The relationship between parental catastrophizing about child pain and distress in response to medical procedures in the context of childhood cancer treatment: A longitudinal analysis

Objective Children with leukemia frequently undergo invasive medical procedures, such as lumbar punctures (LPs) and bone marrow aspirations (BMAs). To date, cross-sectional evidence indicates that LP/BMA procedures continue to elicit distress over the course of treatment in children and parents.  Method  The current study used prospective analyses investigating in 28 children diagnosed with leukemia, the course of parental and child distress when confronted with consecutive LP/BMA procedures and potential moderation by catastrophic thinking. Parents' level of catastrophic thoughts was assessed before the first treatment-related LP/BMA, while child and parent distress was reported on after each LP/BMA procedure.  Results  Whereas parental distress decreased over time among low catastrophizing parents, LP/BMA procedures remained highly distressing for high catastrophizing parents. Child distress during LP/BMA procedures increased over time and was positively related with parental distress.  Conclusion  These findings stress the importance of targeting child and parent distress as early as possible in treatment.&nbsp

Personal distress and sympathy differentially influence health care professional and parents’ estimation of child procedure-related pain

Objective. Caregivers’ pain estimations may have important implications for pediatric pain management decisions. Affective responses elicited by facing the child in pain are considered key in understanding caregivers’ estimations of pediatric pain experiences. Theory suggests differential influences of sympathy versus personal distress on pain estimations; yet empirical evidence on the impact of caregivers’ feelings of sympathy versus distress upon estimations of pediatric pain experiences is lacking. The current study explored the role of caregiver distress versus sympathy in understanding caregivers’ pain estimates of the child’s pain experience.  Design, Setting, Subjects and Methods. Using a prospective design in 31 children undergoing consecutive lumbar punctures and/or bone marrow aspirations at Ghent University Hospital, caregivers’ (i.e., parents, physicians, nurses, and child life specialists) distress and sympathy were assessed before each procedure; estimates of child pain were obtained immediately following each procedure.  Results. Results indicated that the child’s level of pain behavior in anticipation of the procedure had a strong influence on all caregivers’ pain estimations. Beyond the impact of child pain behavior, personal distress explained parental and physician’s estimates of child pain, but not pain estimates of nurses and child life specialists. Specifically, higher level of parental and physician’s distress was related to higher child pain estimates. Caregiver sympathy was not associated with pain estimations.  Conclusions. The current findings highlight the important role of caregivers’ felt personal distress when faced with child pain, rather than sympathy, in influencing their pain estimates. Potential implications for pain management are discussed

Five-year mortality and related prognostic factors after inpatient stroke rehabilitation : A European multi-centre study

Objective: To determine 5-year mortality and its association with baseline characteristics and functional status 6 months post-stroke for patients who received inpatient rehabilitation. Design: A prospective rehabilitation-based cohort study. Subjects: A total of 532 consecutive stroke patients from 4 European rehabilitation centres. Methods: Predictors were recorded on admission. Barthel Index was assessed at 6 months (BI6mths) and patients were followed for 5 years post-stroke. Survival probability was computed using Kaplan-Meier analysis and compared across 3 BI6mths-classes (0-60, 65-90, 95-100) (log-rank test). Significant independent predictors were determined using multivariate Cox regression analysis (hazard ratio (HR)). Results: Five-year cumulative risk of death was 29.12% (95% confidence interval (CI): 22.86-35.38). Age (HR = 1.06, 95% CI: 1.04-1.09), cognitive impairment (HR = 1.77, 95% CI: 1.21-2.57), diabetes mellitus (HR = 1.68, 95% CI: 1.16- 2.41) and atrial fibrillation (HR = 1.52, 95% CI: 1.08-2.14) were independent predictors of increased mortality. Hyperlipidaemia (HR = 0.66, 95% CI: 0.46-0.94), and higher BI6mths (HR = 0.98, 95% CI: 0.97-0.99) were independent predictors of decreased mortality. Five-year survival probability was 0.85 (95% CI: 0.80-0.89) for patients in BI6mthsclass: 95-100, 0.72 (95% CI: 0.63-0.79) in BI6mths-class: 65-90 and 0.50 (95% CI: 0.40-0.60) in BI6mths-class: 0-60 (p < 0.0001). Conclusion: Nearly one-third of rehabilitation patients died during the first 5 years following stroke. Functional status at 6 months was a powerful predictor of long-term mortality. Maximum functional independence at 6 months post-stroke should be promoted through medical interventions and rehabilitation. Future studies are recommended to evaluate the direct effect of rehabilitation on long-term survival

Release of Angiotensin I Converting Enzyme (ACE) Inhibitory Activity during in Vitro Gastrointestinal Digestion: from Batch Experiment to Semicontinuous Model

Gastrointestinal digestion is of major importance in the bioavailability of angiotensin I converting enzyme (ACE) inhibitory peptides, bioactive peptides with possible antihypertensive effects. In this study, the conditions of in vitro gastrointestinal digestion leading to the formation and degradation of ACE inhibitory peptides were investigated for pea and whey protein. In batch experiments, the digestion simulating the physiological conditions sufficed to achieve the highest ACE inhibitory activity, with IC50 values of 0.076 mg/mL for pea and 0.048 mg/mL for whey protein. The degree of proteolysis did not correlate with the ACE inhibitory activity and was always higher for pea than whey. In a semicontinuous model of gastrointestinal digestion, response surface methodology studied the influence of temperature and incubation time in both the stomach and small intestine phases on the ACE inhibitory activity and degree of proteolysis. For pea protein, a linear model for the degree of proteolysis and a quadratic model for the ACE inhibitory activity could be constituted. Within the model, a maximal degree of proteolysis was observed at the highest temperature and the longest incubation time in the small intestine phase, while maximal ACE inhibitory activity was obtained at the longest incubation times in the stomach and small intestine phase. These results show that ACE inhibitory activity of pea and whey hydrolysates can be controlled by the conditions of in vitro gastrointestinal digestion

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