Rosanne C. Harrigan

Stress in families with medically fragile children.

The literature related to the stress experienced by families who care for medically fragile children is analyzed. A model is generated from themes identified in the research literature. Four core themes were identified under which most of the stressors identified in the literature could be grouped. These are role conflict, financial burden, care burden, and independence. These are in turn arranged as a matrix in which the family, the child, the care professional, and health care system interact dynamically with the four core themes. The Family Stress/Task Matrix has the potential for facilitating research related to models that include a family-centered view among health professional and systems.

Medically fragile children: an integrative review of the literature and recommendations for future research.

The literature related to medically fragile children (MFC) is analyzed, and a model is generated to improve quality of care and cost effectiveness. The sources of stress for families include home care professionals, respite care, financial concerns, and limited community resources. Children cared for in hospitals often experience less than desirable quality outcomes. Community-based pediatric extended care facilities may be a means of reducing family stress, improving physiologic and developmental outcomes, and reducing cost. Case management may significantly reduce parental stress and improve the quality of life for these children. Additional systematic study of care options for MFC is essential.

Voicing the Strengths of Pacific Island Parent Caregivers of Children Who are Medically Fragile

Research is deficient regarding the strengths of Pacific Island parents of children who are medically fragile. The purpose of this qualitative ethnographic study was to explore the strengths of Pacific Island parents of these children. Audiotaped interviews were analyzed using Text Smart and peer review. The core theme reflecting strength was positive energy. Participants believed that parents needed to have the ability to handle emotional feelings, solve problems, connect with their spirituality, find meaning, take care of themselves, use family support, use community support, use a positive attitude, be resourceful, meet a challenge, interact with nature, and focus on the present. Themes were affirmed by the literature with the exception of interacting with nature, which may be indigenous to the population’s cultural orientation.

Incorporating translational research with clinical research to increase effectiveness in healthcare for better health

BackgroundThe transfer of new scientific discoveries into healthcare interventions requires that basic and clinical researchers work together with health care providers to generate team science. These innovative models require translational teams, and need to extend beyond the academic environment. The future of translational science requires partnerships with the healthcare community as well as the broader, general community. This new integrated model of effective translational teams holds promise for addressing thorny and persistent health disparities, is consistent with the nation’s strategic priority of eliminating health disparities, and bodes well for increasing healthcare effectiveness aimed at better health for all.DiscussionAs part of the 13th Research Centers in Minority Institutions (RCMI) International Symposium on Health Disparities, several senior academic leaders joined efforts to hold a workshop to discuss a model that considers the incorporation of two translational research strategies in research career development programs: Comparative effectiveness research (CER) and community-based participatory research (CBPR) for increasing healthcare effectiveness and eliminating healthcare disparities. Discussion included what issues may be most germane to the concept of a unified model for research workforce development through formal training and career development leading to increased effectiveness in healthcare for better health.SummaryWe believe that there is a gap in knowledge and skills in formal research career development programs that will enable physicians, other clinicians, and basic scientists to actively participate in these two translational research strategies. The purpose of this paper is to share the outcomes of these discussions, and encourage further discussion and possible innovation in the formulation of a new model for translational research workforce development.

The wellness behavior interaction model

A cognitive-behavioral model for conceptualizing wellness is proposed consisting of situational/antecedent variables, person variables, and consequence variables which, taken individually or together, may serve to describe and explain wellness behavior. The model also is interactional in the sense that different categories of variables or factors within a category may impact on each other in a multidirectional fashion. A selective review of research relating to each variable is provided to demonstrate the need for such a multidimensional conceptual scheme for wellness.

The Relationship of 5-Aminolevulinic Acid on Mood and Coping Ability in Prediabetic Middle Aged and Older Adults

In 2010, approximately 79 million Americans had prediabetes and about 50 percent of those individuals were 65 years and older. The most effective diabetes prevention method in prediabetic adults is lifestyle modification. However, despite the benefits of lifestyle change, diabetes prevalence continues to increase. Maintaining a regular exercise routine and a healthy eating plan may be difficult because of the negative emotional barriers (i.e., stress, mood) that a prediabetic individual faces. This is particularly evident in older individuals when you combine that with decreases in mobility and geriatric syndromes. A potential treatment for these emotional barriers is a natural supplement called 5-aminolevulinic acid (5-ALA). In the current study, the group included 154 participants, both men and women, ranging between the ages of 41 to 71 years old. The study design was a double-blind, randomized parallel-group study. The Psychosocial Depressive Symptoms Questionnaire (PDS) and the Perceived Stress Scale (PSS) were used to examine the effect of two doses of 5-ALA (15 mg and 50 mg) on various components of mood (i.e., hopefulness, loneliness, and motivation) and coping ability. Using SAS software, an ordered logistic regression model was used to analyze the association between the dose groups (control, 15 mg, and 50 mg) and the responses to the two questionnaires, the PDS and PSS, used in this study. An integrative literature review, using the PubMed database, searched for studies on the relationship between 5-ALA administration and mood and coping ability. Our literature review resulted in zero published articles. Next, we found that the intake of 5-ALA was significantly associated with improved coping ability (p = 0.004) and improved self-perception of effort spent (p = 0.002). Finally, we found a significant dose-dependent relationship for the association of 5-ALA intake on measures of effort (p = 0.003), loneliness (p = 0.006), and coping ability (p = 0.003). The 50 mg dose was more effective than the 15 mg dose in improving these measures. In conclusion, after 12 weeks of taking 5-ALA, we found significant improvements in self-perception of effort spent, loneliness, and coping ability in prediabetic middle age and older adults. Improved mood and coping ability may allow prediabetic individuals to overcome the emotional obstacles preventing them from maintaining a healthy lifestyle and ultimately, help them to avoid the development of diabetes.

Idiopathic Neonatal Hepatitis Associated With a Fatal Coagulopathy

Idiopathic neonatal hepatitis (INH) remains a diagnosis of exclusion in the neonate with conjugated hyperbilirubinemia. The major diagnostic challenge for the clinician is to distinguish this condition from other treatable liver disorders such as biliary atresia. Although the prognosis varies for the familial and sporadic forms of neonatal hepatitis, a poor outcome is generally distinguished by chronic and progressive liver failure. After careful review of the literature, we were unable to find a case of INH associated with a profound, irreversible coagulopathy. Herein, we present a case with the primary presenting findings of persistent prolongation of the prothrombin time (PT) and hypofibrinogenemia, resulting in a catastrophic intracranial hemorrhage and death.