Childhood healthcare experience, healthcare attitudes, and optimism as predictors of adolescents' healthcare behavior

Understanding College Students' Healthcare Avoidance: From Early Maladaptive Schemas, through Healthcare Institutional Betrayal and Betrayal Trauma Appraisal of Worst Healthcare Experiences

Understanding healthcare avoidance among college students is critical. In this study, we consider two broad cognitive contributors to greater healthcare avoidance: specific early maladaptive schema and negative appraisals of students' prior worst healthcare experiences. From schema theory, we proposed college students holding greater levels of two early maladaptive schema (disconnection/rejection and impaired autonomy/performance EMS) would be more likely to appraise their problematic healthcare experience as both containing healthcare institutional betrayal (HIB) behaviors and as traumatic and betrayal-inducing; both EMS and these appraisals would predict healthcare avoidance. Using a cross-sectional survey in a large, diverse college student sample (n = 1383, 61.1% female, 18.9% African American, 7.2% Asian, 6.4% Hispanic/Latino), as predicted, both EMS were significantly related to healthcare avoidance. Furthermore, a sequential mediation model was supported, indicating students holding greater EMS of disconnection/rejection or impaired autonomy/rejection reported more HIB in their worst healthcare experience, and appraised that experience as more betraying. Taken altogether, this model accounted for 23% of the variance in students' reports of healthcare avoidance. Core beliefs formed early in life may be a foundational lens through which potentially traumatic healthcare experiences are processed in ways that can impact emerging adults' future healthcare engagement. Findings also support the importance of addressing HIB actions and repairing trauma appraisals accrued during problematic healthcare experiences to prevent healthcare avoidance by emerging adults.

A Mobile Application for Child-Focused Tonsillectomy Education: Development and User-Testing

OBJECTIVE

Patient education is central to Enhanced Recovery After Surgery protocols, but child-focused materials are lacking. We developed and piloted a mobile application to support accessible, interactive patient and caregiver education about pediatric tonsillectomy.

METHODS

Thirty children ages 5-12 who were preparing for tonsillectomy, their caregivers, and six attending otolaryngologists participated in a user-testing trial of a web-based prototype. The trial measured feasibility, fidelity, and patient-centered outcomes. Patients and caregivers rated usability/likeability on the mHealth App Usability Questionnaire. Otolaryngologists rated quality on the Mobile App Rating Scale. The full mobile application, "Ready for Tonsillectomy," was then developed for iOS and Android.

RESULTS

Enrollment was 88.2%, retention was 90.0%, and use was 96.3%. Mean (SD) patient ratings for usability/likeability were 6.3 (1.1) out of 7; caregiver ratings were 6.5 (1.1). In common themes from open-ended feedback, patients described the application as helpful and appealing, and caregivers described it as informative, easy to understand, calming, and easy to use. Among caregivers who used the application during recovery, 92.3% reported that it helped them manage their child's pain. Providers would recommend the application to many or all of their patients (mean [SD]: 4.7 [0.5] out of 5). Mean provider ratings for domains of engagement, functionality, aesthetics, information quality, subjective quality, and app-specific value ranged from 4.1 to 4.8 out of 5.

CONCLUSION

Feasibility and fidelity were high. Families and otolaryngologists endorsed the resource as an engaging, informative tool that supports positive coping. Our mobile application offers a patient-centered solution readily scalable to other surgeries.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:2455-2463, 2024.

The infant-doctor relationship: an examination of infants' distress reactions in the presence of a doctor

Fear of doctors is a common source of distress among infants; however, the underlying sources of this distress are unknown. To investigate the doctor-infant relationship, the behaviors of 61 healthy infants (176-617 days old) were observed in a simulated examination room. Their behaviors and electrocardiograms were recorded. Two groups of infants were analyzed: those who cried and those who did not. When an experimenter dressed in the doctor's attire entered the room, all 9 infants who were crying (14.8% of all infants) stopped crying, all infants gazed at the experimenter, and their mean heart rate (HR) decreased. After the auscultation started, 29.5% of all infants cried, and the HRs of infants who cried were higher than those of infants who did not cry. During the auscultation, 80.0% of infants who cried averted from the experimenter, while 34.4% of infants who did not cry. Within 5 s of gazing at the stethoscope, the number of infants who cried increased from 3 to 12, and their mean HR also increased. Our findings suggest that the fear of doctors is not due to the appearance of doctors but rather to specific actions performed by doctors, such as auscultation. Infants may regard a doctor's appearance as a source of interest. Furthermore, a stethoscope is a possible trigger for infants' crying. These behavioral observations suggest the potential for patient-centered care for infants.

Peripheral intravenous catheter insertion, maintenance and outcomes in Indonesian paediatric hospital settings: A point prevalence study

PURPOSE

This study aimed to assess peripheral intravenous catheter use, maintenance practices, and outcomes of paediatric patients in a developing country setting.

DESIGN AND METHODS

A point prevalence survey using validated checklist was conducted between March and April 2022 in ten hospitals in Indonesia. A total number of 478 participants were approached during the audit. Data were obtained from site observation and medical records.

RESULTS

Of the 386 patients surveyed, >90% (362) had one catheter in-situ. The catheters were mostly inserted by nurses (331, 86%), primarily in the dorsum of the hand (207, 54%) with the purpose of delivering intravenous infusions and medications (367, 95%). Simple transparent dressings (176, 46%) with splint and bandage (295, 76%) were predominantly used for securement methods. Insertion sites were not visible for 182 (47%) patients, and 151 (40%) of daily care practices were poorly documented. Complications were documented in the medical record for 166 (43%) catheters. Adjusted analysis indicated that patient diagnosis, ward, catheter size, location, dressings, infusate, and flushing administration were significantly associated with complications.

CONCLUSIONS

Findings indicate that issues related to paediatric intravenous catheter complications in Indonesia are comparable to developed country settings. Ongoing surveillance is important to evaluate the management practices to benchmark against guidelines, optimise patient safety, and improve outcomes.

PRACTICE IMPLICATIONS

Results demonstrate low and middle-income countries face similar challenges with catheter insertion and care. The study indicates the importance of applying vascular access needs assessments, providing training for inserters, identifying optimum dressing methods, and optimising documentation.

Procedural anxiety among children and adolescents with cystic fibrosis and their parents

BACKGROUND

Procedural anxiety involves acute distress around medical procedures and may lead to avoidance or resistance behaviors that interfere with effective cystic fibrosis (CF) care and health outcomes. While individuals with CF commonly endure uncomfortable and/or distressing medical procedures, procedural anxiety among children and adolescents with CF has received little research attention. This study investigated the prevalence and correlates of procedural anxiety among individuals with CF aged 6-18 and their parents.

METHOD

Eighty-nine parents of children with CF completed surveys examining child procedural anxiety, anxiety, and health behaviors (including treatment adherence); and parent vicarious procedural anxiety.

RESULTS

Seventy-five percent of participants rated at least one CF-related procedure as "extremely" anxiety-inducing for their child. Parental vicarious procedural anxiety was reported in 80.9% of participants. Procedural anxiety significantly correlated with child anxiety, treatment-resistive behaviors, and parent-vicarious procedural anxiety. Procedural anxiety was associated with younger age and frequency of distressing procedures, but not with forced expiratory volume in 1 s, body mass index, hospitalizations, or exposure to general anesthesia.

CONCLUSION

Procedural anxiety is common among children, adolescents, and caregivers, and is associated with child anxiety and treatment resistance, emphasizing the importance of screening and interventions for procedural anxiety as part of routine CF care from early childhood. Implications for screening and intervention are discussed.

Psychosocial needs and interventions for young children with cystic fibrosis and their families

This review summarises the experiences of young children and their families living with CF during the first five years of life following NBS diagnosis, as well as the options of psychosocial support available to them. We present strategies embedded within routine CF care that focus on prevention, screening, and intervention for psychosocial health and wellbeing that constitute essential components of multidisciplinary care in infancy and early childhood.

What do expectations change? Optimistic expectations, job crafting, job satisfaction and a new theoretical model

Purpose

The purpose of this study is to determine the effect of optimistic expectations on job satisfaction at work and whether job crafting behaviour plays a mediating role in this effect. At the same time, this model presents the need for “expectation management” in the context of work psychology to the attention of all academics and practitioners.

Design/methodology/approach

To test the hypotheses of the study, data were obtained from 475 health-care workers in a public hospital. Hypotheses were tested using Process Macro Model of Hayes (2018).

Findings

The result of the analyses determined that the optimistic expectations for the organization as a whole have a positive effect on job satisfaction, both directly and indirectly, and that job crafting behaviour has a partial mediating role in this effect.

Research limitations/implications

The first limitation is that the data were obtained only by a cross-sectional method. The second is that among the various workplace behaviours and workplace psychologies job crafting and job satisfaction were examined in the study. The partial mediation effect between the research variables reveals the existence of many other variables and constitutes the third limitation. The fourth is that only optimistic expectations effects on positive behaviours and positive psychological states were evaluated in this study. Finally, a fifth limitation of this study is that the sample is limited to those working in the health sector and public hospitals.

Practical implications

First, the data were obtained only by a cross-sectional method, and the longitudinal method was not implemented in how the study was designed. Second, among the workplace behaviours, only job crafting behaviour and only job satisfaction as a workplace psychology were analysed. Third, partial mediation effect was found to be among the other variables might indicate the role of additional variables that could be uncovered by further research. Fourth, only optimistic expectations and their effects on positive behaviours and positive psychological states at the workplace were evaluated. Fifth, the sample is limited to those working in the health sector and public hospitals.

Social implications

This study draws attention to “Expectation Management” as a management activity worth exploring and its potential in terms of social and working relations.

Originality/value

This study provides versatile answers to the question of why individuals perform differently despite working under the same conditions. The model suggested in the study takes the conventional way of thinking in the literature one step further by offering an alternative answer to this critical question, whose answers we have been discovering step by step since the Hawthorne studies. In addition, the proposed model draws attention to the need for “expectation management” in the context of business psychology in theory and practice.

Validity of university students' self-reported vaccination status after a meningococcal B outbreak

After an outbreak of meningococcal B (MenB) disease at a university, we surveyed students regarding their vaccination status 2 months and 20 months after campus-led vaccination campaigns and compared students' self-report to vaccination records. Nearly all participants accurately reported the number of vaccine doses at both visits. Among those who received two doses of the vaccine, accurate recall of the timing of MenB vaccination was 85.7% (95% CI: 82.7-88.6) in the short term and 62.9% (95% CI: 56.0-69.8) in the long term. After the outbreak, only one-third reported feeling 'very confident' in their MenB disease and vaccine knowledge. Our findings suggest that the validity of self-reported vaccination status among university students in an outbreak setting is high, but that if the duration of protection is unknown and additional doses of vaccine may be needed, documented vaccination records may be preferred over self-report to assess timing of vaccine receipt.

Nurse knowledge and confidence on peripheral intravenous catheter insertion and maintenance in pediatric patients: A multicentre cross-sectional study

PURPOSE

To examine nursing knowledge and confidence of peripheral intravenous catheter insertion and maintenance in pediatric patients.

DESIGN AND METHODS

An online survey using validated questionnaires was conducted in ten (tertiary and district) hospitals in Indonesia from May to September 2020. Multivariable general linear models were used to investigate associations between nurses' characteristics and knowledge and confidence on the catheter insertion and maintenance score.

RESULTS

A total of 413 out of 458 pediatric nurses completed the survey (a response rate of 90%). The mean score of the nurse knowledge on insertion was 18.9(±3.3) (maximum score: 21), and the maintenance score was 6.5(±2.0) (maximum score: 12). The median score of the nurse insertion and maintenance confidence was quite high: 44 (IQR = 7) out of 50 and 37 (IQR = 4) out of 45, respectively. Initial patient assessment, catheter securement, site assessment and management of complications are areas where nurse knowledge and confidence are still lacking. Adjusted analysis indicates that training and work experience were significantly associated with the knowledge and confidence score (p < 0.05).

CONCLUSION

Pediatric nurses were largely confident in their skills but this was not reflected in their knowledge scores. Training and experience were important predictors for nursing knowledge and confidence in catheter insertion and maintenance.

PRACTICE IMPLICATIONS

The results provide nursing and hospital managers and educational institutions to understand areas of intravenous catheter insertion and maintenance in which nurses lack of knowledge and confidence as well as to formulate tailored and ongoing training to improve nurse knowledge, confidence, practices and optimize patients' care.

Reducing Children's Preoperative Fear with an Educational Pop-up Book: A Randomized Controlled Trial

OBJECTIVE

Preoperative education empowers children to approach surgery with positive expectations, and providers need efficient, child-focused resources. This study aimed to evaluate an interactive pop-up book as a tool for explaining surgery, managing preoperative anxiety, and strengthening coping strategies.

STUDY DESIGN

Prospective randomized controlled trial.

SETTING

Pediatric outpatient surgery center.

METHODS

Patients ages 5 to 12 undergoing outpatient surgery read a pop-up book about anesthesia (intervention) or received standard care (control). Patients self-reported their preoperative fear, pain expectations, views of the procedure and preoperative explanations, and coping strategies. Outcomes also included observer-rated behavioral anxiety and caregiver satisfaction.

RESULTS

In total, 148 patients completed the study. The pop-up book had a significant, large effect in reducing patients' fear of anesthesia induction (Cohen's d effect size = 0.94; P < .001). Intervention patients also expected less pain than control patients from the anesthesia mask and during surgery (d = 0.60-0.80; P < .001). The book encouraged more positive views of the procedure and preoperative explanations (P < .005). Furthermore, the book prepared patients to cope adaptively: intervention patients were significantly more likely to generate positive active coping strategies, distraction strategies, and support-seeking strategies (P < .001). Observer-rated behavioral anxiety at anesthesia induction did not differ between groups (P = .75). Caregivers in the intervention group were significantly more satisfied with each aspect of the surgical experience (P≤ .02).

CONCLUSION

The educational pop-up book offers a child-focused resource that helps alleviate children's preoperative fears, encourages positive coping, and improves caregivers' perceptions of the experience. This study was registered at ClinicalTrials.gov (NCT04796077).

Determinants of Nursing Students’ Confidence in Peripheral Intravenous Catheter Insertion and Management

BACKGROUND: Peripheral intravenous catheter (PIVC) is one of the medical devices commonly inserted in hospitalized patients, both adults and pediatrics. PIVC has crucial functions for delivering drugs, fluids, blood transfusions, and diagnostic tests for patients. Thus, nursing students must be confident in terms of insertion and management of this device. However, studies assessing nursing students’ confidence and its determinants are still limited. AIM: This study aims to examine the internship nursing student’s confidence in PIVC insertion and management in adult patients and its contributing factors. METHODS: A cross-sectional study was conducted to measure internship nursing students’ confidence in PIVC cannulation and management in adult patients as well as its contributing factors. Purposive samples of 100 nursing students in Yogyakarta were recruited, and a 5-point Likert scale questionnaire consisting of 19 questions was used. Kruskal–Wallis test was utilized to investigate the association of the internship nursing student confidence on PIVC insertion and maintenance with the factors. A general linear regression analysis was performed to obtain adjusted estimates of the potential factors with students’ confidence. RESULTS: Results indicated that the internship nursing student’s confidence score ranged from 57 to 95, with a mean value of 75 (±8.1). Among determinants of the student’s confidence investigated in this study, t-test analysis showed that the students’ confidence was associated with their participation in expert lecture, bedside teaching, and direct observation of procedural skill assessment of PIVC insertion and care (p < 0.05). The general linear analysis showed that only bedside teaching and interaction of bedside teaching and direct observation procedural skill assessment were significant predictors of the internship nursing student’s confidence on PIVC insertion and care (β = 10.99, 95% confidence interval [CI] 2.00–20.00 and β = 13.15, 95% CI 1.20–25.15, p < 0.05, respectively). CONCLUSION: This result indicated that nursing students need direct simulation and assessment of PIVC insertion and care to the patients to improve their confidence in PIVC insertion and management in adult patients.

Predicting Intense Levels of Child Anxiety During Anesthesia Induction at Hospital Arrival

In children, intense levels of anxiety during anesthetic induction are associated with a higher risk of pain, poor recovery, and emergence delirium. Therefore, it is important to identify these high-risk children at hospital arrival. The current study examined internalizing behavior (Child Behavior Checklist, CBCL) and state anxiety measures (modified Yale Preoperative Anxiety Scale, mYPAS, and State Trait Anxiety Inventory for Children, STAIC) at hospital arrival as predictors of anxiety during induction of anesthesia. One hundred children (aged 4 to 12 years) undergoing elective daycare surgery were included. The STAIC and mYPAS at hospital arrival were significant predictors of anxiety during induction, whereas CBCL was not. The STAIC state form at hospital arrival was the strongest predictor and could be used to identify children who will experience intense levels of anxiety during anesthetic induction, with sufficient to good diagnostic accuracy. Using the STAIC at hospital arrival allows targeted interventions to reduce anxiety in children.

Utility of Perioperative Laboratory Tests in Pediatric Patients Undergoing Spinal Fusion for Scoliosis

STUDY DESIGN

Retrospective comparative study.

OBJECTIVES

We aimed to characterize the frequency of perioperative laboratory tests for posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and to assess whether test results affected clinical management.

SUMMARY OF BACKGROUND DATA

Perioperative laboratory tests for PSF including complete blood count, coagulation laboratory tests, basic metabolic panels (BMPs), and type and screen, are commonly ordered based on providers' discretion or existing order sets. Studies have shown unnecessary laboratory tests as financially and physically costly in adults; however, no studies have examined the necessity of common perioperative laboratory tests in pediatric spinal deformity surgery.

METHODS

Retrospective review of patients aged 10-18 years who underwent PSF for AIS at our center in the past three years. The clinical utility of perioperative laboratory tests was assessed based on detected incidence of anemia, blood transfusions, hematology/endocrinology/nephrology consultations, insulin administration, and postponed/canceled surgeries.

RESULTS

A total of 234 patients were included (mean age 14.4 ± 1.8 years, 75% female). Of 105 (44.9%) patients with preoperative coagulation laboratory tests, 21 (20%) had abnormal results; however, none had subsequent hematology consultations or canceled/postponed surgeries. Postoperatively, only 5 (2.1%) patients and 30 (12.8%) patients had hemoglobin values less than 8 g/dL on postoperative day (POD) 1 and 2, respectively. Multivariate analysis identified POD1 hemoglobin ≤9.35 g/dL as the only predictor of hemoglobin <8 g/dL on POD2. Overall, there were 8 (3.4%) indicated blood transfusions postoperatively. Costs of unnecessary laboratory tests averaged $95.27 (range $49.72 to $240.27) per patient.

CONCLUSIONS

Many perioperative laboratory orders may be unnecessary in pediatric spinal deformity surgery, subjecting patients to extraneous costs and needlesticks. In particular, preoperative coagulation laboratory tests, perioperative BMPs, and additional postoperative CBCs for those with hemoglobin >9.35 on POD1 may not be warranted.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Assessing the Need for Common Perioperative Laboratory Tests in Pediatric Patients With Femoral Shaft Fractures

BACKGROUND

Femoral shaft fractures are a common cause for hospital admission and surgery in pediatric patients, and laboratory studies are often ordered for historical concerns of excessive bleeding. Recent literature has challenged these assumptions, and unnecessary testing causes undue pain and costs in children. No previous studies have offered evidence-based recommendations for perioperative laboratories in isolated pediatric femoral shaft fractures.

METHODS

We retrospectively reviewed all patients presenting with femoral shaft fractures at our pediatric trauma center between 2013 and 2017. Patients with multitrauma injuries, metabolic/neuromuscular diseases, or intensive care unit stays were excluded. Necessity of laboratory tests was determined by rates of anemia, blood transfusions, specialist consultations, and delayed surgeries. Ordering patterns were recorded, with cost estimation based on Healthcare Bluebook.

RESULTS

We reviewed 95 patients (mean age, 7.9±4.8 y; 70 males). Treatments included elastic nails (33/95, 34.7%), reamed intramedullary nails (24/95, 25.3%), plates/screws (12/95, 12.6%), and spica casting (26/95, 27.4%). Of 32 patients with preoperative coagulation laboratories, 11 were abnormal; however none resulted in hematology consultations or procedure delays. Seventy-five patients (78.9%) and 15 patients (15.8%) had complete blood counts preoperatively and postoperative day 1, respectively. Four patients (4.2%) had hemoglobin<8 g/dL postoperatively, however, there were no perioperative blood transfusions. Of these 4, 3 underwent either reamed intramedullary nails or open reduction internal fixation with plates/screws. Twenty-six patients (27.4%) had preoperative basic metabolic panels that did not alter medical care. On the basis of our criteria, over 72% of laboratories appeared unnecessary, with a total potential cost of $8567. Over 80% of orders were from the emergency department by residents or attending physicians.

CONCLUSIONS

Perioperative laboratory orders may be unnecessary in most isolated pediatric femoral shaft fractures, subjecting patients to extraneous costs, and associated pain. However, laboratories may be justified based on clinical circumstances or for older patients treated with reamed nails or plates/screws. Evidence-based recommendations for perioperative laboratory orders offer the potential to improve quality and value and minimize harm in pediatric orthopaedic trauma.

LEVEL OF EVIDENCE

Level III-retrospective comparative study (therapeutic).

Positive mental health and supportive school environments: A population-level longitudinal study of dispositional optimism and school relationships in early adolescence

OBJECTIVES

The present study examined the degree to which early adolescents' relationship experiences in school (i.e., peer group belonging, peer victimization, and supportive relationships with adults)-at the individual level and at the school-level-were associated with their dispositional optimism, concurrently and over time.

METHOD

Self-report data from over 4000 4th and 7th graders were obtained via a population-level measure designed to assess students' supportive relationships, well-being, and resilience (i.e., the Middle Years Development Instrument). An indicator for family income (SES) was obtained through tax filer information.

RESULTS

Multilevel modeling revealed that in Grade 4, greater peer belonging, fewer experiences of peer victimization, and higher levels of adult support in school were linked to higher optimism, above and beyond the effects of sex, age, English as a Second Language (ESL), and SES. Additionally, school-wide levels of peer belonging and adult support (i.e., indicators of a supportive social school climate) were significant positive school-level predictors of optimism. Longitudinally, school-wide peer belonging in Grade 4 was associated to increases in students' optimism from 4th to 7th grade.

CONCLUSIONS

The findings suggest that positive relationship experiences in school are key contributors to positive mental health, over and above the absence of negative relationship experiences (i.e., victimization). These findings also suggest that being embedded in a school with a positive social relational climate contributes to students' current and future positive mental health, over and above individual relationships with peers and adults. The present research extends previous research by identifying contextual assets that are linked to dispositional optimism and can be applied in the context of school-based intervention programs to promote positive mental health in schools.

The Longitudinal Association between Psychological Factors and Health Care Use

OBJECTIVE

Little attention has been given to psychological factors as correlates of health care use, which could be an important key to manage it. We analyzed the association of psychological factors with health care use.

DATA SOURCES

Primary data were obtained from three follow-ups (2002, 2008, and 2011) of a large population-based study with participants aged 40+.

STUDY DESIGN

Using a longitudinal observational study, we analyzed the psychological factors of negative and positive affect (affective well-being), life satisfaction (cognitive well-being), self-efficacy, loneliness, self-esteem, optimism, and flexible goal adjustment using fixed-effects regressions.

DATA COLLECTION

The participants provided data on health care use (visits to general practitioners [GPs] and specialists as well as hospitalization) and psychological factors via self-administered questionnaires and personal interviews (7,116 observations). The sample was drawn using national probability sampling.

PRINCIPAL FINDINGS

Controlling for self-rated health, chronic diseases and sociodemographics, increases in affective well-being, and optimism decreased health care use of GPs, specialists, and hospital treatment. Increases in cognitive well-being decreased health care use of GPs and specialists. Increases in self-efficacy decreased hospitalization.

CONCLUSIONS

The study underlines the influence of psychological factors on health care use. Thus, whenever possible, future studies of health care use should include psychological factors, and efforts to reduce health care use might focus on such factors.

Perceptions of adolescent 'simulated clients' on barriers to seeking contraceptive services in health centers and pharmacies in Mexico

OBJECTIVE

To examine adolescent simulated clients' perceived barriers to quality care as they sought information on contraceptives in public-sector healthcare facilities and pharmacies in Mexico.

STUDY DESIGN

We used a qualitative research design and conducted semi-structured interviews with eight young women who posed as simulated clients at health centers and pharmacies in Mexico City. Grounded Theory was used to analyze the transcripts.

RESULTS

Barriers to receiving information about contraceptives included healthcare professionals who gave administrative pretexts to avoid providing services. Simulated clients also felt judged by healthcare professionals and reported a lack of simple, understandable and pertinent information. Healthcare professionals did not ensure clients understood and had no further questions about using contraceptives, which resulted in clients' poor perceived self-efficacy, as well as a lack of confidence in the healthcare system to help them.

CONCLUSIONS

When healthcare professionals fail to provide services according to the World Health Organization's five basic criteria of adolescent friendly care, adolescents perceive important barriers in their access to contraceptive methods. Quality of sexual health care in Mexico would benefit from efforts to improve healthcare professionals' knowledge, attitudes and skills related to adolescent friendly service delivery.

Health indicators and social gradient in adolescent immigrants' health risk and healthcare experiences

Few studies have assessed healthcare experiences in apparently healthy adolescents, or whether healthcare attitudes are linked to the two leading adolescent health indicators, smoking and obesity. Even fewer have examined these relationships in adolescent immigrant groups or made comparisons to adolescent non-immigrants. Using a cross-sectional study, healthcare experiences were compared among three groups of adolescents (n = 589) including Russian immigrants (n = 154), Ethiopian immigrants (n = 54), and non-immigrants (n = 381). Bootstrap estimates indicated positive healthcare experiences were less common among Russian adolescent immigrants (OR = 0.38, CI = 0.17, 0.86) compared to non-immigrants, unless the Russian adolescent immigrants reported above average socioeconomic status, in which case they were more likely than non-immigrant adolescents to report positive healthcare experiences (OR = 3.22, CI = 1.05, 9.85). Positive healthcare experiences were less likely among adolescents who were smokers (OR = 0.50, CI = 0.27, 0.91), and more likely for adolescents with a normal or low BMI (OR = 3.16, CI = 1.56, 6.40) and for those relying on parents for health information (OR = 1.97, CI = 1.05, 3.70).

CONCLUSION

Findings suggest a social gradient in which positive healthcare experiences were more common among adolescence with higher socioeconomic status for some immigrants (Russian adolescents) but not for others. The two leading health indicators were related to healthcare experiences, but as adolescent smokers were less likely to have positive healthcare experiences, proactive efforts are needed to engage this group. What is Known: • Health indicators (such as obesity) and healthcare attitudes are linked to healthcare service use among adolescents sampled from outpatient and inpatient populations. What is New: • A social gradient involving socioeconomic status and being an adolescent immigrant was found regarding risky health indicators (i.e., smoking, use of internet as the primary source of health information). • Problematic health indicators, such as smoking, is linked to less positive healthcare attitudes in apparently healthy adolescents (both immigrants and non-immigrants).

Optimism as a Candidate Health Asset: Exploring Its Links With Adolescent Quality of Life in Sweden

This study aims to understand the role that optimism could play in the context of a health asset approach to promote adolescent health-related quality of life (HRQOL). Adolescents (n = 948), between 11 and 16 years old from a medium-sized rural town in Sweden, answered questionnaires measuring optimism, pessimism, and HRQOL. The findings indicate a significant decrease in optimism and a significant increase in pessimism between early and midadolescence. The study has allowed us to present associational evidence of the links between optimism and HRQOL. This infers the potential of an optimistic orientation about the future to function as a health asset during adolescence and by implication may provide additional intervention tool in the planning of health promotion strategies.

Association between Optimism, Psychosocial Well Being and Oral Health: A Cross-Sectional Study

OBJECTIVE

The aim of the study was to assess the association of optimism and psychosocial well being of school going children on their oral health status.

STUDY DESIGN

The study included 12- to 15-year-old school going children (N = 2014) from Tamilnadu, India. Optimism was measured using the revised version of the Life Orientation Test (LOT-R). A questionnaire was sent to the parents regarding their child's psychosocial behavior which included shyness, feeling inferiority, unhappiness and friendliness. Clinical examination for each child was done to assess the DMFT score and OHI-S score. The data obtained were statistically analyzed using Pearson Chi-Square test, Mann-Whitney test and Kruskal-Wallis test with the aid of SPSS software (version 17). Odds Ratio (OR) was calculated with 95% Confidence Interval (CI). The p value ≤ 0.05 was considered statistically significant.

RESULTS

Boys with high optimism had significantly lesser DMFT score than the boys with low optimism (p=0.001). Girls with high optimism had significantly higher DMFT score (p=0.001). In psychosocial outcomes, inferiority (p=0.002) and friendliness (p=0.001) showed significant association with DMFT score. Among the boys, children who felt less inferior (p=0.001), less unhappy (p=0.029) and more friendly (p=0.001) had lesser DMFT score.

CONCLUSION

Among the psychosocial outcomes assessed, inferiority and friendliness had significant association with oral health of the children and hence, can be used as a proxy measures oral health.

The association of children's distress during venepuncture with parent and staff behaviours

Venepuncture and other needle-related procedures can distress children and have a lasting negative impact. Adults' behaviour during these procedures may affect children's reactions. However, the literature is contradictory and rarely considers verbal and non-verbal behaviour together. This study therefore examined the effect of adults' verbal and non-verbal behaviour on children's distress during venepuncture. Participants comprised 51 child and carer dyads and 10 staff members. Child anxiety was measured before the procedure. The procedure was recorded. The resulting audio-visual data were coded using the Child-Adult Medical Procedure Interaction Scale-Revised. Correlation analysis identified variables that were significantly associated with child distress: child anxiety, carer distress-promoting behaviour, staff distress-promoting behaviour and intimate distance. These were included in a path diagram of child distress. Exploration of the diagram identified that children's anxiety was mostly strongly associated with children's distress during venepuncture. Staff and carer behaviour did not increase children's distress. The results suggest interventions to reduce children's distress during venepuncture may be more effective if they focus on reducing children's anxiety beforehand.

[Children's attitudes regarding health care and perception of pain: the mediating role of medical fears]

This study sought to contribute to a better understanding of children's attitudes and opinions regarding health care, mainly in terms of medical procedures, institutions and the efficacy of health professionals. The sample included 381 children, recruited from different schools in Lisbon. The more negative attitudes were attributed to institutions, while positive attitudes were related to the efficacy of health professionals. Medical procedures were considered less painful compared to potential day-to-day accidents. Higher levels of pain were reported by children of the female sex and by children during the primary education phase. Medical fears mediated the relationship between the perception of pain and children's attitudes with respect to health care. Higher levels of pain perception were seen to be related to more negative attitudes regarding health care. However, this relationship was diminished when children's fears about medical issues were contemplated. In conclusion, a translated instrument to assess children's attitudes regarding health care is needed, as it may even contribute to the development of intervention programs within the scope of the promotion of attitudes towards health care.

Effects of balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples: a randomized controlled trial

PURPOSE

The purpose was to determine the effects of the balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples.

DESIGN AND METHODS

In this prospective randomized controlled study, 9- to 12-year-old children in the intervention groups were asked to cough or inflate balloons during the venipuncture procedure. The Faces Pain Scale-Revised was used to assess pain intensity.

RESULTS

Pain intensity significantly differed between the control (n = 44) and intervention groups (balloon inflation [n = 44] and cough trick [n = 44], p < .001).

PRACTICE IMPLICATIONS

Coughing and inflating balloons during venipuncture do not require preparation and are time saving, easy, accessible, and effective in reducing pain.

Future orientation: a construct with implications for adolescent health and wellbeing

Multidisciplinary research has supported a relationship between adolescent future orientation (the ability to set future goals and plans) and positive adolescent health and development outcomes. Many preventive strategies - for example, contracepting, exercising - are based on taking actions in the present to avoid unwanted or negative future consequences. However, research has been hampered by unclear and often divergent conceptualizations of the future orientation construct. The present paper aims to integrate previous conceptual and operational definitions into a conceptual framework that can inform programs and services for youth and efforts to evaluate future orientation as a target for intervention. Recommendations focus on furthering the study of the construct through measurement synthesis as well as studies of the normative development of future orientation. Also suggested is the need to pair environmental intervention strategies with individual level efforts to improve future orientation in order to maximize benefits.

"Is it going to hurt?": the impact of the diagnostic odyssey on children and their families

The pediatric diagnostic odyssey is a period of uncertainty and emotional turmoil for families, often characterized by multiple minor medical procedures (such as venipuncture) that children may find distressing. Interventions to reduce distress are rarely offered, despite evidence that this is crucial both for avoiding anticipatory anxiety before future procedures and for improving healthcare compliance in adulthood. We interviewed ten mothers of children with neuromuscular disorders, asking about their perceptions of their child's experiences with different medical procedures, the emotional impact of the diagnostic odyssey, implications of obtaining a diagnosis, and interactions with healthcare providers. We coded interviews in ATLAS.ti (version 7.0) based on a priori and emergent themes, and analyzed them based on the principles of interpretive description. We found that predicting and assessing children's reactions to procedures is challenging; parents reported non-invasive procedures such as x-rays were distressing for some children, and that providers did not detect subtle indicators of distress. Parents valued obtaining a diagnosis because it validated their concerns, enabled planning for the child's future healthcare needs, and allowed access to established support networks. This study suggests that healthcare providers can improve the experience of the diagnostic odyssey by validating family concerns and connecting them to support services that are available without a diagnosis.

Item response theory analysis of the life orientation test-revised: age and gender differential item functioning analyses

This study is aimed at testing the measurement properties of the Life Orientation Test-Revised (LOT-R) for the assessment of dispositional optimism by employing item response theory (IRT) analyses. The LOT-R was administered to a large sample of 2,862 Italian adults. First, confirmatory factor analyses demonstrated the theoretical conceptualization of the construct measured by the LOT-R as a single bipolar dimension. Subsequently, IRT analyses for polytomous, ordered response category data were applied to investigate the items' properties. The equivalence of the items across gender and age was assessed by analyzing differential item functioning. Discrimination and severity parameters indicated that all items were able to distinguish people with different levels of optimism and adequately covered the spectrum of the latent trait. Additionally, the LOT-R appears to be gender invariant and, with minor exceptions, age invariant. Results provided evidence that the LOT-R is a reliable and valid measure of dispositional optimism.

The effect of brief functional relaxation on college students' needle anxiety during injected vaccinations

OBJECTIVE

This study examined the effect of brief functional relaxation (FR) training on needle anxiety (NA) during vaccinations.

PARTICIPANTS

From October 2010 through May 2012, 48 undergraduates were recruited through the psychology research participant pool.

METHODS

Students (N = 48) were randomly assigned to a 15-minute brief FR session delivered via MP3 player or a standard care condition (15 minutes of sitting quietly) prior to receiving injections at the immunization clinic. Measures were completed before (T1) and after (T2) the assigned condition, assessing expected NA, state anxiety, blood pressure, and heart rate; and after the injection (T3), self-reported NA during the injection.

RESULTS

Unexpectedly, the groups did not differ at T2. However, during the injection, brief FR participants indicated lower self-reported NA (T3) than standard care.

CONCLUSIONS

Brief FR is a simple, inexpensive technique that may reduce NA in college health settings and help decrease delays in treatment seeking.

Brief report: Assessing dispositional optimism in adolescence--factor structure and concurrent validity of the Life Orientation Test--Revised

Dispositional optimism is an individual difference promoting psychosocial adjustment and well-being during adolescence. Dispositional optimism was originally defined as a one-dimensional construct; however, empirical evidence suggests two correlated factors in the Life Orientation Test - Revised (LOT-R). The main aim of the study was to evaluate the dimensionality of the LOT-R. This study is the first attempt to identify the best factor structure, comparing congeneric, two correlated-factor, and two orthogonal-factor models in a sample of adolescents. Concurrent validity was also assessed. The results demonstrated the superior fit of the two orthogonal-factor model thus reconciling the one-dimensional definition of dispositional optimism with the bi-dimensionality of the LOT-R. Moreover, the results of correlational analyses proved the concurrent validity of this self-report measure: optimism is moderately related to indices of psychosocial adjustment and well-being. Thus, the LOT-R is a useful, valid, and reliable self-report measure to properly assess optimism in adolescence.

Intention to seek mental health treatment for adolescent girls: comparison of predictors in mothers and daughters

PROBLEM

To examine predictors of intention to seek mental health treatment for adolescent girls in mothers and daughters.

METHODS

In this cross-sectional study, mothers and adolescent daughters (n = 71) completed measures of behavioral attitudes, subjective norms, perceived behavioral control, and intention to seek mental health treatment for the adolescent daughter.

FINDINGS

Behavioral attitude and perceived behavioral control predicted intention to seek mental health treatment among mothers. Behavioral attitude predicted intention among daughters. There were no associations between mothers and daughters on study variables.

CONCLUSIONS

To promote shared decision making and engagement in mental health treatment, clinicians may target interventions to the mother's perceived behavioral control and behavioral attitudes of daughters and mothers. Based upon study results, clinicians should promote shared decision making and concordance between mothers and daughters on attitudes toward mental health treatment.

Safety of high-concentration nitrous oxide by nasal mask for pediatric procedural sedation: experience with 7802 cases

OBJECTIVES

Nitrous oxide is an effective sedative/analgesic for mildly to moderately painful pediatric procedures. This study evaluated the safety of nitrous oxide administered at high concentration (up to 70%) for procedural sedation.

METHODS

This prospective, observational study included all patients younger than 18 years who received nitrous oxide for diagnostic or therapeutic procedures at a metropolitan children's facility. Patients' age, highest concentration and total duration of nitrous oxide administration, and adverse events were recorded.

RESULTS

Nitrous oxide was administered on 7802 occasions to 5779 patients ranging in age from 33 days to 18 years (median, 5.0 years) during the 5.5-year study period. No adverse events were recorded for 95.7% of cases. Minor adverse events included nausea (1.6%), vomiting (2.2%), and diaphoresis (0.4%). Nine patients had potentially serious events, all of which resolved without incident. There was no difference in adverse event rates between nitrous oxide less than or equal to 50% and greater than 50% (P = 0.18). Patients aged 1 to 4 years had the lowest adverse event rate (P < 0.001), with no difference between groups younger than 1 year, 5 to 10 years, and 11 to 18 years. Compared with patients with less than 15 minutes of nitrous oxide administration, patients with 15 to 30 minutes or more than 30 minutes of nitrous oxide administration were 4.2 (95% confidence interval, 3.2-5.4) or 4.9 (95% confidence interval, 2.6-9.3) times more likely to have adverse events.

CONCLUSIONS

Nitrous oxide can be safely administered at up to 70% concentration by nasal mask for pediatric procedural sedation, particularly for short (<15 minutes) procedures. Nitrous oxide seems safe for children of all ages.

Understanding needle-related distress in children with cystic fibrosis

OBJECTIVE

To explore the nature and management of needle-related distress in children and adolescents with cystic fibrosis (CF).

DESIGN

Qualitative study using semi-structured interviews.

METHODS

Fourteen child-parent dyads took part. Children (5 male; 9 female) had a mean age of 12.4 years (range 7-17) and were mostly diagnosed with CF at birth (N= 11). Frequency of needle procedures ranged from once to six times a year. Parents (3 male; 11 female) had a mean age of 41.5 years and were from a variety of socio-economic backgrounds. Interviews were transcribed and analysed using thematic analysis.

RESULTS

Most participants identified previous needle experiences and pain as related to their needle anxiety. Over half of parents and children considered 'taking control' to be the optimum coping strategy. The majority of parents and children thought inhaled nitrous oxide gas during needle procedures was helpful in managing needle-related distress. Parent and staff influences on needle-related distress are also examined.

CONCLUSIONS

Needle-related distress in children with CF has a substantial impact on children and their parents, and may lead to management problems and treatment refusal. Psychological and pharmacological interventions could reduce distress and aid management.

Procedural pain management for children receiving physiotherapy

PURPOSE

This article provides an overview of literature relevant to the prevention and relief of pain and distress during physiotherapy procedures, with guidance for physiotherapists treating children.

SUMMARY OF KEY POINTS

Physiotherapists are generally well trained in assessing and managing pain as a symptom of injury or disease, but there is a need to improve the identification and management of pain produced by physiotherapy procedures such as stretching and splinting. In contrast to physiotherapy, other health care disciplines, such as dentistry, nursing, paediatrics, emergency medicine, and paediatric psychology, produce extensive literature on painful procedures. Procedural pain in children is particularly important because it can lead to later fear and avoidance of necessary medical care.

RECOMMENDATIONS

We emphasize the need for physiotherapists to recognize procedural pain and fear in the course of treatment using verbal, nonverbal, and contextual cues. We present many methods that physiotherapists can use to prevent or relieve procedural pain and fear in paediatric patients and provide an example of a simple, integrated plan for prevention and relief of distress induced by painful procedures.