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Evaluation of The Effects of Psychotherapy on Anxiety Among Mothers of Children With Leukemia

How to Cite This Article: Nazari Sh, Moradi N, Sadeghi Koupaei MT. Evaluation of The Effects of Psychotherapy on Anxiety Among Mothers of Children With Leukemia. Iran J Child Neurol. 2014 Winter; 8(1):52-57. ObjectiveChildren with leukemia and their families face a long period of medical treatment and uncertainty about the future. These families may suffer from short- and long-term emotional problems. The aim of the present study was to assess theeffect of supportive psychotherapy on the anxiety of mothers whose children suffer from leukemia.Materials & MethodsThe current research were performed on mothers who had a child with leukemia hospitalized in Mofid Children’s Hospital, Tehran, Iran. They were randomly selected. The research method was a pseudo-experimental study with pretest/posttest design. The pretest Kettles’ anxiety questionnaire was given to all the mothers and after seven sessions of supportive psychotherapy, the posttest was performed and the grades were compared.ResultsTen mothers finished all seven therapeutic sessions. There was a statistically significant difference between the pretest and posttest mean scores, confirming the mothers’ reduced anxiety level.ConclusionFinding effective and newer approaches to improve the well-being of parents with a sick child is an important challenge of today’s medical researches. Based on our findings, it is possible to reduce the anxiety in mothers of children withleukemia through supportive psychiatric therapies.ReferencesRedaelli A, Laskin BL, Stephens JM, Botteman MF, Pashos CL. A systematic literature review of the clinical and epidemiological burden of acute lymphoblastic leukemia (ALL). Euro J Cancer Care 2005;14(1):53-62.Pourfathollah AA, Rakhshan M, Ahmadi M, Izadyar M. FAB Classification of childhood leukemia in Iran. Med J Islam Repub Iran 1988;4(2):263-4.Brown R, Madan-Swain A, Lambert R. Posttraumatic stress symptoms in adolescent survivors of childhood cancer and their mothers. J Trauma Stress 2003;16(4):309-18.Dolgin M, Phipps S, Fairclough D, Sahler OJ, Askins M, Noll R, et al. Trajectories of adjustment in mothers of children with newly diagnosed cancer: A natural history investigation. J Pediatr Psychol 2007;32(7):771-82.Patiño-Fernández AM, Pai A, Alderfer M, Hwang WT, Reilly A, Kazak A. Acute stress in parents of children newly diagnosed with cancer. Pediatr Blood Cancer 2008;50(2):289-92.Kazak A, Boeving A, Alderfer M, Hwang WT, Reilly A. Posttraumatic stress symptoms during treatment in parents of children with cancer. J clin oncol 2005;23(30):7405-10.Brown S, Yalom I. Interactional group psychotherapy with alcoholic patients. J Stud Alcohol 1977;38(3):426-456.Corraze J. An outline of General Psychopathology (Mental Diseases).Translated to Persian by Mansour M and Dadsetan P. Tehran: Roshd Publication; 2008. p.210-27. (Text in Persian)Sahler OJ, Fairclough D, Phipps S, Mulhern R, Dolgin M, Noll R, et al. Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: Report of a multisite randomized trial. J Consult Clin Psychol 2005 Apr;73(2):272-83.Streisand R, Rodrique J, Houck C, Graham-Pole J, Berlant N. Brief Report: Parents of children undergoing bone marrow transplantation: Documenting stress and piloting a psychological intervention program. J Pediatr Psychol 2000;25(5):331-7.Wijnberg-Williams BJ, Kamps WA, Klip EC, Hoekstra-Weebers JE. Psychological distress and the impact of social support on fathers and mothers of pediatric cancer patients: Long-term prospective results. Journal J Pediatr Psychol 2006;31(8):785-92.Kazak AE, Alderfer MA, Streisand R, Simms S, Rourke MT, Barakat LP, et al. Treatment of posttraumatic stress symptoms in adolescent survivors of childhood cancer and their families: a randomized clinical trial. J Fam Psychol 2004;18(3):493-504.Young B, Dixon Woods M, Findly M, Heney D. Parenting in a crisis: conceptualizing of mothers of children with cancer. Soc Sci Med 2002;55(10):1835-47.Fisher HR. The need of parents with chronically sick children: a literature review. J Adv Nurs 2001;36(4):600-7.Stewart M, Davidson K, Meade D, Hirth A, Weld-Viscount P. Group support for couples coping with a cardiac condition. J Adv Nurs 2001;33(2):190-9.Kyngas H, Rissanen M. Support as a crucial predictor of good compliance of adolescents with a chronic disease. J Clin Nurs 2001;10:767-74

Abdominal Burkitt’s lymphoma in Children

Background: Burkitt’s lymphoma is a high grade B-cell neoplasm, which is a kind of small non-cleaved cell lymphoma. It is presumably the fastest growing human malignancy, and the patients are prone to develop tumor-lysis syndrome. Here we present findings on our patients with Burkitt lymphoma. Materials and Methods: This descriptive retrospective study included 46 children with abdominal Burkitt's lymphoma who were treated during 15 years from June 1998 to Dec 2013 at Mofid Children’s Hospital. Results: Offourty six patients 32 (70%) were boys and 14 (30%) were girls with ages ranging from 2 to 14 years. Surgical exploration was carried out in all cases, the lesions were located in the small intestine (N=17), large intestine (N=15), ileocecal region (N=12), and stomach (N=2). We performed a complete mass resection in 16 cases, debulking in 10 and lymph node/mass biopsy in 20 cases. Pathologic examination revealed Burkitt’s lymphoma for all patients. The majority were stageIIE and stage IIIE (24 and 19 respectively). Post-operative complications were seen in five cases with the most common being persistent ileus. All patients received a sort of systemic chemotherapy. The mean follow up duration was 6 years. Death occurred in 7(15%) of our patients, due to tumor lysis syndrome and acute renal failure.Conclusion: The extent ofdisease at presentation is the most important prognostic factor in abdominal Burkitt’s lymphoma. Children with BL are at a high risk of tumor lysis syndrome before or during chemotherapy. Surgery still plays an important role in this pathology, and chemotherapy offers an excellent chance for long term disease free survival.

Machine Learning to Generate Adjustable Dose Distributions in Head-and-Neck Cancer Radiation Therapy

In this work, we propose a Machine Learning model that generates an adjustable 3D dose distribution for external beam radiation therapy for head-and-neck cancer treatments. In contrast to existing Machine Learning methods that provide a single model, we create pairs of models for each organ-at-risk, namely lower-extreme and upper-extreme models. These model pairs for an organ-at-risk propose doses that give lower and higher doses to that organ-at-risk, while also encapsulating the dose trade-off to other organs-at-risk. By weighting and combining the model pairs for all organs-at-risk, we are able to dynamically create adjustable dose distributions that can be used, in real-time, to move doses between organs-at-risk, thereby customizing the dose distribution to the needs of a particular patient. We leverage a key observation that the training data set inherently contains the clinical trade-offs. We show that the adjustable distributions are able to provide reasonable clinical dose latitude in the trade-off of doses between organs-at-risk

The association between current smoking and binge drinking among adults: A systematic review and meta-analysis of cross-sectional studies

BackgroundThe substantial increasing trend of binge drinking is a global alarm. Our aim was to undertake a systematic review and meta-analysis of cross-sectional studies to explore the association of current smoking with binge drinking among adults.MethodsWe systematically searched Web of Knowledge; PubMed; Scopus; Embase and Ovid (MEDLINE, EMBASE, PsycARTICLES, PsycINFO, PsycEXTRA, and PsycTests) (from inception to 27 May 2020) databases to identify cross-sectional studies of the association between current smoking and binge drinking. Study screening, data extraction, and methodological quality assessment were all carried out by two independent authors. Adjusted odds ratio (AOR) was pooled with 95% confidence intervals (CI) using random effects model in the meta-analysis, followed by the investigation of the heterogeneity via Q-test and I2 statistic. We assessed publication bias using a funnel plot, the Egger’s, and Begg’s tests.ResultsWe identified 3,171 studies and included nine cross-sectional studies with 64,516 participants. A significant association was found between current smoking and binge drinking among both genders (AOR = 2.97; 95% CI = 1.98 to 4.45; I2 = 90.5%). Subgroup analysis showed that this association among women, men, Caucasians, and Asians/Africans were (AOR = 3.68; 95% CI = 1.03 to 13.18; I2 = 98.9%), (AOR = 2.53; 95% CI = 1.87 to 3.42; I2 = 73.1%), (AOR = 1.36; 95% CI: 1.01–1.83, I2 = 47.4%), and (AOR = 3.93; 95% CI: 2.99–5.17, I2 = 61.3%), respectively. There was no evidence of publication bias.ConclusionCurrent smoking is associated with binge drinking and can be used for identifying and screening binge drinkers. Moreover, this association is stronger among men, and Asians/Africans. This meta-analysis estimation was limited to English-language studies, and the full text of about 3.5% of reports for retrieval was not found, then generalization of the results should be done with caution

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Langerhans Cell Histiocytosis with Thyroid Involvement in a 3 Year-Old Child - a Case Report

Langerhans cell histiocytosis (LCH), a monoclonal disease of histiocytes, may involve several organ systems but rarely primarily involves the thyroid gland. This report presents an extremely rare case of LCH of the thyroid in a 3-year-old boy who presented with a neck mass for several weeks. LCH of the thyroid should be considered in the differential diagnosis of a child with a thyroid mass. Pulmonary examination should be done in these patients

Final 2.indd

Abstract Background: Infectious complications are a major etiology of morbidity and mortality in febrile neutropenic patients. Low serum mannose-binding lectin (MBL)-associated serine protease-2 (MASP-2) concentration may represent a risk factor for infection in leukemia patients receiving chemotherapy. This study evaluates the relationship between serum levels of MASP-2 with neutropenic febrile attacks in children with leukemia. Method: This prospective cohort study conducted between 2009-2010, we measured baseline serum MASP-2 levels by enzyme-linked immunosorbent assay (ELISA) prior to chemotherapy in leukemia patients less than 14 years of age. The relationship of febrile neutropenia (FN) episodes and duration of hospitalization with MASP-2 concentration was analyzed. Results: We evaluated 75 children [38 girls (51%), 37 boys (49%); mean age, 61.6 ± 43.7 months]. There were 8 (10.7%) children with MASP-2 de¿ciency (&lt; 200 ng/mL). Mean MASP-2 was 673.2 ± 288.7 ng/mL (range: 116-1112). Eight patients had no FN episodes. Of the 129 FN episodes recorded, 19 (average 2.4 times) were from the MASP-2de¿cient group and 110 (average 1.6 times) were in the normal group. There was a signi¿cant difference between the mean MASP-2 concentration and FN episodes (P = 0.043). There was an inverse relationship between FN episodes (r = -0.332, P = 0.004) and the duration of hospitalization (r = -0.334, P = 0.005) with MASP-2 concentration. MASP-2 de¿cient patients were hospitalized longer than the normal group, which was strongly signi¿cant (P &lt; 0.001). Conclusion: Our study con¿rmed the results of several previous studies. MASP-2 de¿ciency in leukemic children treated with chemotherapy was associated with an increased risk of FN episodes, prolonged cumulative duration of hospitalization, and intravenous antimicrobial therapy