Association of Asthma Illness Representations and Reported Controller Medication Adherence Among School-Aged Children and Their Parents.

This study examined the relationship between asthma illness representations and reported controller medication adherence of school-aged children (6-11 years) with persistent asthma and their parents. Thirty-four parent-child dyads independently reported on asthma controller medication adherence and asthma illness representations. Hierarchical regression analyses were used to test parent and child illness representation domain variables as predictors of reported medication adherence. Parent beliefs about medication necessity versus concerns was a significant predictor of parent-reported adherence (ß = .55, p < .01), and child treatment control was also a significant predictor of parent-reported adherence (ß = -.50, p < .01). Child beliefs about medication necessity versus concerns was a significant predictor of child-reported adherence (ß = .50, p < .01), and no parent variables reached significance. Although there are similarities between parent and child asthma illness representations, findings indicate that school-aged children develop illness representations somewhat independently from their parents and, therefore, are critical participants in both asthma care and research.

Increase in oxidative stress as measured by cerebrospinal fluid lipid peroxidation during treatment for childhood acute lymphoblastic leukemia.

Five-year survival from childhood acute lymphoblastic leukemia (ALL) approaches 90%, but 40% of survivors experience central nervous system (CNS) treatment-related cognitive problems. Despite considerable evidence for cognitive problems, less is known about mechanisms of neurological injury. Our purpose was to investigate oxidative stress, measured by lipid peroxidation, as a mechanism of CNS treatment-related neurological injury. The sample included 55 children (mean age at diagnosis=6.84 y, SD=3.40) who received intrathecal and intravenous chemotherapy for CNS-directed treatment according to Children's Oncology Group protocols. Glycerophospholipids were extracted from cerebrospinal fluid samples obtained at diagnosis and during intrathecal chemotherapy administration. Unoxidized and oxidized phosphatidylcholine (PC) and phosphatidylinositol (PI) were measured by normal phase high-performance liquid chromatography with diode array detection, and analyzed with a general linear model for repeated measures analysis of variance. Compared with the diagnostic cerebrospinal fluid sample, unoxidized and oxidized PC and PI increased significantly across treatment phases. Amount of intravenous methotrexate received was significantly correlated with oxidized PI, and age at time of ALL diagnosis was significantly associated with oxidized PC. These findings support our hypothesis that oxidative stress is a mechanism of neurological injury associated with CNS-directed treatment for ALL.

Cancer-related cognitive changes in children, adolescents and adult survivors of childhood cancers.

OBJECTIVES: To summarize the current knowledge about 1) cognitive changes associated with central nervous system-directed chemotherapy and cranial radiation among children with acute lymphoblastic leukemia and brain tumors and adult survivors; and 2) interventions designed to prevent or remediate the cognitive and academic problems associated with central nervous system-directed cancer treatment. DATA SOURCES: Classic and current databased publications. CONCLUSION: Future directions for research include 1) identification of sources of variability in long-term outcomes; 2) greater understanding of the developmental evolution of deficits across the survivor lifespan; and 3) interventions to treat and prevent negative outcomes following cancer therapy. IMPLICATIONS FOR NURSING PRACTICE: Pediatric oncology nurses have a critical role in identifying children and adolescents at risk for cognitive changes associated with cancer therapy, initiating referral for assessment of cognitive changes during and after therapy, and advocating for resources to enhance cognitive and academic outcomes.