Risk and Protective Factors for Immune Health in Pediatric Cancer

7.项目摘要/摘要 医学的进步大大提高了儿童癌症的存活率；80%的儿童 被诊断为癌症的患者将存活五年以上。这一胜利为研究带来了新的议程， 随着人们的注意力转移到幸存者生活质量的基础机制上。生活质量包括多样化 功能方面，包括功能能力、心理功能和疾病-以及 与治疗相关的症状。理解这些过程需要综合的生物行为模型 在癌症的背景下发挥作用。不幸的是，儿科竞争模型的开发和测试 已经落后于专注于成人和动物的研究。 这项拟议的研究旨在通过以下方式确定生物和行为机制的第一步 哪些风险和保护因素会影响儿童的健康。来自成体和动物研究的证据 表明压力和免疫功能之间的关系，目前的大部分焦点是细胞因子， 免疫级联反应中的关键蛋白质。广泛的社会人口和生活压力(例如，社会经济地位、生活事件)， 生物因素(如发病年龄)、健康行为(如睡眠、饮食、锻炼)和社会心理因素 过程(例如，应对、意义形成)相互作用，影响心理健康和免疫因素，这些因素 进而影响疾病进程(例如，进展、康复、生活质量)。例如，成人和 动物研究表明，慢性和急性应激会损害免疫功能，进而 会导致更差的癌症结果。然而，这项研究还没有被转化为癌症儿童，尽管 儿童应激与生理、心理和关系系统功能之间的明显联系 在其他情况下。 这两项研究都是关于调节和调节的短期纵向研究。 影响儿童健康的社会人口压力和家庭保护过程之间的关系 结果。在第一项研究中，婴儿的免疫功能与应激性家庭生活事件和 对母性敏感的照顾进行了研究。在第二项研究中，儿童癌症患者的相关性 免疫和心理健康功能与社会人口压力和(1)儿童安全评估和健康 行为，以及(2)照顾者和家庭保护过程。这项工作的公共卫生意义在于 它的潜力突出了人口中多个个人和家庭层面的干预点 脆弱的，免疫功能受损的儿童。

7. Project Summary/Abstract Advances in medicine have dramatically increased pediatric cancer survival rates; 80% of children diagnosed with cancer will survive beyond five years. This victory carries with it new agendas for research, as attention shifts to the mechanisms underlying the quality of life of survivors. Quality of life includes diverse aspects of functioning including functional ability, psychological functioning, and disease- and treatment-related symptoms. Understanding these processes demands integrative, biobehavioral models of functioning in the cancer context. Unfortunately, development and testing of competing models in pediatrics has lagged behind research focusing on adults and animals. The proposed research is designed to be a first step in identifying biological and behavioral mechanisms by which risk and protective factors influence children's health. Evidence from both adult and animal studies indicates a relationship between stress and immune function, with much of the current focus on cytokines, the key proteins in the immune cascade. Broad sociodemographic and life stress (e.g., SES, life events), biological factors (e.g., age at disease onset), health behaviors (e.g., sleep, diet, exercise), and psychosocial processes (e.g., coping, meaning making) interact to influence mental health and immunologic factors, which in turn influences disease processes (e.g., progression, recovery, quality of life). For example, adult and animal research demonstrates that chronic and acute stress can compromise immune function, which in turn fosters poorer cancer outcomes. Yet, this research has not been translated to children with cancer, despite evidenced links between stress and biological, psychological, and relationship system functioning in children in other contexts. The two proposed studies are each short-term longitudinal studies of the mediating and moderating relationships among sociodemographic stress and family protective processes as they influence child health outcomes. In the first study, the association of infants' immune function with stressful family life events and maternal sensitive caregiving is examined. In the second study, the association of pediatric cancer patients' immune and mental health function with sociodemographic stress and (1) child secure appraisals and health behaviors, and (2) caregiver and family protective processes. The public health significance of this work lies in its potential to highlight multiple, individual- and family-level points of intervention within populations of vulnerable, immunocompromised children.