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BACKGROUND Extracellular volume (ECV) overload and endothelial cell dysfunction are mortality risk factors in hemodialysis (HD) patients. Endothelin-1 (ET-1), an endothelium-derived vasoconstrictive peptide, is associated with poor outcomes in HD patients. We hypothesized there would be associations between ET-1 and ECV overload in hypertensive HD patients. METHODS We obtained pre-HD ET-1, ECV/weight (bioimpedance spectroscopy), pre-HD hemodynamics, and ambulatory blood pressure (BP) in an HD cohort. Following appropriate transformations, we conducted correlation and linear regression analyses idendifying associations between ET-1, ECV overload, total peripheral resistance index (TPRI), cardiac index (CI), and ambulatory BP. RESULTS Among 66 patients, median ET-1 was 1.93 (1.49–2.56) pg/ml. Median pre-HD ECV/weight, median TPRI, mean CI, and mean systolic ambulatory BP were 0.25 (0.22–0.30) l/kg, 3,161 (2,711–3,642) dynes × s/cm−5/m2, 2.92 (0.6) l/min/m2, and 143 (14) mm Hg, respectively. After reciprocal-transformation, ET-1 correlated with reciprocal-transformed ECV/weight (r  = 0.3, P  = 0.01), log-transformed TPRI (r  = −0.3, P  = 0.006), CI (r  = 0.3, P  = 0.009), and ambulatory BP (r  = −0.3, P  = 0.02). These associations persisted in linear regression analysis (β = 0.15, P  = 0.002; β = −0.8, P  = 0.002; β = 0.2, P  = 0.002; β = −19, P  = 0.03). CONCLUSIONS In hypertensive HD patients, ET-1 associates with ECV overload higher TPRI and ambulatory BP, and lower CI. Further research is necessary to determine if ECV reduction lowers ET-1 or if pharmacologic ET-1 antagonism can improve outcomes in HD patients with refractory ECV overload. [ABSTRACT FROM AUTHOR]

Trauma is thought to interfere with normal grief by superimposing symptoms of posttraumatic stress disorder. This exploratory pilot study examined the association between traumatic grief and objectively measured physiological reactivity to a trauma interview in 13 children who lost relatives in the Oklahoma City bombing as well as a potential link between children and their maternal figures in physiological reactivity. Although the authors found no association between posttraumatic stress and objectively measured physiological reactivity among children, they found significant differences in objectively measured reactivity associated with loss and grief. Children who lost "close" relatives evidenced greater objectively measured reactivity than those who lost "distant" relatives. For the most part, children with higher levels of grief evidenced greater objectively measured reactivity than those with lower levels of grief. The most interesting of the findings was the parallel pattern in objectively measured physiological reactivity between children and their maternal figures along with a positive association between children's objectively measured physiological reactivity and maternal figures' self-reported physiological reactivity. Research using larger representative samples studied early and over time is indicated to determine the potential significance of these findings. (Contains 1 table.)

Focus groups were conducted with 23 children and adolescents, aged 9 to 17 years, who relocated from Louisiana to Texas following Hurricane Katrina to explore their disaster, evacuation, and resettlement experiences. The resilience described by some was remarkable and, despite evidence of cultural disparity and stigma, many identified positive aspects of the new communities in which they resided. Attempts to help displaced children must begin with a full understanding of the individual experiences and reactions of those being served rather than being based on assumptions about what may have occurred.

Focus groups with 23 New York City children examined their reactions to the September 11 terrorist attacks, their parents' reactions, and their expectations about the future. We identified an initial set of six topics; these topics were reviewed and assigned to a final set of thematic categories--understanding the events and motives, emotional responses, boredom, and coping. This final set was used to independently code the transcripts. The children reported using distraction and avoidant emotion-focused coping strategies. They were confused about some aspects of the events, but they understood the magnitude and gravity of what had occurred. (Contains 1 table.)