Mobilization patterns of children on a hematology/oncology inpatient ward.

BACKGROUND: Children being treated for cancer are admitted to the hospital for treatment of their disease or complications of therapy. Periods of bed rest during hospitalization can cause impairments detrimental to children with cancer who endure many side effects of therapy. Little is known about how these children mobilize while admitted to the hospital. The purpose of this study was to examine how children admitted to a hematology/oncology ward are mobilizing and analyze factors associated with delayed or infrequent mobility. PROCEDURE: A retrospective chart review was conducted on 228 charts with data recorded on documented mobilization and referrals to physiotherapy. Primary outcome was related to mobility including timing, frequency, type, and nature of mobilization. RESULTS: Almost half of children (43%) mobilized between 3 and 5 days per week, with median time to first mobilization being 2 days (interquartile range 1-3). Caregivers assisted with mobilization 91% of the time. Children isolated to their room and those reporting fever had a statistically significant decrease in the percent of admission days involving mobilization (mean difference 15 and 8%, respectively) than those not isolated and without fever. Children who were isolated also mobilized 1 day later (P = 0.016) than children who were not isolated. Percentage of time in isolation was positively correlated with timing (P = 0.04) and negatively correlated with frequency of mobilization (P < 0.001). CONCLUSION: Most children admitted to the hospital for treatment of oncologic or hematologic conditions were noted to mobilize early, but frequency of mobilization could be improved. Periods of time in isolation appear to negatively affect mobilization.

Optimizing an exercise training program in pediatric brain tumour survivors: Does timing postradiotherapy matter?

Background: While exercise training (ET) programs show positive outcomes in cognition, motor function, and physical fitness in pediatric brain tumor (PBT) survivors, little is known about the optimal timing of intervention. The aim of this work was to explore the feasibility and benefits of ET based on its timing after radiotherapy. Methods: This retrospective analysis (ClinicalTrials.gov, NCT01944761) analyzed data based on the timing of PBT survivors' participation in an ET program relative to their completion of radiotherapy: <2 years (n = 9), 2-5 years (n = 10), and > 5 years (n = 13). We used repeated measures analysis of variance to compare feasibility and efficacy indicators among groups, as well as correlation analysis between ET program timing postradiotherapy and preliminary treatment effects on cognition, motor function and physical fitness outcomes. Results: Two to five years postradiotherapy was the optimal time period in terms of adherence (88.5%), retention (100%), and satisfaction (more fun, more enjoyable and recommend it more to other children). However, the benefits of ET program on memory recognition (r = -0.379, P = .047) and accuracy (r = -0.430, P = .032) decreased with increased time postradiotherapy. Motor function improved in all groups, with greater improvements in bilateral coordination (P = .043) earlier postradiotherapy, and in running (P = .043) later postradiotherapy. The greatest improvement in pro-rated work rate occurred in the < 2-year group (P = .008). Conclusion: Participation in an ET program should be offered as part of routine postradiotherapy care in the first 1-2 years and strongly encouraged in the first 5 years.

Client experiences of expertise in midwifery care in New Brunswick, Canada.

OBJECTIVE: This study contextualizes client experiences of midwifery in New Brunswick within the broader literature on midwifery in Canada and contributes to understandings of how midwifery care fits into the landscape of reproductive healthcare in the province. DESIGN: Semi structured interviews with 32 clients and supportive others of the New Brunswick midwifery program were carried out in 2019 and 2020, and transcripts were analysed using general thematic analysis. SETTING: N New Brunswick, Canada PARTICIPANTS: Clients of midwifery care provided by the Fredericton Midwifery Centre, as well as their supportive others (partners and spouses, family members, friends) FINDINGS: Participants in this study reported a high degree of satisfaction with midwifery services and identified several approaches to practice that they felt contributed to high quality midwifery care. These include competence and expertise, time and access as abundance rather than scarcity, attention to the familial context, trauma informed care and attention to mental and emotional health, postpartum care, and supporting agency and autonomy. In short, participants' responses indicate that midwifery care in New Brunswick meets the criteria for respectful maternity care, as outlined by Shakibazadeh et al. (Shakibazadeh et al., 2018) and Butler et al. (Butler et al., 2020). Our findings are in line with research on midwifery care in other settings, although there is a significant emphasis on the medical expertise and training of midwives amongst our participants which is less evident in the scholarly literature. KEY CONCLUSIONS: In a province where reproductive health care has been systematically underfunded, clients celebrate the expertise and competence of midwives, challenging the narrative which constructs midwifery as 'traditional' care, and hospital-based obstetrics as expert care. Instead, midwives are recognized as highly specialized evidence-based practitioners, and this is particularly prized by clients in relation to processes of information sharing.

Are Generalized Anxiety and Depression Symptoms Associated with Social Competence in Children with and without Autism Spectrum Disorder?

Generalized anxiety and depression symptoms may be associated with poorer social outcomes among children with Autism Spectrum Disorder (ASD) without intellectual disability. The goal of this study was to examine whether generalized anxiety and depression symptoms were associated with social competence after accounting for IQ, age, and gender in typically developing children and in children with ASD. Results indicated that for the TD group, generalized anxiety and depression accounted for 38% of the variance in social competence and for children with ASD, they accounted for 29% of the variance in social competence. However, only depression accounted for a significant amount of the variance. The findings underscore the importance of assessing the social impact of internalizing symptoms in children with ASD.

Spontaneous gaze selection and following during naturalistic social interactions in school-aged children and adolescents with autism spectrum disorder.

Using a novel naturalistic paradigm allowing participants the freedom to spontaneously select and follow gaze cues in their environment, this study extends previous research conducted with younger children to determine whether school-age children with autism spectrum disorder (ASD, n = 17) demonstrate abnormal gaze following relative to typically developing (TD, n = 15) children. The participant and experimenter played a series of games, during which the experimenter pseudorandomly averted her gaze toward a social target (person) or a nonsocial target (object). A significant finding was that, relative to TD children, children with ASD were slower to follow the experimenter's gaze relative to the start of the trial (social targets d = -.93 [-1.70, -.16], nonsocial targets d = -1.05 [-1.88, -.20]). When we analyzed the duration of glances to the experimenter, we found that the ASD group made longer glances relative to TD children, but only in the nonsocial target condition (social targets d = .01 [-.68, .71], nonsocial targets d = -.81 [-1.53, -.08]). Other analyses revealed patterns of gaze selection and following that may help interpret the main findings. Despite the differences in the timing of gaze selection and following, the most common type of responder in both groups was one who followed the experimenter's gaze on over half of the trials. This pattern of results argues against a clear deficit in social attention in school-age children with ASD and underscores the importance of measuring both the timing of distinct mechanisms of social attention and the context in which these behaviors occur. (PsycINFO Database Record