American Society of Nephrology Quiz and Questionnaire 2013: Transplantation

The nephrology quiz and questionnaire remains an extremely popular session for attendees of the Annual Meeting of the American Society of Nephrology. As in past years, the conference hall was overflowing with interested audience members. Topics covered by expert discussants included electrolyte and acid–base disorders, glomerular disease, ESRD/dialysis, and transplantation. Complex cases representing each of these categories along with single best answer questions were prepared by a panel of experts. Before the meeting, program directors of United States nephrology training programs answered questions through an Internet-based questionnaire. A new addition to the nephrology quiz and questionnaire was participation in the questionnaire by nephrology fellows. To review the process, members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. Their answers are compared in real time using audience response devices with the answers of nephrology fellows and training program directors. The correct and incorrect answers are then briefly discussed after the audience responds, and the results of the questionnaire are displayed. This article recapitulates the session and reproduces its educational value for the readers of CJASN. Enjoy the clinical cases and expert discussions.     

Parental phubbing accelerates depression in late childhood and adolescence:A two-path model

IntroductionPhubbing is a social exclusion behavior related to mobile phone use. It undermines interpersonal relationships and mental health. This study aimed to test the connections between parental phubbing and depression in late childhood and adolescence, as well as the mediating roles of parental warmth, parental rejection, and relatedness need satisfaction.MethodsWe conducted two studies. Study 1 was a cross-sectional study of 530 Chinese students (268 boys and 262 girls, M_age = 13.15 ± 0.64 years) who completed self-report questionnaires. We conducted structural modeling to test the relationship between parental phubbing and depression. Study 2 used a short longitudinal design to validate the results of Study 1 and test the mediating roles of parental warmth, parental rejection, and relatedness need satisfaction. In Study 2, we recruited 293 Chinese students (151 boys, 141 girls, and one participant with no reported gender information, M _age = 12.87 ± 0.74 years) to complete the questionnaires and applied structural equation modeling to analyze the data.ResultsTwo sequential mediation effects were found. The first was parental phubbing → parental warmth → relatedness need satisfaction → depression (protection-reduced effect). The second was parental phubbing → parental rejection → relatedness need satisfaction → depression (risk-increased effect). Gender differences were non-significant.ConclusionsThe study revealed that parental phubbing was associated with students’ depression in late childhood and adolescence through two paths. The present study highlights the need to establish family norms regulating mobile phone use to reduce phubbing.     

Association Between Parental Marital Status and Types of Suicidal Behavior Among Korean Adolescents: A Cross-sectional Study

ObjectivesAdolescent suicide is a global problem. This study aimed to identify associations between parental marital status and suicidal behavior.MethodsThis study analyzed 118 715 middle and high school students from the 13th and 14th Korea Youth Risk Behavior Web-based Survey. The odds ratios (ORs) of suicidal ideation, planning, and attempts were calculated based on parental marital status, living situation, and socioeconomic factors. The data were analyzed using multiple logistic regression.ResultsWhen compared to those living with 2 married biological parents, the ORs of suicidal ideation among adolescents living with either remarried or no parents were 1.34 (95% confidence interval [CI], 1.17 to 1.53) and 1.36 (95% CI, 1.11 to 1.66), respectively. For suicidal planning, the OR of those living with 1 remarried biological parent was 1.24 (95% CI, 1.01 to 1.52), and that of those living without parents was 1.28 (95% CI, 0.95 to 1.73), when compared to adolescents living with 2 married biological parents. For suicide attempts, when compared to adolescents with 2 married biological parents, the OR of those living with 1 remarried biological parent was 1.48 (95% CI, 1.17 to 1.87) and that of those living without parents was 2.02 (95% CI, 1.44 to 2.83). For adolescents living with 1 remarried biological parent, suicidal behavior was strongly associated with having no siblings and were weakly associated with not living with grandparents.ConclusionsSuicidal behavior among adolescents was associated with the remarriage and loss of parents. Therefore, special attention and interventions are needed for adolescents in those situations.     

The impact of non-HLA antibodies on outcomes after lung transplantation and implications for therapeutic approaches

The role of donor-specific antibodies (DSA) to mismatched human leukocyte antigens (HLA) in lung allograft rejection has been recognized over the past 20 years. During this time, there has been growing experience and recognition of an important role for non-HLA antibodies in lung allograft rejection. Multiple self-antigens have been identified that elicit autoimmune responses including collagen V, K-α 1 tubulin, angiotensin type 1 receptor, and endothelin type A receptor, but it is likely that other antigens elicit similar responses. The paradigm for the pathogenesis of these autoimmune responses consists of exposure of sequestered self-antigens followed by loss of peripheral tolerance, which then promotes allograft rejection. Studies have focused mainly on the impact of autoimmune responses on the development of Bronchiolitis Obliterans Syndrome or its mouse model surrogate. However, there are emerging data that illustrate that non-HLA antibodies can induce acute antibody-mediated rejection (AMR) after lung transplantation. Treatment has focused on antibody-depletion protocols, but experience is limited to cohort studies and appropriate controlled trials have not been conducted. It is noteworthy that depletion of non-HLA antibodies has been associated with favorable clinical outcomes. Clearly, additional studies are needed to identify the optimal therapeutic approaches to non-HLA antibodies in clinical practice.     

What do mothers want to know about teens' activities? Levels,trajectories, and correlates

Middle class mothers (n = 169) of middle adolescents (M = 15.69 years old) in the U.S. rated how much they want to know and responded qualitatively about what they “always” and “never” want to know about adolescents' risky prudential (e.g., drinking alcohol, using illegal drugs), personal (e.g., teens' private conversations), and multifaceted (involving overlapping prudential and personal concerns) activities. Latent growth curve modeling over one year showed that mothers wanted to know most about prudential, less about multifaceted, and least about personal activities; wanting to know declined over time for each type of activity, but less for prudential than for other activities. With teen problem behavior controlled, psychologically controlling parenting, supportive and negative interactions with teens, knowledge of adolescents' activities, and teens' age were associated with individual differences in mothers' initial ratings and trajectories of wanting to know, although results varied by domain and were moderated by teen gender.     

Relationship between European Mitochondrial Haplogroups and Chronic Renal Allograft Rejection in Patients with Kidney Transplant

Mitochondrial DNA variants may contribute to differences in mitochondrial function, leading to an altered immune system. The aim of this study was to analyze the relationship between mtDNA haplogroups and the development of chronic allograft dysfunction in patients with kidney transplant. A retrospective observational study was carried out on 261 patients who received kidney transplant (114 had stable transplant and 147 patients developed chronic allograft dysfunction). DNA samples were genotyped for 14 mtDNA polymorphisms by using Sequenom''s MassARRAY platform (San Diego, CA, USA). Only European white patients within the N macro-cluster were included. Patients with haplogroups V (odds ratio (OR)=0.32; p=0.037) and J (OR=0.36; p=0.038) showed lower odds for developing CRAD than patients with haplogroup H. After adjusting for the most significant variables, haplogroups V and J tended to statistical significance (p=0.091 and p=0.067 respectively). This is a preliminary study in which mtDNA haplogroups seem to be implicated in susceptibility or protection for developing chronic allograft dysfunction.     

How does parental cancer affect adolescent and young adult offspring? A systematic review

ObjectivesTo i) identify and synthesise evidence published since 2007 regarding the impact of parental cancer on adolescent and young adult offspring, ii) identify methodological and evidence gaps addressed during this period and iii) highlight those requiring further attention.DesignA systematic review and thematic synthesis of peer reviewed literature regarding the impact of parental cancer upon AYA offspring.Data sourcesOnline searches of CINAHL, Embase, Medline, PsychInfo and Scopus databases were conducted. Reference lists of included articles were screened and additional searches by prominent authors were performed.Review methodsStudy selection, data extraction and quality analysis was undertaken by three independent researchers. Extracted study data was iteratively reviewed and discussed to achieve consensus regarding thematic synthesis of included studies.ResultsDatabase and hand-searching yielded 1730 articles, 54 of which were included in the final synthesis. Included studies are discussed with respect to the following themes: i) study design and quality; ii) measurement and sampling; iii) positive and negative aspects of parental cancer; iv) needs; v) communication and information; vi) coping strategies; vii) interventions; and viii) family functioning and other predictors. Twenty-nine studies reported negative impacts related to parental cancer, while eight identified positive outcomes related to post-traumatic growth. Five returned null or mixed findings. Unmet needs were frequently explored and a new validated measure developed. Communication and information were particularly important for offspring, though these needs were often unmet and parents wanted guidance regarding discussions with their children. Offspring may adopt a variety of coping strategies, some of which appear maladaptive, and may cycle between different approaches. Few evaluations of interventions were identified, and further work in this area is needed. Further evidence has emerged that poorer family functioning and other family and illness-related factors predict worse psychosocial outcomes for offspring, however evidence for other predictors such as age and gender remain mixed.ConclusionsAdditional evidence for the negative psychosocial impact of parental cancer on adolescent and young adult offspring, their needs, and factors predicting psychosocial outcomes has emerged in the last decade. However, substantial gaps and methodological issues remain and evidence for the development, efficacy or implementation of interventions for this population is very limited. There is also a clear need for greater focus on bereaved and young adult offspring and those from non-western cultural groups, who remain under-represented in research conducted to date.     

The relationship between parenting stress,parental intelligence and child behavior problems in a study of Korean preschool mothers

The current study examined the relationship between Korean mothers’ parenting stress and parental intelligence, and child behavior problems as well as the mediation effects of parental intelligence, which tested the association between parenting stress and child behavior problems. A sample of 436 typically developing children and their mothers participated and were assessed by the Parenting Stress Index—Short Form, the Parental Intelligence Scale and the K‐Child Behavior Check List. Results indicated that parenting stress, parental intelligence and child behavior problems were related; especially, parenting stress significantly predicted child behavior problems. Despite its substantive relationship, parental intelligence did not appear to mediate this relationship.     

Socioeconomic,demographic study on substance abuse among students of professional college in a southern town,Berhampur of Odisha state (India)

Currently there is an increasing trend of substance abuse in developing countries like India. This study attempted to identify the different predisposing factors, associated psycho-social and medical problems, prevalence and types of substance abuse in students. The study covered a cross-section of 720 students with an overall male to female ratio of 4.1:1. The majority of the sufferers were from middle socioeconomic class, aged between 15 and 19 years. Common substances of abuse were chewable tobacco and cannabis. The risk of abuse was more in hostellers hailing from broken families (62.5%). Friends had the highest influence (59%). Most of them (49.4%) tried multiple times to give up, but peer pressure (53%) compelled them to restart. In 60.8% cases the parents were completely unaware about this behavior. The commonly associated problems were psychological (34.3%) and medical (29.5%).Our study at the end points out major risk factors and their remedial measures to curb substance abuse.     

Parental warmth and psychiatric disorders among Puerto Rican children in two different socio-cultural contexts

BackgroundParental warmth (PW) has a strong influence on child development and may precede the onset of psychiatric disorders in children. PW is interconnected with other family processes (e.g., coercive discipline) that may also influence the development of psychiatric disorders in children. We prospectively examined the association between PW and child psychiatric disorders (anxiety, major depression disorder, ADHD, disruptive behavior disorders) over the course of three years among Puerto Rican youth, above and beyond the influence of other family factors.MethodsBoricua Youth Study participants, Puerto Rican children 5 to 13 years of age at Wave 1 living in the South Bronx (New York) (SB) and San Juan and Canguas (PR) (n = 2,491), were followed for three consecutive years. Youth psychiatric disorders were measured by the Diagnostic Interview Schedule for Children-IV (DISC-IV). Generalized Linear Mixed models tested the association between PW (Wave 1) and psychiatric disorders in the next two years adjusting for demographic characteristics and family processes.ResultsHigher levels of PW were related to lower odds of child anxiety and major depressive disorder over time (OR = 0.69[0.60; 0.79]; 0.49[0.41; 0.58], respectively). The strength of the association between PW and ADHD and disruptive behavior disorder declined over time, although it was still significant in the last assessment (OR = 0.44[0.37; 0.52]; 0.46[0.39; 0.54], respectively). PW had a unique influence on psychiatric disorders beyond the influence of other parenting and family processes. Stronger associations were observed among girls for depression and ADHD.ConclusionsIncorporating PW behaviors such as acceptance, support, and comforting into interventions focused on parenting skills may help prevent child psychiatric disorders.