Phlebotomy,a bridge between laboratory and patient

The evidence-based paradigm has changed and evolved medical practice. Phlebotomy, which dates back to the age of ancient Greece, has gained experience through the evolution of medicine becoming a fundamental diagnostic tool. Nowadays it connects the patient with the clinical laboratory dimension building up a bridge. However, more often there is a gap between laboratory and phlebotomist that causes misunderstandings and burdens on patient safety. Therefore, the scope of this review is delivering a view of modern phlebotomy to “bridge” patient and laboratory. In this regard the paper describes devices, tools and procedures in the light of the most recent scientific findings, also discussing their impact on both quality of blood testing and patient safety. It also addresses the issues concerning medical aspect of venipuncture, like the practical approach to the superficial veins anatomy, as well as the management of the patient’s compliance with the blood draw. Thereby, the clinical, technical and practical issues are treated with the same relevance throughout the entire paper.Key words: phlebotomy, venipuncture, laboratory testing, preanalytical phase, preanalytical variability, patient safety, evidence based medicine     

Negative caregiver strategies and psychopathology in urban,African-American young adults

OBJECTIVE: There were three aims: (1). assess the prevalence of reported exposure to negative caregiver strategies in a community-based African-American population, (2). examine the sources of variation in caregiver parenting strategies, including demographic variables and child characteristics, (3). investigate whether mental disorders in young adulthood may differ based on reported degree of exposure to negative strategies. METHOD: The participants were 1197 African-Americans involved in a 1999-2001 young adult follow-up (age M=19.6, SD=.6) of an evaluation of school-based interventions in the Baltimore, MD metropolitan area. Measures included teacher-report of child aggression in first grade, parent-report of demographic variables in first and sixth grade, and young adult self-report of symptomatology, suicidal behaviors, and childhood caregiver discipline strategies. RESULTS: Fifty-four percent of the sample reported some use of physical discipline by caregivers. Lower family income and younger caregiver age, as well as teacher reports of child aggression, were related to reports of caregiver's high use of negative strategies. In addition, young adults who reported a high rate of negative caregiver strategies had a significantly increased risk for psychopathology and were over twice as likely to have experienced a history of suicidal ideation than those reporting low exposure.CONCLUSIONS: The results demonstrate the importance of examining variation in this population, with the poorest and the youngest using negative parenting strategies more frequently. In addition, the present study replicated previous findings of the link between negative caregiver discipline strategies and psychopathology. This association appears robust across diverse populations. The implications for preventive interventions are discussed.     

Developmental Trajectories of Maladaptive Perfectionism Among African American Adolescents

This study examined the developmental trajectories of maladaptive perfectionism over a 7‐year period among African American youth living in an urban setting (N = 547). In particular, the study attempted to determine whether two maladaptive aspects of perfectionism (socially prescribed and self‐critical) changed over time and could be distinguished by variables in 6th and 12th grades (M_age at study entry [first grade] was 6.22 years [SD = 0.34]). Four classes best described the developmental trajectories on both measures of maladaptive perfectionism: high, low, increasing, and decreasing. Sixth‐ and 12th‐grade correlates, including measures of internalizing symptoms, mostly confirmed the distinctiveness of these classes. Parallel process analyses suggested that the two processes are complementary, yet distinct. Implications regarding the prevention of maladaptive perfectionism are discussed.     

A further look at the prognostic power of young children's reports of depressed mood and feelings

A primary objective of the present study was to determine the validity of first graders' self-reports of depressed mood and feelings. To that end, the prognostic power of first grade self-reports of depressed mood and feelings was examined with respect to later psychopathology and adaptive functioning in a population of urban school children (N = 946). First grade self-reports of depressed mood predicted later child academic functioning, the need for and use of mental health services, suicidal ideation, and a diagnosis of major depressive disorder by age 14. The prognostic power of these early self-reports suggests that children as young as 5 or 6 years of age are capable of providing valid reports of depressed mood and feelings.     

School attendance problems and youth psychopathology: structural cross-lagged regression models in three longitudinal data sets

This study tests a model of reciprocal influences between absenteeism and youth psychopathology using 3 longitudinal datasets (Ns = 20,745, 2,311, and 671). Participants in 1st through 12th grades were interviewed annually or biannually. Measures of psychopathology include self-, parent-, and teacher-report questionnaires. Structural cross-lagged regression models were tested. In a nationally representative data set (Add Health), middle school students with relatively greater absenteeism at Study Year 1 tended toward increased depression and conduct problems in Study Year 2, over and above the effects of autoregressive associations and demographic covariates. The opposite direction of effects was found for both middle and high school students. Analyses with 2 regionally representative data sets were also partially supportive. Longitudinal links were more evident in adolescence than in childhood.