Health status in sickle cell disease: examining the roles of pain coping strategies, somatic awareness, and negative affectivity.

People with sickle cell disease (SCD) vary in their pain, activity levels, and medical care. We examined how coping (Coping Strategies Questionnaire), somatic awareness, and illness worry were related to these health indices in 70 African-American adults with SCD. Negative Thinking/Passive Adherence and/or somatic awareness was positively correlated with pain episode frequency, duration, or severity, after controlling for demographics and disease severity and positively correlated with activity reduction or hospitalization frequency after also controlling for pain. Self-reported negative affectivity was correlated with both psychological and SCD measures; and controlling for negative affectivity eliminated several, but not all, relationships. Examination of the Negative Thinking/Passive Adherence factor suggested a distinction between Negative Thinking and Passive Adherence, which was partially supported by their different relationships. We conclude that negative thinking, passive coping, and somatic awareness are related to several measures of poor health in SCD but that some relationships are better accounted for by general measures of negative affectivity.

Parenteral nutrition: hospital to home.

Parenteral nutrition support is the provision of essential nutrients intravenously, bypassing the intestinal tract. It is used in a variety of clinical settings and medical conditions. Parenteral nutrition is a complex technology that requires the input of many professionals, including dietitians. The role of the dietitian in parenteral nutrition support involves direct patient care, consultative services, education, program development, and research. Even though this field of practice is still developing, some common practices can be described. Nutrition assessment determination of macronutrient and micronutrient requirements, and monitoring are vital aspects of the provision of parenteral nutrition support that benefit from the knowledge and experience of a dietitian. The future of parenteral nutrition includes identification of preferred fuels for specific disease states, development of new lipid emulsions, and identification of conditionally essential nutrients.