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the psychological state of parents, who are considered the primary caregivers of a sick child, can affect the child's behavior and emotions. This study analyzed the effectiveness of self-compassion training on hopelessness and resilience in the parents of children with cancer.this was an experimental study with a pre-test and post-test design and a control group. The statistical population included all parents of children with cancer hospitalized in Amir Kabir Hospital of Arak in 2020. The research sample consisted of 30 parents of children with cancer selected through convenience sampling. The participants were equally divided into experimental (n = 15) and control (n = 15) groups at random. The research instruments were the Connor-Davidson Resilience Scale (CD-RISC) and the Beck Hopelessness Scale (BHS). The experimental group underwent eight 90 min sessions of self-compassion training on a weekly basis. Finally, the multivariate analysis of covariance (MANCOVA) was employed for data analysis.the mean (±SD) of the post-test scores of hopelessness and resilience were reported 10.20 (±4.95) and 43.33 (±4.27), respectively, in the experimental group, whereas they were reported 13.78 (±4.94) and 38.73 (±4.07), respectively, in the control group. According to the results, self-compassion training had significant effects on the resilience and hopelessness of the parents of children with cancer (p 0.01). Self-compassion training had a positive, significant effect on their resilience. It was also efficient in decreasing their hopelessness.self-compassion training improved resilience and mitigated hopelessness in the parents of children with cancer.

Morphological analyses are key outcome assessments for nerve regeneration studies but are historically limited to tissue sections. Novel optical tissue clearing techniques enabling three-dimensional imaging of entire organs at a subcellular resolution have revolutionized morphological studies of the brain. To extend their applicability to experimental nerve repair studies we adapted these techniques to nerves and their motor and sensory targets in rats. The solvent-based protocols rendered harvested peripheral nerves and their target organs transparent within 24 hours while preserving tissue architecture and fluorescence. The optical clearing was compatible with conventional laboratory techniques, including retrograde labeling studies, and computational image segmentation, providing fast and precise cell quantitation. Further, optically cleared organs enabled three-dimensional morphometry at an unprecedented scale including dermatome-wide innervation studies, tracing of intramuscular nerve branches or mapping of neurovascular networks. Given their wide-ranging applicability, rapid processing times, and low costs, tissue clearing techniques are likely to be a key technology for next-generation nerve repair studies. All procedures were approved by the Hospital for Sick Children's Laboratory Animal Services Committee (49871/9) on November 9, 2019.

PURPOSE To compare the accuracy of the Barrett Universal II (BUII) five-variable formula to previous generation formulae in calculating intraocular lens (IOL) power following paediatric cataract extraction. METHODS Retrospective study of consecutive paediatric patients who underwent uneventful cataract extraction surgery along with in-the-bag IOL implantation between 2012 and 2018 in the Hospital for Sick Children, Toronto, Ontario, Canada. The accuracy of five different IOL formulae, including the BUII, Sanders-Retzlaff-Kraff Theoretical (SRK/T), Holladay I, Hoffer Q and Haigis, was evaluated. Constant optimization was performed for each IOL and for each formula separately. Mean prediction error (PE) and the mean and median absolute PE (APE) were calculated for the five different IOL formulae investigated. RESULTS Sixty-six eyes of 66 children (59% males) with a median age at surgery of 6.2 years (IQR, 3.2-9.2 years) were included in the study. The mean IOL power that was implanted was 23.3 ± 5.1 D (range; 12.0-39.0 D). Overall, the BUII had a comparable median APE to the Hoffer Q, Holladay I, SRK/T and Haigis formulae (BUII: 0.49D versus 0.48D, 0.61D, 0.74D and 0.58D respectively; p = 0.205). The BUII, together with Hoffer Q, produced better predictability within 0.5D from target refraction compared with the SRK/T formula (BUII:51.5%, Hoffer Q:51.5% versus SRK/T:31.8%, p = 0.002 for both). CONCLUSION The BUII formula had comparable accuracy to other tested formulae and outperformed the SRK/T formula, when calculating IOL power within the 0.5D range from target refraction in paediatric eyes undergoing cataract surgery with in-the-bag IOL implantation.

Aim. To study the formation of anti-diphtheria post-vaccination immunity in practically healthy, and frequently sick children vaccinated with pentavalent, ADTP, and ADT vaccine.Material and methods. We observed 50 practically healthy and 92 frequently sick children. All children were vaccinated three times with a pentavalent vaccine, as well as revaccination with ADTP and ADT. The formation of specific anti-diphtheria immunity was detected for all children after 6 months, after 1 year, and after 5 years. The results were interpreted according to the final value of the optical density levels of protection: basic from -0,01 to 0,1; full protection -> 0.1; long-term protection -> 1.0.Results and discussion. After 6 months the intensity of post-vaccination immunity in both practically healthy and frequently sick children was the highest: full protection (> 0.1) (45,8%), basic protection (0,01 to 0,1) (31,0%). Statistical significance decreased after a year: full protection (45,8% versus 12,1%, p Conclusion. To create stable and long-term immunity when using “killed” vaccines and toxoids, revaccination vaccinations are required at various times after the course of vaccination for frequently ill children, as indicated by the data of basic and complete protection.

The article presents the medical, scientific, and pedagogical activities of the Honored Scientist of the Russian Federation Albert Vazgenovich Papayan (19362002), Head of the Department of Faculty Pediatrics (19742002), Dean of Foreign Students (19691985), Vice-Rector for International Relations (19992002) of the Leningrad Pediatric Medical Institute, then the St. Petersburg State Pediatric Medical Academy. Professor A.V. Papayan is an outstanding scientist who formed the largest pediatric nephrology school within the walls of the SPbSMA, as the founder of the study of the hemostasis system in kidney diseases in children, as a teacher who brought up several generations of pediatricians and nephrologists, as a doctor who restored the health of thousands of sick children. Professor A.V. Papayan is the author of over 400 scientific papers, including 14 monographs and chapters in 14 manuals. Under the guidance of Professor A.V. Papayan completed and defended 62 dissertations of the Candidate of Medical Sciences, with scientific advice 1 dissertation of the Doctor of Medical Sciences. Honored Scientist of the Russian Federation Albert Vazgenovich Papayan is the pride of the national pediatric science, education and health care. The editorial presents medical, scientific, pedagogical activity academician of the Russian Academy of Medical Sciences, Honored Scientist of the Russian Federation.

Background Intra-dialytic hypotension (IDH) is the most common serious adverse event in paediatric haemodialysis (HD). Repeated IDH results in chronic multi-organ damage and increased mortality. At the Hospital for Sick Children, Toronto, retrospective data from all in-centre HD sessions revealed frequently occurring IDH events (16.5 ± 5.6% of HD sessions per week). Based on literature review and clinical expertise, fluid volume management was selected as a potential modifiable risk factor to decrease IDH. Root causes identified as contributing to IDH were incorporated into a Paediatric haemodialysis fluid volume management (PedHDfluid) program using the Model for Improvement methodology including rapid cycles of change. Methods Multiple measures were evaluated including (i) Outcome: IDH events per number of HD sessions per week; (ii) Process: number of changes to estimated dry weight per number of HD sessions per week; (iii) Balancing: time spent on dry weight meeting per week. Data was analysed using statistical process control charts. We aimed to decrease IDH in our dialysis unit to

OBJECTIVE Torcular dural sinus malformations (tDSMs) are rare pediatric cerebrovascular malformations characterized by giant venous lakes localized to the midline confluence of sinuses. Historical clinical outcomes of patients with these lesions were poor, though better prognoses have been reported in the more recent literature. Long-term outcomes in children with tDSMs are uncertain and require further characterization. The goal of this study was to review a cohort of tDSM patients with an emphasis on long-term outcomes and to describe the treatment strategy. METHODS This study is a single-center retrospective review of a prospectively maintained data bank including patients referred to and cared for at The Hospital for Sick Children for tDSM from January 1996 to March 2019. Each patient’s clinical, radiological, and demographic information, as well as their mother’s demographic information, was collected for review. RESULTS Ten patients with tDSM, with a mean follow-up of 58 months, were included in the study. Diagnoses were made antenatally in 8 patients, and among those cases, 4 families opted for either elective termination (n = 1) or no further care following delivery (n = 3). Of the 6 patients treated, 5 had a favorable long-term neurological outcome, and follow-up imaging demonstrated a decrease or stability in the size of the tDSM over time. Staged embolization was performed in 3 patients, and anticoagulation was utilized in 5 treated patients. CONCLUSIONS The authors add to a growing body of literature indicating that clinical outcomes in tDSM may not be as poor as initially perceived. Greater awareness of the lesion’s natural history and pathophysiology, advancing endovascular techniques, and individualized anticoagulation regimens may lead to continued improvement in outcomes.

espanolEl presente articulo versa sobre las enfermedades de larga duracion y la muerte con relacion a edades tempranas. Para ello, se ha hecho un analisis de la revision bibliografica que ha permitido obtener una vision sobre la situacion actual del tratamiento de estas tematicas en el campo educativo. Asimismo, como objetivo principal, se ha llevado a cabo la creacion de un amplio repositorio digital util para la comunidad docente y sanitaria, teniendo como base solida la investigacion bibliografica realizada de manera previa, producto de la investigacion anterior. La metodologia utilizada en este proyecto es la Investigacion Basada en el Diseno, complementada con el modelo IPECC de gestion de proyectos. Como resultado se presenta un analisis de los diferentes aspectos que se ven afectados por diagnosticos sin curacion, asi como la propuesta de un repositorio para docentes con actividades y recursos para tratar el tema. En cuanto a las conclusiones se destaca la realidad acerca de las enfermedades de larga duracion y la muerte como temas que son tabus actualmente y sobre los que es necesario proponer estrategias y recursos para minimizar su impacto en los ninos enfermos, sus familias, y en los companeros de clase. EnglishThis article deals with long-term illnesses and death in relation to early ages. For this, an analysis of the bibliographic review has been made, which has allowed us to obtain a vision of the current situation of the treatment of these issues in the educational field. Likewise, as a main objective, the creation of an extensive digital repository useful for the teaching and health community has been carried out, having as a solid base the bibliographic research carried out previously, and as a result of the previous research. The methodology used in this project is Design-Based Research, complemented by the IPECC model of project management. As a result, an analysis of the different aspects that are affected by diagnoses without cure is pr esented, as well as the proposal of a repository for teachers with activities and resources to deal with the subject. Regarding the conclusions, the reality about long-term illnesses and death is highlighted as topics that are currently taboo and on which it is necessary to propose strategies and resources to minimize their impact on sick children, their families, and on children. classmates.

В статті наведені сучасні принципи класифікації, діагностики та лікування інтерстиціальних захворювань легень у дітей, що є необхідним у практиці педіатрів, сімейних лікарів, дитячих пульмонологів, торакальних хірургів, трансплантологів. Інтерстиціальні захворювання легень входять у структуру дифузних паренхіматозних захворювань легень, до якої на сьогодні включено понад 80 нозологічних форм. Автори звернули увагу на програму спостереження та лікування ChILD (засновану на доказовій базі), що включає активну імунопрофілактику, лікування респіраторної дисфункції (за наявності у хворого), оптимальну нутритивну підтримку, агресивне лікування інтеркурентної інфекції, виключення пасивного куріння та вдихання інших полютантів, освіту та підтримку, генетичне консультування сім’ї пацієнта, фармакотерапію та показання до трансплантації легень. У публікації поданий графік моніторингу пацієнтів протягом року та довготривале спостереження з визначенням прогнозу інтерстиціального захворювання легень у конкретної дитини.

AIMS/PURPOSE To investigate Leber congenital amaurosis (LCA) patients' expectations, decision-making processes and gene therapy-related concerns. METHODS Using a qualitative approach, we explored perceptions of gene therapy and clinical trials among individuals with LCA. Young adults with a clinical diagnosis of LCA were recruited through the Ocular Genetics Programme at the Hospital for Sick Children. Semi-structured interviews were conducted with ten patients and analysed following the principles of qualitative description. RESULTS Study participants were aware of ongoing gene therapy research trials and actively sought information regarding advances in ophthalmology and vision restoration. The majority of participants would enrol or were enrolled in a gene-replacement therapy trial, while a minority was ambivalent or would not enrol if provided an opportunity. Participants attributed different values to clinical trials, which influenced their willingness to participate. Intrinsic factors related to coping, adaptation to vision loss and resilience also influenced decision-making. DISCUSSION This study highlights the complex factors involved in gene-therapy-related decision-making and acts as a proponent for adopting patient-centred care strategies when counselling individuals considering gene therapy or clinical trial participation.

Report 1 presented the definition of numismatics as a historical science, aspects of the study of its components (coins, medals, plaques), the images of common international symbols of pediatrics (Har-pa-Khered, or Harpocrates, a pelican feeding its chicks, and Florentine Infant), it was emphasized the role of prominent scientists and doctors who made an invaluable contribution to the development of pediatrics and they were provided on numismatic materials, their biographies were briefly highlighted. The insufficient modern usage of numismatics facilities in perpetuating the memory of famous pediatricians was emphasized. Report 2 considers the questions of the history of pediatric surgery based on numismatic materials, lists the specialized medical institutions in Argentina, Hungary, Germany, Latvia, Lithuania, Poland, Portugal, Russia, the USA, Uruguay, France, where surgical interventions for sick children are carried out, and scientific forums for children surgeons (congresses, congresses, conferences, symposia) are clarified.

Objective: Hospitalization is a fearful negative experience for children and families. The aim of this study is to learn the feelings and thoughts of school age children hospitalized in the hospital about “illness and hospital”. Material and Method: The study was carried out with 100 children hospitalized in the pediatric ward of a state hospital. In this qualitatively planned study, a sentence completion test was applied with the creative play method aiming to reveal the illness and hospital-related thoughts of hospitalized school-age children. In the sentence completion test, the themes and categories were created by content analysis by the researchers. Ethics committee and necessary permissions were obtained for the study. Results: The Health-illness perception for children consists of four categories, being hospital experience, concerns, and expectations from the hospital. Sick children defined health as feeling good and strong, illness as feeling bad, leaving family, friends and school, and being unable to do anything. They reported staying in the hospital as a bad, sad feeling and a terrible experience. They stated that they regret being separated from their family, school, friends, and teachers in the hospital, and they missed their lessons. Some of the expectations of the children in the hospital are toys in the room, a large playground in the hospital, and an opportunity to follow the lessons they missed at school from their room. Conclusion: In our study, it was determined that the most important concern of school-age children who were hospitalized was their separation from family, school, friends, and lessons.

Pain is one of the main symptoms reported by sick children, particularly by those suffering from cancer. Opioids are very useful in controlling this symptom but they are burdened with significant side effects that limit their use in children. Buprenorphine is a strong opioid that, due to its particular pharmacological characteristics, ensures excellent pain relief with fewer side effects than other opioids. The transdermal formulation allows for good pain control associated with optimal compliance by patients and few limitations on daily life. Unfortunately, transdermal buprenorphine use remains off-label for the control of chronic pain in children; therefore, it is desirable that new studies can validate its use in the paediatric population. This review aims to analyse the clinical advantages of transdermal buprenorphine in the paediatric population and the possible side effects registered in daily clinical practice.

Background We have shown that Ethiopian primary healthcare providers refer only half of the severely sick children who, according to guidelines, should get an urgent referral. Frequently parents of referred ill children don’t bring their children to the next level. We aimed to describe the referral of severely ill Ethiopian children based on primary healthcare register reviews and explore health care providers’ and parents’ perceptions regarding factors that hinder or enhance referral. Methods A mixed-methods study was conducted in 11 districts and a town administration of the Hadiya zone in Ethiopia’s Southern region from May to June 2019. Data collection included interviews and focus group discussions with healthcare providers, key informant interviews with parents of sick children who had been referred, and reviewing registers of sick children treated during the last 12 months at health posts and health centres. We analysed the association between healthcare providers’ and sick children’s characteristics and providers’ compliance with referral guidelines for sick children 0–59 months old. Content analysis was undertaken to explore the perceived factors that influenced referral and adherence to referral from providers’ and parents’ perspectives. Results Healthcare providers did not refer nearly half of the severely ill children that should have been referred, according to guidelines. Providers who had received in-service training on child healthcare were more likely to adhere to referral guidelines. The severity of the child’s illness and mobile phone communication and transport availability were perceived to be positively associated with adherence to referral guidelines. Lack of knowledge of treatment guidelines and skills, and high health worker workload, were among the factors perceived to be linked to lower adherence to guidelines. The healthcare providers considered parents of referred sick children as having low compliance with the referral advice. In contrast, parents had the opinion that compliance with a referral for sick children was high. Perceived awareness of severity of the child’s illness, ability to afford referral costs, and availability of transport or ambulance services were perceived to motivate parents to take their children to the referral facility. Traditional illness perceptions, lack of confidence in the referral site’s medical care, and a long distance were perceived to hurdle caregivers’ referral compliance. Conclusions We found that the healthcare providers’ adherence to referral guidelines was not optimal. Care providers and parents had divergent opinions on parents’ compliance with referral advice. Factors related to the health system, family economy, and available ambulance services influence whether care providers and parents pursued severely ill children’s referral. Adequate referral of sick children is an aspect of primary healthcare quality that is essential to avoid unnecessary under-five deaths.

This study examines the early phase of the self-defining process in Russian literary modernism, which demonstrated a desire to establish clear demarcation between “decadence” and “symbolism” on one hand and to be free from the psychopathological discourse in the evaluation of new artistic phenomena, thereby shifting the conventionally recognized border between “norm” and “pathology.” This paper analyses Aleksander Blok’s own views on “decadence” and “decadents” on the basis of his ego-documents (his diary and notebooks), discusses “decadents” and “symbolists” in the press, and, finally, the poet’s response to them and its literary embodiment — the poem “A. M. Dobrolyubov” (1903). In this poem Blok represents the image of one of the first Russian decadents A. Dobrolyubov, whose life became a legend, giving rise to a certain narrative. The basic concepts of the image created by Aleksander Blok in this poem are investigated, in particular, the image of a “sick child”: its sources, which date back to the polemics of the early 1900s and to a corpus of articles written by Z. Gippius, are identified along with a number of intertextual parallels (D. Merezhkovsky, F. Dostoevsky, A. Dobrolyubov). The article traces the poem’s textological history (from a note in the autograph book and the first publication to the inclusion in the “lyrical trilogy”) and reveals the functions of the epigraph as a marker of the “Petersburg text.”

In this special interview series, we profile members of The FEBS Journal editorial board to highlight their research focus and perspectives on the journal and future directions in their field. Brent Derry is Professor at the Department of Molecular Genetics of University of Toronto and Senior Scientist of the Developmental & Stem Cell Biology Program at The Hospital for Sick Children (Toronto, Canada). He has served as an editorial board member of The FEBS Journal since 2017.

SummaryUntil 2018 only adults had access to rehabilitation in Austria, but since then 5 centers for pediatric rehabilitation with different indications have been established with the goal of improving the health of sick children and young adults. The pediatric rehabilitation center “Leuwaldhof”, which is located south of Salzburg, is the only pediatric oncologic rehabilitation center in Austria. It offers rehabilitation and recovery for pediatric patients who suffered from malignancies, as well as for their families and siblings, but also for acute or chronic disease in metabolism or digestion. Cancer and its treatment significantly decrease the quality of life (QoL) of pediatric patients and their families. Families often have to split up during the months of chemotherapy if there are siblings in the family and very often it is the mother who stays with the sick child in the hospital. To facilitate recovery for the families in these difficult times, interdisciplinary and family-oriented inpatient rehabilitation has recently been implemented in Austria. To evaluate the improvements during the rehabilitation, the QoL of the patients and families has been routinely assessed since the opening of the center. In a specifically designed ‘life app’, patients and families complete the Pediatric Quality of Life Inventory (PedsQL; generic score and cancer module) before and after rehabilitation on their own electronic devices. Data of 98 patients and 124 parents between June 2018 and December 2019 show significant improvements in QoL. Our goal is to support the children and their families to help them return to normal life. Our results show rehabilitation helps achieve this important goal.

Background Delay in receiving the vaccination is a major public health problem that has been associated with vaccine-preventable disease epidemics. In Ethiopia, many children have not received the benefits of age-appropriate vaccination; thus more than 90% of child deaths are largely due to preventable communicable diseases. Objective The present study assessed the magnitude and associated factors of delayed vaccination among 12-23 months old children in Tigray, Ethiopia. Methods A community-based cross-sectional study was carried out among 393, 12-23 months old children from July 1 to 30, 2018. Data were collected using a structured interviewer-administered questionnaire. The questionnaire includes socio-demographic, economic factors, Maternal/caregiver factors, Child's factors, and Service-related factors. We applied bivariable and multivariable logistic regression to determine predictors for delayed Vaccination. The odds ratio with 95% CI was computed to evaluate the strength of the association. Results 393 participants were involved in the study. The magnitude of delayed vaccination was 29.5% (95% CI 26.7-45). Mothers who attend tertiary (University/college) education (AOR 0.169, 95% CI 0.032-0.882), and secondary education (AOR 0.269, 95% CI 0.114-0.636) had the protective effect of delayed vaccination. But the sickness of a child (AOR = 11.8, 95% CI 6.16-22.65) was a risk for delayed vaccination. Conclusions The magnitude of delayed vaccination was high, particularly among participants with Mother's education, and Mother's consideration in the child's wellness to take the vaccine. This implies that it is important to give emphasis, especially for the mothers who have an uneducated and sick child to increase awareness about the advantage of vaccination, which will improve on-time vaccination.

Diabetic ketoacidosis (DKA), a complication of diabetes, is a medical emergency in children and is one of the main causes of childhood mortality. It is the first presentation of diabetes in 30–40% children with the condition, and is more common in younger children. However, it is commonly misdiagnosed as the signs and symptoms in children vary. Treatment should be given as soon as possible, and this is usually only possible in a hospital setting. Therefore, early recognition and transportation to hospital by paramedics ensures the best possible outcome. Children are far more likely to have type 1 than type 2 diabetes, and several factors are associated with childhood diabetes, including genetics, medication, viral infections and environmental issues. Several tools and guidelines can be used to assess children prehospitally. These should be used in conjunction with the clinician's knowledge and standard observations. Paramedics should take an appropriate history, as this could prove invaluable for hospital specialists.

U dječjoj dobi maligna oboljenja ubrajaju se kao drugi vodeći uzrok smrti kod djece u starosti do 15 godina, odmah nakon nesreća. Najčešći oblici malignih bolesti u dječjoj dobi su akutna limfoblastična leukemija, tumori mozga, limfomi i sarkomi mekih tkiva i kostiju. Leukemija je vrsta malignog oboljenja karakterizirana nekontroliranim bujanjem maligno alteriranih i nepotpuno diferenciranih leukocita u koštanoj srži, slezeni, limfnim čvorovima i drugim organima. Unutar godine dana od leukemije oboli negdje oko trideset i sto tisuća djece u dobi do četrnaest godina. Najčešća skupina koja obolijeva je ona od 2. do 7. godine, u većini slučajeva oko 4. godine života. Na kvalitetu života oboljelih od leukemije ne utječu samo simptomi bolesti, nego i nuspojave liječenja, koje je dugotrajno i iscrpljujuće. Onkološka rehabilitacija brine se za postizanje maksimalnog funkcioniranja u svim područjima života oboljele osobe (fizička, mentalna, socijalna, duhovna i profesionalna) unutar ograničenja uzrokovanih bolešću i postupcima liječenja, što je u velikom broju slučajeva kod djece i odraslih postupak koji dovodi do zamora, gubljenja volje za borbom i odustajanjem. U takvim slučajevima psihoedukacijski oblici savjetovanja kao i različiti terapijski programi potpore mogu umanjiti negativne stavove i poimanje bolesti te ojačati pozitivne mehanizme obrane u oboljelog djeteta, a samim time i kod roditelja oboljelog djeteta. Komponenta psihosocijalne terapije onkoloških pacijenata, a posebno djece, u današnje vrijeme je postala ravnopravna svim ostalim vrstama terapije uključene u ozdravljenje pacijenta. Kroz rad je naglašeno kakva je kvaliteta života oboljele djece i roditelja oboljelog djeteta i kakve su roditeljske strategije suočavanja s bolešću djeteta., In childhood, malignant diseases are considered to be the second leading cause of death in children under the age of 15, immediately after accidents. The most common forms of malignant diseases in childhood are acute lymphoblastic leukemia, brain tumors, lymphomas and soft tissue and bone sarcomas. Leukemia is a type of malignant disease characterized by uncontrolled proliferation of malignantly altered and incompletely differentiated leukocytes in the bone marrow, spleen, lymph nodes and other organs. Within a year, between 30,000 and 100,000 children under the age of 14 develop leukemia. The most common group that gets sick is the one from 2 to 7 years, in most cases around 4 years of age. The quality of life of leukemia patients is affected not only by the symptoms of the disease, but also by the side effects of treatment, which is long-lasting and exhausting. Oncology rehabilitation takes care of achieving maximum functioning in all areas of the patient's life (physical, mental, social, spiritual and professional) within the limitations caused by the disease and treatment procedures, which in many cases in children and adults is a procedure that leads to fatigue, loss the will to fight and give up. In such cases, psychoeducational forms of counseling as well as various therapeutic support programs can reduce negative attitudes and perceptions of the disease and strengthen the positive defense mechanisms in the sick child, and thus in the parents of the sick child. The psychosocial component of the therapy of oncology patients, and especially children, is generally recognized and unavoidable in the world today. The paper emphasizes the quality of life of sick children and parents of sick children and what are the parental strategies for dealing with the child's illness.

Every family who enters a hospital is on a personal journey. The awareness of that particular journey allows us to make more intentional and purposeful choices about how health and medical professi...

To evaluate the impact of the COVID-19 pandemic on non-invasive positive airway pressure (PAP) usage among children with sleep-disordered breathing (SDB). PAP usage data in children with SDB aged 1 to 18 years old at The Hospital for Sick Children, Canada, were analyzed. The PAP usage data were recorded for 3 months prior to and 3 months following the COVID-19 lockdown in Ontario, Canada. The primary outcomes of interest were (i) percentage of days that PAP was used for ≥ 4 h and (ii) average daily usage of PAP based on days when PAP was used. A total of 151 children were included. The mean (± SD) age and BMI were 12.6 ± 4.1 years and 28.7 ± 12.4 kg/m2, respectively. The median (IQR) percentage of days of PAP usage for ≥ 4 h and average nightly PAP usage was significantly higher during compared with prior to the pandemic (76.7 [19.0–94.0] vs 62.0 [15.5–89.0]%, p = 0.02, and 406.0 [244.0–525.0] vs 367.0 [218.0–496.0] min, p = 0.006, respectively). Within this cohort, 95/151 (63%) children with SDB showed increased PAP usage and 56/151 (37%) either decreased the amount of time they used PAP or stopped PAP use altogether. COVID-19 pandemic has provided opportunities for increased PAP usage in a significant number of children with SDB. A subset of children with prior evidence for suboptimal PAP usage showed further decreases in PAP usage during the pandemic. This information is critical for clinicians to provide anticipatory guidance to encourage PAP usage both during the pandemic and beyond.

Study Objective To evaluate the diagnostic performance of a Volume and Solid Vascular Tissue Score (VSVTS) for preoperative risk assessment of pediatric and adolescent adnexal masses. Design A retrospective cohort study comprised of all female individuals who presented with an adnexal mass that was managed surgically between April 2011 and March 2016. Setting The Hospital for Sick Children (Toronto, Ontario, Canada). Participants Female individuals 1–18 years of age who presented to a large tertiary pediatric hospital with an adnexal mass that was managed surgically. Main Outcome Measures Main outcome measures included diagnostic performance of the VSVTS for malignancy via sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR−), and receiver operating characteristic area-under-the-curve (AUC) analysis. Results A total of 179 masses in 169 subjects were included. The malignancy rate was 10.6%. The AUC for the VSTVS was 0.919. A VSTVS cut-off value of 4 achieved a sensitivity of 79% (95% CI 0.54-0.93), specificity of 88% (95% CI 0.82-0.93), PPV of 0.44 (95% CI 0.33-0.56), NPV of 0.97 (95% CI 0.94-0.99), LR+ of 6.77 (95% CI 4.18-10.97), and LR− of 0.24 (95% CI 0.10-0.57). Conclusions A sonographic scoring system based on the volume and presence of solid vascular tissue improves PPV for preoperative risk stratification of adnexal masses in the pediatric and adolescent population compared to existing ultrasound-only approaches. Further prospective research is needed to determine how best to incorporate components of such scoring systems into clinical management algorithms.