Outcomes of Care-bundle Implementation for Children With Cancer and Suspected Bloodstream Infection in a Pediatric Oncology Unit in a Resource-limited Setting.

Bloodstream infections (BSIs) are a major cause of mortality among pediatric oncology patients in resource-limited settings. Effective, innovative strategies are needed to improve care and survival. In a pediatric oncology unit in Mexico, we retrospectively analyzed the risk factors for mortality related to BSI and the results of using a care-bundle intervention. The care-bundle consisted of a swift clinical evaluation, initial fluid-resuscitation support, obtaining blood cultures, and administration of effective empirical antibiotic therapy for suspected BSI. The outcomes of patients who received the care-bundle during a 12-month period were compared with those of patients treated with standard care during the 12 months preceding its implementation. The primary outcomes were BSI diagnosis, choice of antibiotics, and mortality. Of the 261 suspected BSIs treated with standard care, 33 (12.6%) infections were confirmed, and of the 308 treated with the care-bundle, 67 (21.7%) BSIs were confirmed. Thus, after implementation of the care-bundle, significantly more BSIs were diagnosed ( P =0.004), and BSI-related mortality was significantly reduced by 22.2% ( P = 0.035). Surgical resection and mechanical ventilation support were independently associated with BSI-related mortality, and receiving effective initial empirical antibiotic therapy was protective against mortality (odds ratio, 0.013; 95% CI: 0.002-0.105; P =0.001), which comprising cefepime plus amikacin or meropenem in 44 (80.0%) of the cases alive. Consistent use of a care-bundle with initial fluid resuscitation, obtaining a blood culture, and administering effective antibiotics to children with cancer and suspected BSI can decrease mortality.

Mexican-origin youth's ethnic-racial identity development: The role of siblings.

Ethnic-racial identity (ERI) formation is an important developmental task. Although families are a primary context for ERI socialization, little is known about siblings' role. Accordingly, we applied the Actor-Partner Interdependence Model to longitudinal data from 2 siblings to examine the links between siblings' ERI exploration, resolution, and affirmation. Participants were Mexican-origin mothers, fathers, and 2 siblings (older siblings Mage = 20.65 years; younger siblings Mage = 17.72 years) from 246 families in Arizona who were interviewed on 2 occasions across 2 years. Siblings' ERI exploration in late adolescence positively predicted young adult ERI, accounting for mothers' and fathers' ERIs. For resolution, the sibling (i.e., partner) effect was moderated by sibling gender constellation, such that the sibling effect emerged only for same-sex dyads. For affirmation, the sibling effect emerged for older but not younger siblings. These findings highlight the need to understand siblings' role in ERI and to expand research on family socialization of ERI beyond parents. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mexican-origin family members' unique and shared family perspectives of familism values and their links with parent-youth relationship quality.

To advance understanding of parents' and adolescents' unique and shared perspectives of familism, a core cultural value in Mexican-origin families, our study addressed 2 goals. First, we identified family members' unique and shared perspectives of familism values using multitrait-multimethod confirmatory factor analysis (Kenny & Kashy, 1992). Second, we examined links between family members' unique and shared perspectives of familism values and mother-youth and father-youth warmth and conflict. Participants were mothers, fathers, and 2 siblings (Mage = 15.48 years for older and Mage = 12.55 years for younger siblings) from 246 Mexican-origin families who were interviewed in their homes on 2 occasions over 5 years. Results indicated that familism values operated as an individual-level process more so than a family-level process and that youth's familism values were most consistently linked to parent-youth relationship quality. These findings provide novel insights into investigating family system dynamics involving familism values, suggest that youth's familism values may keep them connected to their families during adolescence, and highlight potential implications for prevention and intervention programs geared toward Mexican-origin families. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Longitudinal Course and Correlates of Parents' Differential Treatment of Siblings in Mexican-Origin Families.

Parents' differential treatment (PDT) is a common family dynamic that has been linked to youth development and well-being, including adjustment problems and poor sibling relationships. Much less is known, however, about the developmental course of PDT and the conditions under which parents treat their children differently in adolescence and young adulthood. This study examined longitudinal changes in mothers' and fathers' differential warmth and conflict with their two offspring from early adolescence through young adulthood and examined parents' experiences of individual stress (depressive symptoms and role overload) and marital difficulties as time-varying correlates of (changes in) PDT. We also tested crossover effects to determine whether mothers' experiences of individual stress and marital difficulties were linked to fathers' differential treatment, and vice versa. Participants were mothers, fathers, and two siblings from 246 Mexican-origin families who were interviewed in their homes on three occasions over 8 years. Multilevel models revealed that mothers' and fathers' differential conflict with their two children increased until middle adolescence and then declined into young adulthood, but there were no changes over time for parents' differential warmth. In general, both mothers' and fathers' levels of differential treatment were exacerbated by their own experiences of individual stress and marital difficulties and also by the experiences of their spouses. However, in some cases, greater stress than usual was linked to less differential treatment than usual.

Mexican-origin parents' differential treatment and siblings' adjustment from adolescence to young adulthood.

Parents' differential treatment is a common family dynamic that has been linked to youth's well-being in childhood and adolescence in European American families. Much less is known, however, about this family process in other ethnic groups. The authors examined the longitudinal associations between parents' differential treatment (PDT) and both depressive symptoms and risky behaviors of Mexican-origin sibling pairs from early adolescence through young adulthood. They also tested the moderating roles of cultural orientations as well as youth age, gender and sibling dyad gender constellation in these associations. Participants were mothers, fathers, and 2 siblings from 246 Mexican-origin families who participated in individual home interviews on 3 occasions over 8 years. Multilevel models revealed that, controlling for dyadic parent-child relationship qualities (i.e., absolute levels of warmth and conflict), adolescents who had less favorable treatment by mothers relative to their sibling reported more depressive symptoms and risky behavior, on average. Findings for fathers' PDT emerged at the within-person level indicating that, on occasions when adolescents experienced less favorable treatment by fathers than usual, they reported more depressive symptoms and risky behavior. However, some of these effects were moderated by youth age and cultural socialization. For example, adolescents who experienced relatively less paternal warmth than their siblings also reported poorer adjustment, but this effect did not emerge for young adults; such an effect also was significant for unfavored youth with stronger but not weaker cultural orientations. (PsycINFO Database Record

Familism Values, Family Time, and Mexican-Origin Young Adults' Depressive Symptoms.

Using longitudinal data across eight years, this study examined how parents' familism values in early adolescence predicted youths' depressive symptoms in young adulthood via youths' familism values and family time. We examined these processes among 246 Mexican-origin families using interview and phone-diary data. Findings revealed that fathers' familism values predicted male and female youths' familism values in middle adolescence. For female youth only, fathers' familism values also predicted youths' family time in late adolescence. The link between family time and young adults' depressive symptoms depended on parental acceptance and adolescent gender: Among female and male youth, family time predicted fewer depressive symptoms, but only when paternal acceptance was high. For female adolescents only, family time predicted fewer depressive symptoms when maternal acceptance was high but more depressive symptoms when maternal acceptance was low. Findings highlight family dynamics as the mechanisms through which familism values have implications for youths' adjustment.