Abstract A04: Unique Raman spectroscopic fingerprints of Burkitt non-Hodgkin lymphoma

Purpose: Raman spectroscopy (RS) is a noninvasive laser-based technique that provides a very high level of confidence in detecting various molecules through their vibrational modes. A monochromatic laser is used to excite a sample, and inelastic scattered light generated by the sample is used to measure Raman spectra of the sample. Because vibration modes of a molecule are very unique to the molecule, RS is sensitive and highly selective to the molecular composition of various chemicals including biologic tissues and cells. By using micro-Raman systems capable of measuring Raman spectra of single biologic cell, the objective of the study focused on identifying molecular differences between normal B-cells and Burkitt non-Hodgkin lymphoma (BNHL) cells, hypothesizing that unique RS fingerprints of BL could be identified with the overall goal to apply the information for novel diagnostic or treatment strategies.

Methods: Normal B-cells were isolated from peripheral blood using a negative selection Robosep kit (EasySep Human B-Cell Isolation Kit, Stemcell Technologies, Cambridge, MA). BNHL cell lines (Ramos and CA46, ATCC, Manassas, VA), were cultured, washed, and resuspended in a 0.9% saline solution at a concentration of 1 x 106 cells/mL. The cells were mounted on a clean aluminum reflective slide and single cells were analyzed with a micro-Raman system utilizing a 785-nm laser excitation and an automated xyz microscope stage. Asymmetric Least Squares (AsLS) was applied to the spectral data (n=20 spectra per cell type) to obtain baseline spectra. Principal Component Analysis (PCA) followed by k-nearest neighboring (KNN) method was applied to analyze the variance in the spectral data and assess the diagnostic accuracy of the loadings from PCA.

Results: The Raman fingerprints of normal B-cells and BNHL cells identified characteristic peak differences between the cell types, ranging from DNA/protein concentrations to saccharide bonds. These were further analyzed using AsLS and PCA. AsLS informed the PCA, which identified variances in the peaks that formed distinct clusters to differentiate normal B-cells from BL NHL cells. PCA effectively compiles the peaks, demonstrating that the first three components accounted for 97.45% of variance in the data. Several peaks were identified as the major contributors to the loadings, and some (e.g., 831, 1083, 1210, 1257, 1360, 1578, 1658 cm-1) were also reported as biomarkers of BNHL. The KNN on the PCs revealed that diagnostic accuracy was 100% and specificity was 100%.

Conclusions: Raman fingerprints of normal B-cells versus BNHL cells demonstrated unique clustering of molecular changes that could potentially distinguish neoplastic cells from normal cells. As a novel and innovative tool, RS could contribute towards diagnostic resources and new paradigms for intervention for BNHL and other diseases.

This study was supported by the St. Baldrick’s and McCabe Foundations and in part by NIH U54MD007584.

Citation Format: Natalie Kamada, Robert Oda, Tiffany Shieh, Melissa Agsalda-Garcia, Tayro Acosta-Maeda, Anupam Misra, So Yung Choi, Eunjung Lim, Bruce Shiramizu. Unique Raman spectroscopic fingerprints of Burkitt non-Hodgkin lymphoma [abstract]. In: Proceedings of the AACR Special Conference: Pediatric Cancer Research: From Basic Science to the Clinic; 2017 Dec 3-6; Atlanta, Georgia. Philadelphia (PA): AACR; Cancer Res 2018;78(19 Suppl):Abstract nr A04.

Association between Cognitive Restraint, Uncontrolled Eating, Emotional Eating and BMI and the Amount of Food Wasted in Early Adolescent Girls

Understanding of behavioral factors associated with obesity is of importance in addressing this issue. This study examined the association between cognitive restraint, uncontrolled eating, emotional eating and body mass index (BMI) and amount of food plated, consumed, leftovers, and leftover food thrown into the trash (food wasted) in early adolescent girls nine to 13 years in O'ahu, Hawai'i (n = 93). Food plated, consumed, leftovers, and food wasted were estimated using a three-day mobile food record™ (mFR). Weight and height were measured to compute BMI (kg/m²). The three-factor eating questionnaire provided a score from 0 to 100 for cognitive restraint, uncontrolled eating, and emotional eating. Higher scores are indicative of greater cognitive restraint, uncontrolled eating, and emotional eating. Pearson's correlations were computed to examine the relationship between three factor eating scores and BMI. General linear models were conducted to examine the effect of each of three-factor eating scores on food plated, consumed, leftovers, and food wasted. Cognitive restraint was positively correlated with BMI (r = 0.36, p < 0.001) and with BMI z-score (r = 0.40, p < 0.001). There were no associations between three-factor eating scores and food plated, consumed, leftovers, and food wasted at lunch. However, at dinner, total energy plated, left over, and food wasted increased by 4.24 kcal/day (p = 0.030), 1.67 kcal/day (p = 0.002), and 0.93 kcal/day (p = 0.031), respectively, with a unit increase in uncontrolled eating score. Similarly, total energy plated and energy left over at dinner increased by 3.40 kcal/day (p = 0.045) and 1.51 kcal/day (p = 0.001), respectively, with a unit increase in emotional eating score. Additional research should examine the specific roles of cognitive restraint, uncontrolled eating, emotional eating and food waste in the development of obesity in adolescents.

Oral Health Knowledge and Practices of Pediatric and Family Nurse Practitioners

INTRODUCTION

The purpose of the study was to assess the relationship between oral health educational activities of NPs and their current oral health knowledge and practices.

METHOD

An online survey was distributed to practicing NPs and members of the NAPNAP organization.

RESULTS

The study results from n = 147 NPs indicated an association between oral health CE attendance and knowledge on the age to initiate fluoride toothpaste, age for an initial dental visit, as well as NPs comfort in educating about oral hygiene, diets to reduce caries, bacterial transmission and caries development, in addition to the NPs comfort in performing a risk assessment, oral exam, and identifying decay and other oral pathology compared to NPs that had not attended a CE course.

DISCUSSION

The study findings demonstrate the importance of CE courses for NPs on the latest oral health guidelines and practices beyond their traditional academic education, in order to improve oral health outcomes among children.

Progression of diabetes, ischemic heart disease, and chronic kidney disease in a three chronic conditions multistate model

BACKGROUND

Diabetes mellitus, ischemic heart disease, and chronic kidney disease are three major chronic conditions that develop with increasing risks among adults as they get older. The interconnectedness of these three chronic conditions is well known, while each condition acts as a prognostic risk factor for the other two. It is important to understand the progressive relationships of these three conditions over time in terms of transitioning between clinical states and the impact on patients' survival.

METHODS

We investigate the survival characteristics of a Medicare population aged 65 years and above in a multistate system that contained clinical states specified by death and diagnosis combinations of three chronic conditions. The study was conducted using Hawaii Medicare claims data from 2009 to 2013. To evaluate the progression of a subject with one of the newly diagnosed chronic conditions, we analyzed quantities such as state occupation probabilities in eight states and hazards of sixteen transition types. We quantified effects and significances of potential covariates such as age, gender, race/ethnicity, comorbidity burden and financial status on these temporal functions. Nonparametric method of estimating state occupation probabilities and pseudo-value based method for estimating covariate effects of a survival system were utilized.

RESULTS

We found a range of age, gender, race/ethnicity and financial status based interesting covariate influences on transitions and state occupation probabilities of the system.

CONCLUSION

Survival characteristics of the disease system are influenced by subject-specific effects. Subgroup-specific interventions/screenings should be considered for the optimal prevention and care.

Racial/Ethnic and County-level Disparity in Inpatient Utilization among Hawai'i Medicaid Population

We investigated racial/ethnic and county-level disparities in inpatient utilization for 15 clinical conditions among Hawaii's Medicaid population. The study was conducted using inpatient claims data from more than 200,000 Hawai'i Medicaid beneficiaries, reported in the year 2010. The analysis was performed by stratifying the Medicaid population into three age groups: children and adolescent group (1-20 years), adult group (21-64 years), and elderly group (65 years and above). Among the differences found, Asians had a low probability of inpatient admissions compared to Whites for many disease categories, while Native Hawaiian/Pacific Islanders had higher probabilities than Whites, across all age groups. Pediatric and adult groups from Hawai'i County (Big Island) had lower probabilities for inpatient admissions compared to Honolulu County (O'ahu) for most disease conditions, but higher probabilities were observed for several conditions in the elderly group. Notably, the elderly population residing on Kaua'i County (Kaua'i and Ni'ihau islands) had substantially increased odds of hospital admissions for several disease conditions, compared to Honolulu.

Cardio-Pulmonary Stethoscope: Clinical Validation With Heart Failure and Hemodialysis Patients

OBJECTIVE

The purpose of this study is to evaluate the accuracy of a noninvasive radiofrequency-based device, the Cardio-Pulmonary Stethoscope (CPS), to monitor heart and respiration rates, and detect changes in lung water content in human experiments and clinical trials.

METHODS

Three human populations (healthy subjects ( ), heart failure (), and hemodialysis () patients) were enrolled in this study. The study was conducted at the University of Hawaii and the Queen's Medical Center in Honolulu, HI, USA. Measurement of heart and respiration rates for all patients was compared with standard FDA - approved monitoring methods. For lung water measurements, CPS data were compared with simultaneous pulmonary capillary wedge pressure (PCWP) measurements for heart failure patients, and with change in weight of extracted fluid for hemodialysis patients.

RESULTS

Statistical correlation methods (Pearson, mixed, and intraclass) were used to compare the data and examine accuracy of CPS results. Results show that heart and respiration rates of all patients have excellent correlation factors, r≥0.9. Comparisons with fluid removed during hemodialysis treatment showed correlation factor of to 1, while PCWP measurements of heart failure patients had correlation factor of to 0.97.

CONCLUSION

These results suggest that CPS technology accurately quantifies heart and respiration rates and measure fluid changes in the lungs.

SIGNIFICANCE

The CPS has the potential to accurately monitor lung fluid status noninvasively and continuously in a clinical and outpatient setting. Early and efficient management of lung fluid status is key in managing chronic conditions such heart failure, pulmonary hypertension, and acute respiration distress syndrome.

Colorectal cancer screening prevalence and predictors among Asian American subgroups using Medical Expenditure Panel Survey National Data

BACKGROUND

Asian American (AA) ethnic subgroups are diverse in socio-economic status, years in the United States, English proficiency, and cultures with different health seeking behaviors and health care access. Fifty-two percent of AAs age ≥50 years had colorectal cancer screening (CRCS) in 2013, compared with 61% of non-Hispanic whites. We hypothesized that CRCS prevalence among AA ethnicities is heterogeneous and that the reasons related to CRCS among AA subgroups are associated with demographic characteristics, acculturation, health care access, and health attitudes.

METHODS

Medical Expenditure Panel Survey data for 2009-2014 compared CRCS status among whites (n = 28,834), Asian Indians (n = 466), Chinese (n = 652), and Filipinos (n = 788). Multivariate logistic regression examined ethnic differences and correlates of CRCS accounting for complex sampling design.

RESULTS

Whites had the highest prevalence of screening (62.3%), followed by Filipinos (55.0%), Chinese (50.9%), and Asian Indians (48.6%). Older age, having health insurance, and having a usual care provider predicted CRCS across all ethnicities. Different demographic, health care access, and health attitude predictors within each ethnic group were related to CRCS.

CONCLUSION

This study contributes to the literature on influences of differential CRCS prevalence among AA subgroups. CRCS promotion should be tailored according to attitudes and structural barriers affecting screening behavior of specific ethnic subgroups to truly serve the health needs of the diverse AA population. Cancer 2018;124:1543-51. © 2018 American Cancer Society.

Abstract OT3-05-07: PATINA: A randomized open label phase III trial to evaluate the efficacy and safety of palbociclib + anti HER2 therapy + endocrine therapy vs anti HER2 therapy + endocrine therapy after induction treatment for hormone receptor positive, HER2 positive metastatic breast cancer

Background

Pre-clinical data and initial results from clinical studies point to the added benefit of CDK4/6 inhibition when combined with anti-HER2 tx. The current study is designed to evaluate the added benefit of palbociclib when given in combination with anti-HER2 and endocrine tx maintenance in the 1st†line setting of metastatic HER2+HR+ breast cancer.

Trial design

PATINA is an international, open-label, pivotal Phase III study. Primary objective is to demonstrate that the combination of palbociclib with anti-HER2 plus endocrine tx is superior to anti-HER2 plus endocrine tx in prolonging PFS. Sample size is 496 pts. The study starts after completion of 6-8 cycles of chemotherapy-containing anti-HER2 tx for metastatic breast cancer in the 1st line setting. Pts are eligible provided they are without evidence of disease progression by local assessment (i.e. CR, PR or SD). To account for the need for less intense tx regimens for a subset of pts diagnosed with HER2+ER+ disease, clinicians may recommend the combination of trastuzumab with either a taxane or vinorelbine prior to study initiation. Clinicians might also choose a non-pertuzumab option for pts previously treated with pertuzumab in the neo(adjuvant) setting. Secondary objectives include measures of tumor control (OR, CBR, DOR), OS, safety and QOL. The translational science main objective is to compare PFS estimates according to PIK3CA mutation status assessed by cfDNA analysis. Endocrine tx options are AI or fulvestrant. Premenopausal pts must receive ovarian suppression. The study has a 90% power to detect a hazard ratio of 0.667 in favor of the palbociclib arm. Pts approached to participate in AFT-38 will be asked to indicate on the informed consent forms whether remaining biospecimens and clinical data from the control arm of the study can be shared with the Mastering Breast Cancer (MBC) Initiative. The overarching purpose of the MBC is to create a mechanism for understanding the natural history of metastatic breast cancer by cataloguing longitudinally studied tumor-specific markers and treatment effects.

ClinicalTrials.gov Identifier: NCT02947685

Citation Format: Metzger-Filho O, Mandrekar S, Loibl S, Ciruelos E, Gianni L, Lim E, Miller K, Huang C, Koehler M, Francis P, Valagussa P, Goel S, Prat A, Goetz M, Loi S, Krop I, Carey L, Lanzillotti J, Winer E, Tripathy D, DeMichele A. PATINA: A randomized open label phase III trial to evaluate the efficacy and safety of palbociclib + anti HER2 therapy + endocrine therapy vs anti HER2 therapy + endocrine therapy after induction treatment for hormone receptor positive, HER2 positive metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-05-07.

Abstract P4-04-12: Therapeutic targeting of CDK4/6 inhibitor resistant breast cancer

Background:

Selective inhibitors of CDK4/6 kinases (CDK4/6i) were recently FDA approved for use in combination with endocrine therapy (ET), and represent the new standard of care. There are however patients who do not respond or develop resistance to these treatments, and therapies are required in this setting. While there is emerging data on the mechanisms of intrinsic insensitivity to CDK4/6i as monotherapies, which include cyclin E1 amplification, CDK6 amplification and Rb deletion, there is little data on mechanisms of resistance to combined ET and CDK4/6i.

Methods:

We established MCF7 cell line and patient-derived xenograft (PDX) models that are resistant to combined ET and Palbociclib (CDK4/6i) through long-term culture, allowing us to better understand mechanisms underlying CDK4/6i resistance and to model therapeutic strategies in this setting. We also evaluated our therapeutic strategy in vitro and in vivo using MCF cell lines that are resistant to ET, and in an ER+ PDX model derived from a patient who progressed on ET.

Results:

Cells resistant to CDK4/6i alone and in combination with ET show disrupted senescent pathways, and insensitivity to the induction of senescence. MDM2 inhibitors induce cells to enter into senescence, and consequently we are investigating the use of a new generation MDM2 inhibitor (CGM097, Novartis) either in combination with CDK4/6i treatment, or following acquisition of CDK4/6i resistance to prevent exit from senescence. We evaluated a CGM097 either in combination with CDK4/6i treatment, or in combination with fulvestrant following acquisition of CDK4/6i resistance to prevent exit from senescence. CGM097 was effective alone or in combination with fulvestrant in CDK4/6i resistant cells in vitro and in vivo, and resulted in a loss of G1 cells, and a reduction in B galactosidase, a senescence marker.

Another mechanisms of CDK4/6i resistance that has been identified is CDK2 activation, which can occur through Cyclin E amplification. As a second therapeutic strategy, we screened a panel of pan-CDK inhibitors with CDK2 activity in our resistant lines, and identified that CYC065 (Cyclacel), a highly selective CDK2/9 inhibitor, had the most durable response and highest synergy with ET in long-term culture. The combined resistant models were sensitive to CYC065 in vitro and in vivo. CYC065 was mechanistically distinct to CDK4/6i's as it caused arrest in a different phase of the cell cycle and affected expression of different cell cycle proteins.

Conclusion:

An underlying mechanism of combined ET and CDK4/6i resistance is senescent escape, which allows for normal proliferation upon removal of the drug. Using our in vitro and in vivo models of combined ET and CDK4/6i resistance, we have identified two novel therapeutic strategies for this disease, which represents the next clinical challenge in ER+ breast cancer as the natural history of disease is changed with the increasing use of CDK4/6i.

Citation Format: Lim E, Portman N, Alexandrou S, Haupt S, Haupt Y, Caldon E. Therapeutic targeting of CDK4/6 inhibitor resistant breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-04-12.

Racial and Ethnic Disparities in Hospital Mortality among Ischemic Stroke Patients in Hawaii

BACKGROUND

We evaluated disparities in in-hospital mortality rates among whites, Native Hawaiians and other Pacific Islanders (NHOPI), Filipinos, and other Asian groups in Hawaii who were hospitalized for acute ischemic stroke.

MATERIALS AND METHODS

Using a statewide hospital claims database, we performed a retrospective study including sequential acute ischemic stroke patients between 2010 and 2015. We compared in-hospital mortality rates among whites, NHOPI, Filipinos, other Asian groups excluding Filipinos, and other races (Blacks, Hispanics, Native Americans, mixed race).

RESULTS

A total of 13,030 patient discharges were included in this study. The mean (±SD) age in years at the time of stroke was 63.5 ± 14.3 for NHOPI, 69.6 ± 14.4 for Filipinos, 67.8 ± 14.2 for other race, 71.4 ± 13.8 for whites, and 76.1 ± 13.5 for other Asians (P < .001). NHOPI patients had higher rates of diabetes (48.8%), obesity (18.4%), and tobacco use (31.3%) compared with patients in other racial-ethnic categories. Filipino patients had the highest rate of hemorrhagic transformation (9.7%). Age-adjusted stroke mortality rates were highest among Filipinos (15.9%; 95% confidence interval [CI] = 14.3%-17.6%), followed by other Asian groups (15.1%; 95% CI = 14.0%-16.2%), NHOPI (14.8%; 95% CI = 12.8%-16.8%), other race (14.4%; 95% CI = 11.3%-17.4%), and lowest among whites (12.8%; 11.5%-14.2%). After adjusting for other confounding variables, Filipinos had higher mortality (odds ratio = 1.22, 95% CI = 1.03-1.45), whereas other Asian groups, NHOPI, and other race patients had mortality rates that were similar to whites.

CONCLUSION

In Hawaii, Filipino ethnicity is an independent risk factor for higher in-hospital stroke mortality compared with whites.

Study design and rationale to assess Doxycycline Efficacy in preventing coronary Artery Lesions in children with Kawasaki disease (DEAL trial) - A phase II clinical trial

BACKGROUND

Kawasaki disease (KD) is the most common acquired heart disease in children of the developed world, and triggers progressive coronary artery lesions (CAL) in 30% of cases if left untreated. Despite standard anti-inflammatory treatment for KD, CAL (dilation or aneurysm) still occurs in 5-10% of children, increasing their risk for fatal coronary artery complications. CAL is mediated by enhanced matrix metalloproteinase activity and elastin breakdown induced by the inflammatory process in the coronary artery wall. Doxycycline is an effective inhibitor of matrix metalloproteinases, and has been shown to reduce elastin breakdown and CAL in a mouse model of KD, but has not been evaluated in patients.

OBJECTIVE

We aim to evaluate the efficacy of doxycycline in the prevention of CAL in children during the acute phase of KD.

DESIGN

This is a phase II prospective, randomized, double-blinded, clinical trial in two steps. In Step 1, any child older than 1month with the diagnosis of KD will be included. Children with KD will be included in Step 2 if they develop coronary artery dilation (z-score≥2.5) within 20days from the onset of fever. Study subjects in Step 2 will be randomized to receive a 3-week course of doxycycline or placebo.

EVALUATION

The efficacy of a 3-week doxycycline course during the acute phase of KD will be evaluated by measuring the decline in coronary artery z-scores from baseline with doxycycline treatment compared to placebo.

CLINICAL TRIAL REGISTRATION

This study was registered on clinicaltrials.gov (NCT01917721).

Dietary patterns change over two years in early adolescent girls in Hawai'i

BACKGROUND AND OBJECTIVES

In investigating diet-disease relationships, examination of dietary patterns allows for conclusions to be drawn based on overall intake. This study characterized dietary patterns of early adolescent girls over a two-year period and examined the relationship between dietary patterns and body mass index (BMI).

METHODS AND STUDY DESIGN

Cross-sectional analyses were performed using longitudinal data from food records of early adolescent girls (n=148) 9 to 14 years in Hawai'i from the Female Adolescent Maturation (FAM) study. Dietary patterns were identified using principal component analysis (PCA). Pearson's correlations between BMI percentile and z-score and dietary pattern factor scores at Times 1 (2001-2002) and 2 (2002-2003) were calculated. For each dietary pattern, participants were divided into low, intermediate, and high scorers. Mean BMI percentiles and z-scores were compared between groups using analysis of covariance.

RESULTS

At Time 1, three patterns were identified, characterized by: (1) whole grains, nuts and seeds, added sugar; (2) non-whole grain, tomatoes, discretionary fat; and (3) deep yellow vegetables, other starchy vegetables, cooked dry beans/peas. At Time 2, three different dietary patterns emerged: (1) non-whole grains, meat, discretionary fat; (2) other vegetables, fish, eggs; and (3) whole grain, tomatoes, other vegetables. BMI percentile and z-score differed between high and low scorers on Time 1-Pattern 1 and Time 2-Pattern 3.

CONCLUSION

Results revealed changes in dietary patterns over time and an association between intake and BMI. Findings demonstrate the importance of frequent nutrition assessment to monitor changes in intake that may be improved to prevent obesity.

Longitudinal analyses of adoptive parents' expectations and depressive symptoms

Grounded in a theoretical model specific to adoptive parents, we examined the relationship between parental expectations and depressive symptoms across time. Assessments of 129 adoptive parents of 64 children were performed at three time points before and after placement of an adopted child with the family: 4-6 weeks pre-placement and 4-6 weeks and 5-6 months post-placement. Expectations were assessed in four dimensions: expectations of self as parents, of the child, of family and friends, and of society. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression scale. Associations between parental expectations and depressive symptoms were analyzed, and longitudinal multilevel modeling was conducted to explore influences on expectations over time. Parental expectations changed from pre- to post-placement. With the exception of expectations of self as parent, adoptive parents' pre-adoption expectations were affirmed in the post-adoption time periods. In each expectation dimension, higher affirmation of expectations was correlated with decreased depressive symptoms before and after placement of a child. While parental expectations are not unique to adoptive parents, the essence and characteristics of certain expectations are unique to these parents. When working with adoptive parents, nurses who care for families should assess expectations both pre- and post-placement with awareness of their relationship to depressive symptoms.

Racial/Ethnic Disparities in the Association Between Preeclampsia Risk Factors and Preeclampsia Among Women Residing in Hawaii

Objective To assess differences in the rates of preeclampsia among a multiethnic population in Hawaii. Methods We performed a retrospective study on statewide inpatient data for delivery hospitalizations in Hawaii between January 1995 and December 2013. Multivariable logistic regression was used to assess the impact of maternal race/ethnicity on the rates of preeclampsia after adjusting for age, multiple gestation, multiparity, chronic hypertension, pregestational diabetes, obesity and smoking. Results A total of 271,569 hospital discharges for delivery were studied. The rates of preeclampsia ranged from 2.0 % for Chinese to 4.6 % for Filipinos. Preeclampsia rates were higher among Native Hawaiians who are age <35 and non-obese (OR 1.54; 95 % CI 1.43-1.66), age ≥35 and non-obese (OR 2.31; 95 % CI 2.00-2.68), age ≥35 and obese (OR 1.80; 95 % CI 1.24-2.60); other Pacific Islanders who are age <35 and non-obese (OR 1.40; 95 % CI 1.27-1.54), age ≥35 and non-obese (OR 2.18; 95 % CI 1.79-2.64), age ≥35 and obese (OR 1.68; 95 % CI 1.14-2.49); and Filipinos who are age <35 and non-obese (OR 1.55; 95 % CI 1.43-1.67), age ≥35 and non-obese (OR 2.26; 95 % CI 1.97-2.60), age ≥35 and obese (OR 1.64; 95 % CI 1.04-2.59) compared to whites. Pregestational diabetes (OR 3.41; 95 % CI 3.02-3.85), chronic hypertension (OR 5.98; 95 % CI 4.98-7.18), and smoking (OR 1.19; 95 % CI 1.07-1.33) were also independently associated with preeclampsia. Conclusions for Practice In Hawaii, Native Hawaiians, other Pacific Islanders and Filipinos have a higher risk of preeclampsia compared to whites. For these high-risk ethnic groups, more frequent monitoring for preeclampsia may be needed.

Transitions of Adoptive Parents: A Longitudinal Mixed Methods Analysis

As adoptive parents create a new family, they face myriad changes both pre-and post-placement of their child. The aim of this study was to describe parent perceptions and depressive symptoms during this transition via reports collected with an online survey. Using content analysis, we analyzed a total of 110 responses from 64 parents at three time points: 4-6weeks pre-placement, and 4-6weeks and 5-6months post-placement. Five main themes were revealed: Transition from uncertainty to a new normal; unique experiences related to adoption; rest/fatigue: out of balance; life stressors; and faith/spirituality. Two subthemes were also identified: previous losses (pre-placement) and joy and love (post-placement). During the transition from pre-to post-placement, adoptive parents experience a unique passage, with both challenges and strengths exclusive to this group of parents. While acknowledging the commonalities of some parenting experiences, healthcare and adoption professionals should recognize the unique dynamics that adoption brings to families.