Anger in Adolescent Communities: How Angry Are They?

Anger is a common factor in two causes of death in adolescence: homicide and suicide. This study looked at the level of anger in non-clinical convenience sample of adolescents (N = 139) between the ages of 12 and 19 years (early: 12 to 14 years, mid: 15 to 16 years, late: 17 to 19 years) from a large Southeastern Baptist church. Participants completed the State-Trait Anger Expression Inventory, Beck and Children's Depression Inventories, and Children of Alcoholics Screening Test (CAST). The level of self-reported anger was low. The difference in anger between the three age groups was not statistically significant. Differences in gender were generally not significant statistically. A strong correlation exists between stress and anger. A minor relationship between parental drinking behaviors, as measured by the CAST, and anger was found. A significant relationship between anger and depression, and frequency of participation in religious activity and decreased anger was established. By increasing the current knowledge of anger in adolescents, it may be possible to gain insight into risk factors or triggers that cause anger. Interventions must be implemented early to prevent juvenile detention and to help adolescents remain in the community. Public policies addressing anger in adolescents are essential. Health care providers must work together to identify adolescents with disorders or feelings of isolation or disconnect and provide treatment based in communities so adolescents can still function and not be isolated. It is relevant that a mentor or someone that can be trusted is provided to build a safe and secure environment. This greater knowledge may aid in assessment and treatment of adolescents with dysfunctional anger.

A randomized, open-label, 5-period, balanced crossover study to evaluate the relative bioavailability of eltrombopag powder for oral suspension (PfOS) and tablet formulations and the effect of a high-calcium meal on eltrombopag pharmacokinetics when administered with or 2 hours before or after PfOS.

BACKGROUND: Bioavailability of the tablet formulation of eltrombopag, an oral thrombopoietin receptor agonist indicated for the treatment of chronic immune thrombocytopenia, is reduced by chelation of polyvalent cations (eg, calcium). A powder for oral suspension (PfOS) formulation has been developed for use in pediatrics. OBJECTIVE: We aimed to assess the bioavailability of eltrombopag PfOS relative to the tablet formulation and the effect of a high-calcium meal on PfOS bioavailability. METHODS: In this single-dose, open-label, randomized-sequence, crossover study, healthy subjects received 25 mg eltrombopag orally as a tablet fasted and as PfOS fasted or with, 2 hours before, or 2 hours after a high-calcium meal. Noncompartmental pharmacokinetic parameters were estimated from plasma concentration-time data collected over 72 hours post-dose. Tolerability was assessed by laboratory tests, physical examinations, and adverse events (AEs). RESULTS: The 40 enrolled subjects included 22 males and 18 females of white/European (60%) or African-American/African (40%) heritage with mean (SD) (mininum, maximum) age of 34 (12) (19, 62) years, weight of 75 (12) (54, 101) kg, and body mass index of 25.8 (2.9) (19.7, 30) kg/m(2). Plasma eltrombopag AUC(0-∞) was higher for the PfOS than the tablet (geometric least-squares mean ratio [GMR]: 1.22; 90% CI: 1.08-1.38). Plasma eltrombopag AUC(0-∞) was reduced when the PfOS was administered with a high-calcium meal (GMR: 0.25; 90% CI: 0.224-0.287) or 2 hours after a meal (GMR: 0.53; 90% CI: 0.470-0.601), and, to a lesser extent, when administered 2 hours before a meal (GMR: 0.80; 90% CI: 0.711-0.908). The absorption lag time and t(½) did not differ between treatments; T(max) was delayed 1 hour when the PfOS was dosed with a high-calcium meal. AEs were not serious and mild or moderate in intensity. AEs reported in >1 subject included headache (11 subjects; 27.5%), presyncope (3 subjects, 7.5%), and vomiting (2 subjects, 5%). No clinically significant trends in laboratory tests or vital signs were observed. CONCLUSIONS: In a healthy adult volunteer population, bioavailability of eltrombopag PfOS was greater than the tablet and was reduced when administered with or 2 hours before or after a high-calcium meal; this effect was attenuated with PfOS dosing 2 hours before the meal. Eltrombopag was generally well tolerated.

Clinical pharmacokinetics, platelet response, and safety of eltrombopag at supratherapeutic doses of up to 200 mg once daily in healthy volunteers.

This was a double-blind, placebo-controlled, randomized, parallel, dose-escalation study to assess the pharmacokinetics, platelet response, safety, and tolerability of supratherapeutic doses of eltrombopag (100 mg, 150 mg, and 200 mg once daily) administered for 5 days to 33 healthy adult volunteers. Plasma eltrombopag concentrations accumulated between days 1 and 5, with average increases of 66% to 81% for area under the plasma concentration-time curve from time zero to the end of the 24-hour dosing interval (AUC(0-τ)) and 32% to 45% for maximum observed plasma concentration (C(max)) across doses. After 5 days of dosing, AUC(0-τ) was dose-proportional and C(max) was less than dose-proportional over eltrombopag 100 to 200 mg with slope estimates (90% confidence intervals) of 0.92 (0.45-1.39) and 0.76 (0.29-1.22), respectively. Platelet counts peaked at day 14, and maximum change from baseline platelet count increased dose-dependently, with mean platelet count increases of 14, 67, 107, and 150 Gi/L for placebo and eltrombopag 100 mg, 150 mg, and 200 mg, respectively. There was no notable difference in day 14 mean platelet aggregation between eltrombopag (59 to 74%) and placebo (67%), although this was not tested statistically. There was no notable difference in adverse event frequency across eltrombopag doses. Eltrombopag pharmacokinetics and platelet response were dose-dependent, and doses up to 200 mg/d were well tolerated, with safety profiles similar to placebo.

Eltrombopag does not affect cardiac repolarization: results from a definitive QTc study in healthy subjects.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Some non-anti-arrhythmic drugs delay cardiac repolarization, which can be measured as an increase in the QT interval. Delays in cardiac repolarization create an electrophysiological environment that favours the development of cardiac arrhythmias, which may lead to torsade de pointes, which can be fatal. As part of the clinical development of eltrombopag, a thorough QT(c) study was conducted to evaluate the effects of eltrombopag on cardiac repolarization at both therapeutic and supratherapeutic doses and to characterize the relationship between plasma eltrombopag concentrations and change in QT(c). WHAT THIS STUDY ADDS: This study found no clinically significant QT prolongation for eltrombopag when administered as 50 mg or 150 mg every day for 5 days. There were no safety or tolerability signals of clinical concern. A small incidence of ventricular premature beats was observed, but this was consistent with previously reported incidences in healthy volunteers without apparent heart disease. AIM: To evaluate the effect of eltrombopag on cardiac repolarization and to characterize the relationship between plasma eltrombopag concentrations and change in QT(c). METHODS: This was a double-blind, placebo- and active-controlled, randomized, balanced four-period, crossover study in healthy men and women. Subjects were randomized to receive eltrombopag 50 mg and 150 mg, moxifloxacin 400 mg (positive control) and placebo in one of four sequences. RESULTS: Eighty-seven subjects entered the study and 48 completed. There was no prolongation of QT(c) (Fridericia) following eltrombopag treatment, as the upper limit of the 90% confidence interval (CI) for the time-matched change from baseline in QT(c)F between drug and placebo (ddQT(c)F) did not exceed 10 ms for eltrombopag at either dose. Maximum observed mean treatment difference was 2.29 ms (90% CI 0.34, 4.24) for eltrombopag 150 mg at 1 h post-dose and 11.64 ms (90% CI 9.64, 13.64) for moxifloxacin 400 mg at 4 h. Eltrombopag C(max) and AUC(0,24 h) increased in a dose proportional manner between 50 mg and 150 mg after 5 days' dosing. Proportions of subjects with adverse events were similar across treatments (52-66% of subjects). Most withdrawals (26/39 subjects) were due to elevated platelets. Three subjects were withdrawn for ventricular premature beats (one following each active treatment) reported as related to the study drug. CONCLUSIONS: No clinically significant QT(c) prolongation was observed for eltrombopag at therapeutic and supratherapeutic doses.

Ageism revisited: a study measuring ageism in East Tennessee, USA.

Research literature over the past 50 years has addressed ageism, but few studies have examined the measurement of ageism or how to combat it. This study utilized Palmore's Ageism Survey to measure the frequency of occurrence of ageism and to examine the types of ageism reported by older adults in the East Tennessee region of the USA. A convenience sample of 247 community-dwelling older adults was recruited from eight senior centers and nutrition sites. The participants ranged in age from 60-92 years. Eighty-four percent of the participants indicated an experience with at least one type of ageism. The forms of ageism frequently reported were jokes and birthday cards that poked fun at older people. Events showing disrespect also were reported. Differences in urban/suburban and rural reporting were noted. The findings from this and similar studies might provide guidance for the measurement of ageism and how to combat it.

Growing up and growing older.

Americans are living longer than ever before. A child born today can expect to live 80 years, 90 years, or longer. Many of today's children will live to be centenarians. Aging education to prepare people for the long life ahead has been endorsed since the first White House Conference on Aging in 1961. However, little is happening with aging education in our homes, schools, and communities. This article discusses the school nurse's role in helping to prepare children for the long life ahead of them and presents aging education resources and activities. School nurses can help to create a generation of Americans who value older adults, have positive attitudes about aging, and plan for successful healthy aging.