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Abstract. In recent years the necessity of measuring quality of life in childhood cancer survivors has been stressed. This paper gives an overview of the results of studies into the quality of life (QL) of young adult survivors of childhood cancer and suggest areas for future research. The review located 30 empirical studies published up to 2001. The results are described in terms of the following QL dimensions: physical functioning (QL, general health), psychological functioning (overall emotional functioning, depression and anxiety, self-esteem), social functioning (education, employment, insurance, living situation, marital status and family), and sexual functioning. Factors related to survivors' QL are reported: demographics and illness- and treatment related variables. Although the literature yields some inconsistent findings, a number of clear trends can be identified: (a) most survivors reported being in good health, with the exception of some bone tumour survivors; (b) most survivors function well psychologically; (c) survivors of CNS tumours and survivors of acute lymphoblastic leukaemia (ALL) are at risk for educational deficits; (d) job discrimination, difficulties in obtaining work and problems in obtaining health and life insurance were reported; (e) survivors have lower rates of marriage and parenthood; (f) survivors worry about their reproductive capacity and/or about future health problems their children might experience as a result of their cancer history. There is a need for methodological studies that measure QL among survivors of childhood cancer more precisely by taking into account the effects of the severity of the cancer and the long-term impact of different treatments. Additional data are needed to help us understand the needs of survivors and to identify those subgroups of survivors who are at greatest risk for the adverse sequelae of the disease and its treatment.

An overview is given of the social and emotional adjustment in young survivors of childhood cancer. The results are described in terms of self-esteem, anxiety, depression and posttraumatic stress (emotional adjustment), and in terms of behavioral functioning, social competence and school performance (socio-behavioral adjustment). Furthermore, factors related to survivors' adjustment are reported: demographics, illness- and treatment-related factors, coping and social support, and family and parental functioning. Limitations of the studies and consequences for future research are discussed. On the whole, the adjustment of young cancer survivors as a group was reasonably good, but the findings with respect to the emotional and social adjustment were inconsistent. This might be attributed to limitations of the study designs and the fact that the studies were not all directly comparable. In order to gain more insight into the predictors of adjustment, longitudinal studies are recommended, which should include control groups or standardized instruments with norm data, and use cancer-specific measures in addition to generic measures.

Abstract:  Studies concerning sibling adjustment to childhood cancer and published since 1980 were reviewed. Sibling distress was described in terms of emotional, socio-behavioral, academic, physical and positive reactions. Secondly, characteristics and coping resources of siblings that are related to adjustment were summarized. Thirdly, the families' functioning, parental coping resources and family events that relate to adjustment were described. Finally, relevant aspects of the illness that may influence adjustment were described. Results of the 35 studies reviewed are summarized in a table containing general descriptors, methods and results. There are salient difficulties in comparison of the findings owing to variations in design, heterogeneity of the groups of siblings, diversity in sample size, and differences in conceptualizations of adjustment and coping. The lack of longitudinal studies, the precarious definitions and confounding of coping and adaptation, and the marginal role of siblings' coping efforts were identified as the most striking deficiencies in current research.

Abstract: Geophysical and geological studies of an Ethiopian maar, Haro Maja, demonstrate that its eruptive history is more complex than surface geology alone suggests. The crater is 750 m by 1000 m in diameter and varies in depth from 70 m to 110 m. A strong magnetic anomaly is caused by a central basaltic mound, but a broader crater-wide anomaly is best modelled by a 50 m thick frozen lava lake, 30 m below the crater floor. The central mound was not erupted directly onto the lava lake, but was extruded onto top of the sedimentary infill after a quiescent depositional interval. Electrical resistivity measurements further indicate that other basaltic intrusions failed to reach the surface during that eruptive period.

Background: Children born preterm run an increased risk of problems on multiple domains. It is not clear how SES influences these different outcomes.Aims: To study the relation between parental education and multiple domain outcomes at age five in very preterm born children in comparison with term controls.Methods: 104 children born < 30 weeks infants GA and/or < 1000 gr at birth and 95 term controls were assessed at the (corrected) age of five years. Motor, neurological cognitive (total, verbal and performal IQ, and processing speed quotient) and behavioural funtioning were assessed using the M-ABC II, the Touwen examination, the WPPSIIII- NL, and the SDQ. (parents and teachers). The differences between preterm and term children were studied in three strata of parental education level (high, medium, low).Results: The mean difference in IQ score between 104 preterm and 95 term children was 10 points. In the high education stratum this difference was 5 compared to 14 in the low stratum. The same pattern was found for verbal, performal IQ, processing speed and SDQ scores. Neurological outcome of preterm born children was not normal in 49% especially due to minor neurological dysfunction (MND), which occurred in 44%. MND nor M ABC scores were influenced by parental education, with comparable preterm-term diferences in each parental education stratum.Conclusions: The biological risk of preterm children is highlighted by their neurological outcome. The social risk factor modifies this biological risk and determines especially cognitive and behavioral outcome.

Aims: This study investigates agreement between mental development at age 2 and 3 and cognitive development at age 5 in very preterm children, and the prediction of separate cognitive abilities at age 5 by development at toddler age.Methods: Preterm born children (n=102, GA< 30 weeks and/or BW< 1000 grams) were assessed at age 2 and 3 using BSID-II, CBCL and Hempel neurological examination, and at age 5 using WPPSI-III (full scale, verbal and performance intelligence, processing speed).Results: Agreement between mental development at age 2 and cognitive development at age 5 was substantial (?=0.48) and between age 3 and age 5 moderate (?=0.40). Mental development at age 2 and 3 explained half the variance of full scale and verbal intelligence. Performance intelligence and processing speed were less strongly associated with early mental development. Other areas of development at age 2 and 3 related to 5-year cognitive functioning when mental development was already accounted for, were behavior (full scale intelligence) and psychomotor and neurological functioning (processing speed). Perinatal en sociodemographic characteristics were associated with 5 year cognitive outcome as well.Conclusions: Agreement between mental development at toddler age and cognitive development at age 5 is moderate to substantial. The prediction of full scale and verbal intelligence is reasonable, but performance and information processing abilities are more difficult to predict by early developmental assessment. Follow-up until at least age five is needed to be able to distinguish between different aspects of cognitive development, and reveal specific learning deficits.

Background: Children with a chronic disease are twice as likely to develop psychosocial problems as healthy children. A randomized controlled trial is conducted to investigate the effectiveness of a cognitive-behavioural based group intervention (called Samen op Koers) for children with different chronic illnesses and their parents. The intervention aims to improve emotional and social skills to adequately cope with the consequences of their disease.Methods: Children were recruited from seven participating hospitals in the Netherlands, and randomized across three conditions: child intervention, parent and child intervention, and waiting list. The first year of inclusion resulted in 146 participants (12.9%, Mage= 12.15, range 8-18). Target sample size is 162. Outcomes will be evaluated at baseline, after 6 weeks of treatment and at a 6 and 12-month follow-up period.Results: The first baseline data were analyzed and showed that: 1) children in the three RCT conditions did not differ (yet) on the study variables,2) children had relatively high levels of psychosocial problems, which were unrelated to disease characteristics, but were related to child coping skills, perceived impact of the disease, and parenting stress,3) parents, psychologists and children gave positive feedback and were enthusiastic about the content of Samen op Koers.Conclusion: Results are expected in 2012. If proven effective, Samen op Koers will be made available to all medical centres. The ultimate goal is that all children will have access to an evidence based program that limits the mental health consequences of their disease.

Background: Children born preterm run an increased risk of problems on multiple domains. The co-existence of these problems needs more attention.Aim: To find out how may preterm born children have disabilities in comparison with term controls.Methods: Children (N = 127) born at < 30 weeks GA or BW < 1000 g, born in our hospital, reaching the corrected age of 5 in a 18 month period were eligible. Healthy term born children, mostly recruited via the school of each preterm child, served as controls. Motor development was assessed using the M-ABC II, neurological functioning using the Touwen neurological examination, cognitive functioning (total, verbal and performal IQ, and processing speed quotient) using the WPPSI-III-NL, and behaviour using the SDQ. (parents and teachers). Scores > -1SD below mean were defined as disability.Results: 104 preterm born children (mean GA 28.8 weeks (SD 1.6), mean BW 1043 grams (SD 250)) and 91 term controls (mean GA 39.8 weeks (SD 1.8), mean BW 3224 (SD 528) participated. In the preterm group, 50% had one or more abnormal IQ score and 44% had minor neurological dysfunction, while 5% had CP. In the term controls this was 22%, 7% and 0% respectively. In the preterm group, 75% had =1 disability and 52% =2 disability and this was 27 resp. 10% in the term controls.Conclusions: Of very premature children, able to undergo an age appropriate IQ test, only 25 % compared to 73% of term controls is without disability on all domains.