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.

Intergenerational Continuity of Child Maltreatment, Parenting, and Racism: Commentary on Valentino et al., (2012).

Recent editorials published in Child Maltreatment bring much needed attention to racism in child maltreatment reporting and investigation. In this commentary, we extend these efforts by responding to Valentino et al., (2012) and addressing prior omissions in our race-related work by explicitly discussing the role of racism in our explanation of key study findings. Together with scholars with expertise in the impact of racism on children and families, this commentary (a) discusses theoretical models of child maltreatment and of the influence of racism on parenting and child development; (b) discusses parental responses to racism in relation to the Valentino et al., (2012) findings; and (c) highlights future research directions.

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 Associations Between Sibling Relational Aggression and Adolescent Adjustment.

Sibling relational aggression is an important but understudied dimension of sibling relationships that has potential implications for adolescents' adjustment. This study examined the longitudinal associations between being the target of sibling relational aggression and adolescent adjustment (i.e., depressive symptoms, risky behavior, self-worth, and romantic competence) among younger and older siblings over a three-year period in adolescence. The moderating roles of birth order, sibling gender, and sibling dyad gender constellation also were tested. Participants were 196 European American adolescent (firstborn-secondborn) sibling pairs who were 16.47 years (SD = 0.80) and 13.88 years (SD = 1.15) of age, respectively, at the onset of this study. Data were collected separately from each sibling during home interviews. Multilevel models revealed that being the target of sibling relational aggression was associated with all four adjustment outcomes at the between-person level, and with risky behavior and romantic competence at the within-person level. However, some of these effects were moderated by sibling dyad characteristics. Although often overlooked in the literature on adolescence, sibling relationship dynamics play a key role in youth development and adjustment.

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

Parent-Youth Differences in Familism Values from Adolescence into Young Adulthood: Developmental Course and Links with Parent-Youth Conflict.

A critical step in capturing family processes is to incorporate the perspectives and experiences of multiple family members toward characterizing how families operate as systems. Although some research has examined differences between parents' and youth's family experiences, most studies have focused on European American families, and we know little about the nature and implications of divergent parent-youth experiences in other ethnic groups. Accordingly, we focused on Mexican-origin families and assessed the links between mother-youth and father-youth differences in familism values and parent-youth conflict from early adolescence into young adulthood. Participants were mothers, fathers, and two siblings (248 female and 244 male, 51 % female; M age = 14.02 years) from 246 families who were interviewed in their homes on three occasions over 8 years. We operationalized parent-youth differences in familism values using difference scores, controlling for mean levels of familism. Multilevel models revealed that mothers' and fathers' familism values remained relatively stable over time, but youth's familism values declined until age 17, stabilized, and then increased slightly in young adulthood. Lagged models tested directions of effect by examining whether parent-youth differences in familism values predicted parent-youth conflict or vice versa. The findings revealed that parent-youth conflict predicted greater differences in parent-youth familism values, but differences in familism values did not predict conflict. Our findings align with a family systems perspective in documenting the significance of differences between family members' perspectives and highlighting that such processes are dynamic. Further, by testing bi-directional associations in longitudinal models, we were able to disentangle the temporal ordering of differences in familism values and parent-youth conflict thereby advancing understanding of parent-youth discrepancies in cultural values.

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.

Transmission of Work Ethic in African-American Families and Its Links with Adolescent Adjustment.

A strong work ethic generally has positive implications for achievements in work and school settings, but we know little about how it develops. This study aimed to describe the intra-familial transmission of work ethic and the associations between work ethic and adjustment in African American youth. Mothers, fathers, and two adolescent siblings (M age = 14.1 years) in 158 families were interviewed on two occasions. Path models revealed that fathers' work ethic was positively linked with older siblings' work ethic, which in turn was linked with more positive youth adjustment in the domains of school functioning and externalizing and internalizing problems. Moreover, the results indicated that the work ethics of older siblings, but not parents, was linked to those of younger siblings. The discussion focuses on the importance of African American fathers and siblings in youth adjustment and how work ethic may promote positive development.

Pediatric donor cell leukemia after allogeneic hematopoietic stem cell transplantation in AML patient from related donor.

Here we present a male patient with acute myeloid leukemia (AML) initially diagnosed as M5 and with karyotype 46,XY. After induction therapy, he underwent a HLA-matched allogeneic hematopoietic stem cell transplantation, and six years later he relapsed as AML M1 with an abnormal karyotype //47,XX,+10[2]/47,XX,+11[3]/48,XX,+10,+11[2]/46,XX[13]. Based on this, we tested the possibility of donor cell origin by FISH and molecular STR analysis. We found no evidence of Y chromosome presence by FISH and STR analysis consistent with the success of the allogeneic hematopoietic stem cell transplantation from the female donor. FISH studies confirmed trisomies and no evidence of MLL translocation either p53 or ATM deletion. Additionally 28 fusion common leukemia transcripts were evaluated by multiplex reverse transcriptase-polymerase chain reaction assay and were not rearranged. STR analysis showed a complete donor chimerism. Thus, donor cell leukemia (DCL) was concluded, being essential the use of cytological and molecular approaches. Pediatric DCL is uncommon, our patient seems to be the sixth case and additionally it presented a late donor cell leukemia appearance. Different extrinsic and intrinsic mechanisms have been considered to explain this uncommon finding as well as the implications to the patient.