaches for Middle East respiratory syndrome: A systematic review and meta‐analysis

Middle East respiratory syndrome (MERS) is a respiratory disease caused by MERS coronavirus. Because of lack of vaccination, various studies investigated the therapeutic efficacy of antiviral drugs and supportive remedies. A systematic literature search from 10 databases was conducted and screened for relevant articles. Studies reporting information about the treatment of MERS coronavirus infection were extracted and analyzed. Despite receiving treatment with ribavirin plus IFN, the case fatality rate was as high as 71% in the IFN‐treatment group and exactly the same in patients who received supportive treatment only. Having chronic renal disease, diabetes mellitus and hypertension increased the risk of mortality (P < .05), and chronic renal disease is the best parameter to predict the mortality. The mean of survival days from onset of illness to death was 46.6 (95% CI, 30.5‐62.6) for the IFN group compared with 18.8 (95% CI, 10.3‐27.4) for the supportive‐only group (P = .001). Delay in starting treatment, older age group, and preexisting comorbidities are associated with worse outcomes. In conclusion, there is no difference between IFN treatment and supportive treatment for MERS patients in terms of mortality. However, ribavirin and IFN combination might have efficacious effects with timely administration and monitoring of adverse events. Large‐scale prospective randomized studies are required to assess the role of antiviral drugs for the treatment of this high mortality infection.     

Identification of genetic alterations in upper urinary tract urothelial carcinoma in end‐stage renal disease patients

Clinical presentations of end‐stage renal disease (ESRD) patients on dialysis with upper urinary tract urothelial carcinoma (UUT‐UC) are different from those with normal renal function. The pathogenesis remains unknown. We investigated the pathogenetic influence of chromosomal aberrations in patient on dialysis with UUT‐UC. The chromosomal aberrations of UUT‐UC specimens from seven dialysis patients were assessed by conventional comparative genomic hybridization (cCGH). Subsequently, we further investigated 20 cases by whole genome and fine‐tiling oligonucleotide array‐based CGH to demonstrate gains and losses, and compared with the clinicopathologic background. The chromosomal aberrations in UUT‐UC specimens from dialysis patients were more complex than in bladder urothelial carcinoma (B‐UC). Our data showed that gains at 5p, 7, 19q, and losses at 4q, 9p, and 15q are common in UUT‐UC of ESRD patients. Gains in regions associated with DNA repair genes were noted in this study. High‐stage and high‐grade tumors displayed more copy number variants. In addition, female ESRD patients with UUT‐UC had more frequent chromosomal aberrations than their male counterparts. In conclusion, unique chromosomal aberrations were indentified in UUT‐UC in ESRD patients. © 2010 Wiley‐Liss, Inc.     

Potential benefits of mindfulness during pregnancy on maternal autonomic nervous system function and infant development

Mindfulness is known to decrease psychological distress. Possible benefits in pregnancy have rarely been explored. Our aim was to examine the prospective association of mindfulness with autonomic nervous system function during pregnancy and with later infant social‐emotional development. Pregnant women (N = 156) completed self‐report mindfulness and emotional distress questionnaires, and had their autonomic function assessed in their first and third trimesters, including heart rate (HR), indices of heart rate variability (HRV), preejection period (PEP), and systolic (SBP) and diastolic blood pressure (DBP). The social‐emotional development of 109 infants was assessed at 4 months of age. More mindful pregnant women had less prenatal and postnatal emotional distress (p < .001) and higher cardiac parasympathetic activity: root mean square of successive differences (RMSSD: p = .03) and high‐frequency (HF) HRV (p = .02). Between the first and third trimesters, women's overall HR increased (p < .001), and HRV (RMSSD, HF HRV, and low‐frequency (LF) HRV: p < .001) and PEP decreased (p < .001). In more mindful mothers, parasympathetic activity decreased less (RMSSD: p = .01; HF HRV: p = .03) and sympathetic activity (inversely related to PEP) increased less (PEP: p = .02) between trimesters. Their offspring displayed less negative social‐emotional behavior (p = .03) compared to offspring of less mindful mothers. Mindfulness in pregnancy was associated with ANS changes likely to be adaptive and with better social‐emotional offspring development. Interventions to increase mindfulness during pregnancy might improve maternal and offspring health, but randomized trials are needed to demonstrate this.     

African-Americans with End Stage Renal Disease in the Early Years of Kidney Transplantation

Introduction. The first successful kidney transplant in humans was performed in 1954. In the following 25 years, the biomedical, ethical, and social implications of kidney transplantation were widely discussed by both healthcare professionals and the public. Issues relating to race, however, were not commonly addressed, representing a “blind spot” regarding racial disparities in access and health outcomes. Methods. Through primary sources in the medical literature and lay press, this paper explores the racial dynamics of kidney transplantation in the 1950–1970s in the United States as the procedure grew from an experimental procedure to the standard of care for patients in end-stage renal disease (ESRD). Results & Discussion. An extensive search of the medical literature found very few papers about ESRD, dialysis, or renal transplant that mentioned the race of the patients before 1975. While the search did not reveal whether race was explicitly used in determining patient access to dialysis or transplant, the scant data that exist show that African-Americans disproportionately developed ESRD and were underrepresented in these early treatment populations. Transplant outcome data in the United States failed to include race demographics until the late 1970s. The Social Security Act of 1972 (PL 92-603) extended Medicare coverage to almost all Americans with ESRD and led to a rapid increase in both dialysis and kidney transplantation for African-Americans in ESRD, but disparities persist today.