Nos últimos anos, tem sido crescente a atenção dada à temática da fé e do enfrentamento diante da busca da conservação da vida frente a doenças que a ameaçam. Este estudo volta seu olhar para mães, cujos filhos passaram pelo tratamento do câncer, com o objetivo de compreender como enfrentaram a doença do filho e como se deu a manifestação da fé em seu discurso. O trabalho foi desenvolvido no Ambulatório de Curados do Serviço de Oncologia Pediátrica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto USP e contou com a participação de sete mães, cujos filhos têm idade entre 3 e 10 anos e estão em fase final de tratamento de câncer. A estas foi feito um convite, com apresentação do Termo de Compromisso Livre e Esclarecido, e após sua concordância, iniciava-se uma entrevista a partir da seguinte questão norteadora: Gostaria que a senhora me contasse como foi estar passando por esta experiência com a doença de seu filho(a). Este estudo teve como base o método fenomenológico, e sua análise, a partir das entrevistas, foi construída seguindo os passos propostos por Martins e Bicudo (1989) revelando, através de convergências do discurso das mães, dez categorias temáticas. A compreensão das vivências das mães foi feita sob forma de diálogo com a literatura específica e, a partir daí pôde-se concluir que a maioria delas enfrentou a doença com uma postura mais ativa, implicando-se de forma determinada e confiante no tratamento e cuidado ao filho. Enfrentaram a doença como se estivessem numa luta contra a possibilidade de morte. Nesta busca pela cura do filho, as mães relataram o recurso da fé para adquirirem forças para esse enfrentamento e também para dar sentido e aumentar a esperança nos momentos de sofrimento que vivenciaram. A fé, para a maioria das mães, aparece como endereçada a Deus, através do Qual, acreditam ter recebido auxílio para lhes dar forças. A relação destas mães com Deus é permeada pela postura delas frente ao momento vivenciado e frente à vida, de modo que, mães que trazem consigo uma proximidade com a sua existência, tendem a enfrentar a doença de forma mais ativa e Este é requisitado nos momentos em que foge às possibilidades humanas da mãe conseguir a cura para o filho, ou na busca de um sentido para o momento. Em casos de distanciamento da existência, como o choque recebido pelo diagnóstico de câncer em seu filho, a mãe parece se perder em meio ao enfrentar, fazendo-o de maneira mais passiva, aguardando que Deus ou alguém venha a seu socorro. Além do auxílio de Deus, as mães também afirmaram receber diversos apoios de: família, vizinha, pessoas inesperadas e desconhecidas, Casa de Apoio, religião e equipe de profissionais da saúde. Tendo em vista os apoios buscados e recebidos, torna-se importante um cuidado cada vez mais apropriado levando em consideração as necessidades das mães de crianças com câncer. / In the past few years, theres been a great deal of attention paid to the issue of faith and coping to preserve life against threatening diseases. This study focuses on mothers, whose children had undergone cancer treatment, aiming at comprehending how they faced their childrens disease and at what point faith manifested and what role it played through its course. The project was conducted at the Ambulatório dos Curados of the Pediatric Oncology Service from Hospital das Clínicas of the Medical School of Ribeirão Preto USP with the participation of seven mothers, whose children were within a 3 to 10 years old range and are in the final stage of the cancer treatment. They were invited, with the presentation of a free commitment and acknowledgement Term, and after its consent, there was an interview having in mind the following key question: Id like to ask you, maam, how it felt to be going through this experience dealing with your childs disease. This study was based on the phenomenological method and, its analysis from the interview, was built according to steps established by Martins and Bicudo (1989) revealing, through the convergences of the mothers speeches, ten theme categories. The understanding of the mothers experiences was done as a dialog with specific literature and, from that point it was possible to conclude that most of them faced the disease having an active attitude, engaging themselves in a determined and confident way in their childrens treatment and care. They faced the disease as if they were in a battle against the odds of death. In the search for their childrens cure, the mothers reported the resource of faith to get strength for coping and also to have a sense of purpose and nurture their hope during the moments of suffering they experienced. Faith, for most mothers, appears as directed to God, from Whom they believe had received assistance to have enough strength. Their relationship with God is filled with their attitude towards the moment they lived and towards life itself, which means mothers who have proximity with their own existence tend to face the disease more actively and, He, is requested in the moments when the human possibilities of the mother to get a cure for her child run out or when they need to search for a reason. In cases where there is detachment of existence, as in the shock of receiving the cancer diagnosis, the mother seems to lose herself trying to face the situation, being more passive, waiting on God or someone to come and rescue her. Besides Gods help, mothers also state having received support from various sources: family, neighbors, unexpected people and strangers, support groups, religion and health professionals. Having in mind the types of support sought and received, it is really important to offer appropriate care taking into account the needs of mothers who have children with cancer.

O trabalho tem como proposta entrar em contato com o câncer infantil e suas conseqüências do ponto de vista da própria criança com câncer, investigando o que significa para ela estar doente e buscando conhecer o sentido de sua vivência neste momento particular de sua vida. O trabalho fundamenta-se no método de pesquisa qualitativa de inspiração fenomenológica em Psicologia. Partindo de uma questão orientadora - Como é para a criança com câncer conviver com sua doença e seu tratamento? - a fonte de investigação utilizada foram as vivências de crianças com câncer no grupo de apoio psicológico, atividade que faz parte da rotina do Serviço de Psicologia do GACC-Grupo de Apoio à Criança com Câncer. O grupo reuniu-se semanalmente durante 01 hora, em local e horário fixos, no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. Foram utilizados materiais gráfico e lúdicos. As crianças participantes, em média 05 em cada sessão, tinham diferentes diagnósticos de câncer e encontravam-se em diferentes fases de seus tratamentos. Suas idades variaram de 03 a 16 anos. A construção dos resultados compreendeu duas etapas. Na primeira etapa, foram analisadas 30 sessões do grupo de apoio psicológico realizadas no período de abril a dezembro de 1999. Nesta etapa, o objetivo do grupo era propiciar e facilitar a livre expressão de preocupações, dúvidas e sentimentos das crianças participantes, além de proporcionar um momento no qual pudessem compartilhar suas experiências. Desta primeira etapa emergiram três dimensões de análise: os temas das sessões, o próprio grupo enquanto intervenção psicoterapêutica e a gestação da idéia de elaborar o livro das crianças. Na segunda etapa, foram analisadas 15 sessões do grupo de apoio psicológico, realizadas no período de janeiro a junho de 2000. Nesta etapa, o objetivo do grupo era a criação do livro das criança, material informativo sobre o câncer infantil elaborado coletivamente. Desta segunda etapa emergiram os temas das sessões, organizados posteriormente sob a forma do livro das crianças. Após estas duas etapas de análise, foi realizada uma síntese compreensiva da construção dos resultados sob a luz da Psicologia Fenomenológica. Nas considerações finais, foram discutidos os desdobramentos práticos dos aspectos estudados, assim como o papel da Psicologia nestes contextos assistenciais. (FAPESP) / This paper proposes to come into contact with childhood cancer and its consequences from the cancer-stricken child’s own viewpoint, and investigate what it means for the child to be ill, seeking to find out the meaning of its experience at this particular juncture of its life. This paper is based on the qualitative research method of phenomenological inspiration in Psychology. With a leading question as the starting point – What is it like for a child who has cancer to live with this illness and its treatment? – the source used for investigation were the experiences of children suffering from cancer in a psychological support group, a routine activity that is a part of the Psychology Service of the GACC – Support Group for Children with Cancer. This group met weekly for one hour, at a fixed time and place, at the Children’s Hospital of the Ribeirão Preto Medical School of the University of São Paulo (USP). Graphic and playtime materials were used. The participating children, five per session on the average, had different cancer diagnoses, and were at different stages of their treatment. Their ages ranged from 3 to16 years. Construction of results comprised two stages. In the first stage, 30 psychological support group sessions held during the period from April through December 1999 were analyzed. In this stage, the group’s objective was fostering and facilitating the free expression of concerns, doubts and feelings by the participating children, in addition to providing a time for them to share their experiences. In the second stage, 15 psychological support group sessions held during the period from January to June 2000 were analyzed. In this stage, the group’s objective was creating the Children’s Book – collectively prepared informative material on childhood cancer. Subsequently, a synthesis comprising both stages of such construction of results was carried out under the light of Phenomenological Psychology. Practical developments of the aspects studied, as well as the role of Psychology in such care contexts, were discussed in closing remarks.

O trabalho tem como proposta entrar em contato com o câncer infantil e suas conseqüências do ponto de vista da própria criança com câncer, investigando o que significa para ela estar doente e buscando conhecer o sentido de sua vivência neste momento particular de sua vida. O trabalho fundamenta-se no método de pesquisa qualitativa de inspiração fenomenológica em Psicologia. Partindo de uma questão orientadora - Como é para a criança com câncer conviver com sua doença e seu tratamento? - a fonte de investigação utilizada foram as vivências de crianças com câncer no grupo de apoio psicológico, atividade que faz parte da rotina do Serviço de Psicologia do GACC-Grupo de Apoio à Criança com Câncer. O grupo reuniu-se semanalmente durante 01 hora, em local e horário fixos, no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. Foram utilizados materiais gráfico e lúdicos. As crianças participantes, em média 05 em cada sessão, tinham diferentes diagnósticos de câncer e encontravam-se em diferentes fases de seus tratamentos. Suas idades variaram de 03 a 16 anos. A construção dos resultados compreendeu duas etapas. Na primeira etapa, foram analisadas 30 sessões do grupo de apoio psicológico realizadas no período de abril a dezembro de 1999. Nesta etapa, o objetivo do grupo era propiciar e facilitar a livre expressão de preocupações, dúvidas e sentimentos das crianças participantes, além de proporcionar um momento no qual pudessem compartilhar suas experiências. Desta primeira etapa emergiram três dimensões de análise: os temas das sessões, o próprio grupo enquanto intervenção psicoterapêutica e a gestação da idéia de elaborar o livro das crianças. Na segunda etapa, foram analisadas 15 sessões do grupo de apoio psicológico, realizadas no período de janeiro a junho de 2000. Nesta etapa, o objetivo do grupo era a criação do livro das criança, material informativo sobre o câncer infantil elaborado coletivamente. Desta segunda etapa emergiram os temas das sessões, organizados posteriormente sob a forma do livro das crianças. Após estas duas etapas de análise, foi realizada uma síntese compreensiva da construção dos resultados sob a luz da Psicologia Fenomenológica. Nas considerações finais, foram discutidos os desdobramentos práticos dos aspectos estudados, assim como o papel da Psicologia nestes contextos assistenciais. (FAPESP) / This paper proposes to come into contact with childhood cancer and its consequences from the cancer-stricken child’s own viewpoint, and investigate what it means for the child to be ill, seeking to find out the meaning of its experience at this particular juncture of its life. This paper is based on the qualitative research method of phenomenological inspiration in Psychology. With a leading question as the starting point – What is it like for a child who has cancer to live with this illness and its treatment? – the source used for investigation were the experiences of children suffering from cancer in a psychological support group, a routine activity that is a part of the Psychology Service of the GACC – Support Group for Children with Cancer. This group met weekly for one hour, at a fixed time and place, at the Children’s Hospital of the Ribeirão Preto Medical School of the University of São Paulo (USP). Graphic and playtime materials were used. The participating children, five per session on the average, had different cancer diagnoses, and were at different stages of their treatment. Their ages ranged from 3 to16 years. Construction of results comprised two stages. In the first stage, 30 psychological support group sessions held during the period from April through December 1999 were analyzed. In this stage, the group’s objective was fostering and facilitating the free expression of concerns, doubts and feelings by the participating children, in addition to providing a time for them to share their experiences. In the second stage, 15 psychological support group sessions held during the period from January to June 2000 were analyzed. In this stage, the group’s objective was creating the Children’s Book – collectively prepared informative material on childhood cancer. Subsequently, a synthesis comprising both stages of such construction of results was carried out under the light of Phenomenological Psychology. Practical developments of the aspects studied, as well as the role of Psychology in such care contexts, were discussed in closing remarks.

Bakgrund: När ett barn drabbas av cancer påverkas hela dess familj. De friska syskonens vardagsliv och familjerelationer riskerar att ändras drastiskt. Syfte: Syftet var att beskriva hur ett barns cancerdiagnos påverkar relationen mellan det friska och det sjuka syskonet, samt mellan det friska syskonet och föräldrarna. Metod: En beskrivande litteraturstudie baserad på totalt nio artiklar. Data analyserades med innehållsanalys. Resultat: Analysen resulterade i sju kategorier: Närvaro och frånvaro påverkar relationen mellan syskonen, Nedprioritera sin betydelse i relationen och förlust av identitet, Kommunikation mellan syskonen, Konflikter mellan syskonen, Mindre uppmärksamhet och mindre tid tillsammans med föräldrar, Närmare relationer med föräldrarna och Prata om sjukdom och behandling med friska syskon, samt fyra subkategorier. De friska syskonens familjerelationer påverkades ofta negativt under behandlingsperioden. Syskonen nedprioriterade sina egna behov för att inte öka sina familjemedlemmars stress. De friska syskonen blev mer beskyddande mot sitt sjuka syskon och antog ibland en föräldraroll. En öppen kommunikation om sjukdomen var uppskattad, samtidigt som det var vanligt att syskonen fick bristande information. Vissa syskon upplevde att cancerupplevelsen bidrog till närmare familjerelationer. Slutsats: Familjerelationerna påverkades ofta negativt för syskon till barn med cancer. Bidragande faktorer var minskad uppmärksamhet från föräldrarna och mindre tid tillsammans med föräldrarna och det sjuka syskonet. Ibland stärktes dock syskonens familjerelationer. Det är viktigt att sjuksköterskor tillämpar familjecentrerad omvårdnad och inkluderar friska syskon. / Background: When a child is diagnosed with cancer, the whole family is affected. The everyday life and family relations of the healthy siblings may change drastically. Aim: The aim was to describe the impact of a child’s cancer diagnosis regarding the relationship between the healthy sibling and the ill sibling as well as the healthy sibling and the parents. Method: A descriptive literature review. Nine articles were included. Data were analysed with content analysis. Results: Seven categories emerged from the analysis: Presence and absence affect the relationship between siblings, Down-prioritizing one’s own importance in the relationship and a loss of identity, Communication between siblings, Conflicts between siblings, Less attention and less time with parents, Closer relationship with parents and Talking about illness and treatment with the healthy sibling, and four subcategories were identified. The healthy sibling’s family relations were often negatively affected during the treatment. Siblings down prioritized their own needs to avoid stressing their family members. Siblings were more protective of their ill sibling and sometimes assumed a parent-like role. Siblings appreciated open communication about the illness, but often received inadequate information. Some siblings thought that the cancer experience had contributed to closer family relations. Conclusion: The cancer experience often had a negative impact on family relations. Contributing factors were less attention from parents and less time spent with parents and the ill sibling. Sometimes the cancer experience strengthened the family relations. It is important for nurses to practice family centered care and to include the healthy sibling.

Introdução – As crianças e adolescentes com câncer recebem tratamentos que têm os mais diversos efeitos colaterais, entre eles, a ototoxicidade, que é a capacidade de provocar lesão em estruturas da orelha interna e que pode levar à perda auditiva. Objetivos – Estimar a prevalência de perda auditiva e os fatores associados à ocorrência desta nas crianças e adolescentes tratados no Instituto de Tratamento do Câncer Infantil – ITACI, utilizando três classificações propostas na literatura. Métodos – Foram analisados 94 pacientes atendidos no ITACI, no período de 2003 e 2004. Como a avaliação audiológica não é feita de rotina neste Instituto, os pacientes transferidos e os que foram a óbito não puderam ser incluídos no estudo. Os indivíduos foram submetidos a uma anamnese para verificar qualquer comprometimento auditivo. Em seguida, foi feita a inspeção visual do meato acústico externo, para verificar a presença de qualquer ocorrência que pudesse impedir a realização dos exames audiológicos. Foi realizada a avaliação dos limiares auditivos utilizando-se procedimentos de resposta condicionada (por meio da audiometria tonal liminar, audiometria lúdica condicionada ou audiometria com reforço visual), com a finalidade de determinar os limiares auditivos. Por fim, foram realizadas a timpanometria e a pesquisa dos reflexos acústicos, para avaliar as condições da orelha média. A caracterização da amostra foi realizada por meio da estatística descritiva e a análise da concordância no diagnóstico da perda auditiva para as três classificações, por meio da estatística Kappa. A análise dos fatores associados à presença de perda auditiva foi realizada por meio do teste associação pelo qui-quadrado e modelos de regressão logística univariados e múltiplos. Resultados – Os resultados mostraram prevalência de perda auditiva de 42,5% utilizando a classificação proposta pela American Speech-Language-Hearing Association (ASHA), 40,4% de acordo com a classificação proposta pelo Pediatric Oncology Group Toxicity (POGT) e 12,8% pela classificação de Perda Auditiva Bilateral (PAB). A concordância no diagnóstico de perda auditiva pelas classificações POGT e PAB, e para PAB e ASHA foi fraca (respectivamente, k=0,36 e k=0,33). Já a concordância entre as classificações ASHA e POGT foi quase perfeita (k=0,96). O único fator de risco para perda auditiva, pelas três classificações adotadas, foi o uso da cisplatina e este efeito foi potencializado com o uso concomitante da ifosfamida. Conclusões – A perda de audição é um efeito colateral importante nas crianças e adolescentes com câncer. A monitorização auditiva é fundamental, visto que possibilita a detecção precoce das perdas auditivas e a revisão do tratamento, além de identificar a progressão da seqüela. Recomenda-se que sejam feitas avaliações audiológicas periódicas, mesmo após o término do tratamento e que seja adotada uma classificação que contemple as perdas auditivas discretas, como a proposta pela ASHA. / Introduction – The treatment of childhood cancer has several side effects and the ototoxicity is one of them. It can affect the inner ear structures and may lead to a hearing loss. Aim – To estimate the prevalence of hearing loss and risk factors in children and adolescents attended at the Childhood Cancer Treatment Institute (ITACI), using three classifications proposed in the literature. Methods – 94 patients admitted at ITACI between 2003 and 2004 were analyzed. The evaluation of hearing loss is not usually done in this institution and, because of this, the patients who were transferred and those who died could not be evaluated. The parents answered a questionnaire about demographic and clinical conditions. Then, the visual inspection of the external auditory meatus was done in order to verify if there were clinical conditions to perform the audiologic evaluation. The audiologic evaluation was done using pure tone audiometry (conditioned audiometry, play audiometry or visual reinforcement audiometry), tympanometry and tests of acoustic reflexes. The statistical analysis was done using descriptive statistics, the Kappa statistics, chi-squared test and univariate and multiple logistic regression models. Results – The prevalence of hearing loss was 42,5% using the American Speech-Language-Hearing Association (ASHA) classification, 40,4% using the Pediatric Oncology Group Toxicity (POGT) classification and 12,8%, using the bilateral hearing loss (PAB) classification. The agreement on the diagnosis of hearing loss was weak for POGT and PAB (k= 0.36) and for PAB and ASHA (k=0.33). The agreement between ASHA and POGT was almost perfect (k=0.96). The only risk factor for hearing loss for all classifications was the use of cisplatin and its effect was higher if the patients use also the ifosfamide. Conclusions – Hearing loss is an important side effect in children and adolescents with cancer treated with cisplatin. It is recommended a periodic audiological monitoring, even after the patient has finished the treatment. It can early detect a hearing loss, the schedule of treatment can be reviewed and the speech-language pathologist may be indicated to address the consequences of the hearing loss. It is recommended to adopt a classification that can detect slight hearing loss (ASHA).

Childhood cancer is the leading cause of death by disease for children under 15 years of age. Despite a growing survival rate for childhood cancer, psychological research of this population has lagged behind medical advances in treatment. The research that does exist in the psycho-oncology literature is plagued with inconsistency in conclusions and methodological limitations. Focus has been given to measuring maladaptive symptoms with few firm conclusions. Conclusions in the area of social competence of children with cancer have been considerably more reliable than in other domains. Previous research suggests that children with cancer exhibit significant difficulties in the areas of social competence (peer relationships, social functioning) when compared with healthy peers. Although this phenomenon has been consistently demonstrated, it had not been investigated longitudinally or with a focus on pre- and postdiagnosis differences in functioning. This project investigated individual change in social competence in children with acute lymphoblastic leukemia (the most common form of childhood cancer) during their first 3 months of treatment compared to normally developing controls.

Tumours of the central nervous system (CNS) are the second most common cancers diagnosed in children, yet the cause of this disease remains largely unknown. This thesis examines whether polymorphisms in folate-metabolising and glutathione S transferase (GST) genes influence the risk and disease outcome of childhood CNS tumours. 204 children aged ≤18 years diagnosed with a CNS tumour at the Sydney Children??s Hospital between 1989 and 2004 were included in the study. DNA samples were isolated from archival frozen and formalin-fixed paraffin-embedded tumour tissue. Polymorphisms in GST and folate pathway genes were examined using real-time PCR. Genotype distributions in children with CNS tumours were compared to those observed in a control panel of cord blood samples from 363 healthy newborns. Children carrying at least one variant allele for each of MTHFR 677 C>T, MTHFR 1298 A>C, MTR 2756 A>G, MTRR 66 A>G, and RFC 80 G>A were found to have a 2.8-fold greater risk of developing a CNS tumour than non-carriers (OR=2.80; 95%CI: 1.08-7.56, P=0.022), an association which was even more apparent in those children with an embryonal tumour (OR=4.54; 95%CI: 1.13-15.85, P=0.016). Results also showed that children with the GSTP1 105 Val/Val genotype were three times more likely to develop a CNS tumour of embryonal cell origin than children with the GSTP1 105 Ile/Ile or Ile/Val genotypes (OR=3.02; 95%CI: 1.34-6.46, P=0.005). No such association was observed for CNS tumours of glial cell origin. The GSTM1, GSTT1, and GSTP1 Ala114Val polymorphisms did not appear to be associated with the development of a childhood CNS tumour. In addition, children with the MTHFR 677 TT or RFC 80 AA genotypes were found to have a higher risk of death within 5 years of diagnosis compared to children with one or more MTHFR 677 C or RFC 80 G alleles, respectively (HR=5.52, 95%CI: 1.00-30.37, P=0.049 and HR=5.69, 95%CI: 1.38-23.51, P=0.016, respectively), after adjusting for other prognostic factors such as sex, age at diagnosis, period of diagnosis, and tumour grade. Conversely, children with the MTR 2756 AG or GG genotypes, or MTRR 66 AG or GG genotypes, were more likely to survive compared to those with the MTR 2756 AA or MTRR 66 AA genotypes, respectively (HR=0.21, 95%CI: 0.05-0.93, P=0.040 and HR=0.11, 95%CI: 0.02-0.53, P=0.006). Results presented in this thesis indicate that polymorphisms in folate-metabolising and GST genes may play a role in the aetiology and survival of childhood CNS tumours, and that this may vary depending on the histological sub-type of tumour.

<p>The purpose of this essay is to compile interventions for parents of children with cancer in a literature review based on 13 peer-reviewed articles. The objective is twofold: to describe the aim of the interventions, and to investigate their effectiveness. Results indicate that the aim is to reduce stress, prevent the development of posttraumatisk stress, improve problem-solving skills, improve coping behaviour or increase parents’ knowledge of childcancer. Some of the interventions have intended effect, others have effect but not intended effect, and finally some show no effect at all. The main conclusion is that the forthcoming studies need to focus more on developing interventions that are flexible and can satisfy multiple needs.</p>

The aim with this thesis was to assess the impact of prenatal ultrasound exposure on psychotic illness, childhood brain tumors (CBT) and school achievement, and to evaluate prenatal X-ray exposure and the risk of CBT. In a cohort study, children born in Malmö 1973-1978, where prenatal ultrasound was used routinely, were considered exposed (n=13, 212) and children born at hospitals with no use of ultrasound, were considered unexposed (n=357,733). Exposed men had a tendency toward a higher risk of schizophrenia. For other psychoses there were no differences between groups. Other factors related to place of birth might have influenced the results. In a case control study, children born 1975-1984 with a diagnosis of CBT (n=512), and randomly selected control children (n=524) were included. Exposure data on X-ray and ultrasound from antenatal records was completed with information from the Medical Birth Register. We found no overall increased risk for CBT after prenatal X-ray exposure. When stratifying by histological subgroups, primitive neuroectodermal tumors had the highest risk estimates. For ultrasound exposure, no increased risk for CBT was seen and numbers of examinations or gestational age at exposure had no substantial impact on the results. In a follow-up of a randomized trial on prenatal ultrasound scanning 1985-87, we assessed the children’s school grades when graduating from primary school (15-16 years of age). We performed analyses according to randomization, ultrasound exposure in the second trimester and exposure at any time during pregnancy. There were no differences in school performance for boys or girls according to randomization or exposure in the second trimester. Boys exposed to ultrasound any time during fetal life had a reduced mean score in physical education and small, non-significant increased risk of poor school performance in general.

The main aim of this thesis was to longitudinally investigate the potential occurrence of posttraumatic stress disorder (PTSD) among parents of children on cancer treatment (Study I). Additional aims were to describe parents’ perceptions of emotional support and satisfaction with the child’s care (II), perceptions of the child’s symptom burden (III), and parents’ stories about having a child on cancer treatment (IV). The design was prospective, longitudinal, and data was collected at: one week, two months, and four months after the child’s diagnosis and one week/six months after the end of successful treatment/transplantation. Parents (N=259) were consecutively included during the years 2002-2004 and answered questionnaires and open-ended questions over the telephone. Parenting a child with cancer is a very demanding, potentially traumatic, event. Approximately a fourth of the parents report symptoms corresponding to PTSD. The symptom level is related to being a mother, not working before the child’s diagnosis, and to previous trauma experience. Less than half of those who report a need to talk with a psychologist report having had the opportunity to do so. Parents are generally satisfied with the care and report the highest satisfaction with the technical care. Emotional distress, fatigue, nutrition, and pain are, according to parents, the most problematic symptom areas for their children. Pain is identified as especially problematic. Parents in paediatric oncology care should be acknowledged as potential care-recipients. In order to prevent development of PTSD parents of children on cancer treatment should be supported to maintain an ordinary life, for example pursue work and/or activities, and to get sufficient rest. As a means towards this parents need help with e.g. household duties and childcare. In addition to this, parents in approximately two fifths of the families need extended psychosocial support aiming at reducing posttraumatic stress.