Relationship of Parental Overprotection, Child Vulnerabililty, and Parenting Stress to Emotional, Behavioral, and Social Adjustment in Children Diagnosed with Cancer

This study examined the relationship of parental overprotection, perceived child vulnerability, and parenting stress to parent-reported emotional, behavioral, and social functioning in children with cancer. Parenting stress was also examined as a moderator variable. Participants were 36 parents of children aged 2 to 11 years and receiving treatment for cancer at a university-affiliated medical center. Results of hierarchical regression analyses indicated that all three parenting variables significantly predicted increased child emotional and behavioral difficulties and decreased child social functioning after controlling for demographic and disease parameters. Parenting stress did not significantly moderate the relationships between overprotection and child functioning and perceived vulnerability and child functioning. These findings provide support for the transactional relationship between discrete parenting variables and child emotional, behavioral, and social functioning in the context of pediatric cancer. Structured interventions targeting overprotective parenting behaviors and high levels of perceived vulnerability and parenting stress may help improve child functioning.Department of Psycholog

The Association of Parental Depressive Symptoms and Child Anxiety Symptoms: the Role of Specific Parenting Behaviors

A substantial literature indicates that children and adolescents living with a depressed caregiver are at increased risk for emotional and behavioral problems. Although parental depression has been shown to have non-specific associations across child problems, researchers have begun to examine whether specific risk factors, such as parental depression, are associated with specific child outcomes, such as child anxiety. Parenting behavior has been identified as one potential mechanism for the transmission of depression and other psychopathology from parent to child. The extant literature supports this mechanism, as the parenting behaviors of mothers with and without a history of depression have been found to differ in important ways. Moreover, two separate literatures suggest that the same parenting behaviors are associated with both parental depression and child anxiety. The current study was designed to extend past research in the areas of parental depression, parenting, and child anxiety by examining parenting behavior as an explanatory mechanism for the association of parental depressive symptoms and child anxiety symptoms. Using a sample of parents with a history of depression and their 9- to 15-year old children, the current study examined four specific parenting behaviors (i.e., hostility, intrusiveness, withdrawal, and warmth), observed in the context of a stressful parent-child interaction task, as mediators of the association between parental depressive symptoms and both parent and child reports of child anxiety symptoms. Limited support was found for the meditational role of specific parenting behaviors in the association of parental depressive symptoms and child anxiety symptoms. Linear mixed-model analyses revealed an inverse and likely spurious relation between parental depressive symptoms and parent report of child anxiety symptoms. A significant positive association also emerged between parental depressive symptoms and observed parental withdrawal. No support was found for the other relations of the proposed mediation model. Possible reasons for the lack of significant findings are discussed

Parenting and child externalizing behaviors: Are the associations specific or diffuse?

Building upon the link between inadequate parenting and child noncompliance, aggression, and oppositionality, behavioral parent training has been identified as a well-established treatment for externalizing problems in children. Much less empirical attention has been devoted to examining whether inadequate parenting and, in turn, behavioral parent training programs, have specific effects on child externalizing problems or more diffuse effects on both internalizing and externalizing problems. As an initial attempt to examine the specificity of parenting and childhood externalizing problems, this review examines prior research on the association of three parenting behaviors (parental warmth, hostility, and control) with child externalizing versus internalizing problems. Notably, findings revealed relatively little evidence for the specificity of parenting and child externalizing behaviors in the general parenting literature or in the family context of parent depression. Clinical implications and directions for future research are discussed

Parent Depression and Child Anxiety: An Overview of the Literature with Clinical Implications

The association of parental depression with child anxiety has received relatively little attention in the literature. In this paper we initially present several reasons for examining this relationship. We then summarize the empirical support for a link between these two variables. Finally, we discuss directions for future research and clinical implications of an association of parental depression with child anxiety

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research