The psychosocial issues of children with perinatally acquired HIV disease becoming adolescents: a growing challenge for providers

Today, providers caring for children who have perinatally acquired HIV disease treat them differently than they did less than a decade ago. As our knowledge of HIV and its treatment have grown, so have we and so have our children. We are seeing the first wave of adolescents with perinatally acquired HIV disease. This increased longevity has given new meaning to past challenges such as treatment regimens, medication adherence, disclosure, and permanency planning previously faced by providers, children, and their families. New challenges, such as adolescent treatment decisions, relationships, intimacy, college, and careers have been added to the list. As a prediatric nurse practitioner having "grown up" with perinatally acquired HIV disease in the last decade, I reflect on past challenges and offer a perspective on those that lie ahead. A multidisciplinary, family-centered support group intervention that was developed at our AIDS Center Program to assist families, older children, adolescents, and providers in facing these challenges is described.     

肾小球滤过率和蛋白尿预测心血管高危患者结局

<正>较低的肾小球滤过率(eGFR)和较高的尿白蛋白肌酐比值(ACR)与主要心血管复合终点相关,例如,对eGFR<30ml/min·1.73m2和非常高的尿ACR校正后风险比为2.53(95%CI:1.61～3.99)。然而,将有关eGFR和尿ACR的信息添加到危险再分类分析中,对分配至中危分类的患者比例并未带来有意义的     

A systematic review of the psychometric properties of transition readiness assessment tools in adolescents with chronic disease

Background

Health care transition of adolescents with chronic conditions may be unsuccessful when patients have not acquired the necessary skills and developmental milestones. It is therefore critical for health care providers to assess the readiness for transition of their adolescent patients. This is currently hindered by the lack of a recognised, well-established transition-readiness assessment tool.

Methods

We conducted a systematic review of all transition-readiness tools for adolescents with chronic medical conditions published in peer-reviewed journals. Tools were rated by the methodological quality of the validation studies, and the psychometric measurement qualities of each tool.

Results

Ten different assessment tools were identified. Seven targeted specific diseases and 3 tools were generic. Most tools were poorly validated with only one tool, the Transition Readiness Assessment Questionnaire (TRAQ) demonstrating adequate content validity, construct validity, and internal consistency.

Conclusion

The TRAQ was the best-validated transition-readiness tool, with additional benefits of disease-neutrality. Further research should focus on testing the predictive validity of this tool, and exploring correlation with transition-outcomes, in an international population.     

Noncellular immunoadsorbents for preparing typing sera that recognize high-frequency red cell antigens

The feasibility of using salivary ABH substance, covalently coupled to an affinity gel as an immunoadsorbent for anti-A and -B in sera containing antibodies to high-frequency antigens was investigated. Several examples of anti-Hy (n = 4), -Jra (n = 3), -U (n = 3), -Lub (n = 3), -Tja (n = 8), and -Vel (n = 6), plus one anti-Coa, were treated by batch adsorption with the affinity gel. Titration of the adsorbed sera with ABO-incompatible cells lacking the relevant high-frequency antigen, in parallel with ABO-compatible cells expressing the high-frequency antigen, revealed that ABO antibodies could be adsorbed to exhaustion without loss of the sera's activity against cells bearing high-frequency antigens.