Efficacy of Op Koers Online, an online group intervention for parents of children with cancer: Results of a randomized controlled trial.

OBJECTIVE: Parents of children with cancer are at risk for developing psychosocial problems. The present study aims to evaluate the effect of an online group intervention (Op Koers Online, in English: On Track Online) on psychosocial wellbeing and coping skills. METHODS: Parents of a child with cancer (diagnosis <5 years ago) participated in a randomized controlled trial. In six consecutive (and one booster-) protocolled sessions in an online chatroom, trained psychologists and social workers taught coping skills using cognitive behavioral and acceptance and commitment techniques. Questionnaires assessed anxiety, depression, distress, situation-specific emotional reactions and coping skills (Op Koers Questionnaire/Cognitive Coping Strategies Scale Parent Form) and evaluated the intervention. Linear mixed-model analyses were performed to detect differences between the conditions in changes over time; T0-T1 and T0-T2 (6-week and 6-month follow-up), and to detect changes in scores T2-T3 (12-month follow-up) for the intervention group only. RESULTS: 89 parents were included in analyses (mean age 41.9 years, 86% female, 62%/38% post/during treatment of their child). Beneficial intervention effects (p < 0.05) were found at T1 for anxiety, depression, distress, loneliness and relaxation, and at T2 for anxiety, uncertainty and relaxation. In the intervention condition, scores did not change from T2 to T3, except loneliness that decreased and relaxation that improved. All effect sizes were small to medium (ß = -0.21 to 0.46). Parents were generally positive about the intervention. CONCLUSIONS: Op Koers Online for parents of children with cancer has a positive effect on psychosocial wellbeing and the coping skill relaxation. Implementation is recommended to prevent psychosocial problems. CLINICAL TRIAL REGISTRATION: Dutch Trial Register https://onderzoekmetmensen.nl/en NL73763.041.20.

Systematic review of functional outcome and quality of life after total pancreatectomy.

BACKGROUND: Surgeons have traditionally been reluctant to perform total pancreatectomy because of concerns for brittle diabetes and poor quality of life (QoL). Several recent studies have suggested that outcomes following total pancreatectomy have improved, but a systematic review is lacking. METHODS: A systematic review was undertaken of studies reporting on outcomes after total pancreatectomy for all indications, except chronic pancreatitis. PubMed, EMBASE (Ovid), and Cochrane Library were searched (2005-2018). Endpoints included functional outcome and QoL. RESULTS: A total of 21 studies, including 1536 patients, fulfilled the eligibility criteria. During a median follow-up of 20·8 (range 1·5-96·0) months, 18·6 per cent (45 of 242 patients) were readmitted for endocrine-related morbidity, with associated mortality in 1·6 per cent (6 of 365 patients). No diabetes-related mortality was reported in studies including only patients treated after 2005. Symptoms related to exocrine insufficiency were reported by 43·5 per cent (143 of 329 patients) during a median follow-up of 15·9 (1·5-96·0) months. Overall QoL, reported by 102 patients with a median follow-up of 28·6 (6·0-66·0) months, using the EORTC QLQ-C30 questionnaire, showed a moderately reduced summary score of 76 per cent, compared with a general population score of 86 per cent (P = 0·004). CONCLUSION: Overall QoL after total pancreatectomy is affected adversely, in particular by the considerable impact of diarrhoea that requires better treatment. There is also room for improvement in the management of diabetes after total pancreatectomy, particularly with regards to prevention of diabetes-related morbidity.

ANTECEDENTES: Los cirujanos tradicionalmente se han mostrado reacios a realizar una pancreatectomía total (total pancreatectomy, TP) debido a la preocupación por la aparición de diabetes lábil y la mala calidad de vida (quality of life, QoL). Varios estudios recientes han sugerido que el resultado de la TP ha mejorado, sin embargo no existe una revisión sistemática. MÉTODOS: Se ha realizado una revisión sistemática de los estudios que incluían los resultados después de una TP efectuada para todas las indicaciones, excepto para una pancreatitis crónica. Se realizaron búsquedas en PubMed, Embase (Ovid) y Cochrane Library (2005-2018). Los resultados principales eran el resultado funcional y la calidad de vida. RESULTADOS: En total, 21 estudios cumplieron los criterios de elegibilidad, incluyendo 1.536 pacientes que se habían sometido a una TP. Durante una mediana de seguimiento de 20,8 meses (rango 1,5-96,0), el 18,6% de los pacientes (45 de 242) fueron reingresados por morbilidad relacionada con la función endocrina, con una mortalidad asociada del 1,6% (6 de 365 pacientes). No hubo mortalidad relacionada con la diabetes en los estudios que incluyeron solo aquellos pacientes tratados después de 2005. Se observaron síntomas relacionados con insuficiencia exocrina en un 43,5% de los pacientes (143 de 329) durante una mediana de seguimiento de 15,9 meses (rango 1,5-96,0). La calidad de vida global, informada para 102 pacientes con una mediana de seguimiento de 28,6 meses (rango 6,0-66,0) utilizando el cuestionario EORTC QLQ-C30, mostró una puntuación sumatoria moderadamente reducida del 76% en comparación con la puntuación del 86% para la población general (P = 0,004). CONCLUSIÓN: Es necesario seguir mejorando el manejo de la diabetes después de la TP, sobre todo en lo que respecta a la prevención de la morbilidad relacionada con la diabetes. La calidad de vida global se ve afectada después de la TP y, especialmente, el impacto de la diarrea es considerable y requiere mejorar este aspecto en el futuro.

Hearing siblings' voices: exploring the (online) support needs of siblings of children with a chronic condition.

BACKGROUND: Siblings of children and adolescents with a chronic condition are at risk for developing psychosocial problems. It is important, that they receive appropriate support according to their needs. A sibling-specific module of an existing online intervention (Op Koers Online) for adolescents with a chronic condition might be an appropriate way to offer psychosocial support to siblings. The aim of the current study is to identify siblings' online support needs in order to develop a sibling-specific module of the existing Op Koers Online intervention. RESULTS: A total of 91 siblings (mean age 15.2 years, Standard Deviation 2.7) of children with a chronic condition completed an online questionnaire; nine semi-structured interviews were held additionally. Of all participants, 55% would like to initiate or increase contact with other siblings of children with a chronic condition and 46% of those were interested in an online chat course. The themes for online support considered most important were impact on daily life, worrying about brother's/sister's future, handling other people's reactions, and how attention is divided within the family. CONCLUSIONS: Siblings are interested in peer contact and online support. Op Koers Online for siblings seems to be a suitable intervention to offer online psychosocial support. The next step is to develop a sibling specific module of the Op Koers Online course, taking into account the identified themes.

Radon emanation from concrete and the influence of using flyash in cement.

In the Netherlands both Portland cement and blast furnace cement (slags from blast furnaces with about 30% Portland cement) are used for concrete. Radon exhalation measurements were carried out on concrete blocks made with these two types of cement and blocks with 15, 25 and 35% of the cement substituted by three different types of flyash. The results show that substituting part of the cement by flyash has no drastic effect on the exhalation rate. For concrete with Portland cement the exhalation rate decreases using flyash with an average radium content. With blast furnace cement a slight increase may be expected. The exhalation of concrete is greater than the sum of the exhalation values of the constituting components. The water in the pores of the concrete plays an essential role in the emanation process.

The effect of aging, humidity, and fly-ash additive on the radon exhalation from concrete.

Radon exhalation rates of concrete samples have been periodically determined for 6-8 y after pouring the concrete. From the results, it can be concluded that the radon exhalation rate changes with the age of the concrete. The exhalation rate varies considerably in the first 6-12 mo after pouring with a factor of 1.5. After this period, the variation in exhalation rates is much less. Starting 1 y after pouring, the radon exhalation rate was decreased with increasing age of concrete to 0.3-0.6 of the maximum at the end of the observed period. Low humidity conditions dramatically reduce the radon exhalation rate of concrete. If 25% by volume of the cement is replaced by fly ash, the 226Ra concentration is elevated by a factor of 1.5. The radon exhalation rate of concrete made with Portland cement and fly ash was increased only slightly or even decreased, despite the higher 226Ra content. The results indicate that measurements of radon exhalation from samples of concrete have to be standardized on a certain humidity and age of the sample. Under certain conditions, the addition of fly ash to the concrete can reduce the radon exhalation.

JAK2(V617F) positive early stage myeloproliferative disease (essential thrombocythemia) as the cause of portal vein thrombosis in two middle-aged women: therapeutic implications in view of the literature.

The present study describes portal vein thrombosis (PVT) in two women as the first and single presenting symptom of latent or masked myeloproliferative disease (MPD). Essential thrombocythemia (ET) was suspected by a sustained increase in platelet count (>400 x 10(9)/l) and slight splenomegaly on echogram. ET could be diagnosed by the presence of large platelet in peripheral blood smear, an increase in clustered large megakaryocytes in bone marrow smear and the presence of the JAK2(V617F) mutation. A subsequent biopsy specimen was consistent with the diagnosis of true ET. In patients with a first episode of splanchnic vein thrombosis (SVT), analysis of any venous thrombophilic risk factors as well as a JAK2(V617F) mutation status indicative for MPD is warranted. Administration of heparin followed by oral anticoagulation with vitamin K antagonists is the treatment of choice in patients with SVT. Anticoagulation therapy combined with low-dose aspirin and proper treatment of the MPD is recommended in patients with SVT associated with the JAK2(V617F) mutation.

Laundering as decontamination of apparel fabrics: residues of pesticides from six chemical classes.

Research on reducing the level of pesticide residue on a textile substrate has examined many variables under many different conditions. This study controlled fiber type and the use of prewash product in an examination of residue levels for a number of pesticides in different pesticide classes. For all pesticides examined, the use of prewash lowered pesticide residues regardless of fiber type. Differences in pesticide residue level attributable to fiber type were not consistent.