Role of meditation to improve children's health: Time to look at other strategies.

In the United States, it is reported that up to 7 million of the population practice some form of meditation with the main purpose of improving emotional wellbeing and reducing stress. As the prevalence of mental health conditions continues to climb, other forms of health management strategies, including meditation practices, are increasingly used in adults. The evidence continues to emerge for the use of meditation as a way of managing health conditions in adults as demonstrated in systematic reviews and randomised controlled trials. There is also growing evidence evaluating the use of meditation practices and their potential benefits for child and adolescent health. Studies have identified improvements in mood and mental health conditions, school attendance and attention in the classroom in children and adolescents. This article aims to provide a perspective on commonly evaluated meditation types, such as Transcendental Meditation and mindfulness-based stress reduction. The article also aims to discuss the available evidence for the use of meditation to improve health and general wellbeing of children, including the use of meditation programs in schools, the current downfalls and limitations to the existing literature around meditation, and important points that healthcare practitioners need to consider when discussing the use of meditation as an additional strategy to manage and improve health and wellbeing in children and adolescents.

Cost-utility analysis of sodium polystyrene sulfonate vs. potential alternatives for chronic hyperkalemia.

PURPOSE: Hyperkalemia during renin-angiotensin-aldosterone system inhibition (RAAS-I) may prevent optimum dosing. Treatment options include sodium polystyrene sulfonate potassium binding resins, but safety and efficacy concerns exist, including associated colonic necrosis (CN). Alternative agents have been studied, but cost-utility has not been estimated. METHODS: We performed a cost-utility analysis of outpatients ≥ 18 years of age receiving chronic RAAS-I, with a history of hyperkalemia or chronic kidney disease, prescribed either sodium polystyrene sulfonate or a theoretical "drug X" binding resin for chronic hyperkalemia. Data were obtained from existing literature. We used a decision analytic model with Monte Carlo probabilistic sensitivity analyses, from a health care payer perspective and a 12-month time horizon. Costs were measured in US dollars. Effectiveness was measured in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS: Drug X could cost no more than $ 10.77 per daily dose to be cost-effective, at a willingness-to- pay (WTP) threshold of $ 50,000/QALY. At $ 40.00 per daily dose, drug X achieved an incremental cost effectiveness ratio of $26,088,369.00 per QALY gained. One-way sensitivity analysis showed sodium polystyrene sulfonate to be the cost-effective option for CN incidences ≤ 19.9%. Limitations include incomplete information on outpatient outcomes and lack of data directly comparing sodium polystyrene sulfonate to potential alternatives. CONCLUSIONS: Alternatives may not be cost-effective unless priced similarly to sodium polystyrene sulfonate. This analysis may guide decisions regarding adoption of alternative agents for chronic hyperkalemia control, and suggests that sodium polystyrene sulfonate be employed as an active control in clinical trials of these agents.

The long-term effects of mindfulness-based cognitive therapy as a relapse prevention treatment for major depressive disorder.

BACKGROUND: Mindfulness-based Cognitive Therapy (MBCT) is a relapse prevention treatment for major depressive disorder. METHOD: An observational clinical audit of 39 participants explored the long-term effects of MBCT using standardized measures of depression (BDI-II), rumination (RSS), and mindfulness (MAAS). RESULTS: MBCT was associated with statistically significant reductions in depression from pre to post treatment. Gains were maintained over time (Group 1, 1-12 months, p = .002; Group 2, 13-24 months, p = .001; Group 3, 25-34 months, p = .04). Depression scores in Group 3 did begin to worsen, yet were still within the mild range of the BDI-II. Treatment variables such as attendance at "booster" sessions and ongoing mindfulness practice correlated with better depression outcomes (p = .003 and p = .03 respectively). There was a strong negative correlation between rumination and mindful attention (p < .001), consistent with a proposed mechanism of metacognition in the efficacy of MBCT. CONCLUSION: It is suggested that ongoing MBCT skills and practice may be important for relapse prevention over the longer term. Larger randomized studies of the mechanisms of MBCT with longer follow-up periods are recommended.

The politics of risk: a human rights paradigm for children's environmental health research.

A human rights paradigm for environmental health research makes explicit the relationship between poor health and poverty, inequality, and social and political marginalization, and it aims at civic problem solving. In so doing, it incorporates support for community-based, participatory research and takes seriously the social responsibilities of researchers. For these reasons, a human rights approach may be better able than conventional bioethics to address the unique issues that arise in the context of pediatric environmental health research, particularly the place of environmental justice standards in research. At the same time, as illustrated by disagreements over the ethics of research into lead abatement methods, bringing a human rights paradigm to bear in the context of environmental health research requires resolving important tensions at its heart, particularly the inescapable tension between ethical ideals and political realities.

Production of polyhydroxyalkanoate during treatment of low-phosphorus-content wastewater.

To evaluate whether poly-beta-hydroxyalkanoate (PHA) production and wastewater treatment could be combined in a single biological process, a bench-scale sequencing batch reactor was operated with sequential anaerobic and aerobic stages and removal of excess sludge at different stages of treatment. The reactor treated synthetic wastewater with a high organic and low nutrient content, simulating industrial wastewater. Chemical oxygen demand removal efficiency was more than 90% in all cases. Poly-beta-hydroxyalkanoate accumulation was significant, although it did not appear to be induced by oxygen limitations during the anaerobic stage. Sphaerotilus natans was apparently the dominant PHA-accumulating organism at the end of each reactor run and corresponded to a PHA accumulation of 16 to 20% of the total dry cell mass. Before S. natans dominated the reactors, PHA accumulation was approximately 17% when biomass was removed at the end of the aerobic stage and 6.6% when sludge removal also occurred during the anaerobic stage.

An assessment tool for the older person with spinal cord injury.

Normal aging changes intensify the chronic problems that are experienced by individuals with spinal cord injury (SCI). These changes place them at greater risk for developing vital systems failure and functional impairments, which if unrecognized, may lead to institutionalization or death. Understanding the trajectory of aging, and its impact on structure and function, is paramount in caring for individuals with SCI. Moreover, trends in health care toward capitation, managed care systems, and shifts to outpatient care portend a delivery system with more limited resources and greater restrictions (Lubitz, Greenberg, Gorina, Wartzman, & Gibson, 2001; National Institute of Aging, 2000). These trends potentially compromise health care access, quality, and cost for at-risk populations, especially for individuals aging with an SCI. Therefore, it behooves SCI nurses to develop a comprehensive approach to assess individuals who have chronic and debilitating injuries such as SCI. More importantly, assessing these individuals will require SCI nurses to adapt current tools that will aid in this endeavor and perhaps create new ones that will reflect the magnitude of SCI presentations and care. Employing the nursing process, SCI nurses will need to gather data from a myriad of sources. The first important step is establishing a baseline. Using a functional health pattern tool (FHPT) developed by Gordon (1987), and adapted from the North American Nursing Diagnosis Association (1987), is one such method of constructing a database and formulating diagnoses (Gordon, 1994). The FHPT provides a holistic view of individuals and families in any practice setting and it can be easily adapted to specialty areas within nursing. Therefore its application to both SCI and aging is fitting (Popkess-Vawter, 1997). These authors adapted the FHPT format to create a tool that will make it more reflective of changes that occur in individuals who have SCI and are aging.

Un instrumento para evaluar la actuación del terapeuta durante la entrevista clínica / An instrument to assess the performance of the therapist during the clinical interview

No disponible

Formation of DNA-damaging nitroso compounds by interaction of drugs with nitrite. A preliminary screening for detecting potentially hazardous drugs.

Fifty-seven theoretically nitrosatable widely used drugs that are commonly administered orally have been screened to determine the formation of nitroso compounds by drug-nitrite interaction and to evaluate the genotoxicity of their nitrosation products against Chinese hamster ovary (CHO) cells, measured as DNA-damaging potency by the alkaline elution technique. The drug (0.1 mmol) was reacted with NaNO2 (0.4 mmol) at pH 3-3.5 for 1 h. Nitroso compounds were present in varying yield in the nitrosation mixture of 47 drugs. Twenty-two drugs formed direct-acting nitroso compounds capable of producing DNA fragmentation, i.e., a statistically significant (p less than 0.01) increase in the elution rate of CHO cell DNA. On a molar basis, their DNA-damaging potency varied over a 570-fold range, with 12 exhibiting greater potency than that of N-nitroso-N-methylurea.

DNA fragmentation in N-diazoacetylglycine amide-treated cells determined, by the rate of strand separation in alkali with hydroxylapatite chromatography in batch.

DNA damage induced in mammalian cells (CHO-K1) by one hour treatment with several concentrations of N-diazoacetylglycine amide (DGA) was evaluated by the method of DNA denaturation in alkali and successive neutralization followed by separation of single from double stranded DNA with the recently described technique of hydroxylapatite chromatography performed in batch. This latter technique does not need complex apparatus and simplifies the simultaneous handling of large number of samples; it also appears as sensitive and reliable as the DNA alkaline elution on filter, to which it can be regarded as both alternative and complementary.

A practical procedure for testing DNA damage in vivo, proposed for a pre-screening of chemical carcinogens.

The alkaline elution method was adapted to the evaluation of DNA damage induced in vivo through a practical and reliable microfluorometric procedure, without any need for tissue pre-labeling. The DNA damage induced in vivo by treatment with a single dose of N-nitrosodimethylamine (DMNA), N-methyl-N-nitroso-urea (MNU), 1,2-dimethylhydrazine (DMH) or cycasin has been detected in different organs of mice or rats. The results obtained are rather consistent with the organotropism of these carcinogens, and show a satisfactory dose dependent of DNA damage. DMH and cycasin, both negative in the Ames' Salmonella/microsome mutagenicity test, are clearly positive with in vivo DNA damage/alkaline elution assay. This latter method, complemented with other short-term tests, may play a useful role in the pre-screening of chemical carcinogens.