The cold pressor test for the pediatric population: refinement of procedures, development of norms, and study of psychological variables.

OBJECTIVE: The aims of the study were: (a) to propose focal refinements to the cold pressor test (CPT) for the pediatric population, contributing to the development of subjective and behavioral norms; (b) to analyze the influence of personal (gender, age, and skin-fold thickness), and psychological (anxiety, depression, internalization, and externalization) variables on pain perception and its correlation with room temperature. METHODS: After a phase of adaptation in a water bath (24-27 degrees C), the child immersed one arm in cold water (10 degrees C) and reported pain threshold and tolerance. RESULTS: The test was conducted on 141 healthy children. Pain tolerance was reached within the first minute by 50% of the children. Pain intensity affected the children's emotional status. Older children tolerated pain for longer. Gender, psychological, and environmental variables did not influence pain perception. CONCLUSION: This study provides methodological refinements to the CPT contributing to the development of norms for children.

Psychopathological Aspects in Childhood Hematopoietic Stem Cell Transplantation (HSCT): The Perception of Parents and Adolescents.

Background: Data about psychosocial sequelae of childhood Hematopoietic Stem Cell Transplantation (HSCT) are limited and the association with a specific donor type or other medical factors is largely unknown (Chang et al., 2012). The aim of the present study was to compare the psychological aspects of pediatric HSCT survivors with healthy peers. A secondary aim was to detect whether parents and children differed in the perception of mental health status. The influence of medical factors on psychological status was also examined. Method: Thirty seven HSCT survivors (23 males) with a mean age of 14.4 years (SD = 3.03; range 8.16-18.33) were recruited. Twenty-six patients underwent an allogenic HSCT (matched unrelated donor, n = 20; matched sibling donor, n = 6) and 11 patients received an autologous HSCT. The children psychological aspects were assessed using the Youth Self Report (YSR) (Achenbach and Rescorla, 2001) and compared to a group of matched healthy peers. At the same time, parents were requested to complete the Child Behavior Checklist 6-18 (Achenbach and Rescorla, 2001). Medical and socio-demographic data were also collected. Results: HSCT survivors reported significantly higher levels of somatic complains (t27 = 3.14; p = 0.004; mean = 3.1) when compared to healthy peers (mean = 1.5). The parent CBCL scores on "child total competence" exceeded the normative clinical cutoff in 48.6% cases. Inter-rater agreement between parent and patient reports was present only in three scales: total competence score (K = 0.06, p = 0.002), somatic complaints (K = 0.21, p = 0.003) and attention problems (k = 0.13; p = 0.02). According to Ancova models, internalizing problems were more frequent in HSCT from family donors (F2 = 3.13; p = 0.06) or in the presence of acute complications (F1 = 11.95; p = 0.003). Conclusion: In contrast to the perception of parents, pediatric HSCT survivors reported good psychological health. However, they complained about more somatic problems as compared with healthy peers. Medical aspects such as donor source and the presence of acute complications should be taken into consideration for the psychological approach in order to improve pediatric HSCT survivor care.