Adolescent Transition to Adult Care in Solid Organ Transplantation: a consensus conference report.

Transition of care from pediatric to adult-oriented health care providers is difficult for children with special health care needs. Children who have received solid organ transplants and their providers experience the same difficulties and frustrations as children with other major illnesses. A consensus conference was organized by several transplant organizations to identify major issues in this area and recommend possible approaches to easing the process of transition for solid organ transplant recipients. This report summarizes the discussions and recommendations.

Psychosocial correlates of morbidity in women with systemic lupus erythematosus.

OBJECTIVE: Modifiable psychosocial factors that are associated with health outcomes may provide new opportunities for treatment. We investigated the associations of various psychosocial factors with 3 measures of morbidity in women with systemic lupus erythematosus (SLE). METHODS: We collected information on 16 social, psychological, behavioral, and medical care factors in a cross sectional survey of 100 women with SLE, and related these to measures of physical disability (assessed by the Health Assessment Questionnaire Disability Index), SLE activity (assessed by the Systemic Lupus Activity Measure), and cumulative organ damage (assessed by the SLICC/ACR Damage Index). RESULTS: In multivariate analyses, greater physical disability was significantly associated with higher depression scale scores and higher body mass indexes. Greater SLE activity was associated with less adequate social support. Greater cumulative organ damage was associated with lower self-esteem and a time orientation that favored the present over the future. Financial barriers to medical care, knowledge about SLE, health locus of control, marital status, and health behaviors including compliance with medications, smoking, alcohol use, and exercise, were not significantly associated with any measure of morbidity. CONCLUSION: Selected psychosocial factors are associated with morbidity in SLE, but differ with the measure of morbidity examined.

Socioeconomic status and health in women with systemic lupus erythematosus.

OBJECTIVE: Health outcomes of patients with chronic illnesses are commonly worse in people of lower socioeconomic status (SES). We investigated psychosocial factors that may mediate the relationship between SES and measures of morbidity in women with systemic lupus erythematosus (SLE). METHODS: We collected information on SES, psychosocial factors, and health status in a cross sectional survey of 100 women with SLE. SES was rated using the Hollingshead Two-Factor Index, a weighted average of years of formal education and occupational prestige (higher Hollingshead Index=lower SES). Health status measures included the Health Assessment Questionnaire Disability Index (HAQ), the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR), the Systemic Lupus Activity Measure (SLAM), and the SLE Disease Activity Index (SLEDAI). Potential mediators consisted of 18 environmental, medical care, social, psychological, and behavioral factors. RESULTS: Patients with higher Hollingshead Indexes (lower SES) had more functional disability as measured by the HAQ (r=0.22: p=0.03) and more cumulative organ damage as measured by the SLICC/ACR Damage Index (r = 0.19; p=0.06). SES was not related to either the SLAM or SLEDAI. Significant univariate associations were present between the Hollingshead Index and 10 potential mediating variables: household crowding, insurance status, organizational barriers to medical care, depression, health locus of control by powerful others, SLE knowledge, social support, marital status, body mass index, and regular alcohol use. However, in multiple linear regression analyses, only 3 of these variables modified the relationship between Hollingshead Index and the HAQ: more severe depression scores, higher body mass index, and more restricted access to medical care. More severe depression and greater locus of control by powerful others tended to mediate the relationship between low SES and greater organ damage. CONCLUSION: SES is related to morbidity in women with SLE. There are identifiable and potentially modifiable mediators of this relationship.

Seasonality of reproductive function and weight loss in rural Nepali women.

Menstrual and hormonal disturbances have been reported in thin, dieting and exercising Western women, and also recently in rural African women. A study of salivary progesterone profiles was undertaken in a Nepali population to examine whether seasonal increases in workload and changes in energy balance influenced ovarian function. Women's energy expenditure levels were moderately heavy in the winter and very heavy in the monsoon, and body mass fluctuated by -2.8 to +4.8 kg. Samples were collected from 24 normally menstruating women in two seasons, each individual serving as her own control. Progesterone levels were significantly depressed in the monsoon relative to winter for women who lost weight, but not for women who gained weight, indicating that energy imbalance is associated with a loss of fecundity. No differences in body mass index were found between women who lost or gained weight. Progesterone levels were age-dependent, and the degree of hormonal disturbance between age-groups was related to weight loss. The study demonstrates seasonal changes in the fecundity of hard-working Nepali women and a direct link between ovarian function and weight loss (negative energy balance), which is independent of current nutritional status.

PIP: In October-November 1990 and August-September 1991, anthropologists collected saliva samples from 24 17-46 year old nonpregnant, nonlactating, and normally menstruating Tamang women in a remote village in the foothills of the Himalayas in northwestern Nepal to measure progesterone levels (indicative of ovarian function). They used these levels to determine whether a very heavy workload during the monsoon season and changes in dietary intake affected ovarian function. Anthropometric measurements were also taken. The women served as their own controls. Seasonal changes in body mass ranged from -2.8 kg to 4.8 kg. Mean and mid-luteal progesterone levels fell 27% (104-76 pmol/l) and 38% (138-85 pmol/l), respectively, between the winter and monsoon (p .01). The levels of ovarian function were much lower than those of healthy, regularly menstruating Western women and of menstruating Lese women of the Ituri forest in Zaire (mean luteal phase progesterone levels, 104 pmol/l vs. 232 pmol/l for Boston women and 140 pmol/l for Lese women). Reduction in progesterone levels was most significant for 24-34 year old women. In fact, the reduction in mid-luteal progesterone levels was only significant in this age group (p .05). Body mass index did not influence progesterone levels, regardless of changes in weight or age. Reduced progesterone levels was only significant for women who lost weight between the winter and the monsoon seasons, suggesting that energy imbalance is linked to loss of fecundity. Younger women were more likely to gain weight than older women (.6 kg vs. -1.1 kg for middle aged women and -.2 for older women; p .05). The regression between changes in progesterone levels and degree of weight loss was also significant (p .01). Between the winter and the monsoon, the percentage of ovulatory cycles decreased from 71 to 38%. These findings showed seasonal changes in the fecundity of these women and a direct association between ovarian function and weight loss, regardless of current nutritional status.