COVID-19 in Children with Cancer and Continuation of Cancer-Directed Therapy During the Infection

Objective To report the experience with COVID-19 in children with cancer at the largest tertiary-cancer care and referral center in India. Methods This study is a single tertiary center experience on COVID-19 in children with cancer and continuation of cancerdirected therapy in them. Children?15 y on active cancer treatment detected with COVID-19 until September 15th, 2020 were prospectively followed up in the study. Patients were managed in accordance with well-laid guidelines. Treatment was continued for children with COVID-19 who were clinically stable and on intensive treatment for various childhood cancers. Results One hundred twenty-two children (median age 8 y; range 1–15 y, male:female 1.7:1) with cancer were diagnosed with COVID-19. Of 118 children, 99 (83.9%), 60 (50.8%), 43 (36.4%), 26 (22.0%), and 6 (5.1%) had RT-PCR positivity at 14, 21, 28, 35, and 60 d from diagnosis of COVID-19, respectively. Scheduled risk-directed intravenous chemotherapy was delivered in 70 (90.9%) of 77 children on active systemic treatment with a median delay of 14 d (range 0–48 d) and no increased toxicities. All-cause mortality rate was 7.4% (n=9) and COVID-19 related mortality rate was 4.9% (n=6). One hundred-ffteen (94.2%) children with COVID-19 did not require any form of respiratory support during the course of infection. Conclusions COVID-19 was not a major deterrent for the continuation of active cancer treatment despite persistent RT-PCR positivity. The long-term assessment of treatment adaptations requires further prospective follow-up and real-time addressal.

A organização do trabalho pedagógico da Educação Física com crianças em tratamento oncológico / The organization of the pedagogical work of Physical Education with children undergoing cancer treatment / La organización del trabajo pedagógico de Educación Física con niños en tratamiento oncológico

RESUMO Discute o trabalho pedagógico de professores de Educação Física com crianças em tratamento oncológico, considerando as agências, as autorias e as produções culturais dos infantis. Trata-se de uma Pesquisa-Ação Colaborativa, desenvolvida com 61 crianças entre 4 e 12 anos. Os dados produzidos pela observação participante e registrados em diário de campo foram sistematizados em três categorias: planejamento em conjunto, tempo do brincar e agências infantis. Os resultados apontam para a construção coletiva do planejamento e para o reconhecimento das crianças como agentes de si, produtoras de cultura e protagonistas em seus processos de socialização, dando visibilidade ao que é criado e ressignificado por elas.

ABSTRACT Discusses the pedagogical work of Physical Education teachers with children with cancer, considering the agencies, authorship, and cultural productions of children. This is a Collaborative Action Research, developed between 2019 and 2021, with 61 children between 4 and 12 years old. The data produced by observation and recorded in a field diary were systematized into three categories: joint planning, playtime, and children's agencies. The results point to the collective construction of planning and the recognition of children as agents of themselves, producers of culture, and protagonists in their socialization processes, giving visibility to what is created and re-signified by them.

RESUMEN Discute el trabajo pedagógico de los profesores de Educación Física con niños con cáncer, considerando los organismos, la autoría y las producciones culturales de los niños. Se trata de una Investigación Acción Colaborativa, desarrollada entre 2019 y 2021, con 61 niños entre 4 y 12 años. Los datos producidos por la observación y registrados en un diario de campo fueron sistematizados en tres categorías: planificación conjunta, tiempo de juego y agencias infantiles. Los resultados apuntan para la construcción colectiva de la planificación y el reconocimiento de los niños y niñas como agentes de sí mismos, productores de cultura y protagonistas de sus procesos de socialización, dando visibilidad a lo creado y resignificado por ellos.

Feeding difficulties and eating disorders in pediatric patients with cancer / Trastornos y dificultades en la alimentación en pacientes pediátricos con cáncer

Abstract Background Feeding difficulties and disorders are a common problem in the pediatric population, which involve a series of deficient behaviors about nutrition processes that can adversely affect psychomotor, psychosocial, and physical development of children. This study aimed to describe the frequency of feeding difficulties or disorders in pediatric patients with cancer. Methods A prospective study which included 125 children from 1-19 years treated at the Department of Oncology of the Instituto Nacional de Pediatría, Mexico City, was conducted. The diagnosis of eating disorders and feeding difficulties was determined during the first 48 h since admission, and the age of the patient influenced the type of disorder and feeding difficulties. Results Children older than 11 years presented more frequently an intense resistance of feeding because of discomfort pain (fear of feeding) than younger children (11.4 ± 4.7 vs. 7.4 ± 4.9, p ≤ 0.001). The most frequent alteration associated with malnutrition was loss of appetite (odds ratio [OR]: 8.8, confidence interval [CI] 95% 2.9-26.9, p<0.001), followed by fear of feeding (OR: 3.14, CI 95% 1.24-7.9, p=0.015), and the organic causes showed the highest risk for malnutrition (OR: 3.1, CI 95% 0.98-9.7, p=0.054). Conclusions Over 90% of the studied population demonstrated at least one eating disorder or feeding difficulty. The principal effect is inadequate nutritional intake due to limited appetite and fear of feeding, which can result in undernutrition. For this reason, the identification of alterations in nutrition processes should be part of the comprehensive assessment of cancer patients.

Resumen Introducción Los trastornos y dificultades para la alimentación son problemas comunes en la edad pediátrica. Estas situaciones conllevan una serie de comportamientos inadecuados respecto de los procesos de nutrición que pueden afectar de manera adversa el desarrollo psicomotor, psicosocial y físico del niño. El objetivo de este trabajo fue describir la frecuencia de desórdenes y dificultades en la alimentación en niños con cáncer a través de un estudio prospectivo. Métodos Se incluyeron 125 niños de 1 a 19 años de edad del Servicio de Oncología del Instituto Nacional de Pediatría, Ciudad de México. El diagnóstico de desorden y dificultad en la alimentación se determinó en las primeras 48 horas del ingreso. Resultados Los niños mayores de 11 años presentan con mayor frecuencia resistencia a comer debido a dolor o malestar (miedo a comer) (11.4±4.7 años versus 7.4±4.9 años; p≤0.001). La alteración más frecuente asociada a malnutrición fue la disminución del apetito (razón de momios [RM]: 8.8; intervalo de confianza [IC] 95%: 2.9-26.9; p<0.001), seguido del miedo a comer (RM: 3.14; IC 95%: 1.24-7.9; p=0.015) y las causas con mayor riesgo de malnutrición fueron las orgánicas (RM: 3.1; IC 95%: 0.98-9.7; p=0.054). Conclusiones Se encontró que en más del 90% de esta población se presentó por lo menos un desorden alimentario o dificultad al alimentarse. El principal efecto es la ingesta nutricional inadecuada debida al apetito limitado y al miedo a alimentarse, lo que puede resultar en desnutrición. Por esta razón, la identificación de alteraciones en los procesos de nutrición deben ser parte de la valoración integral de los pacientes con cáncer.

Factores de riesgo para la no adherencia al tratamiento, de cuidadores familiares de niños con cáncer / Risk factors for non-adherence to treatment of family caregivers of children with cancer

La situación, de los factores de riesgo para la no adherencia a los tratamientos, ha sido abordada por la OMS, como un problema multifactorial. Es así, como en el caso de los niños con cáncer, siendo una enfermedad crónica no transmisible, se hace necesario intervenir a los cuidadores familiares, sobre la toma de conciencia acerca de la importancia de seguir el tratamiento y que el temor no sea un motivo para perder el contacto con el equipo de salud. Objetivo: Determinar los factores de riesgo para la no adherencia al tratamiento, de cuidadores familiares de niños con cáncer. Método: Estudio de abordaje cuantitativo, descriptivo y corte transversal, en el cual se incluyeron 110 cuidadores familiares de niños con cáncer, con edades comprendidas entre 0 y 14 años, con mínimo 3 meses de tratamiento, en el Instituto Nacional de Cancerología. Se aplicó la ficha de caracterización de pacientes con enfermedad crónica del grupo "Cuidado de Enfermería al Paciente Crónico y su familia" y el Instrumento para evaluar los Factores que Influyen en la Adherencia a los Tratamientos Farmacológicos y no Farmacológicos en Pacientes con Riesgo de Enfermedad Cardiovascular (tercera Versión). Análisis: se utilizó estadística descriptiva. Resultados El factor socioeconómico, para los cuidadores familiares, se ubicó como elemento de riesgo para la no adherencia a los tratamientos, mientras que el factor relacionado con el proveedor se encontró en el rango de ventaja para adherencia. Conclusiones: Los cuidadores familiares de niños con cáncer, presentaron comportamientos que indican que su adherencia es buena y como factor influyente los relacionados con el equipo de salud.

The situation of the risk factors for the non-adherence to treatments has been tackled by the OMS, like a multifactorial problem. For that, as in the case of children with cancer, being a chronic non-transmissible disease, it´s necessary intervene the family Caregivers, about the awareness relating to the importance of follow the treatment and that fear is not a reason to lose the contact whit the health team. Objective: Determine the risk factors for the no adherence to treatment of family Caregivers of children with cancer. Method: Study of quantitative, descriptive and cross-section approach, in which one were include 110 family Caregivers of children with cancer, with ages between 0 and 14 year, with minimum 3 months of treatment, in the National Institute of Cancerology. The characterization card of patients with chronic disease of the group "Care of Nursing to the Chronic Patient and his family" and the Instrument to evaluate the Factors that Influence the Adherence to Pharmacological and Non-Pharmacological Treatments in Patients at Risk of Cardiovascular Disease was applied. (Third Version). Analysis: Descriptive statistics was used. Results: The socioeconomic factor for family caregivers was assign like the risk element for no adherence to treatments, while the factor related to the supplier was found in the range of advantage for adherence. Conclusions: The family Caregivers of children with cancer presented behaviors that indicate that their adherence is good and as an influential factor, the related with the health team

Depression And Anxiety In Mothers Of Children With Cancer And How They Cope With It: A Cross-Sectional Hospital Based Study In Eastern India

Objective: Cancer is a chronic, long-term illness that affects not only the child but also the family as a whole. The family faces objective as well as subjective difficulties, e.g. stress, anxiety and depression. The burden is often experienced by mothers, since they take on the major responsibility of care giving. We conducted a study in mothers of children with acute lymphoblastic leukemia (ALL) and determined whether their coping mechanisms were acceptable and if these mechanisms were helpful to reduce depression. Methods: Mothers of 58 children with Pre (precursor) B cell leukemia were evaluated using Beck's depressive inventory (BDI), Coping Health Inventory for Parents (CHIP), and State-Trait Anxiety Inventory (STAI). Results: Coping with behaviors used by mothers of children with ALL was ineffective. The mothers mostly used coping behavior, which involved family life and relationships, and the parents' outlook on life of the affected child. The use of CHIP sub scale-type I, ie.“talking with other individuals/parents in my same situation” was significantly related to more use of sub scale-type II, ie. “doing things together as a family, involving all members of the family” are both were significantly related to STAI (p < 0.001). However total BDI score was not significantly related with any of the coping scores (BDI scores more than 9). Patients with higher BDI scores had lower scores in all sub scales of CHIP. Conclusions: Our subjects did not use social support and did not understand the medical situation through communication with other parents, or medical professionals. Fewer depressed patients used more coping skills. Educating the parents about healthy coping mechanism can be a good way to reduce stress. Encouraging social support networking and providing information about the disease may help to increase the acceptance among the mothers with ALL. A

Seroconversión frente a primovacunación reforzada contra hepatitis B en niños con cáncer / Seroconversion in response to a reinforced primary hepatitis B vaccination in children with cancer

Introducción: La respuesta inmune a los antígenos de las vacunas está disminuida en los niños con cáncer. El objetivo de este estudio fue evaluar la seroconversión frente a vacuna ADN recombinante contra hepatitis B al momento del inicio de la quimioterapia y/o remisión en niños con cáncer. Pacientes y método: Estudio prospectivo, bicéntrico, controlado, no aleatorizado de niños con diagnóstico reciente de cáncer pareados con niños sanos. Los casos fueron vacunados a tiempo 0, 1 y 6 meses, a dosis de 20 y 40 μg si eran < ó > 10 años, respectivamente, con vacuna ADN recombinante contra hepatitis B, en el momento del diagnóstico en el caso de los tumores sólidos y luego de la remisión en el caso de los tumores hematológicos. El grupo control recibió el mismo esquema, con dosis de 10 o 20 μg respectivamente. Se midieron anticuerpos séricos anti-HBs a los 2, 8 y 12 meses posvacunación. Seroconversión se definió como títulos anti-HBs > 10 mUI/ml al octavo mes. Resultados: Un total de 78 niños con cáncer y 25 controles fueron evaluados con títulos anti-HBs al octavo mes. La tasa de seroconversión fue de 26,9%, en niños con cáncer, sin diferencia por edad, género ni tipo de tumor (p = 0,13; 0,29; y 0,44, respectivamente), y de 100% en el grupo control (p < 0,0001, comparado con los niños con cáncer). En el seguimiento a los 12 meses solo el 31,9% de los niños con cáncer presentaba títulos anti-HBs > 10 mUI/ml. Conclusiones: La vacunación contra hepatitis B con vacuna ADN recombinante, con esquema reforzado de 3 dosis, en el momento del inicio de la quimioterapia y/o remisión provee una respuesta inmune insuficiente en la mayoría de los niños con cáncer. En esta población debieran evaluarse vacunas de tercera generación, con adyuvantes más inmunogénicos, esquemas reforzados a los 0, 1, 2 y 6 meses, medición de títulos de anticuerpos al octavo y duodécimo mes, eventual uso de refuerzos y reevaluación de inmunogenicidad si correspondiese.

Introduction: Immune response against vaccine antigens may be impaired in children with cancer. The aim of this study was to evaluate the seroconversion response against hepatitis B vaccination (HBV) at the time of chemotherapy onset and/or remission in children with cancer. Patients and method: Prospective, two-centre, controlled, non-randomised study conducted on children recently diagnosed with cancer, paired with healthy subjects. Cases received HBV at time 0, 1 and 6 months with DNA recombinant HBV at a dose of 20 and 40 μg if < or > than 10 years of age, respectively, at the time of diagnosis for solids tumours and after the remission in case of haematological tumours. Controls received the same schedule, but at of 10 and 20 μg doses, respectively. HBs antibodies were measured in serum samples obtained at 2, 8 and 12 months post-vaccination. Protective titres were defined as > 10 mIU/ml at 8th month of follow up. Results: A total of 78 children with cancer and 25 healthy controls were analysed at month 8th of follow up. Seroconversion rates in the cancer group reached 26.9%, with no differences by age, gender or type of tumour (P = .13, .29, and .44, respectively). Control group seroconversion was 100% at the 8th month, with P < .0001 compared with the cancer group. At month 12 of follow up, just 31.9% of children with cancer achieved anti-HBs antibodies > 10 mIU/ml. Conclusions: Vaccination against hepatitis B with three doses of DNA recombinant vaccine at an increased concentration, administrated at the time of onset of chemotherapy and/or remission provided an insufficient immune response in a majority of children with cancer. More immunogenic vaccines should be evaluated in this special population, such as a third generation, with more immunogenic adjuvants, enhanced schedules at 0, 1, 2, 6 month, evaluation of antibody titres at month 8 and 12 h to evaluate the need for further booster doses.

Nutritional status at presentation, comparison of assessment tools, and importance of arm anthropometry in children with cancer in India.

BACKGROUND: In India, approximately 40,000 new cases of cancer in children are diagnosed each year. However, there are no good studies analyzing their nutritional status. Also, since accurate and sensitive nutritional assessment is critical for optimal clinical outcomes through timely remediation of malnutrition, it is important to assess the relative sensitivity and feasibility of commonly used nutritional screening tools. METHODS: This observational study analyzed height/length (cm), weight (kg), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSFT) as well as their Z-scores or percentiles, albumin levels and history of weight loss at diagnosis in children aged 2–15 years being treated for cancer between November 2008 to December 2013. Body mass index (BMI) and arm muscle circumference (AMC) were calculated respectively from height and weight, and MUAC and TSFT. RESULTS: A total of 1693 new patients were enrolled; 1187 had all anthropometric measurements performed. The prevalence of malnutrition was 38%, 57%, 76%, 69% and 81% on the basis of BMI, TSFT, MUAC, AMC, and arm TSFT + MUAC respectively with the highest prevalence in solid abdominal tumours. Addition of BMI and serum albumin to arm anthropometry increased the proportion classified as severely nutritionally depleted by a mere 2% & 1.5% respectively. Positive history of significant weight loss additionally identified 16.5% at nutritional risk over arm anthropometry. CONCLUSIONS: The prevalence of malnutrition in Indian children with cancer at presentation is very high ranging from 40% and 80% depending on the method used for assessment, being higher with MUAC and lowest with BMI. Either MUAC alone or TSFT + MUAC (wherever feasible) should be used for screening for malnutrition in children with cancer at diagnosis to plan timely nutritional interventions, reduce the treatment-related morbidity and optimise their chance of long-term cure.

A influência do lúdico no cuidado humanizado a pacientes oncológicos pediátricos no hospital do município de Aracaju-Se / Impact of playing activities on a humane care for pediatric cancer patients in the Aracaju-Se town hospital

Resumen:

Introducción: el estudio pretende conocer cómo las actividades de juego contribuyen a la atención humanizada a los niños con cáncer, hospitalizados en una institución de salud. Método: es un estudio exploratorio y descriptivo, cualitativo y cuantitativo, con una muestra de 40 acompañantes de niños hospitalizados. Resultados: los resultados mostraron que en los niños predominaron las edades entre 11 y 15 años, los acompañantes, hombres, adulto joven. La duración de la estancia hospitalaria entre 11 a 15 días. La causa más común de hospitalización es la del tratamiento para la leucemia. La influencia de los juegos es positiva, ya que minimiza el peso de la hospitalización, reduce el estrés tanto para el niño y el acompañante, socializa, reintegra al niño a su mundo infantil, ayuda a la recuperación de este.

Conclusión: se concluyó que la promoción del juego en un entorno sanitario contribuye al proceso de socialización y la comunicación entre pacientes, cuidadores y profesionales de la salud.

Abstract:

Introduction: The study was aimed to understand how playing activities contribute to a humane care for children with cancer admitted in a health institution.

Methods: A descriptive exploratory study, based on qualitative and quantitative methods, in a sample made of 40 people accompanying hospital-admitted children.

Results: A predominance of 11-15 years old children was observed; most accompanying individuals were young adult men. Length of hospital stay was 11 to 15 days. Most common cause for hospital admission was leukemia therapy. Impact of playing activities is positive, because they reduce the burden of hospitalization, reduce stress both for child and accompanying individual; enhance socialization, return patients to a children world, and help recovery. Conclusion: Promotion of playing activities in a hospital setting helps to enhance socialization and communication among patients, caregivers and health workers.

Introdução: o estudo objetiva conhecer como as atividades lúdicas contribuem para o cuidado humanizado às crianças com câncer internadas em instituição de saúde.

Método: trata-se de um estudo exploratório e descritivo, de natureza qualitativa e quantitativa, com 40 acompanhantes de crianças internadas. Resultados: os resultados mostraram que houve predominância para as idades entre 11 e 15 anos, sexo masculino, os acompanhantes tinham perfil adulto jovem, tempo de internação entre 11 a 15 dias, tendo o tratamento para leucemia a causa mais comum de internação. A influência do lúdico na ótica dos entrevistados é positiva, pois minimiza o peso da hospitalização, reduz o estresse tanto da criança como do acompanhante, socializa, reintegra a criança ao seu mundo infantil, ajuda na recuperação da criança.

Conclusão: concluiu-se que a promoção do brincar no espaço da hospitalização infantil contribui para o processo de socialização e comunicação entre pacientes, acompanhantes e profissionais de saúde.

Construções de significados acerca do adoecimento e morte nas narrativas de crianças com câncer / Construction of meanings about illness and death in the narratives of children with cancer

As narrativas surgem para ordenar a experiência humana alterada pela ruptura no seu estado canônico. Nesse sentido, uma doença como o câncer pode ser considerada uma experiência excepcional, que requer a narrativa para significá-la. Esse estudo investigou a construção de significados acerca do adoecimento e da morte nas narrativas de crianças com câncer em etapas distintas do tratamento. Para tanto, foram realizadas seis sessões de brincadeira com cada participante. A análise dos dados demonstrou que crianças com mais tempo de tratamento tendem a finalizar suas narrativas com a morte dos personagens e que crianças com menos tempo de tratamento apresentam narrativas relacionadas ao desconforto físico que o tratamento ocasiona e aos impedimentos que a doença acarreta em suas vidas. Esses resultados apontam para a necessidade de uma maior atenção à forma como as crianças falam do seu adoecimento e da subsequente possibilidade de morte no decorrer do tratamento oncológico, a fim de que possamos atentar para a diversidade dos momentos de tratamento, compreendendo que esses configuram diferentes relações subjetivas da criança para com sua doença e a morte. (AU)

Narratives come out to arrange the human experience altered by the disruption in its canonical status. In this sense, a disease like cancer can be considered an exceptional experience that requires the narrative to mean it. This study investigated the construction of meanings about the disease and death in the narratives of children with cancer in different stages of treatment. Thus, six sessions of play were performed with each child. Data analysis showed that children in longer treatment tend to conclude their narratives with the death of the characters and the children under shorter treatment time present narratives related both to physical discomfort to which the treatment leads to and impairments that the disease cause in their lives. The results indicate the need for greater attention on how children talk about the disease and the subsequent possibility of death during the course of cancer treatment, so that we can be aware of the diversity of treatment moments, understanding that they configure different subjective relationships about children's health problem and death. (AU)

Research on psychological resilience and its influencing factors among parents of children with cancer / 中国实用护理杂志

Objective To probe into the psychological resilience and its influencing factor among parents of children with cancer.Methods A total of 125 parents were investigated by self-designed general information questionnaire,Connor-Davidson psychological resilience scale (CD-RISC),Chinese version of Parents' Perception Uncertainty in Illness Scale (PPUS),Social Support Rating Scale (SSRS),self-rating depression scale (SDS) and self-rating anxiety scale (SAS).Results The total score of psychological resilience was (54.86±12.88) and the illness uncertainty score was (91.52±14.66).The social support score was moderate with a total score of (39.86±7.99).The anxiety and depression among parents got a total score of (40.08±7.19) and (44.61±7.38) respectively.Psychological resilience was negatively correlated with illness uncertainty and depression,and was positively correlated with the social support.The depression,illness uncertainty,residence,children's age,clinical diagnosis entered into the multiple linear regression equation of psychological resilience,predicting 30.1％ of total variation in psychological resilience.Conclusions Social support,illness uncertainty and depression are the important factors which affect psychological resilience among parents of children with cancer.Nurses should assess the social support that parents receive,the level of depression and the disease feeling of the parents,and provide targeted interventions to relieve it,help to establish effective coping style and improve their psychological state.

Entre o hospital e a escola: o cancer em crianças / Between the hospital and school: cancer in children / Entre el hospital y la escuela: el cáncer en niños

No presente artigo propomo-nos levantar alguns impasses escolares de crianças adoecidas pelo câncer. Ao constatarmos seus impedimentos à vida escolar buscamos trazer à discussão questões inerentes às barreiras impostas pelo adoecimento, laços sociais e pela própria instituição escola. Nossas intervenções, orientadas pela psicanálise, vêm indicando que a infância, quando inscrita no ambiente hospitalar, sofre mudanças que necessitam uma reorganizacão dos investimentos libidinais da criança, dos pais e dos profissionais envolvidos no processo. Mesmo que a legislação brasileira reconheça o direito de crianças e adolescentes hospitalizados ao atendimento pedagógico-educacional, que escolhas têm esses sujeitos? O que pode um psicanalista, desafiado em sua cidade, responder a esses impasses sem abrir mão de sua ética no laço estabelecido com as áreas da saúde e da educação?.

En el presente artículo nos proponemos a investigar las difíciles situaciones de niños enfermos por cáncer. Al percibimos sus obstáculos a la vida escolar, buscamos discutir cuestiones inherentes a las barreras impuestas por la enfermedad, a los lazos sociales y la propia institución escolar. Nuestras intervenciones, basadas por el psicoanálisis, vienen apuntando que la infancia, cuando inscrita en un ambiente hospitalario, sufre cambios, que necesitan una reorganización de las inversiones libidinales del niño, de los padres y de los profesionales envueltos en el proceso. Aunque la legislación brasileña reconozca los derechos de los niños y adolescentes hospitalizados al atendimiento pedagógico-educativa, en este panorama, ¿qué elecciones tienen esos niños? ¿Qué puede un psicoanalista, provocado en su ciudad, contestar a esos obstáculos sin renunciar de su ética, en el enlace establecido entre las áreas de la salud y de la educación.

In this paper we propose to raise some dilemmas of school children fell ill with cancer. When we realize their impediments to school we seek to bring into discussion issues related to barriers imposed by illness, social ties and the school institution itself. Our guided interventions by psychoanalysis have indicated that childhood, when entered in the hospital, undergoes changes that require a reorganization of libidinal investment of the child, parents and professionals involved in the process. Even though Brazilian law recognizes the right of children and adolescents admitted to the pedagogical-educational service, which choices are the subject child? What can a psychoanalyst, challenged in his city, to respond to these dilemmas without sacrificing their ethics in the bond established with the areas of health and education?.

Development of a Tool to Measure the Need for Child Hospice Care in Families of Children with Cancer / 아동간호학회지

PURPOSE: The purpose of this study was to develop a tool to assess the need for child hospice care in families of children with cancer. METHOD: The research design was a methodological study. The tool was developed in 4 stages : first, preliminary items were developed based on a questionnaire about the needs for child hospice care that was given to 20 families of children with cancer; second, a panel of specialists reduced the number of preliminary items using 3 validity tests for the content; third, final items were selected from the results of a pre-test. Finally, from February to July 2004, reliability and validity were tested with a sample of 104 families who had a child with cancer. RESULTS: The final tool on the need for child hospice care consisted of 22 items and Cronbach's alpha coefficient for internal consistency was .93. Using factor analysis, 5 factors were extracted and these factors explained 69% of the total variance. CONCLUSION: The instrument, for assessing the need for child hospice care in families of children with cancer, developed in this study was identified as a tool with a high degree of reliability and validity. In this sense, this tool can be effectively utilized for implementing and improving hospice care for children with cancer.

Influence of Resiliency Factors on Adaptation in Families of Children with Cancer / 아동간호학회지

PURPOSE: This study was conducted to identify resiliency factor, to test causal relationship and effect of resiliency factors on adaptation in families of children with cancer. A conceptual framework was constructed based on McCubbin's resiliency model. Hypotheses were tested with empirical data. METHOD: Data were collected using self-report questionnaire from 232 families of children with cancer. The collected data were analyzed using the SAS program and LISREL program for covariance structural analysis. RESULT: Family hardiness and problem-solving coping had significant direct effects on adaptation in families of children with cancer. Social support had significant indirect and total effect on adaptation. Family Schema had significant direct effect on family hardiness and problem-solving coping. Problem-solving communication had a significant direct effect on family hardiness and an indirect effect on family functioning and problem-solving coping. Among the resiliency factors, family hardiness had the greatest effect on adaptation in family of children with cancer. CONCLUSION: The findings suggest that nursing interventions to enhance family hardiness, problem-solving coping and social support would result in an increase in adaptation in families of children with cancer. An integrated intervention that emphasizes and promotes resiliency factors should be developed and established for families of children with cancer.

A Study on the Comparison of Psychosocial Adjustment of Children with Cancer between on and off Treatment / 아동간호학회지

PURPOSE: The purpose of this study was to compare psychosocial adjustment in children aged 4-11 years with cancer between on and off treatment. METHOD: The data was collected from parents of children with cancer through interviews with structured questionnaire at the pediatric outpatient department and inpatient ward of one university hospital located in Seoul. The instrument were the Child Behavior Check List(CBCL) developed by Achenbach(1991) and revised to standardize for Korean children by Oh et al(1997). RESULT: Total behavior problem score for children on treatment was greater than the score off treatment but there was no significant difference. Children on treatment reported higher levels of depression/anxiety, withdrawal, internalizing scores than children off treatment. Social competence score of children off treatment was greater than the score on treatment and the difference of school performance score of children between on and off treatment was not significant. The scores on the withdrawal, somatic complaints, social immaturity, internalizing scales in the cancer group including both on and off treatment was greater than normative findings in the general population. The scores on the school competence of children off treatment were lower than the norms for healthy children. CONCLUSION: Findings from this study support the importance of nursing interventions to facilitate the adjustment of children with cancer both on and off therapy.

Health Problems and Psychosocial Adaptation of Children with Cancer / 간호학회지

PURPOSE: The purpose of this study was to describe health problems and psychosocial adaptation in children with cancer and to determine the relationship between these two variables. METHOD: The data were collected from parents of 61 children with cancer, aged 4-11 years at one university hospital in Seoul. The instruments for this study were the Korea Child Behavior Check List (KCBCL) and a physical symptom checklist developed by the researchers. RESULT: The major health problems were coughing, sleeping disturbances, fatigue and weakness. The total behavior problem score for children in the cancer group was higher than the score for those in the norm group. The scores on the scales for withdrawal, somatic complaints, social immaturity, and internalizing problems were higher in the children with cancer compared to normative findings. Scores on social and school competence in the cancer group were lower than the norms for healthy children. The relationship between health problems and psychosocial adaptation was significant in the subscales of withdrawal, anxiety/depression, internalizing problems and social involvement in the off therapy group. CONCLUSIONS: This study shows the various areas that need further study in caring for children with cancer.

Analysis on Family Value of the Family with Cancer Children / 아동간호학회지

The family value is expected to play a crucial role in adjusting a new environment for the family, especially in the critical situation as having a child with cancer in the family. The purpose of the study was to analyze the family values of the family with cancer children in order to offer descriptive data, which will facilitate family adjustment with cancer children. The survey was conducted from July 18, 2000 to August 30, 2000 and the analysis included 309 parents of the children who have been diagnosed as cancer, 18 years of age or less, and treated either hospitalized or at the outpatient clinics. Two instruments were used to measure family value. The modified form of General family value scale was 18 items with a 5 points of Likert response format (Cronbach alpha= .78) and Family value scale was developed for the study with 12 items on a 5 points of Likert response format(Cronbach alpha= .73). The data analysis utilized SAS 6.12 for percentage, frequency, Mean, and t-test of demographic characteristics and mean, F score, ANOVA, and Duncan follow-up test of variable relationships. The study findings were as follows. 1) In General family value, the fathers gave the higher scores to 'The children should live with their parents'(M=4.01), and 'A parents and their children are like one body' (M=3.91). The item with lowest score was 'Its not impossible for man to have extramarital relationship'(M=1.92). The mothers thought the most important items were 'A parents and their children are like one body'(M=3.79), and 'A wife needs to be patient to keep harmony of the family' (M=3.56), and the item with lowest score was 'Its not impossible for man to have extramarital relationship'(M=1.44). 2) The mean scores of the mothers were higher than the fathers for all items in family value with cancer children, while fathers gave more points for items in general family value. Both of parents gave the highest score to 'The health of the family is most important to me'(M=4.85 for fathers, M=4.97 for mothers), and followed by 'The husband and wife need to be patient and understand each other to overcome the difficulties'. The item with lowest scores was 'The parents can have conflicts in making decisions since their child was sick'(M=3.34 for fathers, M=3.37 for mothers). 3) There were significant differences between fathers and mothers in items of General family value; fathers gave more points to the items of 'The children should live with their parents', 'Its essential to hold the ceremony to respect their forefathers', 'Its not impossible for man to have extramarital relationship', 'A woman with two daughters should have one more baby to succeed the generation', 'The husbands are responsible for the household economy', and 'When his mother and wife dont get along, the man should be on his mothers side'. However, there was no significant difference between fathers and mothers in items of Family value with cancer children. 4) The general family value was significantly different by the birth order of cancer children, mothers age, mothers education level, and types of payment. On the other hand, the family value with cancer children was significantly different by the age of cancer children, period of illness, period after completing treatment, family type, the number of family members, and the number of total children.

Experience of Siblings of Children with Cancer / 아동간호학회지

Illness is a situational crisis which affects entire family members. Children have different experiences and responses when their sibling has a cancer. There are many studies on sibling experiences to childhood cancer which have many problems in the USA. The main purpose of this study is to describe sibling experiences to childhood cancer accurately and coprehensively by collecting data from sibling to provide the data to develop nursing interventions for the families with childhood cancer. The data was collected from October 1 to November 6, 1995. A total of ten siblings with childhood cancer were interviewed. The meaningful contents were classified and categorized to four areas. Theses areas include knowledge and perception related to illness, changes in family life, changes in school life, and siblings' marturation. The results of this study were as follows : 1. Knowledge and perception related to childhood cancer : Children had limited knowledge about illness and expressed the desire to know more about sibling's illness. 2. Changes in family and school life : Children expressed loneness, emptiness, sadness, depression about separation with the mother and sibling, family mood change, leisure activities and financial difficulties. Many children reported that their school performance had suffered since sibling's illness. 3. Maturation of children : Some positive outcomes related to having a sibling with a cancer are maturation, increased affection for the sibling, empathy for their parents. The results of this study indicate that it is important to develop comprehensive nursing intervention programs for the families with a childhood cancer.