Relationships of Parental Uncertainty and Caregiver Burden to Adjustment Outcomes in Children with Cancer: the Moderating Role of Parenting Stress

The current study sought to determine whether levels of parental uncertainty and caregiver burden, as reported by parents of children with pediatric cancer, were related to the child's emotional, behavioral, and social functioning. Additionally, the moderating role of parenting stress in these relationships was investigated. Data were collected from 46 parents of children on treatment for cancer at the time of participation. Parents completed the Parental Perceptions of Uncertainty Scale, the Care of My Child with Cancer Scale, the Parenting Stress Index, and rated their child's functioning using the Behavior Assessment System for Children - 2nd Edition and the Social Skills Rating Scale. Results indicated that, contrary to expectations, neither levels of parental uncertainty nor levels of caregiver burden were significantly related to the child's emotional, behavioral, or social functioning. Additionally, although parenting stress did not moderate the relationships between parental uncertainty and child adjustment, level of parenting stress emerged as a significant independent predictor of the child's emotional and social functioning. Moreover, parenting stress did not moderate the relationship between caregiver burden and child adjustment in the total sample of parents, but did moderate the relationship between caregiver burden and child emotional functioning in the subset of mothers only. Specifically, children evidenced better emotional adjustment under conditions of high caregiver burden and low parenting stress, and poorer emotional adjustment under conditions of low caregiver burden and low parenting stress. It is suggested that mothers who are evidencing higher level of burden due to their hands-on involvement in the child's treatment and care, but are not overwhelmed by the situation (i.e., report lower stress), have children who are better adjusted with regard to their emotional functioning. On the other hand, mothers who reported low levels of both caregiver burden and parenting stress may be distancing themselves from the situation of the child's illness, and therefore distancing themselves emotionally from their child, which could result in the child feeling isolated, sad, withdrawn, or worried.Department of Psycholog

Relationship Between Post-Treatment Intellectual Functioning and Long-Term Social Functioning in Survivors of Pediatric Cancer

The current study sought 1) to determine whether post-treatment intellectual functioning was associated with current levels of emotional, behavioral, and social functioning in survivors of pediatric cancer; and 2) whether survivors of pediatric brain tumors differed from survivors of other types of pediatric cancer on measures of social functioning. Participants included 30 children and adolescents who underwent treatment for childhood cancer, and received a post-treatment neuropsychological evaluation. Child participants completed the Behavior Assessment System for Children, 2nd Edition (BASC-2), the Loneliness and Social Dissatisfaction Questionnaire (LSDQ), the Social Support Scale for Children, and the Self-Perception Profile. The parent participants rated their child's current functioning using the BASC-2, and a revised version of the LSDQ. Results revealed that post-treatment intellectual functioning was not related to current adjustment outcomes. Further, survivors of pediatric brain tumors reported significantly higher levels of current perceived social competence than survivors of other types of pediatric cancer.Department of Psycholog

Practice patterns and outcomes of pediatric partial nephrectomy in the United States: Comparison between pediatric urology and general pediatric surgery

BACKGROUND: In the United States, both pediatric urologists (PUROs) and general pediatric surgeons (GPSs) perform nephrectomies in children, with PUROs performing more nephrectomies overall, most commonly for benign causes. GPSs perform more nephrectomies for malignant causes. We questioned whether the same trends persisted for partial nephrectomy. OBJECTIVE: We hypothesized that PUROs performed more partial nephrectomies for all causes, including malignancy. Our primary aim was to characterize the number of partial nephrectomies performed by PUROs and GPSs. We also compared short-term outcomes between subspecialties. STUDY DESIGN: We analyzed the Pediatric Health Information System (PHIS), a database encompassing data from 44 children\u27s hospitals. Patients were ≤18 years old and had a partial nephrectomy (ICD-9 procedure code 554) carried out by PUROs or GPSs between 1 January, 2004 and June 30, 2013. Queried data points included surgeon subspecialty, age, gender, 3M™ All Patient Refined Diagnosis Related Groups (3M™ APR DRG) code, severity level, mortality risk, length of stay (LOS), and medical/surgical complication flags. Data points were compared in patients on whom PUROs and GPSs had operated. Statistical analysis included the Student t test, chi-square test, analysis of covariance, and logistic regression. RESULTS: Results are presented in the table. While PUROs performed the majority of partial nephrectomies, GPSs operated more commonly for malignancy. For surgeries performed for non-malignant indications, PURO patients had a shorter LOS and lower complication rate after controlling for statistically identified covariates. There was no difference in LOS or complication rate for patients with malignancy. DISCUSSION: A Pediatric Health Information System study of pediatric nephrectomy demonstrated PUROs performed more nephrectomies overall, but GPSs performed more surgeries for malignancy. The difference was less dramatic for partial nephrectomies (63% GPS, 37% PURO) than for radical nephrectomies (90% GPS, 10% PURO). PUROs performed more partial nephrectomies for benign indications (94% PURO, 6% GPS) at an even greater rate than nephrectomies (88% PURO, 12% GPS). As a national database study, there are a number of inherent limitations: applicability of results to non-participating hospitals, possibility of inaccurate data entry/coding, and lack of data points that would be relevant to the study. CONCLUSIONS: While most partial nephrectomies in the United States are performed by PUROs, GPSs perform the majority of surgeries for malignancy. There is no difference in LOS or complication rate undergoing nephron-sparing surgery for malignant disease; however, PUROs had a shorter LOS and lower complication rate when operating for benign diseases

Primary Caregivers of Children Affected by Disorders of Sex Development: Mental Health and Caregiver Characteristics in the Context of Genital Ambiguity and Genitoplasty

Purpose. To determine the relationship between having a child with a DSD including ambiguous external genitalia, as well as the decision of whether or not to have early genitoplasty for that child, on the mental health and parenting characteristics of caregivers. Materials and Methods. Caregivers were recruited from centers that specialize in DSD medicine and completed the Beck Depression Inventory 2nd Edition (BDI-2), Beck Anxiety Index (BAI), Parent Protection Scale (PPS), Child Vulnerability Scale (CVS) and Parenting Stress Index/Short Form (PSI/SF). Results and Conclusions. Sixty-eight caregivers provided informed consent and completed the study. Among female caregivers whose children never received genitoplasty, greater parenting stress was reported (F(1, 40) = 5.08, p = .03). For male caregivers, those whose children received genitoplasty within the first year of life reported more overprotective parenting and parenting stress than those whose children received genitoplasty later than 12 months of age (F(1, 13) = 6.16, p = 0.28); F(1, 15) = 6.70, p = .021), respectively)

Differences in adjustment by child developmental stage among caregivers of children with disorders of sex development

<p>Abstract</p> <p>Background</p> <p>The current study sought to compare levels of overprotection and parenting stress reported by caregivers of children with disorders of sex development at four different developmental stages.</p> <p>Methods</p> <p>Caregivers (<it>N </it>= 59) of children with disorders of sex development were recruited from specialty clinics and were asked to complete the Parent Protection Scale and Parenting Stress Index/Short Form as measures of overprotective behaviors and parenting stress, respectively.</p> <p>Results</p> <p>Analyses of covariance (ANCOVAs) were conducted to examine differences between caregiver report of overprotection and parenting stress. Results revealed that caregivers of infants and toddlers exhibited more overprotective behaviors than caregivers of children in the other age groups. Further, caregivers of adolescents experienced significantly more parenting stress than caregivers of school-age children, and this effect was driven by personal distress and problematic parent-child interactions, rather than having a difficult child.</p> <p>Conclusions</p> <p>These results suggest that caregivers of children with disorders of sex development may have different psychosocial needs based upon their child's developmental stage and based upon the disorder-related challenges that are most salient at that developmental stage.</p

INTELLECTUAL FUNCTIONING AND LONG-TERM SOCIAL FUNCTIONING IN SURVIVORS OF PEDIATRIC CANCER

ii ACKNOWLEDGEMENTS I would first like to thank my primary advisor and mentor, Dr. Larry L. Mullins, for his ongoing support and encouragement. You have changed the person I want to become both personally and professionally and have showed me by example that it is completely possible to be successful in your career while still maintaining a balanced life. You have taught me so much about myself and have helped to strengthen any weaknesses I have felt during graduate school. I do not think I could ever really thank you for all you have done! I would also like to extend a special thank you to the other members of my committee, Drs. Jennifer L. Callahan and John M. Chaney. Thank you both for your support and guidance throughout my graduate school experience. I have relied on you so much and I truly appreciate you “giving me a home ” at OSU. At this time, I would also like to thank my family for their love and encouragement. Mom, Dad, and Jordan, I would not be where I am today without the three of you. You all loved me and believed in me when I did not believe in myself. Although many miles separate us, I know you are all only a phone call or plane rid

Postoperative urinary retention in men is common after carotid endarterectomy and is associated with advanced age and prior urinary tract infection.

OBJECTIVE: This study was undertaken to analyze the occurrence of postoperative urinary retention (POUR) after carotid endarterectomy (CEA) and determine whether there are any associated modifiable risk factors. CEA was chosen to minimize the confounding effects of known risk factors for POUR, including immobilization, regional and severe pain, and neuroaxial anesthesia. METHODS: This was a retrospective record review of 186 male patients undergoing CEA between 2007 and 2011. Demographic, comorbidities, and operative characteristics were compared. Continuous variables are reported as median and interquartile range (IQR) and categoric variables as frequencies and proportions. Pearson χ(2) or Mann-Whitney U tests compared categoric and continuous variables, respectively. Logistic regression was used to examine univariate and multivariate odds of POUR. Multivariate analysis controlled for known predictors of urinary retention. Association with other complications was examined with the Pearson correlation coefficient. RESULTS: POUR occurred in 34 patients (18.3%). Median age and history of urinary tract infection (UTI) were significantly associated with POUR: median age was 73.0 years (IQR, 67-80 years) for those with POUR vs 69.5 years (IQR, 63-76 years) for those without (P = .047); 17.6% of patients with a history of UTI developed POUR vs 5.9% without (P = .023). These findings persisted on multivariate analysis controlling for known predictors of POUR (body mass index, history of diabetes, benign prostate hyperplasia, and prior prostate surgery): median age (odds ratio, 1.05; 95% confidence interval, 1-1.1) and history of UTI (odds ratio, 4.16; 95% confidence interval, 1.23-14.05; P = .022). The occurrence of POUR was significantly correlated with postoperative UTI: 18.8% with POUR vs 0.7% without (Pearson r = 0.369; P \u3c .001). CONCLUSIONS: POUR requiring bladder catheterization after CEA predisposes patients to postoperative UTI and is more common in older patients and those with a history of UTI. CEA patients lack inherent risk factors for POUR and would be a useful population for prospective studies involving POUR

Postoperative urinary retention in men is common after carotid endarterectomy and is associated with advanced age and prior urinary tract infection

OBJECTIVE: This study was undertaken to analyze the occurrence of postoperative urinary retention (POUR) after carotid endarterectomy (CEA) and determine whether there are any associated modifiable risk factors. CEA was chosen to minimize the confounding effects of known risk factors for POUR, including immobilization, regional and severe pain, and neuroaxial anesthesia. METHODS: This was a retrospective record review of 186 male patients undergoing CEA between 2007 and 2011. Demographic, comorbidities, and operative characteristics were compared. Continuous variables are reported as median and interquartile range (IQR) and categoric variables as frequencies and proportions. Pearson χ(2) or Mann-Whitney U tests compared categoric and continuous variables, respectively. Logistic regression was used to examine univariate and multivariate odds of POUR. Multivariate analysis controlled for known predictors of urinary retention. Association with other complications was examined with the Pearson correlation coefficient. RESULTS: POUR occurred in 34 patients (18.3%). Median age and history of urinary tract infection (UTI) were significantly associated with POUR: median age was 73.0 years (IQR, 67-80 years) for those with POUR vs 69.5 years (IQR, 63-76 years) for those without (P = .047); 17.6% of patients with a history of UTI developed POUR vs 5.9% without (P = .023). These findings persisted on multivariate analysis controlling for known predictors of POUR (body mass index, history of diabetes, benign prostate hyperplasia, and prior prostate surgery): median age (odds ratio, 1.05; 95% confidence interval, 1-1.1) and history of UTI (odds ratio, 4.16; 95% confidence interval, 1.23-14.05; P = .022). The occurrence of POUR was significantly correlated with postoperative UTI: 18.8% with POUR vs 0.7% without (Pearson r = 0.369; P \u3c .001). CONCLUSIONS: POUR requiring bladder catheterization after CEA predisposes patients to postoperative UTI and is more common in older patients and those with a history of UTI. CEA patients lack inherent risk factors for POUR and would be a useful population for prospective studies involving POUR