Longitudinal patterns of psychological distress in adult survivors of childhood cancer.

BACKGROUND: This study investigated longitudinal patterns of psychological distress in adult survivors of childhood cancer. METHODS: Participants included 4569 adult survivors in the Childhood Cancer Survivor Study Cohort (CCSS) who completed the Brief Symptom Inventory-18 on three occasions between 1994 and 2010. Longitudinal latent class analysis was used to identify discrete classes of psychological distress. Predictors of class membership were examined through logistic regression modelling with odds ratios (ORs) and 95% confidence intervals (CIs) reported. RESULTS: Survivors were a median of 39 years of age and 30 years from diagnosis at the most recent follow-up. Most survivors reported few or no symptoms of distress over time, although subsets of survivors reported persistently elevated (depression: 8.9%; anxiety: 4.8%; somatisation: 7.2%) or significant increases in distress symptoms over the follow-up period (depression: 10.2%; anxiety: 11.8%; somatisation: 13.0%). Increasing distress symptoms were predicted by survivor perception of worsening physical health over time (depression: OR=3.3; 95% CI=2.4-4.5; anxiety: OR=3.0; 95% CI=2.2-4.0; somatisation: OR=5.3; 95% CI=3.9-7.4). Persistent distress symptoms were also predicted by survivor perception of worsening physical health over time, as well as by worsening pain and ending analgesic use. CONCLUSION: Subgroups of adult survivors are at-risk for chronic distress or significant increases in distress decades following their original cancer diagnosis. Routine screening of psychological distress in adult survivors of childhood cancer is warranted, especially for survivors who experience physical health morbidities.

Anorexia nervosa in a 7-year-old girl.

We report on a 7-year-old girl with anorexia nervosa and consider factors contributing to this early emergency. Cognitive differences in younger children can alter their understanding of this illness, so we chronicled this girl's treatment because it diverged from practices used with older patients. Accordingly, effective interventions in very young anorexics might require modifications of treatments used in postpubertal populations.

Mother-infant feeding interaction in full-term small-for-gestational-age infants.

Maternal and infant behavior during feeding was assessed in 30 mother-infant dyads: 15 small-for-gestational-age (SGA) infants (birth weights below the 10th percentile) and 15 appropriate-for-gestational-age (AGA) infants (birth weights between the 25th and 90th percentiles). The groups were balanced for gestational age, sex, neonatal risk factors, and maternal age, parity, socioeconomic status, and race. Behaviors indicative of infant feeding difficulties were coded for mother and infant. The SGA mothers had higher frequencies of these behaviors than did their AGA counterparts. Qualitative ratings of interactive behavior were recorded for mother and infant: SGA infants had ratings indicative of less optimal interactions than those of the AGA group. Infant caloric intake (calories per kilogram per feeding) was calculated by first dividing the change in infant weight in grams before feeding and immediately after feeding by the infant's weight before feeding and then converting it to calories. Although no difference in caloric intake was observed between the two groups, infant behaviors and ratings were associated with caloric intake. These data suggest the importance of including neonatal behavior during feeding in the risk assessment of potential growth failure in SGA infants.