Study protocol for a randomized controlled trial testing the efficacy of Emotion Detectives In-Out: a blended version of the unified protocol for transdiagnostic treatment of emotional disorders in Portuguese children

BACKGROUND

Childhood emotional disorders (EDs; i.e., anxiety and depressive disorders) are currently a public health concern. Their high prevalence, long-term effects, and profound influence on the lives of children and families highlight the need to identify and treat these disorders as early and effectively as possible. This clinical trial will examine the efficacy of a blended version (i.e., combining face-to-face and online sessions into one treatment protocol) of the Unified Protocol for Children (the "Emotion Detectives In-Out" program). This program is a manualized cognitive-behavioral therapy for the transdiagnostic treatment of EDs in children aged 7 to 12 years that aims to reduce the intensity and frequency of strong and aversive emotional experiences by helping children learn how to confront those emotions and respond to them in more adaptive ways.

METHODS

This study is designed as a multicenter equivalence randomized controlled parallel-group two-arm trial comparing the Emotion Detectives In-Out program with an evidenced-based group intervention for children with anxiety disorders (the Coping Cat program). Participants will be children aged between 7 and 12 years with an anxiety disorder or with clinically significant anxiety symptoms as well as one of their parents or a legal representative. A minimum sample size of 138 children (69 per group) is needed to test whether the efficacy of the proposed intervention is equivalent to that of the well-established Coping Cat intervention.

DISCUSSION

We expect Emotion Detectives In-Out to be a feasible and efficacious alternative intervention for treating children's EDs by allowing for a greater increase in children's access to care. A blended format is expected to overcome common barriers to treatment (e.g., parents´ lack of time to attend regular sessions) and make the intervention more accessible to families.

TRIAL REGISTRATION

The clinical trial is registered at ClinicalTrials.gov (Identifier: NCT05747131, date assigned February 28, 2023).

Parents' acceptability of blended psychological interventions for children with emotional disorders

Objectives

This study aims to (1) describe parents' knowledge and use of online resources to address children's mental health issues and the family's general internet and technology usage patterns; (2) examine parents' acceptance of blended interventions for children with emotional disorders (ED); and (3) analyse the predictors of parents' intention to use a blended intervention if their children experienced an ED.

Method

The sample included 164 Portuguese parents (95.7 % mothers) of children between the ages of 6 and 13 years who completed an online survey. The study was disseminated through social networks, personal contacts of the researchers, and among parents participating in a randomized controlled trial investigating the efficacy of a psychological intervention for children with ED.

Results

Only 4.3 % of parents knew about online psychological interventions for children, and only 1.2 % had used them before. Most parents (73.2 %) reported that they would choose face-to-face individual therapy as their first option if their child had any ED, followed by blended therapy (14.8 %). Regression analyses showed that higher levels of parents' intention to use a blended intervention were predicted by their perceptions of the utility or efficacy of this type of delivery format.

Discussion/conclusion

These results suggest that although most parents show unfamiliarity with blended psychological interventions for children, they consider it a treatment modality to which they would resort if their children had emotional difficulties. Their intention to use such an intervention seems to be more likely if they perceive it as useful and effective.

Development of a New Questionnaire to Assess Parental Perceived Barriers When Promoting Healthy Eating Habits in Young Children: First Findings

Social cognitive models suggest a crucial role played by perceived barriers in promoting healthy behaviors, including healthy eating. We aimed to develop a new questionnaire to assess parental perceived barriers to healthy feeding in young children and perform the instrument's preliminary psychometric evaluation. The initial pool of items was developed based on reviews and qualitative studies. First, we conducted an online, descriptive, cross-sectional study with 278 parents of 2-6-year-old children to examine its factorial structure and internal consistency. Then, a second study with 168 parents from a similar population assessed convergent/discriminant and known-groups validity. The exploratory factorial analysis confirmed the scale's theoretical structure. Five scales were found: Child-Related Barriers, Parent-Related Barriers-Vegetables and Fruit, Parent-Related Barriers-Added Sugars, Social Context-Related Barriers, and Cost-Related Barriers. All scales presented adequate reliability. We found weak to moderate, negative, and significant correlations between child- and parent-related barriers regarding vegetables and fruits, feeding practices to promote children's eating self-regulation, and food parenting self-efficacy. Additionally, parents who perceived their children as easy and well-regulated reported significantly fewer child-related barriers than parents with poorly self-regulated and inhibited children. The results support the instrument's preliminary psychometric adequacy regarding its validity and reliability and corroborate earlier empirical studies about the main parental barriers when promoting young children's healthy eating habits.

Gastric rupture during fiberoptic bronchoscopy, a rare complication of oxygen administration by nasopharyngeal cannula: a case report

Concomitant use of a nasopharyngeal catheter is frequently used for oxygen supply during fiberoptic bronchoscopy (FOB). This is a procedure that presents possible complications that are not negligible. We demonstrate the case of a 61-year-old woman who underwent FOB due to a history of hemoptoic sputum. During the procedure, gastric rupture occurred with a large pneumoperitoneum and bilateral pneumothorax requiring immediate drainage of the air and an emergent laparotomy. This was probably a complication of the nasopharyngeal catheter. The knowledge of these complications is essential for their correct identification and treatment.

Cumulative Risk Exposure and Social Isolation as Correlates of Carer and Child Mental Health During the COVID-19 Pandemic: An Online Study with Families from Various Europeans Countries

This study adopted a cumulative risk approach to examine the relations between various domains of risk factors (i.e., social isolation and home confinement, other pandemic-related risk factors, and pre-existing psychosocial risk factors) and carers' and children's mental health during the first wave of the COVID-19 pandemic in Europe. The sample consisted of 1475 carers of 6- to 16-year-old children and adolescents residing in five European countries (Portugal, United Kingdom, Romania, Spain, and The Netherlands) who completed an online survey. The results showed that each of the three domains of adversity accounted for unique variation in carers' and children's mental health outcomes. Also, the results indicated that pre-existing psychosocial risk factors moderated the relationship between pandemic-related risk factors and children and carers' anxiety and between social isolation and confinement and carers' well-being. Simple slopes analysis suggested a stronger relationship between these domains of adversities and mental health outcomes in already more vulnerable families. It is important to consider the implications of social isolation measures and confinement for families' mental health, paying special attention to families with pre-existing psychosocial vulnerabilities.

Development and Psychometric Characteristics of an Instrument to Assess Parental Feeding Practices to Promote Young Children's Eating Self-Regulation: Results with a Portuguese Sample

A parental child-centered feeding approach is likely to keep children’s biological mechanisms activated while eating, protecting them in an obesogenic context. However, few feeding practice measures assess parents’ behaviors to guide and prompt children to identify and respond appropriately to their signs of hunger and satiety. We aimed to develop and study the reliability, validity, and measurement invariance of a new scale to assess parental feeding practices to promote children’s self-regulation of food intake. To pursue this aim, we conducted two descriptive, cross-sectional, online studies in Portugal in an online format; a total of 536 parents of 2- to 6-year-old children completed the evaluation protocol. Factorial analysis findings support the theoretical organization proposed for the scale. The confirmatory factorial analysis supported a first-order factor structure with two subscales, Prompting for eating self-regulation and Teaching about eating consequences, with eight items in total. Both scales presented good internal consistency and adequate temporal stability, with a significant, positive, and moderate relationship. The results showed metric invariance for the child’s sex. Both types of practices were positively correlated with the child’s enjoyment of food. Prompting for eating self-regulation showed negative associations with parents’ emotional lack of control, children’s satiety responsiveness, slowness in eating, and fussiness. Preliminary studies confirmed both the validity and reliability of the instrument and the adequacy of adopting a self-regulatory approach when assessing child-centered feeding practices. Combining this instrument with others that assess coercive practices can be beneficial to capture ineffective parents’ behaviors on children’s eating self-regulation.

Patterns of Parental Reactions to Their Children's Negative Emotions: A Cluster Analysis with a Clinical Sample

Parents’ emotion socialization practices are an important source of influence in the development of children’s emotional competencies This study examined parental reactions to child negative emotions in a clinical sample using a cluster analysis approach and explored the associations between clusters of parents’ reactions and children’s and parents’ adjustment. The sample comprised 80 parents of Portuguese children (aged 3–13 years) attending a child and adolescent psychiatry unit. Measures to assess parental reactions to children’s negative emotions, parents’ psychopathological symptoms, parents’ emotion dysregulation, and children’s adjustment were administered to parents. Model-based cluster analysis resulted in three clusters: low unsupportive, high supportive, and inconsistent reactions clusters. These clusters differed significantly in terms of parents’ psychopathological symptoms, emotion dysregulation, and children’s adjustment. A pattern characterized by high supportive reactions to the child’s emotions was associated with higher levels of children’s adjustment. On the other hand, an inconsistent reactions pattern was associated with the worst indicators of children’s adjustment and parental emotion dysregulation. These results suggest the importance of supporting parents of children with emotional and behavioural problems so that they can be more responsive to their children’s emotional manifestations.

Cerebrospinal fluid fistula after combined spinal-epidural block

Neuraxial anaesthesia is an essential technique in obstetric anaesthesia practice. Cerebrospinal fluid (CSF) fistula is a rare complication and there is no consensus about its clinical approach. We present a case of a 28-year-old nulliparous woman that developed a cutaneous CSF fistula following combined spinal and epidural block for caesarean delivery. After multidisciplinary discussion it was decided that hydration, absolute bed-rest and compressive dressing with abdominal binder was the best option and the patient fully recovered without any sequelae.Based on literature, symptoms of intracranial hypotension and leakage of clear fluid surrounding the puncture site usually motivate referral to anaesthesia. Management strategies can be both conservative and invasive, including direct suture of the skin puncture site and epidural blood patch.Regarding the anaesthesia practice on this topic, most of the available evidence is based on case reports, rendering the decision-making process challenging.

SmartFeeding4Kids, an online self-guided parenting intervention to promote positive feeding practices and healthy diet in young children: study protocol for a randomized controlled trial

Background

Caregivers’ influence on young children’s eating behaviors is widely recognized. Nutritional interventions that focus on the promotion of children’s healthy diet should actively involve parents, focusing on their feeding behaviors and practices.

Methods

This work aims to describe the development and study protocol of the SmartFeeding4Kids (SF4K) program, an online self-guided 7-session intervention for parents of young (2–6 years old) children. The program is informed by social cognitive, self-regulation, and habit formation theoretical models and uses self-regulatory techniques as self-monitoring, goal setting, and feedback to promote behavior change. We propose to examine the intervention efficacy on children’s intake of fruit, vegetables, and added sugars, and parental feeding practices with a two-arm randomized controlled with four times repeated measures design (baseline, immediately, 3 and 6 months after intervention). Parental perceived barriers about food and feeding, food parenting self-efficacy, and motivation to change will be analyzed as secondary outcomes. The study of the predictors of parents’ dropout rates and the trajectories of parents’ and children’s outcomes are also objectives of this work.

Discussion

The SmartFeeding4Kids program relies on technological resources to deliver parents’ self-regulation techniques that proved effective in promoting health behaviors. The study design can enhance the knowledge about the most effective methodologies to change parental feeding practices and children’s food intake. As a self-guided online program, SmartFeeding4Kids might overcome parents’ attrition more effectively, besides being easy to disseminate and cost-effective.

Trial registration

The study was registered in ClinicalTrials.gov (NCT04591496) on October 19, 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05897-z.

Parenting and child mental health during the COVID-19 pandemic: An online study with Portuguese and British Families

COVID-19 and the subsequent public health response created many additional stresses for families. We examined parental behaviour during the COVID-19 pandemic in two European Countries and explored the association between parents’ behaviour and children’s anxiety and quality of life. Caregivers of children and adolescents (N = 442; 86.7% mothers) between 6 and 16 years old (M = 10, SD = 2.85) participated in an online cross-sectional survey in Portugal and the United Kingdom. Results show that higher children’s anxiety and lower quality of life were associated with higher levels of unrealistic parental demands, lower parental self-care, and higher parental emotional dysregulation. Encouragement of children’s emotion expression and management of exposure to COVID-19 information was negatively associated with children’s anxiety. Promotion of routines, support of children’s emotion modulation and promotion of children’s healthy lifestyles were positively associated with children’s quality of life. The predictors differed according to country and age group. These results highlight the importance of specific parenting behaviours on children’s mental health during COVID-19. The need to moderate unrealistic demands and attend to parental self-care to reduce parental emotional dysregulation is important. Keywords: Parenting; child’s anxiety; child’s quality of life; COVID-19.

Portuguese parental beliefs and attitudes towards vaccination

Introduction

Portugal has one of the highest vaccine coverage rates among European countries, associated with excellent vaccine convenience and confidence levels. Considering both the high rate of pediatric vaccination in Portugal and the excellent indicators of vaccine convenience established, an analysis of confidence and complacency indicators could help understand this positive example. This study aimed to characterize parental beliefs according to the intention to vaccinate a next child and identify cognitive and demographic predictors of that intention in a Portuguese sample.

Methods

We measured perceptions of vaccines’ safety and efficacy, perceptions of the severity of vaccine-preventable diseases, beliefs related to conspiracy theories, attitudes towards immunization requirements, perceptions of social norms as predictors of the intention to vaccinate a subsequent child. We also inquired if parents had previously refused a recommended vaccine. The authors disseminated the questionnaire online to reach a diverse population of parents of 0–12 years old children. The final sample included 1,118 parents, 96.9% reported their intention to vaccinate the next child, and 3.6% had previously refused a vaccine. Two additional open-ended questions regarding motives to vaccinate or refuse a future baby's vaccination were answered by 886 parents.

Results

All the evaluated parental cognitive dimensions were significantly different between the group of parents who would vaccinate a next child and those who expressed the intention not to vaccinate. Beliefs about the safety and efficacy of vaccines and having fewer children were significant predictors of that intention.

Conclusion

The vast majority of parents reported attitudes and beliefs favorable to pediatric vaccination with high consistency in all cognitive dimensions assessed. Concerns regarding pediatric vaccines’ safety need to be sensitively and actively addressed by health providers to maintain excellent vaccination coverage rates.

Changing parental feeding practices through web-based interventions: A systematic review and meta-analysis

Web-based parent interventions designed to promote children’s healthy eating patterns can enhance parents’ engagement and facilitate behavior change. However, it is still unclear how much the existing programs focus on changing parental feeding practices, and if so, which behavioral methodologies are used and how effective these interventions are in changing these parental behaviors. This systematic review and meta-analysis studied randomized controlled trials of web-based interventions targeting parents of 0-12-year-old children, aiming to promote children’s healthy diet or prevent nutrition-related problems and reporting parental feeding behaviors as one of the outcomes. We conducted an electronic search in four databases from the earliest publication date until February 2020. Of the 1271 records found, we retained twelve studies about nine programs, comprising 1766 parents that completed the baseline evaluation. We found recent interventions, mainly directed to parents of young children, with small, non-clinical samples, and mostly theory-based. The programs were heterogeneous regarding the type of intervention delivered and its duration. The most assessed parental feeding practices were Restriction, Pressure to eat, and Food availability/accessibility. The behavior change techniques Instruction on how to perform the behavior, Demonstration of the behavior, and Identification of self as role model were frequently used. Meta-analytic results indicated that most programs’ effects were small for the evaluated parental practices, except for Food availability/accessibility that benefited the intervention group only when all follow-up measurements were considered. The development of high-quality and controlled trials with larger samples is needed to determine with greater certainty the interventions’ impact on parental feeding behaviors. The more frequent inclusion of measures to evaluate parental practices to support children’s autonomy and of self-regulatory strategies as intervention components should be considered when designing programs.

Post-traumatic growth during the COVID-19 pandemic in carers of children in Portugal and the UK: cross-sectional online survey

BACKGROUND

Although the negative effects of the COVID-19 pandemic on mental health have attracted interest, little attention has focused on its positive effects and possible post-traumatic growth.

AIMS

To assess anxiety, well-being and post-traumatic growth in carers of children aged 6-16 years in Portugal and the UK.

METHOD

A cross-sectional online survey of volunteers conducted at the peak of the first wave of COVID-19 during lockdown (1 May to 27 June 2020).

RESULTS

A total of 385 caregivers (Portuguese, n = 185; UK, n = 200), predominantly mothers (n = 341, 88.6%), completed the survey. The majority were working exclusively from home (n = 271, 70.4%), almost half reported a reduction in income (n = 174, 45.2%), most children were home taught (n = 358, 93%), and 75 (19.5%) identified a family member with suspected or confirmed COVID-19 infection. In total, 341 caregivers (88.6%) identified positives arising from COVID-19, most commonly related to the post-traumatic growth domains of improved relationships, a greater appreciation of life, discovering and embracing new possibilities, and positive spiritual change. A comparison of those who did (n = 341) and did not (n = 34) report any positives found a significant difference in well-being scores (t373 = 2.24, P = 0.025) but not in anxiety scores (t373 = 0.75, P = 0.45).

CONCLUSIONS

Despite experiencing considerable adversity, examples of post-traumatic growth during the lockdown were common. Although the voluntary online nature of our survey is a limitation, our findings suggest that further research exploring post-traumatic growth following pandemics is warranted.

Cardiac arrest after a cerebral gas embolism. Case report

Cerebral arterial gas embolism is a serious and often iatrogenic fatal event associated with invasive procedures. It is a possible cause of a cardiac arrest and the diagnosis is challenging. We report a case of a cardiac arrest after a cerebral arterial gas embolism, in a 63-year-old male subjected to a Computed Tomography-guided Transthoracic Needle Aspiration Biopsy, which was successfully managed with hyperbaric oxygen therapy.

Father's and mother's beliefs about children's anxiety

BACKGROUND

Previous research has focused on parenting styles and parental behaviors associated with children's anxiety. Parental beliefs about their child's anxiety have scarcely been studied, in spite of their probable influence in parents seeking help. The present study intended to fil that gap, by exploring what parents think about their children's anxiety and whether these cognitions are related or not to their use of professional help.

METHOD

In-depth semistructured interviews were conducted with 48 parents (50% fathers) of children (9-12 years old) with anxiety problems. Theoretical thematic analysis was performed on the transcripts.

RESULTS

Three dimensions were derived from the analysis, concerning (a) the causes of child's anxiety, (b) the impact of anxiety in the child's functioning, and (c) the evolution of anxiety. Most parents perceived the child's anxiety as a permanent condition, attributing it to external and parental factors and considering that the anxiety problems have a negative impact on the child's well-being. Plus, parents who had previously sought professional help for the child's emotional problems tended to believe that anxiety could improve with child's or parents' efforts and with professional guidance, contrarily to those who had not. Implications for research and clinical practice are discussed.

CONCLUSION

The present study highlighted important parental beliefs about their children's anxiety that might influence their attitudes and decisions (e.g., seek for professional help). Other parental cognitions should be investigated in order to understand parenting in the context of childhood anxiety.

Optical and Photovoltaic Properties of Thieno[3,2-b]thiophene-Based Push-Pull Organic Dyes with Different Anchoring Groups for Dye-Sensitized Solar Cells

The effect of anchoring groups on the optical and electrochemical properties of triphenylamine-thienothiophenes, and on the photovoltaic performance of DSSCs photosensitized with the prepared dyes, was studied using newly synthesized compounds with cyanoacetic acid or rhodanine-3-acetic acid groups. Precursor aldehydes were synthesized through Suzuki cross-coupling, whereas Knoevenagel condensation of these with 2-cyanoacetic acid or rhodanine-3-acetic acid afforded the final push-pull dyes. A comprehensive photophysical study was performed in solution and in the solid state. The femtosecond time-resolved transient absorption spectra for the synthesized dyes were obtained following photoexcitation in solution and for the dyes adsorbed to TiO₂ mesoporous films. Information on conformation, electronic structure, and electron distribution was obtained by density functional theory (DFT) and time-dependent DFT calculations. Triphenylamine-thienothiophene functionalized with a cyanoacetic acid anchoring group displayed the highest conversion efficiency (3.68%) as the dye sensitizer in nanocrystalline TiO₂ solar cells. Coadsorption studies were performed for this dye with the ruthenium-based N719 dye, and they showed dye power conversion efficiencies enhanced by 20-64%. The best cell performance obtained with the coadsorbed N719 and cyanoacetic dye showed an efficiency of 6.05%.

Parenting Strategies to Deal with Children's Anxiety: Do Parents Do What They Say They Do?

Parents' perceptions about their strategies to deal with children's anxiety have been minimally explored. Based on a mixed-method approach, the current study compared the strategies that parents said they use more frequently to deal with their child's anxious behaviors and the strategies they actually used during two mildly anxiogenic interactions with their child. Forty-two parents of children with anxiety disorders, aged 9-12 years, participated in the study. Semi-structured interviews were administered to identify parental perceptions about their strategies to deal with their children's anxiety. Subsequently dyadic interactions were observed and coded by two independent coders. We found discrepancies relating to four strategies. Significantly more parents used strategies based on overinvolvement and anxious behavior during the interactions than had been reported by them in the interviews. In contrast, reassurance and reinforcement of avoidance/dependence were used in interactions by fewer parents than would be expected, according to the interviews. Relevant implications for assessment and intervention with families of anxious children are suggested.

A Novel Method for Studying the Pharmacokinetics of [(14) C]Umeclidinium After Application to the Axilla or Palm of Healthy Male Subjects

Umeclidinium (UMEC), a long-acting muscarinic antagonist approved for chronic obstructive pulmonary disease (COPD), was investigated for primary hyperhidrosis as topical therapy. This study evaluated the pharmacokinetics, safety, and tolerability of a single dose of [(14) C]UMEC applied to either unoccluded axilla (UA), occluded axilla (OA), or occluded palm (OP) of healthy males. After 8 h the formulation was removed. [(14) C]UMEC plasma concentrations (Cp) were quantified by accelerator mass spectrometry. Occlusion increased systemic exposure by 3.8-fold. Due to UMEC absorption-limited pharmacokinetics, Cp data from the OA were combined with intravenous data from a phase I study. The data were described by a two-compartment population model with sequential zero and first-order absorption and linear elimination. Simulated systemic exposure following q.d. doses to axilla was similar to the exposure from the inhaled therapy, suggesting that systemic safety following dermal administration can be bridged to the inhaled program, and offering the potential for a reduced number of studies and/or subjects.

Parental self-regulation, emotional regulation and temperament: Implications for intervention

This work presents a theoretical and integrative review about parental self-regulation and emotional regulation processes, and its connections with parental coping and temperament. Parents' adaptation requires the ability to regulate their own behavior in reaction to their perception and interpretation of the child's behavior. These self-regulation processes are often intertwined with intense emotions that need to be regulated. Parenting attitudes and behaviors cannot be fully understood without considering the parents' emotional dysregulation and their emotional regulation strategies. However, only few studies focus the effects of parents' emotional regulation strategies on the parenting behavior. Experiential avoidance and overprotection are discussed as extreme cases of parental emotional regulation strategies that may have particularly detrimental effects in childrearing. The authors propose that, although the main parenting interventions already use a self-regulation approach, specific training in adaptive emotional regulation strategies should be included in these programs.

Agreement and discrepancy between mother and child in the evaluation of children's anxiety symptoms and anxiety life interference

This study explored the agreement and discrepancy between mother and child reports of children's anxiety symptoms and anxiety life interference. A large community sample of 1,065 Portuguese children aged between 7 and 14 years and their mothers completed a DSM-based anxiety symptoms scale. For a subsample of 135 children with an anxiety disorder, additional data on children's anxiety life interference and maternal anxiety and depression symptoms were collected. The results showed that children generally reported higher levels of anxiety symptoms than their mothers. Overall, most correlations between mother and child reports of anxiety symptoms were significant but in the low to moderate range, with the strongest associations for symptoms of specific phobias and school phobia. In the subsample of children with an anxiety disorder, mothers reported higher levels of anxiety life interference than children, and the correlation between mother and child reports of anxiety life interference was significant but again modest in magnitude. Lastly, maternal anxiety was positively associated with the discrepancy between mother and child reports of anxiety symptoms. Together, the results of this study further underline the importance of a multi-informant approach in the evaluation of children's anxiety problems.

School Social Behavior Scales: an adaptation study of the Portuguese version of the social competence scale from SSBS-2

This study analyses the psychometric proprieties of a Portuguese version of the social competence scale from the School Social Behavior Scales (SSBS-2, Merrell, 2002). It is a rating instrument of children and adolescents behavior, to be used by teachers and other school personnel. This scale includes 3 subscales: self-management/compliance, peer relations and academic behavior. In our first sample, 175 teachers rated 344 students from grade 1 through 12. On the second sample 13 teachers rated 251 3rd and 4th grades students. The results from the Portuguese adaptation support the multidimensional structure of the social competence scale from the SSBS-2, although an alternative model demonstrated a better fit to the data than the model originally proposed by the author. The scale showed good internal consistency and good intercorrelations between subscales, as well as between subscales and the total scale. The final model was well replicated in the second sample. These results encourage us to pursue the SSBS-2 Portuguese adaptation, in order to provide a useful and validated instrument for the assessment of social competence and for educational interventions.

Determination of the glucocorticoid fluticasone propionate in plasma by automated solid-phase extraction and liquid chromatography-tandem mass spectrometry

A sensitive, robust and high throughput mass spectrometry based method is described for the determination of the glucocorticoid fluticasone propionate in plasma. The method employs solid-phase extraction in 96 well microtitre plate format which has been automated by means of a custom built Zymark robotic system. The extracts are analysed by liquid chromatography-tandem mass spectrometry using thermally and pneumatically assisted electrospray ionisation and selected reaction monitoring. The method is both accurate and precise with both intra- and inter-assay precision (C.V.) of less than <6%. The method provides a lower limit of quantification of 20 pg/ml from 0.5 ml of human plasma, sufficient to monitor systemic concentrations of inhaled fluticasone propionate at therapeutic doses.