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STUDY QUESTION Does adolescent attachment to parents and peers differ between singletons and twins born with ART or natural conception (NC)? SUMMARY ANSWER Adolescent attachment anxiety with the father was higher among NC singletons than among ART and NC twins, whereas attachment avoidance with the father was higher in ART singletons than in NC singletons and NC twins. No differences were found in attachment to the mother, best friend or romantic partner. WHAT IS KNOWN ALREADY Most studies have not found differences between ART and NC singletons in parent–adolescent relationships, but twin relationships may be more at risk. No previous study has examined all four groups in the same study, or specifically looked at attachment relationships. STUDY DESIGN, SIZE, DURATION This was an 18-year, prospective and controlled longitudinal study with families of 496 ART singletons, 101 ART twin pairs, 476 NC singletons and 22 NC twin pairs. Families were recruited during the second trimester of pregnancy; the ART group was recruited from five infertility clinics in Finland and the control group was recruited from a hospital outpatient clinic during a routine visit. PARTICIPANTS/MATERIALS, SETTING, METHODS Mothers and fathers gave background information for this study during pregnancy, and during the child's first year and early school age (7–8 years). For the ART group, infertility characteristics and prenatal medical information was also obtained from the patient registry of the infertility clinics. Children (originally 50% girls) filled in electronic questionnaires related to their attachment to mother, father, best friend and romantic partner (Experiences in Close Relationships—Relationship Structures) at 17–19 years of age. MAIN RESULTS AND THE ROLE OF CHANCE Adolescent attachment anxiety to father was higher in NC singletons than in ART twins, P  = 0.004 and marginally higher than in NC twins, P  = 0.06. Adolescent attachment avoidance to father was higher in ART singletons than in NC singletons, P  = 0.006 and marginally higher than in NC twins, P  = 0.055. LIMITATIONS, REASONS FOR CAUTION The sample size was small especially in the NC twin group and there was drop-out over the 18-year time period, especially among boys and families with lower parental education level. The study only included native Finnish-speaking families. The results could differ in a more diverse population. ART singletons were younger and had fewer siblings than ART twins and NC children, and ART and NC twins had more newborn health risks than ART and NC singletons. WIDER IMPLICATIONS OF THE FINDINGS The study adds to a growing body of evidence that neither ART treatments nor being a twin places mother–child relationships or peer relationships at long-term risk. However, in our study, which was the first to examine both ART and twinhood simultaneously, we found that there may be more problems in father–adolescent relationships, but only in ART singletons and only related to attachment avoidance. Our findings suggest that men, as well as women, should receive enough support in pre- and peri-natal health care during and after infertility treatments. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Academy of Finland (grant number 2501308988), the Juho Vainio Foundation and the Finnish Cultural Foundation. The authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Modern lasers can produce a high-quality beam. This allows the use of a small focal point even smaller than 0.3 mm in diameter. Welding with a small spot can provide excellent productivity but it has limitations; for example, a very narrow weld that is not suitable for all types of joints. The problem in the laser welding of tube-to-tube joints is the positioning of the tubes and roundness error of the tube ends. One possible solution is studied in the present work: the use of a self-steering joint and welding with an oscillating mirror. A self-steering joint might help due to a zero gap in every case. With scanner laser welding, it is possible to achieve wider welds with sufficient weld quality. The scanner allows more precise control of the process and gives more options for laser welding. The welding process can be more accurately controlled due to a wide range of parameters. [ABSTRACT FROM AUTHOR]

This article presents results on nursing and midwife students' willingness to care for patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). An international cross-sectional survey design was used and the data were collected from educational institutions in Finland (N=169), Estonia (N=132) and Lithuania (N=170) between autumn 2005 and spring 2006. Participants (N=471) were nursing and midwife students training to be RN, public health nurses or midwives. A modified version of a scale developed by Duppert et al. (1994) was applied to measure willingness to care for patients with HIV/AIDS. The study found a general willingness on the part of students to provide care for patients with HIV/AIDS. However, nursing and midwife students willingness varied between countries and was also related to specific nursing interventions. Factors associated with students willingness also varied within each country, depending on nurses' age, nursing experience (Finland), positive attitudes to treating patients with HIV/AIDS in general (Finland, Estonia), and previous experience in taking care of a patient with HIV/AIDS (Lithuania). It is important to develop strategies for nursing vulnerable patient populations and international nursing curricula to identify prejudicial thinking and intolerance towards patients with HIV/AIDS. [ABSTRACT FROM AUTHOR]

Suominen T, Koponen N, Mockiene V, Raid U, Istomina N, Vänskä M-L, Blek-Vehkaluoto M, Välimäki M. International Journal of Nursing Practice 2010; 16: 138-147 Nurses' knowledge and attitudes to HIV/AIDS-An international comparison between Finland, Estonia and Lithuania This paper presents baseline data on nurses' knowledge of and attitudes to HIV/AIDS in three countries: Finland, Estonia and Lithuania. The prevalence of HIV/AIDS is steadily increasing in Finland, Estonia and Lithuania. At the same time, labour mobility and also nursing mobility between these countries increases. Previous international studies have shown that lack of knowledge and negative attitudes continue to exist. A total of 681 registered nurses from one Finnish ( n = 322), one Estonian ( n = 191) and one Lithuanian ( n = 168) hospital were surveyed in spring 2006. The questionnaire was originally developed by Held in 1993 and modified for this study. The questionnaire has three scales: demographic and other background variable, nurses' knowledge related to HIV/AIDS, and nurses' attitudes towards people with HIV/AIDS and towards the disease itself. Across the whole sample respondents showed average levels of HIV/AIDS knowledge and attitudes towards people with HIV/AIDS. Years of work experience correlated negatively with the knowledge and attitude levels. A significant correlation was found between the level of knowledge and attitudes. Significant differences were found between countries, Finnish nurses showing the highest knowledge levels and most positive attitudes towards patients with HIV/AIDS. Factors positively influencing levels of knowledge and attitudes were education, previous experience of providing care to HIV/AIDS patient or knowing someone with the infection, and willingness to provide care to HIV/AIDS patients. Supplementary education is needed to strengthen nurses' knowledge. It is important to recognize that there might be differences in knowledge and attitudes between neighbour countries. This needs to be taken into account when planning education for degrees and for further nursing education. [ABSTRACT FROM AUTHOR]

This paper presents baseline data on attitudes towards HIV/AIDS patients and homophobic levels among nursing students in three Baltic Sea countries: Finland, Estonia and Lithuania. The aim is to describe and compare nursing students' attitudes in these three countries and to explore how attitudes towards HIV/AIDS correlate with background variables. The total sample comprised 471 nursing students. The respondents demonstrated average attitude scores towards patients with HIV/AIDS and rather positive attitudes towards homosexually oriented patients. Significant country differences were found, with Finnish nursing students showing the most positive attitudes towards HIV/AIDS patients and homosexually oriented patients. Previous experience of HIV/ AIDS patients was the single factor with the greatest positive impact on nursing students' attitudes. Nursing students' willingness to provide care for an HIV/AIDS patient was associated with a positive attitude towards these patients. Length of employment experience correlated negatively with general attitude, and older nursing students with more work experience showed a more negative attitude towards homosexual patients. Proper education to achieve a sound knowledge base and good nursing skills promotes a more positive attitude to HIV/ AIDS. It is important that nursing students are sensitive and show respect for the patient's human dignity. There is need for greater harmonization of education in the three countries. [ABSTRACT FROM AUTHOR]

This study aims to describe and compare nurses' willingness to provide care for patients with HIV/AIDS and factors associated with this in three countries. An international cross-sectional survey was conducted among nurses working in medical, surgical and gynaecology units in Finland (n =427), Estonia (n =221) and Lithuania (n =185) in early 2006. The response rates were 75% (n = 322) in Finland, 54% (n =119) in Estonia and 86% (n = 160) in Lithuania. A modified version of a scale developed in 1994 by Dubbert et al. was applied. Our findings showed a general willingness of the nurse participants to provide care for patients with HIV/AIDS. However, this willingness varied both among and within countries and was also related to specific nursing interventions. The results underline the importance of providing education on ethical issues related to HIV/AIDS care in Europe and tailoring the content of this education to meet nurses' national educational needs. [ABSTRACT FROM AUTHOR]

The quality of infant-directed speech (IDS) and infant-directed singing (IDSi) are considered vital to children, but empirical studies on protomusical qualities of the IDSi influencing infant development are rare. The current prospective study examines the role of IDSi acoustic features, such as pitch variability, shape and movement, and vocal amplitude vibration, timbre, and resonance, in associating with infant sensorimotor, language, and socioemotional development at six and 18 months. The sample consists of 236 Palestinian mothers from Gaza Strip singing to their six-month-olds a song by their own choice. Maternal IDSi was recorded and analyzed by the OpenSMILE- tool to depict main acoustic features of pitch frequencies, variations, and contours, vocal intensity, resonance formants, and power. The results are based on completed 219 maternal IDSi. Mothers reported about their infants' sensorimotor, language-vocalization, and socioemotional skills at six months, and psychologists tested these skills by Bayley Scales for Infant Development at 18 months. Results show that maternal IDSi characterized by wide pitch variability and rich and high vocal amplitude and vibration were associated with infants' optimal sensorimotor, language vocalization, and socioemotional skills at six months, and rich and high vocal amplitude and vibration predicted these optimal developmental skills also at 18 months. High resonance and rhythmicity formants were associated with optimal language and vocalization skills at six months. To conclude, the IDSi is considered important in enhancing newborn and risk infants' wellbeing, and the current findings argue that favorable acoustic singing qualities are crucial for optimal multidomain development across infancy., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: High levels of post-traumatic stress are well documented among refugees. Yet, refugee adolescents display high heterogeneity in their type of trauma and symptom levels. Objective: Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children's Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan ( n  = 148), Syria ( n  = 234), and Somalia ( n  = 175) living in Europe. Method: The model fit for the confirmatory factor structures was tested, as well as measurement invariance between the three groups. The robustness of results was evaluated by testing measurement invariance between recently arrived and settled adolescents, and between different response labelling options. Reliability ( α , ω , and ordinal α ), criterion validity, and prevalence estimates were calculated. Results: The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali adolescents, and strong measurement invariance between Syrian and Somali adolescents. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian adolescents (.717-.856), whereas it was higher among Somali adolescents (.831-.887). The total score had medium-sized correlations with emotional problems (.303-.418) and low correlations with hyperactivity (.077-.155). There were statistically significant differences in symptom prevalence: Afghan adolescents had higher prevalence (55.5%) than Syrian (42.8%) and Somali (37%) adolescents, and unaccompanied refugee minors had higher symptom prevalence (63.5%) than accompanied adolescents (40.7%). Conclusions: This study mostly supports the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult, as the risk of misclassification is high.

Exposure to early life stress (ELS) is associated with a variety of detrimental psychological and neurodevelopmental effects. Importantly, ELS has been associated with regional alterations and aberrant connectivity in the structure and functioning of brain regions involved in emotion processing and self-regulation, creating vulnerability to mental health problems. However, longitudinal research regarding the impact of ELS on functional connectivity between brain regions in the default mode network (DMN) and fronto-limbic network (FLN), both implicated in emotion-related processes, is relatively scarce. Neuroimaging research on ELS has mostly focused on single nodes or bi-nodal connectivity instead of functional networks. We examined how ELS is associated with connectivity patterns within the DMN and FLN during rest in early adulthood. The participants ( n = 86; 47 females) in the current functional magnetic resonance imaging (fMRI) study were young adults (18-21 years old) whose families had participated in a longitudinal study since pregnancy. ELS was assessed both prospectively (parental reports of family relationship problems and mental health problems during pregnancy and infancy) and retrospectively (self-reported adverse childhood experiences). Inter-subject representational similarity analysis (IS-RSA) and multivariate distance matrix regression (MDMR) were used to analyze the association between ELS and the chosen networks. The IS-RSA results suggested that prospective ELS was associated with complex alterations within the DMN, and that retrospective ELS was associated with alterations in the FLN. MDMR results, in turn, suggested that that retrospective ELS was associated with DMN connectivity. Mean connectivity of the DMN was also associated with retrospective ELS. Analyses further showed that ELS-related alterations in the FLN were associated with increased connectivity between the prefrontal and limbic regions, and between different prefrontal regions. These results suggest that exposure to ELS in infancy might have long-lasting influences on functional brain connectivity that persist until early adulthood. Our results also speak for the importance of differentiating prospective and retrospective assessment methods to understand the specific neurodevelopmental effects of ELS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ilomäki, Lindblom, Salmela, Flykt, Vänskä, Salmi, Tolonen, Alho, Punamäki and Wikman.)

Background: Schools are considered natural environments in which to enhance students' social-emotional skills and mental health in general, but they can be especially important for students with refugee and immigrant backgrounds. The current study tested the effectiveness of two school-based interventions in enhancing the mental health and wellbeing of adolescents of native, refugee, and immigrant backgrounds. It further analyzed the role of age, gender, daily stressors, and discrimination in affecting the interventions' effectiveness., Methods: A three-arm cluster RCT with parallel assignment was applied among the 16 schools. Schools were randomized to three conditions of two active interventions and a waiting-list control condition. Students ( n = 1974) filled in an online questionnaire at baseline before the interventions, after the interventions, and at follow-up an average of 9 months after the interventions. The effectiveness criteria were internalizing and externalizing problems, resilience, and prosocial behavior., Results: Interventions were generally not effective in decreasing mental health problems and increasing psychosocial resources. The expected positive intervention effects were dependent on students' age and gender and exposure to socioeconomic daily stressors., Conclusion: Interventions enhancing teacher awareness and peer relationships at school should be carefully tailored according to the strengths and vulnerabilities of participating students, especially their daily stress exposure, but also age and gender.

The study aim was to determine the benefit of the measurement of serum caspase-cleaved cytokeratin-18 (CK-18) fragment as a prognostic marker of febrile neutropenia (FN) in hematological patients. The study population consisted of 86 consecutive patients with FN who received intensive chemotherapy for hematological malignancy at the adult hematology ward of Kuopio University Hospital. Twenty-three patients (27%) had acute myeloid leukemia, and 63 patients (73%) were autologous stem cell transplant recipients. Serum caspase-cleaved CK-18 fragment M30, C-reactive protein (CRP) and procalcitonin (PCT) were measured at the onset of FN (d0), on day 1 (d1), and on day 2 (d2). Eight patients (9%) developed severe sepsis, including three patients with septic shock. Eighteen patients (21%) had a blood culture-positive infection. Serum CK-18 fragment peaked on the first day after fever onset in patients with severe sepsis. Higher CK-18 level was associated with severe sepsis, intensive care unit treatment, and fatal outcome, but not with blood culture positivity. In ROC curve analysis, d1 serum CK-18 fragment predicted severe sepsis with an area under the curve (AUC) of 0.767, CRP with an AUC of 0.764, and PCT with an AUC of 0.731. On d2, the best predictive capacity was observed for CRP with an AUC of 0.832. The optimal cutoff of caspase-cleaved CK-18 fragment M30 for predicting severe sepsis was 205 U/L on d1. In hematological patients, serum CK-18 fragment was found to be a potential prognostic marker of severe sepsis at early stages of FN., (© 2021. The Author(s).)

Background: Schools are natural environments in which to enhance young people's social and emotional skills, mental health, and contact between diverse groups, including students from refugee and immigrant backgrounds. A layered or tiered provision of services is recommended as it can be effective to meet the needs of war-affected adolescents who variably show mental health problems (such as posttraumatic stress disorder (PTSD)). The current protocol describes the study design for a multi-layered intervention model. The study will test the effectiveness of two interventions: a teacher-training intervention In-Service Teacher Training (INSETT) combined with targeted cognitive-behavioral treatment-based Teaching Recovery Techniques (TRT) and a classroom-focused preventive intervention Peer Integration and Enhancement Resources (PIER). We analyze, first, whether the interventions are effective in decreasing psychological distress and increasing positive resources, i.e., prosocial behavior and resilience among refugee and immigrant students. Second, we analyze which student-, school-, and parent-related factors mediate the possible beneficial changes. Third, we look at which groups the interventions are most beneficial to., Methods: A three-arm cluster RCT with parallel assignment, with a 1:1:1 allocation ratio, is applied in 16 schools that agreed to participate in the Refugees Well School interventions and effectiveness study. Schools were randomized to three conditions of two active interventions and a waiting list control condition. Students, their parents, and teachers in intervention and control schools participated in the study at baseline before the interventions, after the interventions, and at 6 to 12 months after the interventions. The primary effectiveness criterion variables are psychological distress (SDQ) symptoms, resilience (CYRM-12), and prosocial behavior (SDQ)., Discussion: The current study presents a recommended universal approach of layered interventions aiming to reduce psychological distress and increase resilience among refugee and immigrant students. A combination of promotive, preventive, and targeted interventions may offer a holistic, ecological intervention package for schools to better address the needs of the whole group., Trial Registration: ISRCTN ISRCTN64245549 . Retrospectively registered on 10 June 2020., (© 2022. The Author(s).)

This person-oriented study aimed to identify adolescents' hierarchical attachment profiles with parents and peers, and to analyze associations between the profiles and adolescent psychosocial adjustment. Participants were 449 Finnish 17-19-year-olds reporting their attachments to mother, father, best friend, and romantic partner and details on mental health (internalizing symptoms, inattention/hyperactivity, and anger control problems) and risk-taking behavior (substance use and sexual risk-taking). Attachment was measured with Experiences in Close Relationships - Relationship Structures (ECR-RS); internalizing, inattention/hyperactivity, and anger control problems with Self-Report of Personality - Adolescent (SRP-A) of the Behavior Assessment System for Children, third edition (BASC-3); substance use with the Consumption scale of the Alcohol Use Disorders Identification Test (AUDIT-C) and items from the Finnish School Health Promotion Study; and sexual risk-taking behavior with the Cognitive Appraisal of Risky Events (CARE). Latent profile analysis identified five attachment profiles: "All secure" (39%), "All insecure" (11%), "Parents insecure - Peers secure" (21%), "Parents secure - Friend insecure" (10%), and "Parents secure - Partner insecure" (19%). "All insecure" adolescents showed the highest and "All secure" adolescents the lowest levels of mental health problems and substance use. Further, parental attachment security seemed to specifically prevent substance use and anger control problems, while peer attachment security prevented internalizing problems. Our findings help both understand the organization of attachment hierarchies in adolescence and refine the role of specific attachment relationships in psychosocial adjustment, which can be important for clinical interventions in adolescence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Flykt, Vänskä, Punamäki, Heikkilä, Tiitinen, Poikkeus and Lindblom.)

The quality of parenting shapes the development of children's emotion regulation. However, the relative importance of parenting in different developmental stages, indicative of sensitive periods, has rarely been studied. Therefore, we formulated four hypothetical developmental timing models to test the stage-specific effects of mothering and fathering in terms of parental autonomy and intimacy in infancy, middle childhood, and late adolescence on adolescents' emotion regulation. The emotion regulation included reappraisal, suppression, and rumination. We hypothesized that both mothering and fathering in each developmental stage contribute unique effects to adolescents' emotion regulation patterns. The participants were 885 families followed from pregnancy to late adolescence. This preregistered study used data at the children's ages of 1 year, 7 to 8 years, and 18 years. At each measurement point, maternal and paternal autonomy and intimacy were assessed with self- and partner reports using the Subjective Family Picture Test. At the age of 18 years, adolescents' reappraisal and suppression were assessed using the Emotion Regulation Questionnaire and rumination using the Cognitive Emotion Regulation Questionnaire. Stage-specific effects were tested comparing structural equation models. Against our hypotheses, the results showed no effects of mothering or fathering in infancy, middle childhood, or late adolescence on adolescents' emotion regulation patterns. The results were consistent irrespective of both the reporter (i.e., self or partner) and the parental dimension (i.e., autonomy or intimacy). In addition to our main results, there were relatively low agreement between the parents in each other's parenting and descriptive discontinuity of parenting across time (i.e., configural measurement invariance). Overall, we found no support for the stage-specific effects of parent-reported parenting in infancy, middle childhood, or late adolescence on adolescents' emotion regulation. Instead, our findings might reflect the high developmental plasticity of emotion regulation from infancy to late adolescence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Tammilehto, Punamäki, Flykt, Vänskä, Heikkilä, Lipsanen, Poikkeus, Tiitinen and Lindblom.)

Background: Taking care of infants in conditions of war is highly demanding and a few studies reveal the negative impact of war trauma on maternal and infant well-being. Yet, little is known regarding the influence of trauma on infant development and the potential explanatory mechanisms. First, the present study examines how mothers' prenatal exposure to traumatic war events is associated with infant cognitive, motor, and socioemotional development. Second, it analyses the mediating roles of maternal postpartum mental health problems, quality of dyadic mother-infant interaction, and earlier infant development (at six months) in the association between prenatal traumatic war events and infants' developmental skills at 18 months., Method: This prospective three-wave study involved 502 Palestinian pregnant females in their first trimester during the 2014 Gaza War and participated at delivery (T1) and when the child was six (T2;N = 392) and eighteen (T3; N = 386) months of age. Mothers reported their exposure to traumatic war events (human and material losses, horrors, and threat to life) at T1 and T2, and researchers photo-documented the extent of destruction at T1. Mothers reported infants' language, fine- and gross-motor, and socioemotional skills at T2 and researchers tested infants' motor, cognitive-language and socioemotional skills using the Bayley Scales of Infant development (BSID-II) at T3. Mothers reported their mental health problems (symptoms of post-traumatic stress disorder [PTSD], depression and somatization) at T2 and T3 as well as dyadic interaction quality (the emotional availability self-report, [EA-SR] brief) at T2., Results: First, the structural equation model (SEM) on direct effects indicated, in contrast to our hypotheses, that maternal prenatal exposure to traumatic war events did not associate with infants' developmental skills at T2 and predicted higher level of developmental skills at T3. Second, as hypothesized, we found two negative underlying mechanisms (paths) between high exposure and low levels of motor, cognitive-language, and socioemotional skills at T3: (1) through increased maternal mental health problems at T2, which then were associated with problems at T3, and (2) through increased maternal mental health problems at T2, which then were associated with a low quality of mother-infant-interaction and low level of infant developmental skills at T2., Conclusion: Improving maternal mental health and encouraging close and positive dyadic interaction can be critical for infant sensorimotor, cognitive, and socioemotional development in war conditions., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

The oncofetal protein insulin-like growth factor 2 mRNA-binding protein 3 ( IGF2BP3 ) belongs to a family of RNA-binding proteins involved in localization, stability, and translational regulation of target RNAs. IGF2BP3 is used as a diagnostic and prognostic marker in several malignancies. Although the prognosis of pediatric B-cell acute lymphoblastic leukemia (B-ALL) has improved, a subgroup of patients exhibits high-risk features and suffer from disease recurrence. We sought to identify additional biomarkers to improve diagnostics, and we assessed expression of IGF2BP3 in a population-based pediatric cohort of B-ALL using a tissue microarray platform. The majority of pediatric B-ALL cases were positive for IGF2BP3 immunohistochemistry and were associated with an increased proliferative phenotype and activated STAT5 signaling pathway. Two large gene expression data sets were probed for the expression of IGF2BP3 -the highest levels were seen among the B-cell lymphomas of a germinal center origin and well-established (KMT2A-rearranged and ETV6-RUNX1) and novel subtypes of B-ALL (e.g., NUTM1 and ETV6-RUNX1-like). A high mRNA for IGF2BP3 was associated with a proliferative "metagene" signature and a high expression of CDK6 in B-ALL. A low expression portended inferior survival in a high-risk cohort of pediatric B-ALL. Overall, our results show that IGF2BP3 shows subtype-specificity in expression and provides prognostic utility in high-risk B-ALL.

Toxicant, teratogen and carcinogen metal war remnants negatively affect human health. The current study analyzes, first, the persistence of heavy metal contamination in newborn hair in four cohorts across time in Gaza Palestine; second, the change in mothers' and infants' heavy metal contamination from birth to toddlerhood; and third, the impact of heavy metal contamination on infants' and toddlers' growth and development. The hair of newborns was analyzed for twelve heavy metals by Inductively Coupled Plasma Mass Spectrometry (ICP/MS) in cohorts recruited at delivery in 2011, 2015, 2016, and 2018-2019. In the 2015 cohort, mothers' hair samples were taken at delivery, and toddlers and mothers hair were also analyzed 18 months later. Growth levels of infants at six months and toddlers at 18 months were assessed according to World Health Organization (WHO) standards according to a mother report and pediatric check-up, respectively. 1. The level of metal contamination in utero was persistently high across 8 years, 2011, 2015, 2016, 2019, following three major military attacks (2009, 2012, 2014). 2. The 2015 cohort babies exposed in utero to attacks in 2014 at six months showed association of high load at birth in mother of arsenic and in newborn of barium with underweight, of barium and molybdenum in newborn with stunting. 3. Eighteen months after birth, toddlers had a higher level of metals in hairs than when they were born, while, in their mothers, such levels were similar to those at delivery, confirming persistence in the environment of war remnants. Underweight and stunting, both in infants and toddlers, were higher than reported for previous years, as well as being progressive within the cohort. Severe environmental factors, metal contamination and food insecurity put Gaza's infant health at risk.

In search of a biomarker for complicated course of febrile neutropenia (FN), plasma IL-18 was measured in 92 hematological patients after intensive chemotherapy at the beginning of FN (days 0-3). Complicated course was defined as blood culture positivity or septic shock. IL-18 varied according to background hematological malignancy and showed an inverse correlation with leukocyte count. IL-18 was not associated with complicated course of FN, defined as blood culture positivity or septic shock, in the whole study group, but an association was observed on d1 and d2 after the onset of FN in the subgroup of autologous stem cell transplant recipients with non-Hodgkin lymphoma., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier Ltd.)

Background: People in war zones are exposed to heavy metal contamination deriving from new-generation weapons, in addition to exposure to psychologically traumatizing war events. Pregnant women and their children-to-be are particularly vulnerable to both biological and psychological war effects., Objective: The aim of the current study was to analyse the impact of maternal prenatal heavy metal contamination on infant emotional development and to examine the potential moderating role of maternal symptoms of post-traumatic stress disorder (PTSD) in the association between heavy metal load and infant emotional development., Methods: The participants were 502 Palestinian mothers, pregnant in their first trimester during the 2014 War on Gaza. The mothers were recruited at their delivery (T1) and followed at the infants' age of 6-7 months (T2; N = 392). The load of five weapon-related heavy metals (chromium, mercury, vanadium, strontium, and uranium) was analysed by Inductively Coupled Plasma Mass Spectrometry (ICP/MS) from mothers' hair samples at childbirth (T1). Assessment of maternal PTSD symptoms was based on the Harvard Trauma Questionnaire (HTQ) and infant emotional development on the Infant Behavior Questionnaire (IBQ), both reported by mothers (T2)., Results: Two of the analysed metals, chromium and uranium, adversely predicted children's early emotional development, indicated by decreased positive affectivity, increased negative emotionality, and problems in early orientation and regulation. Mother's PTSD did not moderate the impact of heavy metal contamination on children's emotional development., Conclusions: Adverse impact of war is not limited to those who experience it directly, but is passed on to future generations through multiple mechanisms. International organizations are obliged to protect parents and infants from the modern weaponry in wars., (Copyright © 2019. Published by Elsevier Inc.)

We examined, first, how prenatal maternal mental health and war trauma predicted mothers' experience of their infant crying, indicated by emotions, cognitions, and behavior; and second, how these experiences influenced the mother-infant interaction and infant development. Participants were 511 Palestinian mothers from the Gaza Strip, reporting their war trauma, symptoms of posttraumatic stress disorder (PTSD), depression, and perceived stress during pregnancy (Time 1). They reported experiences of infant crying at 4 months (Time 2), and the mother-infant interaction and infant sensorimotor and language development at 12 months of infants' age (Time 3). Results revealed that maternal mental health problems, but not war trauma, were important to experiences of infant crying. A high level of PTSD symptoms predicted negative emotions evoked by infant crying, and high depressive symptoms predicted low active and positive responses to crying. Unexpectedly, high prenatal perceived stress predicted high active and positive responsiveness. Concerning the consequences, mothers' sensitive interpretation of infant crying predicted optimal infant sensorimotor development, and mothers' active and positive responses predicted high emotional availability in mother-infant interaction. Crying is the first communication tool for infants, and mothers' sensitive responses to crying contribute to infant well-being. Therefore, reinforcing mother's optimal responses is important when helping war-affected dyads., (© 2019 Michigan Association for Infant Mental Health.)

Introduction: The aim of this study was to compare the mental health problems between parents after oocyte donation treatment, after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with own gametes and after naturally conceiving (NC)., Material and Methods: This is a prospective, longitudinal questionnaire study. The study group consisted of 26 oocyte donation mothers and their matched IVF/ICSI (n = 52) and NC (n = 52) controls. Matching was performed according to mother's age, parity, type of pregnancy, and number of returned questionnaires. The parents filled-in the General Health Questionnaire (GHQ-36) at gestational weeks 18-20 (T1), and at 2 months (T2) and 12 months (T3) after the childbirth., Results: Full response rate (T1-T3) for oocyte donation mothers was 76.9% and for oocyte donation fathers was 73.1%. At T1, no significant differences were found between groups in depression, anxiety, sleeping difficulties, or social dysfunction, but they differed at T2 and T3 in anxiety (T2, P = .02; T3, P = .01), in sleeping difficulties (T2, P = .02; T3, P = .04) and in social dysfunction (T2, P = .01; T3, P = .04). Oocyte donation mothers showed less anxiety than NC mothers (T2, T3), and fewer sleeping difficulties and less social dysfunction than IVF/ICSI (T2, T3) and NC mothers (T2). Mental health problems of oocyte donation fathers did not differ from those of IVF/ICSI and NC control fathers at T1-T3., Conclusions: Oocyte donation mothers showed fewer mental health symptoms in early parenthood compared with IVF/ICSI and NC mothers. No differences were found among mothers during pregnancy and among fathers at any time point., (© 2018 Nordic Federation of Societies of Obstetrics and Gynecology.)

Objective: The study aim was to compare the performance of interleukin-1 receptor antagonist (IL-1Ra) to C-reactive protein (CRP) and procalcitonin (PCT) in early prediction of the clinical course of febrile neutropenia., Methods: The study population consisted of 86 consecutive patients with febrile neutropenia who received intensive chemotherapy for haematological malignancy between November 2009 and November 2012 at the adult haematology ward of Kuopio University Hospital. Twenty-three (27%) patients had acute myeloid leukaemia and 63 (73%) patients were autologous stem cell transplant recipients. IL-1Ra, CRP and procalcitonin were measured at the onset of fever (d0), on day 1 (d1) and on day 2 (d2)., Results: Eight patients developed severe sepsis, including three patients with septic shock. Eighteen patients had bacteraemia. After the onset of febrile neutropenia Youden´s indices (with their 95% confidence intervals) to identify severe sepsis were for IL-1Ra on d0 0.57 (0.20-0.71) and on d1 0.65 (0.28-0.78), for CRP on d0 0.41 (0.04-0.61) and on d1 0.47 (0.11-0.67) and for PCT on d0 0.39 (0.05-0.66) and on d1 0.52 (0.18-0.76)., Conclusions: In haematological patients, IL-1Ra has a comparable capacity with CRP and PCT to predict severe sepsis at the early stages of febrile neutropenia., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The aim of the study was to explore the incidence, microbiological etiology and outcome of febrile neutropenia among adult hematological patients following autologous stem cell transplantation (ASCT)., Methods: The study population consisted of patients who received ASCT between 1 December 2006 and 30 November 2012. The epidemiology was compared to a retrospective series covering eleven previous years at the same institution. Non-Hodgkin lymphoma (NHL) patients, who had been identified as a risk group in the retrospective study, received ciprofloxacin prophylaxis from January 2008., Results: Altogether, 142 out of 178 of the included patients (80%) developed febrile neutropenia. The blood cultures were positive in 24 cases (17%). Of all bacteremia's, 88% were caused by Gram-positive and 12% by Gram-negative bacteria. The number of Gram-negative bacteremia were significantly lower in the prospective study compared to the retrospective study (3/142, 2.1% vs. 23/265, 8.7%, p = .01). Pseudomonas aeruginosa was prevalent in the retrospective series but not discovered in the present series. Enterococcus faecium was found more frequently in the prospective study (6/142, 4.2 vs. 2/265, 0.8%, p = .02). The infectious mortality among patients with febrile neutropenia was 4/142 (2.8%) in the present series and 9/265 (3.4%) in those who received ASCT in 1996-2006., Conclusion: Most patients who received ASCT developed febrile neutropenia and a minority had bacteraemia. In comparison to the earlier time period, the incidence of Gram-negative bacteraemias decreased, probably due to ciprofloxacin prophylaxis in NHL patients, but simultaneously the incidence of Enterococcus bacteraemias increased. Infectious mortality during febrile neutropenia was low in both series.

Research has demonstrated the importance of early family characteristics, such as the quality of caregiving, on children's later mental health. Information is, however, needed about the role of more holistic family systems and specific child-related socioemotional mechanisms. In this study, we conceptualize families as dynamic family system types, consisting of both marital and parenting trajectories over the transition to parenthood. First, we examine how early family system types predict children's anxiety, depression, peer exclusion, and emotion regulation. Second, we test whether couples' infertility history and other family related contextual factors moderate the effects of family system types on child outcomes. Third, we test whether children's emotion regulation and peer exclusion mediate the effects of family system types on anxiety and depression. The participants were 452 families representing cohesive, distant, authoritative, enmeshed, and discrepant family types, identified on the basis of relationship autonomy and intimacy from pregnancy to the child's age of 2 and 12 months. Children's anxiety, depression, emotion regulation, and peer exclusion were assessed at the age of 7-8 years. Structural equation modeling showed that distant, enmeshed, and discrepant families similarly predicted children's heightened anxiety and depression. Infertility history, parental education, and parity moderated the associations between certain family system types and child outcomes. Finally, emotion regulation, but not peer exclusion, was a common mediating mechanism between distant and enmeshed families and children's depression. The results emphasize the importance of early family environments on children's emotion regulation development and internalizing psychopathology. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Neutropenic sepsis is a common clinical problem in hematological patients receiving intensive chemotherapy. Complications will develop in a minority of these patients. Biomarkers can be used for the recognition of infection as well as to estimate its severity and risk of complications and also to assess treatment response. Experience gained from other patient groups or sepsis patients treated in intensive care units cannot be directly extrapolated to hematological patients. Numerous biomarkers of infections have been investigated in hematological patients, but no optimal marker has been found. C-reactive protein is still the most commonly used biomarker in hematological patients, but procalcitonin may be a real challenger, although more studies are still needed.

Study Question: Do children born after assisted reproductive techniques (ART; IVF/ICSI) display more mental health issues or social and cognitive developmental problems at 7-8 years than naturally conceived (NC) controls, and does child gender play a role?, Summary Answer: ART children do not differ with regard to mental health or social and cognitive developmental problems when compared with controls, but some gender-specific differences do exist., What Is Known Already: Systematic reviews have not found any evidence of delays in neurocognitive or sensorimotor development in ART children. However findings on the effect of the type of ART treatment (IVF versus ICSI) on the offspring's physical and mental development have not been uniform. Knowledge of the role of child gender in ART research is scarce., Study Design, Size, Duration: This prospective follow-up study compares mental health and social and cognitive developmental problems between 7-8-year-old ART and NC children, controlling for the father's age, length of the parents' partnership, mother's parity, child's gestational age, and the need of neonatal intensive care unit (NICU). Further, within the ART group, we analysed whether the treatment type (IVF versus ICSI) and the child's gender are associated with the mental health and developmental outcomes., Participants/materials, Setting, Methods: In this study, 255 singleton ART children (IVF and ICSI) were compared with 278 NC children on parent-reported internalizing and externalizing symptoms, and social (social skills and peer relations) and cognitive development (executive functioning, perception, memory, and language). Within the ART group, 164 IVF and 76 ICSI children were compared on the same outcomes. Statistics included analyses of covariates (ANCOVA) with group main effects, group and gender interaction effects, and Bonferroni post hoc tests., Main Results and the Role of Chance: ART and NC children did not differ generally in terms of their internalizing and externalizing symptoms or in the number of social and cognitive developmental problems (Group main effects, P > 0.05), but gender-specific group differences existed. The ART boys showed lower levels of cognitive problems than the NC boys, whereas ART girls showed higher levels of cognitive problems than the NC girls (Group × Gender-interaction effects with Bonferroni post hoc tests on mother-reports, P < 0.01). Further, unlike in the NC group, where boys showed more externalizing symptoms and social and cognitive developmental problems than girls (Group × Gender-interaction effects with Bonferroni post hoc tests for both parents' reports, P < 0.05), gender differences were not found in the ART group. Within the ART group, IVF and ICSI children did not differ in terms of mental health or developmental outcomes, and no significant gender differences emerged., Limitations, Reasons for Caution: The information on children's mental health and development was based on parental reports only. The dropout rate between the child's first year and the school age assessments was very high for fathers (57.4%) and substantial for mothers (30.1%), and the participating group was biased for older age of both parents and for better education of the fathers., Wider Implications of the Findings: The findings indicate the importance of considering child gender in learning about multiple developmental outcomes among children born after ART., Study Funding/competing Interests: This study was supported by the Academy of Finland (#11232276), the Emil Aaltonen Foundation, The Family Federation of Finland, Helsinki University Central Hospital Research Funds, and the National Graduate School of Psychology. None of authors has any competing interests to declare., (© The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Neutropenic fever is common in patients receiving intensive chemotherapy for hematological malignancies. The clinical course may be aggravated by infectious complications like severe sepsis, septic shock or even death. We prospectively studied 100 patients with neutropenic fever and evaluated human plasma cell-free DNA (cfDNA) during the first 3 days after the onset of fever as a prognostic biomarker for complicated clinical course, defined as sepsis or septic shock. Complicated course was observed in 21 patients (21%). There were no significant differences in cfDNA levels between the patients with or without complications on any study day when all the patients were analyzed as one group. In subgroups according to hematological malignancy, patients with acute myeloid leukemia (AML) had lower cfDNA levels than patients with lymphoma. Among AML patients d0 cfDNA/leukocyte ratio and among lymphoma patients d0 cfDNA was associated with subsequent development of sepsis or septic shock. cfDNA deserves further studies in hematological patients with sepsis.

Parent-child relationship is created already in prenatal fantasies and expectations of the child-to-be. Negative violation of these expectations after the child is born is known to be harmful for the parent-child relationship. Yet, research is scarce about the medical and psychological factors contributing to violated expectations (VE). This study models the role of parent-, delivery- and infant-related underlying mechanisms for VE. It further compares parents with assisted reproductive treatment (ART) and spontaneous conception (SC), and primi- and multiparous couples. The couples (n = 743) separately filled in questionnaires concerning their prenatal expectations (T1) and 2 months postnatal representations (T2) of intimacy and autonomy in the relationship with their child, measured with Subjective Family Picture Test. A negative or positive discrepancy indicated violated expectations. The parent-related (mental health and marital quality), delivery-related (maternal and paternal birth experience, unplanned Caesarean, and amount of analgesia) and infant-related (infant health problems, difficult infant characteristics, and parental worry) factors were assessed at T2. Results show that among mothers, the associations were mostly indirect and mediated via mental health problems. Among fathers, the associations were direct, marital problems most crucially predicting VE. ART fathers were less susceptible to VE resulting from infant-related problems than SC fathers, but more susceptible to VE resulting from delivery problems. Delivery- and infant-related factors also predicted VE differently among primi- and multiparous mothers. Considering factors that contribute to VE is important when working with couples in transition to parenthood., (PsycINFO Database Record (c) 2014 APA, all rights reserved.)

Early diagnosis of complicated course in febrile neutropenia is cumbersome due to the non-specificity of clinical and laboratory signs of severe infection. This prospective study included 100 adult hematological patients with febrile neutropenia after intensive chemotherapy at the onset of fever (d0) and for 3 days (d1-d3) thereafter. The study aim was to find early predictors for complicated course of febrile neutropenia, defined as bacteremia or septic shock. Interleukin 6 (IL-6), interleukin 10 (IL-10), procalcitonin (PCT) and C-reactive protein (CRP) all predicted complicated course of febrile neutropenia on d0, but only PCT was predictive throughout the study period. For IL-10 on d0-1 with cut-off 37 ng/L, sensitivity was 0.71, specificity 0.82, positive predictive value 0.52 and negative predictive value 0.92. For PCT on d0-1 with cut-off 0.13 μg/L, the respective measures were 0.95, 0.53, 0.36, and 0.98. For the combination of IL-10 and PCT on d0-1 with the same cut-offs, specificity improved to 0.85 and positive predictive value to 0.56. In conclusion, the present study confirms the high negative predictive value of PCT and provides new evidence for IL-10 as an early predictor for complicated course of febrile neutropenia in hematological patients. Combining IL-10 with PCT improves the early prediction for complicated course of febrile neutropenia., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Copeptin, the surrogate marker of arginine vasopressin (AVP), has been suggested to be a useful biomarker in monitoring sepsis reflecting hemodynamic imbalance and stress state. This prospective study conducted at a hematology ward in a Finnish University Hospital aimed to investigate whether plasma copeptin predicts the development of complicated course of neutropenic fever (bacteremia or need for treatment at intensive care unit) in 100 hematological patients experiencing their first neutropenic fever episode after intensive chemotherapy for hematological malignancy. Contrary to study presumptions, not elevated copeptin but the lack of a proper initial increase of plasma copeptin (<0.02 ng/mL from day 0 to day 1) predicted blood culture positive sepsis (p=0.023) and gram-negative bacteremia (p=0.045). No correlation was observed with plasma sodium, blood pressure or evaluated osmolality. Plasma copeptin correlated inversely with the same day pentraxin 3 on day 0-day 2 (all p-values <0.001) and with C-reactive protein on day 1 (p=0.015). In conclusion, copeptin did not correlate with disease severity, but the lack of a proper initial increase was associated with bacteremic complications of febrile neutropenia in hematological patients. The findings suggest the possibility of central dysregulation of AVP release and do not support the use of copeptin as a biomarker of septic complications in this patient group., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: This study aimed at assessing the cut-off levels for pentraxin 3 (PTX3) in predicting complications of neutropenic fever (bacteraemia, septic shock) in haematological patients., Methods: A prospective study during 2006-2009 was performed at haematology ward in Kuopio University Hospital. A patient was eligible for the study if having neutropenic fever after intensive therapy for acute myeloid leukaemia (AML) (n = 32) or non-Hodgkin lymphoma (NHL) (n = 35). Blood cultures were taken, and maximal PTX3 and C-reactive protein (CRP) were evaluated during d0 to d3 from the beginning of fever onset., Results: The level of PTX3 was associated with both the underlying malignancy and the presence of complications, with highest level in NHL patients with complicated course of febrile neutropenia and lowest in AML patients with non-complicated course. The cut-off level of PTX3 to predict complications was ten-fold in patients with NHL (115 μg/L) in comparison with patients with AML (11.5 μg/L). In combined analysis based on separate cut-offs, PTX3 predicted complications of febrile neutropenia with sensitivity of 0.86, specificity of 0.83, positive predictive value of 0.57 and negative predictive value of 0.96., Conclusions:   PTX3 was superior to CRP in predicting complicated course of febrile neutropenia, but only when the effect of the underlying malignancy had been taken into account., (© 2011 John Wiley & Sons A/S.)

We evaluated pentraxin 3 as a marker for complications of neutropenic fever in 100 hematologic patients receiving intensive chemotherapy. Pentraxin 3 and C-reactive protein were measured at fever onset and then daily to day 3. Bacteremia was observed in 19 patients and septic shock in 5 patients (three deaths). In comparison to C-reactive protein, pentraxin 3 achieved its maximum more rapidly. Pentraxin 3 correlated not only with the same day C-reactive protein but also with the next day C-reactive protein. High pentraxin 3 on day 0 was associated with the development of septic shock (P=0.009) and bacteremia (P=0.046). The non-survivors had constantly high pentraxin 3 levels. To conclude, pentraxin 3 is an early predictor of complications in hematologic patients with neutropenic fever. High level of pentraxin 3 predicts septic shock and bacteremia already at the onset of febrile neutropenia. (ClinicalTrials.gov Identifier: NCT00781040.).