The relationship between maladaptive health beliefs, pandemic-related stress, and health anxiety during the COVID-19 pandemic.

BACKGROUND: Research has demonstrated that people experience specific distress and anxiety regarding COVID-19. This distress may consist of interconnected symptom categories corresponding to a COVID stress syndrome. Susceptibility to COVID stress syndrome may be related to one's maladaptive health beliefs; however, no research has investigated the association between maladaptive health beliefs and COVID stress. The present study explored the impact of health beliefs on COVID stress, health anxiety, and associated psychological constructs. PARTICIPANTS AND PROCEDURE: This cross-sectional survey study included 221 adults (M age = 20.59, SD = 2.28). Participants completed an online survey including demographic questionnaires and self-report measures of health beliefs, COVID stress, health anxiety, and related psychological constructs. RESULTS: Health anxiety, anxiety sensitivity, state/trait anxiety, intolerance of uncertainty, and depression accounted for significant variance in COVID stress (F(6, 214) = 11.18, R2 = .24, p < .001). Health beliefs (i.e., perceived likelihood of illness, medical service inadequacy, and difficulty coping) were associated with greater COVID stress, although health beliefs were not found to mediate the relationship between health anxiety and COVID stress. CONCLUSIONS: Health beliefs were associated with greater COVID stress, although health beliefs did not mediate the relationship between health anxiety and COVID stress. The relationship between health anxiety and COVID stress may be better explained by other COVID-related cognitions (e.g., vaccine efficacy, dangerousness of COVID-19). The findings highlight the importance of peoples' health beliefs during the pandemic. Given anxiety's influence on peoples' behavioural responses to the pandemic, further research should identify COVID-specific cognitions for prevention of COVID stress and health anxiety.

A systematic review of attention-deficit/hyperactivity disorder in people living with cystic fibrosis.

There is a lack of research that has focused on attention-deficit hyperactivity disorder (ADHD) in people with cystic fibrosis (pwCF). Given ADHD is associated with executive functioning impairments, exploring ADHD in the context of living with cystic fibrosis (CF) is of great importance. The purpose of the current systematic review was to examine ADHD in pwCF across the lifespan in terms of its prevalence, its impact on various health outcomes, and treatments for managing ADHD. This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles reporting studies of any design that focused on ADHD in pwCF were included. Studies were excluded if they did not meet this criterion and if they were written in languages other than English. PsycINFO, MEDLINE, EMBASE, and CINAHL databases were searched. Search items were based on three concepts: (1) terms related to CF, (2) terms related to ADHD, and (3) terms related to age. Ten studies were included in this systematic review. Reported prevalence rates of ADHD in pwCF ranged from 5.26% to 21.9%. The reported relationships between ADHD and CF and other health outcomes is inconsistent. In terms of treatment considerations, pharmacological interventions and behavioural strategies for managing ADHD in the context of living with CF have been reported as being successful. Additional research is needed to further explore ADHD in the CF population and health variables that may be associated with CF prognosis.

Annual Research Review: Health anxiety in children and adolescents-developmental aspects and cross-generational influences.

Health anxiety involves excessive worries about one's health along with beliefs one has an illness or may contract a serious disease. Concerning evidence suggests that health anxiety is on the rise in society, possibly further fueled by the COVID-19 pandemic. Recent classification systems acknowledge that impairing health-related worries and beliefs can emerge in early childhood with significant levels of symptoms persisting throughout childhood, and possibly continuous with diagnostic considerations in adulthood. This narrative review summarizes recent research advances in health anxiety in children and adolescents, focusing on various developmental aspects of health anxiety and related concepts in youths. Findings suggest that health anxiety symptoms in young age groups are associated with impairment, distress, and increased healthcare use, as well as substantial comorbidity with mainly other emotional problems and disorders. Furthermore, longitudinal studies suggest that childhood health anxiety can persist across adolescence, perhaps with links to chronic courses in adulthood. The growing literature was further reviewed, thus extending our understanding of early risk factors, including the potential role of exposure to serious illness and transgenerational transmission of health anxiety. Learning more about developmental trajectories will be highly relevant to inform strategies for early detection and prevention. While modified cognitive behavioral therapies in adults are successful in treating health anxiety, specific interventions have not yet been tested in youths. Given substantial overlaps with other psychopathology, it could be important to develop and explore more transdiagnostic and scalable approaches that take advantage of common factors in psychotherapy, while also including a wider perspective on potential familiar maladaptive illness cognitions and behaviors.

Measurement properties of the Health Anxiety by Proxy Scale (HAPYS): A new questionnaire to assess parents' worries about their child's health.

OBJECTIVE: Health anxiety by proxy refers to parents' excessive worries about their child's health. The Health Anxiety by Proxy scale (HAPYS) is a new self-report questionnaire to assess parents' worries and behaviors regarding their child's health. This study aimed to investigate the measurement properties of the HAPYS. METHODS: Questionnaires were completed by 204 parents, and a HAPYS score was obtained for 200 parents: 39 parents diagnosed with health anxiety, 33 parents with different anxiety disorders, 33 parents with a Functional Somatic Disorder, and 95 healthy parents. We evaluated the following measurement properties: structural validity, reliability, convergent validity ((pain catastrophizing, parents' reports of child's emotional and physical symptoms), discriminant validity (parental reports of child's well-being), and known-groups validity (see compared groups above). RESULTS: HAPYS demonstrated a one factor dimensionality, and excellent internal reliability (α = 0.95; CI: 0.93-0.97) and test-retest reliability after two weeks (ICC = 0.91; CI: 0.87-0.94). Convergent validity with the construct of parental catastrophizing about child pain was good (r = 0.72; CI: 0.64-0.78)). Good known-groups validity was demonstrated by the largest total HAPYS score observed in parents with health anxiety (median = 35; IQR: 9-53) and the lowest score in healthy parents (median = 9; IQR: 5-15) (p < 0.001). CONCLUSION: The findings support that HAPYS is a useful measure of health anxiety by proxy. Future research should examine the measurement properties in larger samples and different languages with further statistical analyses of structural validity.

Health anxiety and associated constructs in school-age children and adolescents with congenital heart disease and their parents: A children's healthy-heart activity monitoring program in Saskatchewan cohort study.

Youth with congenital heart disease (CHD) have been found to experience higher levels of health anxiety and associated constructs than typically developing peers. The association between youth and parent health anxiety has been explored in typically developing youth but this association remains unknown in youth with CHD. This association was explored using a prospective, cross-sectional study that included 36 school-age children and adolescents with CHD (median age =10.5 years, IQR = 4) and 35 parents (median age = 44 years, IQR = 10.5). Participants completed a demographic form and measures of health anxiety, anxiety sensitivity, intolerance of uncertainty, and anxiety disorder symptom categories (youth) or general anxiety (parent). Associations were observed between child and adolescent panic/agoraphobia symptoms and parent state anxiety (r = .41), child and adolescent intolerance of uncertainty and parent state and trait anxiety (r = .37; r = .46, respectively), and child and adolescent anxiety sensitivity and parent state anxiety (r = .40). No association was observed between health anxiety in children and adolescents and parents nor between child and adolescent health anxiety and parent associated constructs. For parents, associations between health anxiety and all measures of associated constructs of interest were observed. Study findings will facilitate improved understanding of the psychological needs of school-age children and adolescents with CHD.

The Use of General Anesthesia for Pediatric Dentistry in Saskatchewan: A Retrospective Study.

INTRODUCTION: The rate of general anesthesia (GA) use for pediatric dental treatment in Saskatchewan is among the highest in Canada. Although the prevalence of and risk factors for early childhood caries (ECC) has been reviewed nationally, few studies have focused on Saskatchewan. The objective of this study was to determine the prevalence of and predictive factors for dental treatment under GA in Saskatchewan. METHODS: This retrospective review focused on pediatric patients who required dental treatment under GA in Saskatchewan between 2015 and 2018. Demographic, dental diagnostic and treatment data and number of previous exposures to GA were collected and analyzed. RESULTS: We reviewed 570 patient records. Dental treatment needs among the sample were complex; children had 10.85 ± 3.56 (mean ± standard deviation) teeth treated, for an average cost of $3231.72 ± $898.95 per child. Children who lived in less accessible or remote locations had a significantly higher caries experience, number of teeth treated and cost of treatment. In addition, children who lived in such locations were more likely to have had previous dental treatment under GA (odds ratio [OR] 1.29, 95% CI 1.029-1.645) compared with those who lived in easily accessible/accessible areas (OR 0.81, 95% CI 0.700-0.953). CONCLUSION: Our findings confirm previous research that children who require dental treatment under GA have extensive caries and treatment needs. Our results suggest that children who live in less accessible and more remote areas of the province have a higher burden of disease and are more likely to require repeated GA exposures for dental treatment.

Effects of 12-Week Home-based Resistance Training on Peripheral Muscle Oxygenation in Children With Congenital Heart Disease: A CHAMPS Study.

Background: A hallmark feature of children with congenital heart disease (CHD) is exercise intolerance. Whether a home-based resistance training intervention improves muscle oxygenation (as measured by tissue oxygenation index, TOI) and exercise tolerance (V˙O2 reserve) during aerobic exercise in children with CHD compared with healthy children is unknown. Methods: We report findings for 10 children with CHD (female/male: 4/6; mean ± standard deviation age: 13 ± 1 years) and 9 healthy controls (female/male: 5/4; age: 12 ± 3 years). Children with CHD completed a 12-week home-based exercise programme in addition to 6 in-person sessions. Exercise tolerance was assessed with a peak exercise test. Vastus lateralis TOI was continuously sampled during the peak V˙O2 test via near-infrared spectroscopy. Results: There was a medium effect (Cohen's d = 0.67) of exercise training on lowering TOI at peak exercise (pre: 30 ± 16 %total labile signal vs post: 20 ± 13 % total labile signal; P = 0.099). Exercise training had a small effect (Cohen's d = 0.23) on increasing V˙O2 reserve by 1.6 mL/kg/min (pre: 27.2 ± 5.7 mL/kg/min vs post: 29.4 ± 8.8 mL/kg/min; P = 0.382). There was also a small effect (Cohen's d = 0.27) of exercise on peak heart rate (pre: 175 ± 23 beats/min vs post: 169 ± 21 beats/min; P = 0.18). TOI, V˙O2 reserve, and heart rate were generally lower than healthy control participants. Conclusions: Our findings indicate that home-based resistance training may enhance skeletal muscle oxygen extraction (lower TOI) and subsequently V˙O2 reserve in children with CHD.

Contexte: L'une des manifestations caractéristiques de la cardiopathie congénitale chez les enfants est l'intolérance à l'effort. Il n'est pas clair si un entraînement musculaire à la maison permet d'améliorer l'oxygénation musculaire (selon l'indice d'oxygénation tissulaire, ou TOI pour tissue oxygenation index) et la tolérance à l'effort (réserve de consommation d'oxygène [V˙O2]) lors d'un exercice aérobique chez les enfants atteints d'une cardiopathie congénitale, comparativement aux enfants en bonne santé. Méthodologie: Les résultats présentés concernent 10 enfants atteints d'une cardiopathie congénitale (filles/garçons : 4/6; âge moyen ± écart-type : 13 ans ± 1 an) et neuf enfants témoins en bonne santé (filles/garçons : 5/4; âge : 12 ans ± 3 ans). Les enfants atteints d'une cardiopathie congénitale ont participé à un programme d'exercices à la maison de 12 semaines, en plus d'assister en personne à six séances. La tolérance à l'effort a été évaluée au moyen de l'épreuve d'effort maximal. Le TOI du muscle vaste externe a été mesuré de façon continue pendant le test du V˙O2 max par spectroscopie proche infrarouge. Résultats: Le programme d'exercices a entraîné un effet modéré (valeur d de Cohen = 0,67) sur la réduction du TOI au moment de l'effort maximal (pré-entraînement : signal labile total de 30 ± 16 % vs post-entraînement : signal labile total de 20 ± 13 % ; p = 0,099). Le programme d'exercices a eu un effet léger (valeur d de Cohen = 0,23) sur l'augmentation de la réserve de V˙O2, soit de 1,6 ml/kg/min (pré-entraînement : 27,2 ± 5,7 ml/kg/min vs post-entraînement : 29,4 ± 8,8 ml/kg/min; p = 0,382). On a également observé un effet léger (valeur d de Cohen = 0,27) sur la fréquence cardiaque maximale (pré-entraînement : 175 ± 23 battements/minute vs post-entraînement : 169 ± 21 battements/minute; p = 0,18). Le TOI, la réserve de V˙O2 et la fréquence cardiaque étaient généralement inférieurs comparativement aux témoins en bonne santé. Conclusions: Nos résultats montrent qu'un entraînement musculaire à la maison pourrait améliorer la capacité d'extraction de l'oxygène par les muscles squelettiques (TOI inférieur) et ultimement la réserve de V˙O2 chez les enfants atteints d'une cardiopathie congénitale.

A new measure of excessive parental worries about children's health: Development of the Health Anxiety by Proxy Scale (HAPYS).

OBJECTIVE: Health anxiety by proxy is a newly introduced term to describe parents' experience of excessive and unpleasant worries about their child's health. This article describes the development of a new measure, the Health Anxiety by Proxy Scale (HAPYS), for systematic assessment of health anxiety by proxy. METHOD: The development of the HAPYS was performed over three phases. (1) Patients clinically assessed to have health anxiety by proxy participated in semi-structured interviews to elaborate their experience of worries regarding their child's health and their related behaviours, and to examine the face validity of items in an existing questionnaire: 'Illness Worry Scale - parent version'. (2) Based on the findings from Phase 1 the project group and a panel of experts selected and formulated questionnaire items and scoring formats. (3) The HAPYS was pilot-tested twice using cognitive interviewing with healthy parents and parents with health anxiety by proxy followed by further adjustments. RESULTS: The final version of HAPYS consists of 26 items characteristic of health anxiety by proxy and of an impact section with five items. CONCLUSION: Based on the pilot testing the HAPYS showed good face and content validity. It holds the potential to be a valid questionnaire to help clinicians across health care settings assess parents suffering from health anxiety by proxy.

Pilot Examination of the Efficacy of the Internet-Delivered, Preoperative, Preparation Program (I-PPP).

Limited evidence-based, interactive, Internet-delivered preoperative preparation programs for children and their parents exist. The purpose of this investigation was to compare the Internet-delivered, preoperative program (I-PPP) in alleviating anxiety in children undergoing outpatient surgery delivered alone (I-PPP) and in conjunction with parental presence (I-PPP + parent) to treatment as usual (TAU). 104 children undergoing day surgery procedures at a local hospital and their parents/guardians participated. Primary outcome measures: (a) observer-rated child anxiety and (b) induction compliance. Results demonstrated an interaction between the I-PPP and TAU groups over time, F(1, 64) = 5.11, p = .027, partial η p2 = .07. At anesthetic induction, the I-PPP group demonstrated lower observer-rated anxiety than TAU, F(1, 64) = 4.72, p = .034, η p2 = .07. I-PPP group demonstrated the best anesthesia induction compliance, F(1, 64) = 4.84, p = .031, η p2 = .07. Our findings demonstrate that the I-PPP is an efficacious preoperative preparation intervention for children. The 'real-world' uptake and integration of the I-PPP into pediatric preoperative settings require exploration going forward. Trial retrospectively registered March 2019 (Open Science Registration https://doi.org/10.17605/osf.io/2x8rg ).

Examining the relationships between childhood abuse history, attachment, and health anxiety.

This study examined the relationship between childhood abuse experiences and health anxiety in adulthood and investigated the role of attachment in this relationship. In total, 181 university students (aged 18-29 years) completed a battery of measures that assessed childhood abuse, health anxiety, and attachment orientation. Health anxiety was associated with all categories of childhood abuse and overall childhood abuse severity. Anxious attachment partially mediated the relationship between overall childhood abuse and health anxiety in adulthood. The results further our understanding of the relationship between childhood abuse and health anxiety in adulthood and provide support for the interpersonal model of health anxiety.

A cardiovascular disease risk factor in children with congenital heart disease: unmasking elevated waist circumference - a CHAMPS* study *CHAMPS: Children's Healthy-Heart Activity Monitoring Program in Saskatchewan.

BACKGROUND: Children with congenital heart disease (CHD) have an elevated risk of future cardiovascular disease but the underlying mechanisms are unclear. Abdominal obesity (measured as waist circumference) is a risk factor for adult onset of cardiovascular diseases and is correlated with low physical activity levels, commonly found in children with congenital heart disease. Elevated waist circumference may be a mechanism by which cardiovascular disease risk is elevated in children with CHD. The purpose of this study was to compare waist circumference between children with and without CHD, while considering potential confounders. We hypothesized that children with CHD would have higher measures of waist circumference when controlling for differences in birthweight, lean mass, and physical activity. METHODS: Thirty-two children with CHD (10.9 ± 2.6 years; 12 female) from the Children's Healthy-Heart Activity Monitoring Program in Saskatchewan, and 23 healthy controls (11.7 ± 2.5 years; 10 female) were studied. Waist circumference, physical activity (physical activity questionnaire), body composition (lean mass; dual x-ray absorptiometry), and birthweight were assessed. Analysis of covariance, Mann-Whitney U, and independent sample t-tests were used to assess group differences (p < 0.05). RESULTS: Children with CHD had greater waist circumference than controls, controlling for lean mass, physical activity, birthweight, and sex (F (1, 49) = 4.488, p = 0.039). Physical activity, lean mass, and birthweight were not significantly different between groups (p > 0.05). CONCLUSION: Our findings generate a novel hypothesis-higher waist circumferences in children with CHD compared to age-matched controls, may contribute to an elevated risk of cardiovascular disease.

Health anxiety and associated constructs in children and adolescents with congenital heart disease: A CHAMPS cohort study.

This study explored health anxiety and associated constructs in children and adolescents with congenital heart disease and typically developing children and adolescents. A total of 84 participants (7-16 years) completed measures of health anxiety, intolerance of uncertainty, anxiety sensitivity, and DSM-IV anxiety disorder symptom categories. Results demonstrated that children and adolescents with congenital heart disease experienced significantly higher levels of health anxiety and associated constructs compared to typically developing children and adolescents. Our findings highlight a specific chronic physical health population who may be at risk of clinical levels of health anxiety and related psychopathology and require appropriate intervention.

A systematic review of technology-based preoperative preparation interventions for child and parent anxiety.

PURPOSE: The purpose of this systematic review was to examine the effect of technology-based preoperative preparation interventions on children's and parents' anxiety. SOURCES: PsycINFO, Cochrane, Science Direct, Taylor and Francis, and Pubmed MEDLINE databases were searched. Studies were restricted to those reporting on technology-based preoperative preparation interventions for pediatric patients (0-18 yr old) receiving elective surgery under general anesthesia. PRINCIPAL FINDINGS: Thirty-eight studies that provided level II or level III evidence were included (33 randomized-controlled trials and five non-randomized-controlled studies). Of the 38 studies, preoperative anxiety (measured by various indices of anxiety) was significantly reduced in children and parents in 25 and 11 studies, respectively. For children, tablet and handheld devices with interactive components were the most encouraging strategies. Video preparation alone may provide sufficient information to manage preoperative anxiety in parents. CONCLUSION: The available literature is extremely heterogeneous and limits the ability to make definitive conclusions about the efficacy of technology-based preoperative preparation interventions. The available literature suggests that, for children, tablet and handheld devices with interactive capacity may represent a viable option to address preoperative anxiety. The findings are more mixed for parents, with video preparation a possible option. Execution of well-designed, methodologically sound studies is required to facilitate a better understanding of the efficacy of technology-based preoperative preparation.

RéSUMé: OBJECTIF: L'objectif de cette revue systématique était d'examiner l'impact des interventions de préparation préopératoire fondées sur la technologie sur l'anxiété des enfants et de leurs parents. SOURCE: Les bases de données PsycINFO, Cochrane, Science Direct, Taylor and Francis et Pubmed MEDLINE ont été passées en revue. Les études retenues se sont limitées à celles rapportant des interventions de préparation préopératoire fondées sur la technologie pour les patients pédiatriques (0-18 ans) recevant une chirurgie non urgente sous anesthésie générale. CONSTATATIONS PRINCIPALES: Trente-huit études présentant des données probantes de niveau II ou III ont été incluses (33 études randomisées contrôlées et cinq études non randomisées contrôlées). Parmi les 38 études, l'anxiété préopératoire (telle que mesurée par divers indices d'anxiété) a été significativement réduite chez l'enfant et les parents dans 25 et 11 études, respectivement. Pour les enfants, les tablettes et les appareils portatifs comprenant des composantes interactives constituaient les stratégies donnant les résultats les plus encourageants. La préparation sur vidéo seule pourrait offrir suffisamment d'informations pour prendre en charge l'anxiété préopératoire des parents. CONCLUSION: La littérature existante est extrêmement hétérogène et limite notre capacité d'émettre des conclusions définitives quant à l'efficacité des interventions de préparation préopératoire fondées sur la technologie. La littérature disponible suggère que, pour l'enfant, les tablettes et appareils portatifs disposant de capacités interactives pourraient constituer une option viable pour prendre en charge l'anxiété préopératoire. Les résultats sont plus mitigés pour les parents, la préparation par vidéo constituant potentiellement une option. L'exécution d'études bien conçues et rigoureuses d'un point de vue méthodologique est nécessaire afin de mieux comprendre l'efficacité des interventions de préparation préopératoire fondées sur la technologie.

Examination of the Effectiveness of a Brief, Adapted Dialectical Behavior Therapy-Skills Training Group for Bariatric Surgical Candidates.

BACKGROUND: Bariatric surgery is the most effective treatment for morbid obesity, yet 20 to 30% of such patients regain weight approximately 2 years post-surgery. A psychological intervention adjunctive to bariatric surgery that addresses eating pathology often observed in bariatric populations may improve outcomes. In the present study, a brief, adapted DBT-ST group for bariatric surgical candidates was evaluated as an adjunctive intervention to bariatric surgery in the pre-surgical period to reduce eating pathology and clinical impairment. METHODS: Participants included 95 bariatric surgery candidates, with 50 candidates in the DBT-ST plus treatment as usual (TAU) group and 45 candidates in the TAU (i.e., comparison) group. Participants completed measures of eating pathology at three time points (i.e., T1 = pre-DBT-ST program; T2 = post-DBT-ST program; T3 = 4 months post-DBT-ST; comparable time points employed for TAU group). Average wait time for surgery following the pre-surgical program was approximately 2 to 4 months. RESULTS: A series of 2 (group: DBT-ST + TAU versus TAU) × 3 (assessment time: T1, T2, and T3) mixed-model ANOVAs were completed. Participants in the DBT-ST plus TAU group showed significant reductions in binge eating, emotional eating, global eating pathology, and clinical impairment related to eating difficulties over time in comparison to TAU. CONCLUSIONS: Findings demonstrated that a brief DBT-ST group integrated as an adjunctive intervention to TAU in a bariatric pre-surgical program could aid in addressing eating pathology. Bariatric participants in a DBT-ST plus TAU group may be on a better weight loss trajectory than those who only receive TAU.

Fetal health anxiety: development and psychometric properties of the fetal health anxiety inventory.

Objective: To develop a measure to assess fetal health anxiety and examine its factor structure, convergent and divergent validity. Methods: In Study 1, the Short Health Anxiety Inventory-14 item version (SHAI) (Salkovskis et al., Psychol Med. 2002;32:843-853) was adapted for use with pregnant women to examine fetal health anxiety named the Fetal Health Anxiety Inventory (FHAI). Four pregnant women and three subject matter experts (SMEs) reviewed the FHAI. In Study 2, 100 pregnant women completed the FHAI and related self-report measures. Results: In Study 1, both reviewer groups provided feedback directing minor changes to the FHAI. In Study 2, a revised version was used. The revised FHAI demonstrated excellent internal consistency (α = 0.91). Results from an EFA suggested that the FHAI may be conceptualized as a one- or two-factor scale. Convergent (pregnancy-related anxiety [r = 0.56, p = .0001], parental health anxiety [r = 0.53, p = .0001], anxiety [r = 0.57, p = .0001], anxiety sensitivity [r = 0.28, p = .004] and intolerance of uncertainty [r = 0.29, p = .003]) and divergent (parental depression [r = 0.16, p = .12]) validity was evidenced with additional measures of interest. Conclusion: Preliminary findings suggest that the FHAI represents a psychometrically sound instrument to measure the construct of fetal health anxiety. Practical and theoretical implications of the present results are discussed.

Randomized-controlled trial of parent-led exposure to anesthetic mask to prevent child preoperative anxiety.

PURPOSE: To examine the efficacy of parent-directed anesthetic mask exposure and shaping practice to prevent child preoperative anxiety, with a specific focus on timing of exposure. METHODS: This randomized-controlled trial included 110 children ages four to seven years undergoing day surgery dental procedures and their parents. Families were randomly assigned to one of three groups: 1) parent-directed mask exposure/shaping practice at least three times in the week prior to surgery (Group 1); 2) parent-directed mask exposure/shaping practice at least once on the day of surgery (Group 2); 3) no exposure prior to induction (Group 3). Child anxiety was observer-rated using the modified Yale Preoperative Anxiety Scale during the day surgery experience, and induction compliance was observer-rated using the Induction Compliance Checklist. RESULTS: Results demonstrated significant differences in observer-rated child anxiety at anesthetic induction across groups. Group 2 demonstrated significantly lower observer-rated anxiety than Group 3 with a medium effect, F(1, 71) = 4.524, P = 0.04, η p 2 = 0.06. A significant interaction was observed between these two groups over time (i.e., admission to anesthesia induction), F(1, 71) = 4.365, P = 0.04, η p 2 = 0.06 (i.e., small to medium effect). Group 2 demonstrated the best anesthesia induction compliance (i.e., significantly lower scores than Group 3, P = 0.04). CONCLUSION: Timing of the delivery of mask exposure (i.e., on the day of surgery) to address child preoperative anxiety and induction compliance in the day surgery setting may be an important consideration. The current results inform the integration of this simple, effective strategy into practice.

RéSUMé: OBJECTIF: Examiner l'efficacité d'une exposition au masque anesthésique menée par un parent et détermination d'une pratique visant à prévenir l'anxiété préopératoire de l'enfant en se concentrant spécifiquement sur le moment de l'exposition. MéTHODES: Cette étude randomisée contrôlée a inclus 110 enfants âges de quatre à sept ans subissant une procédure dentaire en chirurgie d'un jour et leurs parents. Après randomisation, les familles ont été assignées à l'un des trois groupes suivants : 1) exposition au masque/pratique de modelage comportemental dirigée par le parent au moins trois fois dans la semaine précédant l'intervention (Groupe 1); 2) exposition au masque/pratique de modelage comportemental dirigée par le parent au moins une fois le jour de la chirurgie (Groupe 2); 3) aucune exposition avant l'induction (Groupe 3). L'anxiété de l'enfant a été évaluée par un observateur utilisant l'échelle mYPAS (échelle modifiée d'anxiété préopératoire de Yale) au cours de l'expérience le jour de la chirurgie et la conformité de l'induction a été évaluée par un observateur utilisant l'ICC (liste de vérification de la conformité de l'induction). RéSULTATS: Les résultats ont mis en évidence des différences significatives entre les groupes sur l'anxiété de l'enfant évaluée par un observateur au moment de l'induction anesthésique. Le Groupe 2 a présenté une anxiété évaluée par l'observateur significativement inférieure à celle du Groupe 3 avec un effet médian F (1, 71) = 4,524, P = 0,04, η P 2 = 0,06. Une interaction significative a été observée entre ces deux groupes au fil du temps (c'est-à-dire entre l'admission et l'induction de l'anesthésie), F (1, 71) = 4,365, P = 0,04, η P 2 = 0,06 (soit un effet petit à moyen). Le Groupe 2 a manifesté la meilleure conformité de l'induction de l'anesthésie (c'est-à-dire, des scores significativement inférieurs au Groupe 3, P = 0,04). CONCLUSION: Il peut être important de tenir compte du moment de l'exposition au masque (c'est-à-dire le jour de l'intervention) pour répondre à l'anxiété préopératoire de l'enfant et à la conformité de l'induction dans le cadre de la chirurgie d'un jour. Les résultats actuels renseignent sur l'intégration de cette stratégie simple et efficace dans la pratique.

Physical activity modulates arterial stiffness in children with congenital heart disease: A CHAMPS cohort study.

Children with congenital heart disease are at risk for developing increased arterial stiffness and this may be modulated by physical activity. OBJECTIVE: To compare arterial stiffness in high- and low-physically active children with congenital heart disease and healthy age- and sex-matched controls. PATIENTS: Seventeen children with congenital heart disease (12 ± 2 years; females = 9), grouped by low- and high-physical activity levels from accelerometry step count values, and 20 matched controls (11 ± 3 years; females = 9) were studied. OUTCOME MEASURES: Carotid-radial pulse wave velocity was assessed with applanation tonometry to determine arterial stiffness. Body composition and 6-min walk test measures were performed. Data were analyzed using analysis of variance and multiple regression. Significance was P < .05. RESULTS: Arterial stiffness was increased in low-physically active children with congenital heart disease (9.79 ± 0.97 m/s) compared to high-physically active children with congenital heart disease (7.88 ± 0.71 m/s; P = .002) and healthy-matched controls (8.67 ± 1.28 m/s; P = .015). There were no differences in body composition measures between groups (all P > .05), but 6-min walk test distance was less in both congenital heart disease groups (high-physically active: 514 ± 40 m; low-physically active: 539 ± 49 m) versus controls (605 ± 79 m; all P < .05). Average daily step count significantly predicted arterial stiffness in children with congenital heart disease (R2 = 0.358) with a negative correlation (R = -0.599, P = .011), while % fat mass (P = .519) and % lean mass (P = .290) did not predict arterial stiffness. CONCLUSIONS: Low-physically active children with congenital heart disease have increased arterial stiffness compared to high-physically active children with congenital heart disease and healthy-matched controls. Regular physical activity in children with congenital heart disease may modulate arterial stiffness.

Internet-delivered, preoperative, preparation program (I-PPP): Development and examination of effectiveness.

STUDY OBJECTIVE: Limited evidence-based, interactive, Internet-delivered preoperative preparation programs for children and their parents exist. The purpose of this investigation was to develop and examine the effectiveness of the Internet-delivered, preoperative program (I-PPP) in alleviating prepoperative anxiety in children undergoing outpatient surgery. In Study 1, the I-PPP was developed and then evaluated by parent/child dyads and health care professionals. In Study 2, the effectiveness of I-PPP was examined. DESIGN: This study was a development and effectiveness study. SETTING: For Study 1, participants were recruited from the community. For Study 2, participants were recruited from the Royal University Hospital. PATIENTS: In Study 1, participants were 9 parent/child dyads and 5 health care professionals. In Study 2, participants were 32 children (3-7years) scheduled for outpatient surgery and one parent for each child. INTERVENTION: In Study 1, I-PPP modules were created and parent/child dyads and health care professionals evaluated I-PPP modules and treatment credibility. In Study 2, child patients and their parents completed the I-PPP prior to day of surgery. MEASUREMENTS: Observer-rated anxiety of child participants was measured during the day surgery experience. Parent state anxiety was measured prior to completing I-PPP, pre- and post-surgery. Post-surgery parents provided comments regarding the I-PPP. Post-surgery child behaviour change was assessed. MAIN RESULTS: For Study 1, ratings for I-PPP components and treatment credibility surpassed our acceptability criterion. Minor changes were made to I-PPP. For Study 2, mYPAS scores were stable across day surgery. mYPAS scores in current study at induction did not differ significantly from benchmark studies. Significant reduction in parent anxiety was observed pre- to post-surgery. Parents positively endorsed the program. Negative post-operative behaviours were observed in a proportion of children. CONCLUSIONS: Our findings suggest that I-PPP represents a viable option for preoperative preparation for children and their parents.

Measurement invariance across Genders on the Childhood Illness Attitude Scales (CIAS).

OBJECTIVE: The Childhood Illness Attitude Scales (CIAS) were created as a developmentally appropriate measure for symptoms of health anxiety (HA) in school-aged children. Despite overall sound psychometric properties reported in previous studies, more comprehensive examination of the latent structure and potential response bias in the CIAS is needed. The purpose of the present study was to cross-validate the latent structure of the CIAS across genders and to examine gender-specific variations in CIAS scores. METHODS: The sample comprised data from 602 Canadian and Danish school-aged children (Mage=10.54, SD=0.99; 52.5% girls). Confirmatory factor analyses were conducted to test 3-, modified 3-, and 4-factor models in both samples. Multigroup confirmatory factor analysis was performed to test factor structure invariance across boys and girls in a combined sample. Differential Item Functioning (DIF) was assessed using test characteristic curves. RESULTS: A modified 3-factor solution (i.e., fears=11 items, help-seeking=6 items, and symptom effects=4 items) provided the best fit to the data (χ2 (364, N=602)=681.7, p<0.001; χ2/df=1.803; RMSEA=0.037; CFI=0.926). The factor structure was stable, well-fitting, and indicated measurement invariance across groups. DIF analyses revealed no gender-based response bias at the scale level. CONCLUSION: Results support a revised 3-factor version of the CIAS that can be used with confidence to assess symptoms of HA in school-aged boys and girls.

The relationship between childhood health anxiety, parent health anxiety, and associated constructs.

The purpose of the present investigation was to explore the relationship between self-reported childhood health anxiety and self-reported parent health anxiety and associated constructs. Participants were 77 children (8-15 years) and one parent or guardian of each child. Children completed a measure of health anxiety and parents completed measures of health anxiety, anxiety sensitivity, and depression. Results demonstrated a significant association between child health anxiety and all measures of self-reported parent measures, with the exception of the measure of anxiety sensitivity. No self-reported parent measures independently predicted child health anxiety. Future directions and implications are discussed.