Psychopathological Aspects in Childhood Hematopoietic Stem Cell Transplantation (HSCT): The Perception of Parents and Adolescents.

Background: Data about psychosocial sequelae of childhood Hematopoietic Stem Cell Transplantation (HSCT) are limited and the association with a specific donor type or other medical factors is largely unknown (Chang et al., 2012). The aim of the present study was to compare the psychological aspects of pediatric HSCT survivors with healthy peers. A secondary aim was to detect whether parents and children differed in the perception of mental health status. The influence of medical factors on psychological status was also examined. Method: Thirty seven HSCT survivors (23 males) with a mean age of 14.4 years (SD = 3.03; range 8.16-18.33) were recruited. Twenty-six patients underwent an allogenic HSCT (matched unrelated donor, n = 20; matched sibling donor, n = 6) and 11 patients received an autologous HSCT. The children psychological aspects were assessed using the Youth Self Report (YSR) (Achenbach and Rescorla, 2001) and compared to a group of matched healthy peers. At the same time, parents were requested to complete the Child Behavior Checklist 6-18 (Achenbach and Rescorla, 2001). Medical and socio-demographic data were also collected. Results: HSCT survivors reported significantly higher levels of somatic complains (t27 = 3.14; p = 0.004; mean = 3.1) when compared to healthy peers (mean = 1.5). The parent CBCL scores on "child total competence" exceeded the normative clinical cutoff in 48.6% cases. Inter-rater agreement between parent and patient reports was present only in three scales: total competence score (K = 0.06, p = 0.002), somatic complaints (K = 0.21, p = 0.003) and attention problems (k = 0.13; p = 0.02). According to Ancova models, internalizing problems were more frequent in HSCT from family donors (F2 = 3.13; p = 0.06) or in the presence of acute complications (F1 = 11.95; p = 0.003). Conclusion: In contrast to the perception of parents, pediatric HSCT survivors reported good psychological health. However, they complained about more somatic problems as compared with healthy peers. Medical aspects such as donor source and the presence of acute complications should be taken into consideration for the psychological approach in order to improve pediatric HSCT survivor care.

Brief report: Self-blame and PTSD symptoms in adolescents exposed to terrorism: is school connectedness a mediator?

Previous research has shown that self-blame predicts increased risk of posttraumatic stress disorder (PTSD) in youth exposed to terrorism, but little is known about the factors mediating such relationship. This study aimed to explore whether school connectedness (SC) mediates the effect of self-blame on PTSD in 60 adolescents (aged 14-18 years) who survived the 2004 terrorist attack against school no. 1 in Beslan, Russia. Participants completed measures of coping, SC, and PTSD three years after the traumatic event. Endorsement of self-blaming behaviors was found to be significantly positively related to the presence of PTSD; self-blame was negatively associated with SC, which in turn was negatively related to PTSD. The mediation hypothesis was supported, with SC partially mediating the link between self-blame and PTSD. Adolescents affected by terrorism may benefit from school-based interventions aimed at fostering students' sense of belonging and emotional bonding to teachers, peers, and the school environment.

Neurodevelopmental functioning in very young children undergoing treatment for non-CNS cancers.

OBJECTIVE: We initiated a prospective study of very young children with cancer, in comparison with matched healthy children, to investigate neurodevelopmental consequences of non-CNS cancers and treatment. METHODS: A total of 61 children (≤42 months) with non-CNS cancers and 61 matched controls underwent an identical age-appropriate neuropsychological test battery. RESULTS: Children with cancer manifested deficits compared to healthy controls in motor, mental, and language development, but were similar to controls in cognitive representational abilities and emotional relationships in interaction with their mothers. Better physician-rated health status at diagnosis and mother-rated behavioral status 1 month prior to assessment were associated with better motor and mental performance in the cancer group. CONCLUSIONS: This study identifies deficits as well as spared functions in children with non-CNS cancers; the results suggest ways parents and healthcare professionals may plan specific remediations to enhance quality of life in young cancer survivors.

Are Beslan's children learning to cope? A 3-year prospective study of youths exposed to terrorism.

OBJECTIVE: This longitudinal study aimed to assess the course of psychological symptoms and coping behaviors in 33 adolescents directly and indirectly exposed to the 2004 terrorist attack in Beslan, Russia. We also investigated the role of coping in the development of posttraumatic stress. METHOD: At 1.5 and 3 years postattack, youths' psychological distress was measured using the Brief Symptom Inventory 18; emotional and behavioral difficulties were assessed via the Strength and Difficulties Questionnaire; and coping behaviors were measured using the Brief COPE. Three years after the attack, posttraumatic stress symptoms were evaluated via the UCLA Posttraumatic Stress Disorder Reaction Index. RESULTS: Directly exposed youths showed a significant increase in psychological distress (P = .05) and a decrease in active coping (P = .042), whereas indirectly exposed youths reported better mental health and more active coping over time. Compared to girls, boys showed a disproportionate increase in psychological distress, emotional and behavioral problems, and avoidant coping. Direct exposure to the attack and the endorsement of avoidant coping behaviors significantly predicted the severity of posttraumatic symptoms at follow-up (P < .05 for both). CONCLUSIONS: Our findings highlight the importance of conducting follow-up studies to monitor long-term psychological functioning and to screen for adolescents who may need additional referral for trauma treatment. The long-term detrimental effects of avoidant coping on youths' psychological well-being underscore the need to implement early psychoeducational interventions to minimize adverse outcomes and prevent the chronicity of posttraumatic reactions.

Trauma reminders and PTSD symptoms in children three years after a terrorist attack in Beslan.

As a consequence of a terrorist attack, children may experience trauma-related internal and external reminders that are directly linked to their physical and psychological health. We assessed PTSD and trauma reminders in 58 school-age children three years after the terrorist attack in Beslan, Russia in 2004, as well as their association with degree of exposure, psychological distress and coping. Findings revealed a prevalence of situational trauma reminders associated with high levels of distress in more exposed children. The presence of PTSD was predicted by level of exposure to the attack, frequency of exposure to trauma reminders, and support seeking as a coping strategy. Findings are discussed in light of the socio-political climate in Beslan and distress experienced by the population three years after the attack.

Social support, sense of community, collectivistic values, and depressive symptoms in adolescent survivors of the 2004 Beslan terrorist attack.

This cross-sectional study aimed to investigate the influence of socio-contextual variables on depressive symptoms in 158 adolescent survivors of the 2004 terrorist attack in Beslan, Russia, based on an ecological perspective. Participants were assessed 18 months after the traumatic event. Adolescents aged 14-17 years completed self-reported measures assessing depressive symptoms, social support, sense of community, and collectivism. The results of path analyses indicated that for both boys and girls, the endorsement of collectivistic values was related to increased family support, which in turn was associated with lower rates of depressive symptoms. In the male group, collectivism and sense of community were positively associated with peer support, which in turn was negatively related to depressive symptomatology. The findings suggest that social support and community connectedness may serve as protective resources in adolescents' psychological responses to terror-related stressors, and that gender differences as well as cultural values should be taken into consideration when implementing interventions with youths exposed to terrorism.

Recognition of facial expressions of mixed emotions in school-age children exposed to terrorism.

This exploratory study aims at investigating the effects of terrorism on children's ability to recognize emotions. A sample of 101 exposed and 102 nonexposed children (mean age = 11 years), balanced for age and gender, were assessed 20 months after a terrorist attack in Beslan, Russia. Two trials controlled for children's ability to match a facial emotional stimulus with an emotional label and their ability to match an emotional label with an emotional context. The experimental trial evaluated the relation between exposure to terrorism and children's free labeling of mixed emotion facial stimuli created by morphing between 2 prototypical emotions. Repeated measures analyses of covariance revealed that exposed children correctly recognized pure emotions. Four log-linear models were performed to explore the association between exposure group and category of answer given in response to different mixed emotion facial stimuli. Model parameters indicated that, compared with nonexposed children, exposed children (a) labeled facial expressions containing anger and sadness significantly more often than expected as anger, and (b) produced fewer correct answers in response to stimuli containing sadness as a target emotion.

Attention and memory in school-age children surviving the terrorist attack in Beslan, Russia.

Little is known about the impact of terrorism on children's cognitive functioning and school learning. The primary purpose of this study was to report on cognitive functioning among school-age children 20 months after a terrorist attack against their school. Participants included 203 directly and indirectly exposed children from Beslan and 100 nonexposed children from another town of the Russian Federation. All children were tested using nonverbal neuropsychological measures of attention, memory, and visual-spatial performance. Predisaster traumatic events and terrorism-related exposure factors were evaluated. Findings revealed that overall, directly and indirectly exposed children performed significantly less well than controls in all domains. In addition, direct exposure and loss of a family member were associated with poor memory performance.

Psychological adjustment of adolescents 18 months after the terrorist attack in Beslan, Russia: a cross-sectional study.

OBJECTIVE: Children exposed to terrorism are at high risk for developing emotional and behavioral problems, but only a few studies have examined adolescents' long-term psychological adjustment after a terrorist attack. We aimed to assess psychological distress, problem behaviors, and coping in adolescents who survived the terrorist attack on School No. 1 in Beslan, Russia. METHOD: Seventy-one youths aged 14 to 17 years held as hostages by terrorists completed self-reported measures of psychological symptoms, emotional and behavioral difficulties, and coping behaviors 18 months after the traumatic event. They were compared with 100 adolescents who were not directly exposed to the attack. Data were collected during a 1-month period in May 2006. RESULTS: No significant differences were found between the 2 groups in overall levels of psychological symptoms as well as in emotional and behavioral problems. Girls in both groups reported significantly more psychological distress (p = .0001) and total difficulties (p = .0001) than boys. In the directly exposed group, avoidant coping was related to worse psychological functioning for girls (r = 0.54, p < .001) and boys (r = 0.50, p < .01), whereas in the indirectly exposed group this strategy was associated with psychological distress (r = 0.43, p < .01) and total difficulties (r = 0.40, p < .01) for girls only. CONCLUSIONS: More than 1 year after a terrorist attack, adolescents may experience psychological distress regardless of being directly or indirectly exposed. Professionals working with adolescents affected by terrorism should be sensitive to developmental level and gender, consider the cultural context, and foster coping skills that may be differentially effective for girls and boys.

Narratives from caregivers of children surviving the terrorist attack in Beslan: issues of health, culture, and resilience.

Acts of terrorism have an extremely negative impact on the mental health of children and families. The school siege in Beslan, Russia, in 2004, represents a particularly traumatizing event as it was directed specifically at children and involved the entire community. This qualitative study aims to: (a) examine caregiver reactions to the terrorist attack in Beslan as reported 3 months after the traumatic event; (b) determine the extent to which indigenous cultural values and religious belief systems play a role in Beslan's caregivers' reactions to such event; and (c) identify variables that may function as sources of resilience to caregivers. A convenience sample of 17 primary caregivers from Beslan with at least one child who survived the school siege were asked to participate in semi-structured interviews. Narratives generated from the interviews were qualitatively analyzed using a thematic approach; nine major themes were identified. Caregivers' concerns centered on children's physical and psychological well-being, the reorganization of family life, and the disruption of community ties. Cultural values of pride, heroism, courage, and revenge emerged as relevant aspects shaping caregivers' reactions to the traumatic event. Possible sources of resilience included the willingness to return to normality, social support, and the reaffirmation of positive, culturally shared values in face of the perceived threat of future terrorist attacks. Findings are discussed in terms of their theoretical implications on the effects of trauma on children and families as well as interventions with highly traumatized populations in diverse cultural settings.

A pilot project of a cancer patient library in Italy: results of a customer-satisfaction survey and its products.

AIMS: The purpose of this study is to determine the degree of satisfaction of users of the Cancer Information Point section of the Library for Patients (CIP-LP), active since 1998 at the National Cancer Institute of Aviano, Italy. The CIP-LP is based on a skilled intermediary, adequate informative material and a specific location, within the Scientific Library of the Institute. PATIENTS AND METHODS: A survey was developed to assess service functionality and quality from the users' viewpoint. During a 6-month period, a questionnaire was mailed to 194 patients and relatives who previously used the CIP-LP; 113 (58%) were returned and processed. RESULTS: Of the respondents, 91% were pleased with the CIP-LP and 95% would recommend the service to other people. The information obtained contributed to a clearer understanding of the illness and treatment (45% as first answer) and a better control of the situation (33%). Fifty-one per cent evaluated the information received as 'good', 42%'excellent' and 4%'of sufficient quality'. CONCLUSION: This survey shows the appreciation and usefulness in the users' perception of a specific hospital library for cancer patients and their relatives, providing an information service supplementary to doctor-patient communication.

Posttraumatic reactions among injured children and their caregivers 3 months after the terrorist attack in Beslan.

This report describes symptoms of posttraumatic stress disorder (PTSD) among a group of Beslan's children (N=22) and their primary caregivers (N=20) 3 months after the children had been taken hostage in their school by a group of terrorists. Attention and memory were also measured. Children and their caretakers showed high levels of ongoing PTSD symptoms. Children also showed difficulties in sustaining attention and in short-term memory (digit span). These scores strongly indicate the need for appropriate interventions and ongoing monitoring of course of recovery.

Parental narratives of quality of life in children with leukemia as associated with the placement of a central venous catheter.

Thirty mothers of children with leukemia were interviewed about the child's and family's daily routines using a version of the Ecocultural Family Interview. Parental narratives were analyzed qualitatively and quantitatively. Four broad dimensions, encompassing 23 subthemes, were identified: child coping (alpha=0.88), child quality of life (alpha=0.72), parental coping (alpha=0.72), and parental trust in the medical care (alpha=0.73). Two objective variables were drawn from the medical charts (time from the diagnosis, time from central venous catheter [CVC] placement). Regression analyses showed that the number of days from the CVC placement (beta=0.46) and child coping (beta=0.44) significantly predicted children's quality of life, which in turn predicted parental trust in the medical care (beta=0.31). The methodological implications of our narrative approach are discussed.

Conversational strategies with parents of newly diagnosed leukaemic children: an analysis of 4880 conversational turns.

GOALS OF WORK: Communication with parents of children newly diagnosed with cancer poses a number of problems, mostly due to the psychological effects of parental trauma. This study was designed to answer the following questions: How can we sustain the flow of communication with parents of children newly diagnosed with leukaemia so that it may become easier and more effective? What should we say to gather more reliable information from parents? How can we help empower their coping strategies? PATIENTS AND METHODS: We analysed 4880 conversational turns in individual conversations carried out between psychologists and 21 parents of children with leukaemia. The conversations were aimed at gathering information of the families' daily routines. Dialogues were audiotaped and fully transcribed. The type and frequency of speech acts present in each turn were coded along 18 categories by two independent judges (inter-rater agreement, Cohen Kappa =0.73). MAIN RESULTS: The parental speech acts expressing emotion in various ways go up to 58% of the total number of their speech acts. The lag-sequential analysis showed that such expressions are not associated with any of the interviewer's speech act. The same analysis showed that, by contrast, the interviewer's style has an effect upon the cognitive aspects of parents' conversation. Support of hope favoured parental ability to identify their coping strategies. Explicit requests, confirmations such as "sure" and key words summarizing parents' viewpoints are followed by parental factual and objective narratives. CONCLUSIONS: Based on these results, a few practical recommendations for health care professionals are given in order to better communicate with parents of children newly diagnosed with cancer.