Factors Surrounding and Influencing the Primary Disclosure in Child Sexual Abuse

This study aimed to investigate the context within which children initially disclose their sexual abuse. The study sought to identify triggers that prompted the initial disclosure event, and to investigate the relationship between the choice of initial confidante and the childs age and likelihood of disclosing during formal interview. Data were obtained in a prospective fashion from 60 alleged child sexual abuse victims referred to the Yale Child Sexual Abuse Clinic (CSAC). Inclusion criteria required that a child must have disclosed to a confidante prior to referral to the Clinic; 57 of 60 children met this criterion and are included. Victim and perpetrator demographics, details of the initial disclosure event, and any identified triggers were obtained in a systematic fashion as part of the standard clinical evaluation by CSAC social workers. Analysis was conducted to investigate the relationship between childs age and choice of confidante, and childs choice of confidante and likelihood of disclosing in a formal interview. Of 57 children, 23% were abused by immediate family members and 39% by extended family members; 49% of cases involved penetrative abuse; and 51% of perpetrators were aged 18 or younger. The three most common triggers for disclosure included: questioning by an adult (26.3%), witnessed abuse (12.3%), and safety of being away from perpetrator (10.5%). The three most common initial confidantes included parent-figures (42%), DCF workers or police (15%), and child peers (12%). The majority of children (81%) disclosed during a formal interview with a Clinic social worker. There was a statistically significant relationship between victims age and choice of confidante: 60% of children aged 2-7 initially disclosed to a parent figure, in comparison to only 28% of children aged 8-15 (p=0.034). Additionally, 21% of older children first disclosed to a child peer or sibling, while no younger children did so. We found no relationship between a childs initial choice of confidante and likelihood of disclosing during formal interview (p=0.06). No relationship existed between a childs age and likelihood of disclosing during formal interview (p=0.43); older children, however, were more likely to provide detailed disclosures during formal interview than younger children (p=0.054). In support of our first hypothesis, our data showed a statistically significant relationship between victims age and choice of confidante. Of equal interest, the results did not support our hypothesis that there would exist a relationship between a childs initial choice of confidante and likelihood of disclosing during the formal interview, nor our hypothesis that educational programs or discussions would result in spontaneous disclosures. Of central importance to the understanding of childrens disclosures, our sample most frequently disclosed to a parent-figure while at home and often while engaging in one-on-one activities with the trusted adult confidante to whom they disclosed

Rationale and design of Children’s Oncology Group (COG) study ACCL20N1CD: financial distress during treatment of acute lymphoblastic leukemia in the United States

Background The study purpose is to describe trajectories of financial distress for parents of children (ages 1–14.9 years) with newly diagnosed acute lymphoblastic leukemia (ALL). The secondary aim is to identify multilevel factors (child, parent, household, treating institution) that influence change in financial distress over time. Methods The study uses a prospective cohort design, repeated measurements, and mixed methods. The settings are Children’s Oncology Group (COG) institutions participating in the National Cancer Institute Community Oncology Research Program (NCORP). Eligible participants are English- and/or Spanish-speaking parents or legal guardians (hereafter “parents”) of index children. Parents are asked to complete a survey during their child’s induction (T1) and maintenance therapy (T2), and near treatment completion (T3). Study surveys include items about (a) the child’s cancer and clinical course, (b) parental socio-economic status, financial distress and financial coping behaviors, and (c) household material hardships. At least 15 parents will be invited to participate in an optional semi-structured interview. NCORP institutions that enroll at least one parent must complete an annual survey about institution resources that could influence parental financial distress. Discussion The results will inform future interventions to mitigate financial distress for parents of children diagnosed with ALL and could be instructive beyond this disease group. Trial registration This trial was initially registered with the NCI Clinical Trial Reporting Program ID: NCI-2021–03,567 on June 16, 2021. The study can be found on clinicaltrials.gov, Identifier NCT04928599

Genomic profiling of pediatric hematologic malignancies and diagnosis of cancer predisposition syndromes: tumor-only <i>versus</i> paired tumor-normal sequencing

Not available

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer.

Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century

Race, ethnicity, and goal‐concordance of end‐of‐life palliative care in pediatric oncology

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/170308/1/cncr33768.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/170308/2/cncr33768_am.pd

Socioeconomic disparities in survival after high‐risk neuroblastoma treatment with modern therapy

BackgroundModern therapeutic advances in high‐risk neuroblastoma have improved overall survival (OS), but it is unclear whether these survival gains have been equitable. This study examined the relationship between socioeconomic status (SES) and overall survival (OS) in children with high‐risk neuroblastoma and whether SES‐associated disparities have changed over time.ProcedureIn this population‐based cohort study, children <18 years diagnosed with high‐risk neuroblastoma (diagnosis at age ≥12 months with metastatic disease) from 1991 to 2015 were identified through the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. Associations of county‐level SES variables and OS were tested with univariate Cox proportional hazards regression. For a subcohort diagnosed after 2007, insurance status was examined as an individual‐level SES variable. Multivariable regression analyses with treatment era and interaction terms were performed when SES variables reached near‐significance (p ≤ .1) in univariate and bivariate modeling with treatment era.ResultsAmong 1217 children, 2‐year OS improved from 53.0 ± 3.4% in 1991–1998 to 76.9 ± 2.9% in 2011–2015 (p < .001). In univariate analyses, children in high‐poverty counties (hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.17–2.60, p = .007), and those with Medicaid (HR = 1.40, 95% CI = 1.05–1.86, p = .02) experienced an increased hazard of death. No interactions between treatment era and SES variables were statistically significant in multivariable analyses, indicating that differences in the OS between SES groups did not change over time.ConclusionsSurvival disparities among children with high‐risk neuroblastoma have not widened over time, suggesting equitable access to and benefit from therapeutic advances. However, children of low SES experience persistently inferior survival. Interventions to narrow this disparity are paramount.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/169316/1/pbc29127.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169316/2/pbc29127_am.pd