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1.
Cureus ; 15(9): e45124, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37842390

RESUMO

BACKGROUND: Globally, a very high percentage of acute kidney injury (AKI) occurs in low- and middle-income countries (LMICs) where late recognition contributes to increased mortality. There are challenges with using existing biomarkers of AKI in LMICs. Emerging evidence suggests renin may serve as a biomarker of kidney injury that can overcome limitations in creatinine-based diagnostics. METHODS: Two study populations in Uganda were assessed. Cohort #1 was a two-site, prospective cohort study enrolling 600 children with severe malaria (SM). Cohort #2 was a prospective cohort study enrolling 185 children with sickle cell disease (SCD) hospitalized with a vaso-occlusive crisis. Plasma or serum renin concentrations were measured in both cohorts of children at the time of hospital admission using Luminex® (Luminex Corporation, Austin, Texas, United States) or enzyme-linked immunosorbent assay (ELISA), respectively. We assessed the ability of renin to discriminate between children with or without AKI and between children who survived and children who died using receiver operating characteristic curves. RESULTS: In both cohorts, renin concentrations were strongly associated with AKI and mortality. Renin was able to discriminate between children with or without AKI with an area under the curve (AUC) of 0.70 (95%CI, 0.65-0.74) in children with SM and 0.72 (95%CI, 0.6co3-0.81) in children with SCD. Renin was able to discriminate between children who survived and children who died with an AUC of 0.73 (95%CI, 0.63-0.83) in children with SM and 0.94 (95%CI, 0.89-0.99) in children with SCD. In Cohort #2, we compared renin against urine neutrophil gelatinase-associated lipocalin (NGAL) as the leading biomarker of AKI, and it had comparable performance in discriminating AKI and predicting mortality. CONCLUSIONS: In two independent populations of children at risk of AKI with key differences in the etiology of kidney injury, renin was strongly associated with AKI and mortality and had moderate to good diagnostic performance to predict mortality.

2.
Front Hum Neurosci ; 17: 1177242, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37200952

RESUMO

Introduction: Cerebral malaria is one of the most severe manifestations of malaria and is a leading cause of acquired neurodisability in African children. Recent studies suggest acute kidney injury (AKI) is a risk factor for brain injury in cerebral malaria. The present study evaluates potential mechanisms of brain injury in cerebral malaria by evaluating changes in cerebrospinal fluid measures of brain injury with respect to severe malaria complications. Specifically, we attempt to delineate mechanisms of injury focusing on blood-brain-barrier integrity and acute metabolic changes that may underlie kidney-brain crosstalk in severe malaria. Methods: We evaluated 30 cerebrospinal fluid (CSF) markers of inflammation, oxidative stress, and brain injury in 168 Ugandan children aged 18 months to 12 years hospitalized with cerebral malaria. Eligible children were infected with Plasmodium falciparum and had unexplained coma. Acute kidney injury (AKI) on admission was defined using the Kidney Disease: Improving Global Outcomes criteria. We further evaluated blood-brain-barrier integrity and malaria retinopathy, and electrolyte and metabolic complications in serum. Results: The mean age of children was 3.8 years (SD, 1.9) and 40.5% were female. The prevalence of AKI was 46.3% and multi-organ dysfunction was common with 76.2% of children having at least one organ system affected in addition to coma. AKI and elevated blood urea nitrogen, but not other measures of disease severity (severe coma, seizures, jaundice, acidosis), were associated with increases in CSF markers of impaired blood-brain-barrier function, neuronal injury (neuron-specific enolase, tau), excitatory neurotransmission (kynurenine), as well as altered nitric oxide bioavailability and oxidative stress (p < 0.05 after adjustment for multiple testing). Further evaluation of potential mechanisms suggested that AKI may mediate or be associated with CSF changes through blood-brain-barrier disruption (p = 0.0014), ischemic injury seen by indirect ophthalmoscopy (p < 0.05), altered osmolality (p = 0.0006) and through alterations in the amino acids transported into the brain. Conclusion: In children with cerebral malaria, there is evidence of kidney-brain injury with multiple potential pathways identified. These changes were specific to the kidney and not observed in the context of other clinical complications.

3.
J Gerontol B Psychol Sci Soc Sci ; 78(8): 1396-1401, 2023 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-36842065

RESUMO

OBJECTIVES: We offer new insights on how older adults in the United States navigate the aftermath of gray divorce (i.e., divorce that occurs among adults aged 50+) by describing their living arrangements upon divorce and tracking the stability of these configurations over time. Living arrangements are important to decipher because they are linked to health, well-being, and longevity. METHODS: Using data from the 1998-2014 Health and Retirement Study, we uncovered patterns of U.S. older adult living arrangements upon divorce (N = 1,057), distinguishing among those who lived alone, lived with others, and lived with a new partner. Multinomial logistic regression models were estimated to assess how individual characteristics (demographics, marital biography, economic resources, health, and social ties) were associated with these configurations. Cumulative survival probabilities gauged the relative stability of these 3 living arrangements. RESULTS: About half of U.S. adults lived alone upon gray divorce, another one-third lived with others, and the remaining 14% lived with a new partner. Adults living with a new partner tended to exhibit the most advantaged sociodemographic profiles, whereas those living solo or with others were largely comparable. More than 70% of adults experienced a subsequent living arrangement transition if they lived with others upon divorce, versus just 50% of those living alone and only 30% of those with a new partner. DISCUSSION: After divorce, older adults reside in a range of living arrangements, some of which are more stable than others. Future work should address whether and how these arrangements and their durability are related to postdivorce adjustment.


Assuntos
Divórcio , Casamento , Humanos , Estados Unidos , Idoso , Características de Residência , Longevidade , Aposentadoria
4.
J Gerontol B Psychol Sci Soc Sci ; 78(9): 1591-1603, 2023 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-36462213

RESUMO

OBJECTIVES: This study examined short- and long-term psychological adjustment to parental bereavement in later life for mothers and fathers. METHODS: Using 9 waves of data from the United States (1998-2014 Health and Retirement Study), I estimated trajectories of mothers' and fathers' depressive symptoms surrounding child death in later life, highlighting gender differences in adjustment. Moderation analyses were performed to uncover heterogeneous trajectories across parental characteristics. RESULTS: Mothers were more likely to experience child death and reported higher depressive symptoms prior to parental bereavement than fathers. Mothers and fathers who lost a child reported an increase in depressive symptoms that diminished over time. The short-term elevation in depressive symptoms was marginally greater for mothers than fathers, but depressive symptoms declined at a faster rate for mothers than fathers in the years following the death. These counterbalancing changes resulted in mothers and fathers returning to their respective prebereavement levels of depressive symptoms between 2 and 4 years postbereavement. Parental age moderated trajectories distinctly by gender, and the presence of surviving children buffered the impact of child death on depressive symptoms for mothers but not fathers. DISCUSSION: Mothers more often experience child death in later life and their adjustment process differs from that of fathers, underscoring the salience of gender in shaping how older parents respond to the death of a child. Older parents and mothers without surviving children are vulnerable to prolonged elevations in depressive symptoms following the death of a child in later life.


Assuntos
Luto , Depressão , Feminino , Humanos , Depressão/epidemiologia , Depressão/psicologia , Fatores Sexuais , Mães/psicologia , Pais/psicologia
5.
J Marriage Fam ; 84(4): 1220-1233, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36312598

RESUMO

Objective: This study documented change in the midlife first marriage rate for U.S. adults aged 40-59 between 1990 and 2019 and assessed the sociodemographic correlates of midlife first marriage formation for today's women and men. Background: Median ages at first marriage are at record highs for women and men, signaling that marriage may be increasingly occurring at older ages. However, first marriage formation among midlife adults remains largely overlooked. Method: Data from the 1990 U.S. Vital Statistics and the 2010 and 2019 American Community Survey (ACS) were used to estimate change in women's and men's first marriage rates across age groups, with a focus on how the rate has changed for midlife adults. Average marginal effects (AMEs) were derived from logistic regression analyses that drew on the 2019 ACS to examine associations between sociodemographic factors and midlife first marriage formation for women and men. Results: Since 1990, the midlife first marriage rate has increased by 75% for women and 45% for men. The shares of women and men entering a first marriage who were aged 40-59 quadrupled between 1990 and 2019 (rising from 2% to 9% among women and from 3% to 12% among men). Some of the well-established predictors of first marriage in young adulthood operated uniquely for first marriage formation in midlife. Conclusion: Future research on first marriage formation should incorporate midlife adults.

6.
J Gerontol B Psychol Sci Soc Sci ; 77(5): 930-935, 2022 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-34969095

RESUMO

OBJECTIVES: We introduced a unique form of kinlessness: sole family survivorship, which describes the lack of family of origin (i.e., biological parents and siblings) kin. This form of kinlessness may be particularly consequential for older adults who experience other forms of kinlessness (e.g., no spouse/partner or no children) as they are especially likely to have relied on their family of origin for support. METHODS: Data from the 1998-2014 Health and Retirement Study (N = 148,346 person-waves) were used to estimate the prevalence of sole family survivorship among adults aged 55 and older and men and women aged 55-74 and 75+. Variation in prevalence levels of sole family survivorship across sociodemographic characteristics, health indicators, and family factors were also estimated. Finally, we tracked cohort trends in sole family survivorship. RESULTS: More than 1 in 10 adults aged 55+ were sole family survivors and this figure rose to more than 1 in 4 among those aged 75+. Adults with no spouse/partner and no children were especially likely to be sole family survivors, meaning they face a double burden of kinlessness. DISCUSSION: Sole family survivorship represents the culmination of loss of multiple, lifelong kin ties. It is more common among those lacking other close kin, signaling the presence of a uniquely vulnerable group of older adults who experience multiple forms of kinlessness. Future research should address how older adults and society at large adapt to kinlessness to ensure successful aging.


Assuntos
Envelhecimento , Família , Idoso , Feminino , Humanos , Masculino , Sobreviventes
7.
J Gerontol B Psychol Sci Soc Sci ; 77(1): 212-223, 2022 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-34309664

RESUMO

OBJECTIVES: Divorce is now widespread in later life, yet little is known about how older adults and their adult children respond in the aftermath of gray divorce. Guided by the life course perspective, this study examines the consequences of gray divorce and subsequent repartnering for parent-adult child relationships from the parent's perspective. METHODS: Using longitudinal data from the 1998-2014 Health and Retirement Study in the United States, we estimated growth curve models to compare fathers' and mothers' frequent contact with and financial support to their adult children prior to, during, and following gray divorce. RESULTS: Gray divorce and repartnering had disparate effects on father- versus mother-adult child relationships. Following a divorce, fathers' frequent contact with their adult children decreased but financial support to their adult children increased. Fathers' repartnering had an enduring negative effect on frequent contact with their children. Gray divorce did not alter mothers' financial support to adult children and it actually increased interaction between mothers and adult children as the odds of frequent contact doubled upon divorce. Repartnering had no appreciable effects on mothers' relationships with their adult children. DISCUSSION: The results of our study are consistent with prior research showing that divorce creates a matrifocal tilt in our kinship system. The shifting dynamics of parent-adult child relationships in response to gray divorce and repartnering raise questions about whether gray-divorced parents will be able to rely on their adult children for care as they age.


Assuntos
Filhos Adultos/psicologia , Divórcio/psicologia , Relações Pai-Filho , Relações Mãe-Filho/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estados Unidos
8.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(10): 123-130, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34874667

RESUMO

Research shows that not only medical but also psychological factors such as parents' emotional state, their parenting skills, quality of very early relationships with the infant influence child's physical and mental health and development. The support of good infant-mother relationships is an essential part of early family-centered help to premature babies. The article reviews existing evidence-based programs of neonatal care and support of early mother-child relationships for preterm babies at the hospital. It covers three main directions: discussing with parents prognosis of a child's health and development; supporting natural conditions of child development, and including parents into child early care and observation. Data presented in the article shows that if using each of the mentioned above directions that are important for quality early care and interaction, positive dynamics is seen both on parents' and preterm infant's side. Designated programs can be widely implemented in neonatal intensive care units for children born before term, including those with extremely low body weight when they achieve clinical stabilization. The material presented in the article may be used as the scientific base for implementing in Russian Federation early care system both at the hospital level and, later, in the family environment. It also constitutes new directions for research of preterm babies and their parents.


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro , Feminino , Hospitais , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Relações Pais-Filho , Pais
9.
Soc Forces ; 99(3): 1209-1232, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33462540

RESUMO

The gray divorce rate, which describes divorce among individuals aged 50 and older, has doubled since 1990. Extending prior research that showed the transition to parenthood has a "braking effect" on divorce, we examined whether the transition to grandparenthood, an emotionally meaningful midlife event that typically renews midlife marriages, exerts an analogous "braking effect" on gray divorce. Using panel data from the 1998-2014 Health and Retirement Study, we found that becoming biological grandparents has a large deterrent effect on gray divorce that persists even after accounting for a host of other factors known to be associated with divorce. However, the transition to step grandparenthood has no protective effect on gray divorce. Our study demonstrates the importance of the larger family system and in particular the life webs connecting the generations for promoting marital stability among midlife couples.

10.
Gerontologist ; 61(7): 1085-1094, 2021 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-33245327

RESUMO

BACKGROUND AND OBJECTIVES: Marital dissolution has become more common in midlife with the doubling of the divorce rate among middle-aged adults. Guided by the stress model that stipulates losing economic, social, and psychological resources lowers well-being, we posited that midlife adults who experienced divorce or widowhood were at greater risk of cognitive impairment than the continuously married. Subsequent repartnering was expected to negate the increased risk. RESEARCH DESIGN AND METHODS: We used data from the 1998-2016 Health and Retirement Study to estimate discrete-time event history models using logistic regression to predict cognitive impairment onset for men and women. RESULTS: Roughly 27% of men who experienced spousal death in midlife went on to experience mild cognitive impairment by age 65. For women, experiencing divorce or widowhood was associated with higher odds of cognitive impairment onset although these differentials were accounted for by economic, social, and psychological resources. Men and women who repartnered after marital dissolution did not appreciably differ from their continuously married counterparts in terms of their likelihoods of cognitive impairment onset. DISCUSSION AND IMPLICATIONS: A stressful life event, midlife marital dissolution can be detrimental to cognitive well-being, placing individuals at increased risk of developing dementia in later life. The growing diversity of partnership experiences during the second half of life points to the continued importance of examining how union dissolution and formation shape health and well-being.


Assuntos
Disfunção Cognitiva , Viuvez , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Cognitiva/epidemiologia , Divórcio , Estado Civil , Casamento , Aposentadoria
11.
Ann Palliat Med ; 6(Suppl 1): S28-S38, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28595434

RESUMO

BACKGROUND: To examine radiotherapy (RT) patterns-of-care and utilization at the end of life (EOL) among non-small cell lung cancer (NSCLC) patients with brain metastasis (BrM) in an integrated health care system. METHODS: Central tumor registry identified 5,133 patients diagnosed with NSCLC from 2007-2011. BrM were determined by imaging. Patient and clinical characteristics were obtained by chart abstraction. In addition to abstracted variables, graded prognostic assessment (GPA) score of 0-1 was derived by collected data and tested as a predictor of death within 14 or 30 days of RT. RESULTS: On NSCLC presentation, 10% harbored BrM while 7% developed BrM thereafter. Of 900 BrM patients, 15% were not referred for RT, with median time to death of 21 days. Median time to death for 5% not recommended RT was 48 days. Among those receiving brain RT, 11.9% died within 14 days and 23.3% (cumulatively) died within 30 days of treatment. Over 50% with GPA score 0-1 received RT, 11% within 14 days and 21% within 30 days of death; median survival of GPA score 0-1 patients was 49 days. GPA score 0-1 independently predicted for death within 30 days of RT receipt. CONCLUSIONS: BrM are common in NSCLC, and most patients are referred for brain RT. A surprising proportion of patients received treatment near the EOL, as 23% died within 30 days of RT. GPA score of 0-1 predicted for death within 30 days of treatment. RT referral, recommendation, and timing should be better tailored to life expectancy, and additional benchmarks for quality of care are needed.


Assuntos
Neoplasias Encefálicas/radioterapia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Neoplasias Pulmonares/radioterapia , Cuidados Paliativos/estatística & dados numéricos , Idoso , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/secundário , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/secundário , Feminino , Humanos , Expectativa de Vida , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Metástase Neoplásica , Sistema de Registros , South Carolina , Análise de Sobrevida
15.
Pract Radiat Oncol ; 5(5): 328-329, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25800087
16.
Vestn Khir Im I I Grek ; 173(1): 58-61, 2014.
Artigo em Russo | MEDLINE | ID: mdl-25055513

RESUMO

The article presents an analysis of the features of primary peritonitis in children. Medical reports of 182 patients with primary and appendicular peritonitis were analyzed. It was significant, that the sick girls aged 4-7 years often had the primary peritonitis after acute inflammatory processes, which took place a month earlier. Chronic infection foci were noted in these patients. The age-specific features of maturation of the immune and reproductive systems predisposed the disease.


Assuntos
Apendicite/complicações , Peritonite , Procedimentos Cirúrgicos Operatórios , Abdome Agudo/diagnóstico , Abdome Agudo/epidemiologia , Abdome Agudo/cirurgia , Cavidade Abdominal/fisiopatologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/fisiopatologia , Peritonite/cirurgia , Período Pré-Operatório , Estudos Retrospectivos , Medição de Risco , Federação Russa/epidemiologia , Fatores Sexuais , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
17.
Vestn Khir Im I I Grek ; 173(2): 57-60, 2014.
Artigo em Russo | MEDLINE | ID: mdl-25055536

RESUMO

An immunological research of the patients and control group with primary peritonitis was made. The main indices of immune response were in the range of age rates. However, the immune signs of foci of chronic inflammation were revealed in patients after operation. The consequences of disease (an abdominal cavity effusion) were eliminated during surgical interventions, but not the cause of the inflammation. Children with the primary peritonitis should be examined for detection of infection foci.


Assuntos
Cavidade Abdominal/cirurgia , Formação de Anticorpos , Imunidade Celular , Imunoglobulinas/sangue , Infecções/complicações , Peritonite , Complicações Pós-Operatórias , Cavidade Abdominal/fisiologia , Cavidade Abdominal/fisiopatologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Infecções/imunologia , Monitorização Imunológica/métodos , Peritonite/etiologia , Peritonite/imunologia , Peritonite/fisiopatologia , Peritonite/cirurgia , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório
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