Hematopoietic stem cell transplantation (HSCT) is a lifesaving intervention for various hematologic and oncologic diseases that presents significant psychological risks for pediatric patients and their caregivers. Implementation of a longitudinal screening pathway for associated symptoms of post-traumatic stress disorder (PTSD) has been recommended; however, feasibility and utility in directing behavioral health needs remains unclear. Patients’ eligibility for enrollment included scheduled allogeneic or autologous HSCT through our institution’s Center for Cancer and Blood Disorders. Eligible caregivers and patients completed psychometrically validated self-report instruments assessing PTSD symptoms via REDCap pre-transplant, at 30 days, 100 days, 180 days, and 365 days following transplant. Individuals who reported experiencing clinically significant trauma symptoms at any timepoint were referred to a mental health clinician for treatment. If already involved in therapy, session frequency was recommended to increase and trauma-focused interventions were prioritized. Between April 2022 and April 2024, approximately 90% of eligible patients and caregivers consented for study participation ( N = 62). Preliminary findings suggest excellent retention and participants represented a diverse sample. Additionally, based on screening results at each timepoint, approximately 70% of our sample was connected to mental health services or offered increased session frequency if already engaged in treatment based on screening results. HSCT reflects a stressful experience for both patients and their caregivers. Systematically screening for PTSD among this population at the time of transplant and throughout the subsequent year was feasible and enabled targeted provision of behavioral health services. 

Development of a Trauma Screening Pathway for Youth and Their Primary Caregiver Undergoing Bone Marrow Transplant: A Feasibility Study

Bu çalışmada, Dicle Nehri’nden 2013-2014 yılları arasında toplanan Unio mancus ve Anodonta anatina türlerininiç organ kitlesinde Cu, Ni, Co, Zn, Cd ve Pb’nun birikim düzeyinin tespit edilmesi amaçlanmıştır. Bu amaçlabelirlenen üç istasyondan alınan 90 adet midye örneğinde ağır metal analizi ICP-OES ile yapılmıştır. Unio mancustüründe ölçülen ağır metal konsantrasyonları Zn (94.2 ppm)> Cu (31.66 ppm)> Ni (14.10 ppm)> Pb (5.72 ppm)>Co (2.51 ppm) olmak üzere en yüksek değerlerin (Zn hariç) I. istasyonda olduğu görülmüştür. Zn metalinin enyüksek değeri ise II. istasyonda 107.86 ppm olarak ölçülmüştür. Anodonta anatina türünde I. ve II. istasyondakonsantrasyonlar Zn> Cu> Ni> Pb> Co, III. istasyonda ise Zn> Ni> Cu> Pb> Co olarak ölçülmüştür. Cu (23.75ppm), Ni (16.06 ppm), Co (3.05 ppm), Pb (3.84 ppm) metallerinin en yüksek değerleri I. istasyonda, Zn (117.68 ppm)metalinin ise en yüksek değeri III. istasyonda ölçülmüştür. İstatistik hesabı ANOVA-Tukey testi ile yapılmış ve ağırmetal konsantrasyonları Unio mancus türünde Cu (F=74.238; P=0.000), Ni (F=39.584; P=0.000), Co (F=13.738;P=0.000); Anodonta anatina türünde ise Cu (F=35.369; P=0.000), Ni (F=20.107; P=0.000), Co (F=6.777; P=0.004),Zn (F=16.298; P=0.000) ve Pb (F=16.347; P=0.000) şeklinde anlamlı bulunmuştur (p<0. 05). Çalışmamızda eldeedilen ağır metal düzeyleri ülkemizde çift kabuklu yumuşakçalarda Türk Gıda Kodeksi Bulaşanlar Yönetmeliği’ne(2011) göre kabul edilir değerlerin üzerinde, EPA ve FAO’ya göre belirlenen sınır değerlerin ise altında olduğugörülmüştür.

Distribution of Mn54from Fall-out in Population of Freshwater Lamellibranchs (unio Mancus Elongatulus Pfeiffer)

The ecotoxicology of nano-titanium oxide (TiO2-NPs) has been initiated recently but still there is no clarity in the results. The objective of this study was to evaluate the response of sub lethal toxicity of nanoparticles of TiO2 on the muscular antioxidant system in Clarias gariepinus and the defensive role of both vitamin C and E. Fishes were at random distributed into 5 groups and a total 50 fish in each group. Fishes of the first and second group were given 1 and 2 mg/L nano-TiO2 of, respectively. Fishes of the third and fourth group were administered with 1 and 2 mg/L TiO(2)NPs and a mixture of vitamins C and E in a dose of 500 mg/kg diet (250 mg of each) and group five was control. After 7 and 15 days of exposure, muscle homogenates were prepared for the biochemical determination of lipid peroxides (LPOs), reduced glutathione (GSH) levels and SOD, CAT, GR, GPx and GST activities. The mRNA expression levels of SOD, CAT, GR, GPx and GST were determined in fish muscle. Fish muscle LPO concentration was significantly decreased while GSH concentration, SOD, CAT, GR, GPx and GST activities were significantly decreased in groups exposed to nano-TiO2 as compared to control. A significant amelioration in these parameters in groups treated with vitamin C and E. In conclusion, the sublethal doses of nano-TiO2 have the ability to affect the antioxidant system in C. gariepinus and it can be used as a bio-indicator for TiO2 toxicity. (C) 2017 Friends Science Publishers

Fish Exposure To Sub-Lethal Toxicity Of Nano-Titanium Oxide And Changes In Muscular Antioxidant Enzymes And Protective Role Of Vitamins C And E In Clarias Gariepinus

Retinoblastoma is a rare childhood ophthalmic cancer that requires frequent eye examinations under anaesthesia and painful or distressing procedures. This can cause significant anxiety for children and their families.We evaluated a Starlight Children's Foundation programme, 'Captains on Call', at the Queensland Children's Hospital, which aims to provide positive distraction and reduce stress, anxiety and pain during the perioperative journey for children in the retinoblastoma treatment pathway. This study examined the impact of the programme on the perioperative experience of the children and their families, using a qualitative design.This study was conducted in a paediatric operating suite at a tertiary-level children's hospital in Australia. We interviewed a parent from 20 families (from a cohort of 40 families, including 44 children), whose children received treatment or screening for retinoblastoma, focusing on the programme's impact on the child and family at various stages during the perioperative journey. We undertook a thematic analysis of transcribed interviews.We identified two themes, each with two sub-themes: (1) the programme positively contributed to the overall treatment journey, by addressing different needs at different times, and helping to reframe a traumatic medical experience, and (2), the programme supported the whole family unit by empowering children through play, and adopting a family systems approach which recognised the impact of cancer treatment on the whole family.This study highlights the value of the Captains on Call programme in supporting children with retinoblastoma and their families during perioperative visits. The Captains, particularly as non-medicalised professionals in a healthcare setting, built trust and rapport with the children through play over repeated episodes of care. The interprofessional collaborative approach with a reflective cycle of practice extended it beyond a programme providing simple distraction. Other retinoblastoma services may benefit from implementing a similar approach. 

Captains on call: A qualitative investigation of an intervention to support children with retinoblastoma undergoing regular eye examinations

The role of parental factors in the emergence of post-traumatic stress symptoms (PTSSs) following pediatric surgeries is well recognized, but the specific influence of parents’ subjective preparedness for their child’s surgery has not been explored. In a study involving 253 children hospitalized in a pediatric surgery ward, parents completed a demographic questionnaire during their child’s stay, which included the question, “As a parent, have you been prepared for the surgical intervention your child is undergoing?” Four months post-surgery, the same parents were interviewed using two questionnaires that evaluated their children’s post-traumatic symptoms. Our findings indicate that in emergency surgical settings, children whose parents felt prepared experienced significantly fewer PTSSs compared to children whose parents did not feel prepared. In contrast, for elective surgeries, parental subjective perception of preparedness did not significantly impact the children’s PTSSs. We conclude that for emergency surgical procedures, addressing parents’ subjective preparedness could be crucial. Further research is necessary to develop targeted interventions that leverage this insight to minimize the risk of PTSSs in children undergoing emergency surgeries. 

The Impact of Parents’ Subjective Preparedness on Their Children’s Post-Traumatic Symptoms Following Surgery

After a traumatic medical event, such as surgery or hospitalization, a child may develop a phobia of medical care, sometimes preventing future medical adherence and impairing recovery. This study examined the correlation of Pediatric Medical Traumatic Stress (PMTS) on the development of Medical Phobia (MP) and subsequent treatment adherence. We enrolled 152 parents of children aged 1–6 hospitalized in a surgical ward. During hospitalization, parents completed questionnaires that identified post-traumatic stress symptoms. Four months post hospitalization, parents completed questionnaires on post-traumatic stress, medical phobia, psychosocial variables and medical adherence. We found a positive correlation between PMTS and MP and low adherence to medical treatment. In addition, MP mediated the relationship between PMTS severity and adherence, indicating that PMTS severity is associated with stronger medical phobia, and lower pediatric adherence to medical treatment. Our findings suggest that medical phobia serves as an essential component of PMTS. It is important to add medical phobia to medical stress syndrome definition. In addition, as MP and PMTS are involved in the rehabilitation and recovery process and subsequent success, it is an important aspect of treatment adherence.

/pdf/a-cross-sectional-study-to-identify-traumatic-stress-medical-20ygf7tg.pdf

A Cross Sectional Study to Identify Traumatic Stress, Medical Phobia and Non-Adherence to Medical Care among Very Young Pediatric Patients

Background: Illness, surgery and surgical hospitalization are significant stressors for children. Some children who experience such a medical event may develop Pediatric Medical Traumatic Stress (PMTS). PMTS affects physical recovery, and many areas and functions in children’s lives, both short- and long-term. The aim of the study is to examine the difference in the rate of PMTS between the Arab and Jewish populations and the difference in risk factors for the development of this syndrome. Method: The study involved 252 parents of children aged 1–6 who were hospitalized in the surgical ward of Hadassah Medical Center. During hospitalization, parents completed questionnaires to identify risk factors for the development of PMTS. At 3 months from the time of discharge, the children’s level of PMTS was measured. Results: The rate of children diagnosed with PMTS among Arab children was significantly higher than the rate in the Jewish population. The affiliation to an ethnic group affected different socioeconomic, demographic, social, linguistic and cultural background variables, which in turn affected the emergence of PMTS. Conclusion: The study emphasizes the nature of PMTS at the intercultural level, which can be an important source for theoretically understanding both the disorder and culture, as well as for clinical implications in developing population-sensitive treatment.

/pdf/intercultural-differences-in-the-development-of-pediatric-1m28pkvn.pdf

Intercultural Differences in the Development of Pediatric Medical Traumatic Stress (PMTS) in Children Following Surgical Hospitalization

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A Cross Sectional Study to Identify Traumatic Stress, Medical Phobia and Non-Adherence to Medical Care among Very Young Pediatric Patients

Intercultural Differences in the Development of Pediatric Medical Traumatic Stress (PMTS) in Children Following Surgical Hospitalization