Supporters' experiences of sensory characteristics of children with profound intellectual and multiple disabilities in after-school daycare centres: A qualitative study

AIM

To examine how supporters working at after-school daycare centres, who are involved in the lives of children with profound intellectual and multiple disabilities in the community, pay attention to the sensory characteristics of these children and provide support.

DESIGN

A qualitative descriptive design.

METHODS

Data were collected through semi-structured interviews with 20 supporters in after-school daycare centres. Interview transcripts were analysed via qualitative content analysis.

RESULTS

The participants' years of involvement in supporting children with profound intellectual and multiple disabilities ranged from 0.5 to 40 years, with an average of 9.8 years. Data were classified into 68 subcategories, 11 categories and three themes: understanding sensory characteristics and devising support, systematic support and challenges supporting the children. Supporters dealt with physical complications and cooperated with other caregivers to understand and respond to children's sensory characteristics. Difficulties dealing with sensory characteristics, challenges due to the supporters' own characteristics and challenges with the facility's infrastructure were identified. The findings could guide sensory characteristics considerations and support systems in after-school daycare facilities for children with profound intellectual and multiple disabilities. Both support content and challenges in supporting these children were identified.

Consensus on the items for early identification of unmet psychosocial needs of siblings of children with cancer and blood disease: A modified Delphi method

AIM

To reach a consensus on question items for early identification of unmet psychosocial needs of school-aged siblings of children with cancer and blood disease.

DESIGN

Modified Delphi method.

METHODS

Twenty-three studies were reviewed to extract question items, which were classified into seven categories. A total of 39 question items were selected for this study. The selected question items were carefully considered using the modified Delphi method. The participants were 28 medical staff from a childhood cancer hub hospital and 20 sibling support group staff members. The first round consisted of a questionnaire (n = 48); the second, a focus group interview (n = 8) and the third, another questionnaire (n = 8). The first and third rounds used a 5-point Likert scale. This survey was conducted from July to October 2021.

RESULTS

A total of 38, 26, and 24 question items were included in the first, second, and third rounds respectively. A total of 24 question items were extracted using the modified Delphi method to identify siblings' unmet psychosocial needs: relationship with family members, 3; daily life issues, 4; stress, 6; emotions, 3; information, 3; relationships with medical staff, 1 and social and medical resources, 4. Seven categories and 24 question items were confirmed as items for identifying the unmet psychosocial needs of school-aged siblings of children with cancer and blood disease.

Differences in specific concerns perceived by parents of children with cleft lip and/or palate based on the types of cleft

BACKGROUND

Parents of children with cleft lip and/or palate (CL/P) have concerns including guilt and worry. Differences in concerns by cleft type is, however, under-researched.

AIM

To compare differences in perceived concerns among parents of children with CL/P by cleft type, adjusting for children's gender and age.

DESIGN

Cross-sectional study conducted in an outpatient centre, assessing psychological status of 171 parents of children aged <12 with CL/P using 12 items.

RESULTS

Across cleft types, 'I am worried about whether the child's teeth will be straight' was the most strongly perceived concern (70.8%). After adjusting for gender and age, logistic regression showed significant differences in type of CL/P for (eg) 'I am worried that the child's appearance will not be beautiful', associated with CL over CP (OR = 0.07, 95% CI: 0.02-0.26) and CLP over CP (8.52, 3.23-22.50);' 'I am concerned about my child being able to speak well', associated with CP (3.12, 1.07-9.11) and CLP (5.69, 2.43-13.33) over CL, and 'I am worried that the child could suffer due to his/her appearance', associated with CL over CP (0.08, 0.02-0.29) and CLP over CP (10.07, 13.78-27.36).

CONCLUSIONS

Parents' concerns were influenced by cleft type.

Hospital Support for Siblings of Children With Illness in Japan

Recent years have seen increased attention to the needs and support of siblings of children with chronic illness, and reports of intervention studies on siblings are gradually increasing worldwide. In Japan, the basic policy approved by the Cabinet in 2021 of The Basic Law for Child and Maternal Health and Development stipulates promoting support for the siblings of children with chronic illness, medical care, and disabilities. Simultaneously, practical reports are emerging. However, reports on the actual state of sibling support at medical institutions in Japan are limited. This study aimed to describe the actual state of support for siblings of children with illness in Japanese medical institutions using a cross-sectional design. Responses were obtained from 207 of 484 registered training facilities for Board-Certified Pediatricians of the Japan Pediatric Society through anonymous questionnaires investigating the actual state of siblings' support. Descriptive statistics were calculated, and the state of siblings' support was described. Fifty-two participants (25.1%) answered that the entire ward, including two outpatient departments, provided siblings' support, while 37 (17.9%) answered some staff made an effort, and 117 (56.5%) did not. Support mentioned included conversing with siblings, actively speaking to siblings, calling siblings' names, and counseling care through the parents. Of the 45 cases (21.7%) where siblings were invited to events and gatherings, 10 (22.2%) were siblings-centered events. Some cases involved collaboration with local sibling support groups such as non-profit organizations. This study clarified the actual state of siblings' support, and further expansion of this support is required.

Children's psychosocial and behavioural consequences during their siblings' hospitalisation: A qualitative content analysis from caregivers' perspectives

AIMS AND OBJECTIVES

This study aimed to comprehensively describe the psychosocial and behavioural consequences experienced by siblings of hospitalised children from the caregivers' perspective.

BACKGROUND

After children are diagnosed with a major illness, their siblings may begin to exhibit psychological and behavioural problems, coupled with decreased quality of life.

DESIGN

This study employed qualitative content analysis to describe the perspectives of 147 caregivers of siblings of hospitalised children, following the COREQ guidelines.

METHODS

From January to March 2015, data were collected from 33 medical institutions in Japan using a survey that utilised an open-ended question.

RESULTS

Four themes comprising 13 comprehensive categories were extracted: (1) maintaining their usual self, (2) internalising difficulties, (3) externalising difficulties, and (4) personal growth. During data analysis, value judgments were avoided, with the focus instead placed on dividing the perspectives into positive and negative categories.

CONCLUSIONS

The neutral data analysis enabled us to describe the psychosocial and behavioural adjustments that siblings make to 'maintain their usual self'.

RELEVANCE TO CLINICAL PRACTICE

This study's results can be used to educate healthcare providers, teachers and families about the psychosocial and behavioural effects of hospitalisation on siblings of hospitalised children to ensure that siblings struggling with psychosocial conflicts receive the necessary support.

Effectiveness of a Volunteer Training Program on the Learning Support of Children in Hospice Palliative Care

BACKGROUND

Volunteers are expected to play a key role in children's hospice. However, there is a lack of information about how to cultivate effective volunteer training programs.

OBJECTIVE

To verify the effect of a training program on volunteers' confidence in providing learning support and sharing experiences with children with life-threatening conditions and their families in a children's hospice.

METHODS

In this pre-post study, participants were 48 undergraduate and graduate students from 3 universities in Japan. They received 5 lectures on children's hospice learning support. They evaluated the training program by rating their self-confidence in meeting each of the 15 program goals on a questionnaire.

RESULTS

An exploratory factor analysis of the questionnaire yielded 12 goals in 4 factors: understanding of one's own and others' mental state, accommodating the learning needs of children with life-threatening conditions, understanding and accommodating the physical state of children with life-threatening conditions, and understanding the significance of children's hospice. A paired t test revealed that participants' self-confidence had increased significantly in 3 of these 4 factors after the program. However, the score for accommodating the learning needs of children with life-threatening conditions decreased but not significantly.

CONCLUSION

Although it needs some improvements, the program was effective for improving volunteers' self-confidence in and understanding of learning support and sharing experiences with children with life-threatening conditions.

Resilience and difficulties of parents of children with a cleft lip and palate

AIM

The present study explored the differences in emotional difficulties and resilience between fathers and mothers of a child with a cleft lip and palate.

METHODS

Married couples were recruited who were accompanying their child with a cleft lip and palate (<12 years old) on regular visits to an outpatient clinic in a Japanese hospital. The participants were distributed an anonymous questionnaire that included items regarding emotional difficulties with the cleft lip and palate and a scale to measure resilience when caring for the children. In the data analysis, the paired t-test was used to compare the individuals within the couples.

RESULTS

By analyzing the data of 64 couples who provided valid responses, two items with the highest mean score for the difficulties that were faced by both the father and mother of a child with a cleft lip and palate were: "I am worried about whether the child's teeth will be straightened" and "I am worried that the children could suffer due to their appearance." The mothers felt significantly more worry about their child's future and more guilt than did the fathers. In contrast, the fathers had greater resilience, in terms of problem-solving skills and recognition and acceptance than did the mothers.

CONCLUSION

It is important that healthcare providers understand the difference between the fathers' and mothers' worries about their child with a cleft lip and palate. Specific support services should be offered to fathers with a high level of resilience, in terms of the acceptance of reality and problem-solving, which could increase their parenting ability.

Related Variables of Behavioral and Emotional Problems and Personal Growth of Hospitalized Children's Siblings: Mothers' and Other Main Caregivers' Perspectives

The psychological well-being of the siblings of hospitalized children is at risk. This study examined the variables related to siblings’ internalizing problems and personal growth during hospitalization from the perspectives of mothers and other main caregivers who temporarily assumed the main caregiver role to the siblings of hospitalized children in place of mothers in the period of children’s hospitalization. A cross-sectional, exploratory survey conducted in Japan examined 113 mothers’ and 90 other main caregivers’ perspectives regarding the psychological state of 2- to 18-year-old siblings of hospitalized children. Mothers and/or other main caregivers of siblings during their brothers’ or sisters’ hospitalization completed the Child Behavior Checklist and the Siblings’ Personal Growth Scale. Multiple linear regression analysis was performed with Child Behavior Checklist internalizing problems and total Siblings’ Personal Growth Scale scores as dependent variables for mothers’ and caregivers’ perspectives. From mothers’ perspectives, environmental factors that change with hospitalization affected siblings. From the perspectives of the other main caregivers, children’s and families’ demographic factors affected siblings’ psychological state. Frequency of e-mail contact between mothers and siblings, explanation of the hospitalized child’s condition, and hospital visitation rules (F = 5.88, P = .001) explained 12.3% of variance in mothers’ Siblings’ Personal Growth Scale scores. Among other main caregivers, 11.6% of variance in the Child Behavior Checklist scores was explained by hospitalized children’s birth order and main caregiver’s prehospitalization residence (F = 5.51, P = .006). Results suggest that the perceived variables related to siblings’ psychological changes differ between mothers and other main caregivers.

Predictors of maternal state anxiety on arrival at a Japanese hospital outpatient clinic: a cross-sectional study

AIMS AND OBJECTIVES

To identify the factors that predict maternal state anxiety when mothers and their sick children visit the outpatient unit of a paediatric hospital.

BACKGROUND

While previous studies have focused on predictors of anxiety in mothers with ill children, the existing literature is limited in study design, research timing, respondent characteristics, sample size and data analysis.

DESIGN

A cross-sectional design with self-administered questionnaires.

METHODS

Mothers were recruited from the outpatient unit of a Japanese paediatric hospital (N = 1077). Participants' state anxiety scores were collected using the Japanese version of Spielberger's State-Trait Anxiety Inventory. The independent variables were the mothers' and sick children's background information.

RESULTS

Participants were 1077 mothers; 990 provided valid responses. Mothers' mean state anxiety score was 49·72. Significant predictors of maternal anxiety were mothers' childrearing anxiety, child age, the sick child having a fever, sick child having siblings, having a person providing childrearing support, the mother's first visit to the hospital, out-of-hours visit and severity of the child's illness. The overall model explained 21·6% of the variance (multiple regression analysis).

CONCLUSIONS

As various factors predicted maternal anxiety, identifying methods to address these factors may reduce maternal state anxiety.

RELEVANCE TO CLINICAL PRACTICE

There is potential for improved understanding of the predictors of maternal state anxiety to aid in the development of materials that would best measure anxiety. The present findings may also suggest some means of providing appropriate information and support to anxious mothers. Our findings cannot demonstrate causation, however, and teaching methods and supportive practices were not investigated; therefore, a qualitative study on the concrete content of maternal anxiety and an intervention study to create support services for anxious mothers is required. In addition, prospective or longitudinal studies are also important for investigating causation.

Influence of mutations and size of multimers in type II von Willebrand disease upon the function of von Willebrand factor

We compared the properties of plasma von Willebrand factor (vWF) from normal individuals and from two patients with type IIA (Glu875Lys) and type IIB (duplication of Met 540) von Willebrand disease (vWD) with the corresponding fully multimerized recombinant proteins. We included cryosupernatant from normal human plasma and type IIA plasma (Cys509Arg). Functions of vWF were analyzed by binding assays to platelets in the presence of ristocetin or botrocetin. Parameters of binding (number of binding sites per vWF subunit, and dissociation constant Kd) were quantitatively estimated from the binding isotherms of 125I-botrocetin or glycocalicin to vWF, independently of the size of the multimers. We found that ristocetin- or botrocetin-induced binding to platelets was correlated in all cases with the size of vWF multimers. In the absence of inducer, only type IIB rvWF Met-Met540 spontaneously bound to platelets. No significant difference of binding of purified botrocetin to vWF was found between normal and patients' plasma, or between wild-type rvWF (rvWF-WT) and rvWF-Lys875. In contrast, affinity of botrocetin for type IIB rvWF Met-Met540 was decreased. Botrocetin-induced binding of glycocalicin to vWF from all plasma and cryosupernatant was similar. Compared with rvWF-WT, binding of glycocalicin to rvWF-Lys875 was normal. In contrast, the affinity for type IIB rvWF Met-Met540 was 10-fold greater. Thus, our data suggest that, in the patients tested, the abnormal IIA phenotype results from the lack of large-sized multimers and is independent of the point mutations. In contrast, the type IIB mutation is directly involved by providing a conformation to the vWF subunits that allows the high molecular weight multimers to spontaneously interact with platelet glycoprotein Ib.

Studies on anti-von Willebrand factor (vWF) monoclonal antibody NMC-4, which inhibits both ristocetin- and botrocetin-induced vWF binding to platelet glycoprotein Ib

Anti-von Willebrand factor (vWF) monoclonal antibody NMC-4 completely inhibited vWF binding to platelet glycoprotein (GP) lb induced by either ristocetin or botrocetin at an IgG concentration of approximately 10 micrograms/mL, and also blocked binding of asialo-vWF to GP lb. NMC-4 coupled beads isolated a 97-Kd fragment (Fr) from a whole tryptic digest of vWF. The N-terminal sequencing of the nonreduced 97-Kd Fr, in combination with amino acid analysis, showed it to be a homodimer of residues 449 through 728 of the constituent subunit. Present data, together with the results obtained from previous studies, confirm the existence of one or three possible inter-subunit disulfide bonds between cysteine residues 459, 462, and 464. NMC-4 bound to reduced vWF Fr(s) more weakly than to nonreduced Fr(s), but it did not react with Fr III-T2 of vWF, a disulfide-linked twin heterodimer of residues 273 through 511 and 674 through 728 (Marti et al, Biochemistry 26:8099, 1987). Fr III-T2 completely inhibited ristocetin-induced vWF binding at a concentration of 100 mumol/L but had no effect on botrocetin-induced binding. In addition, both the N- and C-terminal polypeptides, residues 449 through 549 and 674 through 728, generated by subdigestion of the 52/48-Kd Fr (Fujimura et al, J Biol Chem 261:381, 1986), inhibited preferentially ristocetin-induced vWF binding without affecting to botrocetin-induced vWF binding. These findings suggest that amino acid residues 512 through 673 of the vWF subunit are involved in botrocetin-induced vWF binding.

Enhanced botrocetin-induced type IIB von Willebrand factor binding to platelet glycoprotein Ib initiates hyperagglutination of normal platelets

Botrocetin, a protein isolated from the venom of the snake Bothrops jararaca, induces platelet aggregation/agglutination by von Willebrand factor (vWF) binding to the membrane glycoprotein (GP) Ib, an action resembling that of ristocetin. However, some differences in the interaction between vWF and platelet GPIb induced by these two substances have been reported. We have recently shown that the GPIb binding domain on the vWF molecule, in both instances, resides in the tryptic 52/48 kDa fragment extending from amino acid residue 449 to 728 of the constituent subunit. In the present report, we demonstrate that botrocetin does not induce agglutination of formalin-fixed platelets from a patient with Bernard-Soulier syndrome congenitally lacking GPIb and GPIX as well as GPV, a finding similar to that shown with ristocetin. A monoclonal antibody against GPIb (AP-1) inhibits either ristocetin- or botrocetin-dependent vWF binding to formalin-fixed platelets from normal individuals. Therefore, botrocetin-induced vWF binding to formalin-fixed platelets may reflect the interaction between vWF and platelet GPIb. To strengthen this concept, we have now found that heightened botrocetin-induced type IIB vWF binding to platelet GPIb causes hyperagglutination of normal platelets.

Blood clotting factor IX Kashihara: amino acid substitution of valine-182 by phenylalanine

Hemophilia B Kashihara is a severe hemorrhagic disorder in which the factor IX antigen is present in normal amounts but factor IX biological activity is markedly reduced. In addition, purified factor IX Kashihara is not activated by purified factor XIa in the presence of calcium ions. Amino acid sequence analysis of one of the tryptic peptides isolated from factor IX Kashihara indicated that Val-182 (equivalent to Val-17 in the chymotrypsin numbering system) had been replaced by Phe. No substitution was found in the members of the catalytic triad His-221, Asp-269, and Ser-365 of factor IX Kashihara. The Val-to-Phe replacement found in factor IX Kashihara appears to sterically hinder the cleavage of Arg 180-Val 181 by factor XIa required for the activation of this zymogen.

[Intracranial hemorrhage associated with aplastic anemia]

Intracranial hemorrhage is a fatal complication associated with aplastic anemia. We have encountered four patients who experienced six episodes of intracranial hemorrhage (intracerebral hemorrhage; 3, subarachnoid hemorrhage; 2, and subdural hematoma; 1,). Intracranial hemorrhage occurred without traumatic episodes, and was followed by frequent hemorrhagic episodes in other parts of about one year duration. This disease is considered to recur after a short interval. The site, type and degree of intracranial hemorrhage varied, and therefore intracranial hemorrhage seemed to be caused not only by thrombocytopenia but also by multifactorial hemorrhagic tendency. Transfusion of platelet rich plasma, and administration of Glycerol and steroids produced good results for conservative therapy. Continuous spinal drainage for subarachnoid hemorrhage was a relatively safe and useful means of management. In the patients who showed precipitous deterioration, the CT scan findings indicated that the high-density-area was diffusely spread with an unclear border, just like "contusional hemorrhage". For such severe cases, blood evacuation with craniotomy and emergency splenectomy are considered to be valuable.

Protein C in the neonatal period

Protein-C activity and antigen were measured in 141 full-term infants during the first month of life. The levels of both protein-C activity and antigen were about one third the level for normal adults in cord blood, and significantly lower than the cord blood during the 1st to 2nd days of life. They increased with age progressively, but did not reach the lowest limit in normal adults even in the first month. The low ratio of protein-C activity and antigen was demonstrated in some infants within the first 4 days of life. The precipitin arc of neonatal infants, which had a discrepancy between protein-C activity and antigen levels, showed an anodal shift upon agarose gel electrophoresis in the presence of Ca2+. The abnormal protein C in the neonatal period may be regarded as protein induced by vitamin-K absence or antagonist.

Hemostatic effect of a heat-treated factor VIII concentrate (Haemate P) in von Willebrand's disease

A heat-treated factor VIII (F VIII) concentrate (Haemate P) has been administered to patients with various types of von Willebrand's disease (vWD). The 4 activities of F VIII/vWF as well as change in the multimeric structure of vWF were then studied. In 4 patients with type I vWF who were given a Ristocetin cofactor (Rcof) dose of 42-78 U/kg, there was a clear reduction of the bleeding time and an increase of F VIII: C, F VIII: Ag, Rcof and vWF: Ag for several hours. The recovery of Rcof. after 1 h was 50-75%. Although the multimeric composition of vWF in these patients was similar to that of normal plasma, the density of each multimer band was very low. After infusion, however, the density of all multimer bands increased for several hours, to decrease again after 24 h. In 4 patients with type II A vWD who received a dose of Rcof of 55-76 U/kg, the 4 activities of F VIII/vWF increased similarly as was the case in type I. All patients had only 3-4 smaller multimer bands. New larger and intermediate multimers appeared for several hours after infusion of the preparation. Two patients with type III vWD who received doses of Rcof of 52 and 65 U/kg showed also a similar increase in the 4 activities of F VIII/vWF after infusion. All the multimers lacking in these patients appeared for several hours after infusion.