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.

Honeycomb Map: A Bioinspired Topological Map for Indoor Search and Rescue Unmanned Aerial Vehicles.

The use of robots to map disaster-stricken environments can prevent rescuers from being harmed when exploring an unknown space. In addition, mapping a multi-robot environment can help these teams plan their actions with prior knowledge. The present work proposes the use of multiple unmanned aerial vehicles (UAVs) in the construction of a topological map inspired by the way that bees build their hives. A UAV can map a honeycomb only if it is adjacent to a known one. Different metrics to choose the honeycomb to be explored were applied. At the same time, as UAVs scan honeycomb adjacencies, RGB-D and thermal sensors capture other data types, and then generate a 3D view of the space and images of spaces where there may be fire spots, respectively. Simulations in different environments showed that the choice of metric and variation in the number of UAVs influence the number of performed displacements in the environment, consequently affecting exploration time and energy use.

Parental Cognitions and Motivation to Engage in Psychological Interventions: A Systematic Review.

This paper reviews the available research on the predictors of parental engagement in preventive and therapeutic psychological interventions that target mental health problems in children. Based on previous literature, seven predictors concerning parental motivation to engage are considered: perceived child problems, perceived parenting, attributions of problems, self-efficacy, expectations about treatment, perceived obstacles and global motivation to engage. PRISMA guidelines for systematic review were used to conduct the literature search. Thirty-seven studies that examined prospective relations between parental cognitions evaluated at the beginning of the intervention and parental engagement during the intervention were included. Most studies focused on the parents' perception of the child's problems and of parenting, with fewer studies examining the role of the other parental cognitions. The results suggest that the psychological dimensions proposed in motivational models may play an important role in understanding parental engagement in preventive and therapeutic psychological interventions.

Effectiveness of a parental school-based intervention to improve young children's eating patterns: a pilot study.

OBJECTIVE: To evaluate the effectiveness of a pilot study of a parental school-based intervention to promote healthy eating behaviours in young children. DESIGN: A quasi-experimental longitudinal design with three conditions (complete intervention (CIG), minimal intervention (MIG), control (CG)), with repeated measures at baseline, immediately after the intervention, 6 months and 1 year after intervention. SETTING: Fourteen public and state-funded kindergartens near Lisbon, Portugal. SUBJECTS: Parents (n 349) of 3- to 6-year-old children assigned to the three conditions completed the baseline protocol. The 'Red Apple' intervention included four parental group sessions about young children's growth, nutritional guidelines and positive parental feeding strategies, which was combined with adult-child activities at home and in the classroom, and newsletters (CIG). MIG included only a single nutritional counselling session, whereas the CG had no intervention. At the end, thirty-eight, twenty-six and fifty-four parents in the CIG, MIG and CG, respectively, had completed all evaluation components. Data regarding parental perception of children's weight, self-efficacy, nutritional knowledge, feeding strategies, eating behaviours and BMI were collected at the four assessment moments. RESULTS: The CIG showed improvements in children's healthy food intake, compared with the MIG and CG. Parental self-efficacy regarding the regulation of children's eating behaviours decreased in the CG but not in both intervention groups. CONCLUSIONS: Considering the low dosage of the intervention, the results obtained were positive. Future studies should offer additional solutions to overcome barriers to parents' participation.

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.

Examining the Mechanisms of Therapeutic Change in a Cognitive-Behavioral Intervention for Anxious Children: The Role of Interpretation Bias, Perceived Control, and Coping Strategies.

This study examined the role of theoretically meaningful mediators of therapeutic change-interpretation bias, perceived control, and coping strategies-in a cognitive-behavioral intervention for anxious youth. This is one of the few studies that examined the change in potential mediator and outcome variables by means of a longitudinal design that included four assessment points: pretreatment, in-treatment, post-treatment, and at 4-months follow-up. Forty-seven 8- to 12-year-old children with a principal DSM-IV diagnosis of anxiety disorder participated in the study. On each assessment point, questionnaires assessing the mediator variables and a standardized anxiety scale were administered to the children. The results showed that perceived control and interpretation bias (but not coping strategies) accounted for a significant proportion in the variability of various types of anxiety symptoms, providing a preliminary support for the notion that these cognitive dimensions' act as mechanisms of therapeutic change in cognitive-behavioral therapy for anxious children.

Predictors of parental concerns about child weight in parents of healthy-weight and overweight 2-6 year olds.

INTRODUCTION: Parental awareness and concerns about a child's weight can promote healthy food parenting behaviors. Understanding the factors that influence parent's concerns about childhood (over)weight may help professionals define more effective strategies when working with families. This study aimed to assess parental concerns about their young child's weight and to identify contributors of parental concerns about weight in parents of healthy-weight and overweight children, considered separately. MATERIAL AND METHODS: Data collection was performed using a cross-sectional design. Parents of 339 children aged from 2 to 6 years completed a Children's Eating Habits Questionnaire and rated their perceptions of and concerns about their child's weight and diet quality. Children's body mass index was assessed and two samples were defined according to the child's nutritional status: healthy-weight (N = 230) and overweight (N = 109) children. Binomial logistic regression was used to predict parental concerns about the child's weight in each sample. RESULTS: Parental concerns about the child's weight were moderate in both groups. For healthy-weight children, parental concerns about the child's weight were significantly predicted by the parents' perception of the child's weight, concerns about the child's diet and the child's healthy food intake. In the overweight children group, parents' perception of the child's weight, concerns about the child's diet and perception of the child's diet quality predicted parental concerns, with the child's gender and recall of physician's warnings about the child's overweight condition as marginal predictors. CONCLUSIONS: Our results show that concerns about the child's weight in these two groups of parents share some common determinants but also differ regarding other factors, thus suggesting the need to consider these differences when working with parents of young children with different weight status.

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.

Parental Involvement in Cognitive-Behavioral Intervention for Anxious Children: Parents' In-Session and Out-Session Activities and Their Relationship with Treatment Outcome.

The present study explored the role of parents' in-session and out-session involvement in CBT for anxious children. Fifty 8- to 12-year-old children with a principal DSM-IV anxiety disorder participated in a group CBT program. Parental involvement in the therapy was assessed by the clinician and the children and parents completed a standardized anxiety scale as the main therapy outcome measure, at pre- and post-intervention. In addition, the parents completed questionnaires to evaluate a number of possible correlates of parental involvement, namely, child's anxiety symptoms intensity and interference, parental beliefs about anxiety, expectancies regarding the efficacy of the intervention, and parental anxiety. The results indicated that the parents were moderately involved in the therapy and that socio-economic status and parental beliefs about anxiety were significant correlates of parental involvement. Finally, partial support was found for the idea that parents' involvement in the therapy might have a positive impact on therapy outcome.

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.

Blended Psychological Interventions for Emotional Disorders in Youth: Acceptability and Intention to Use in a Sample of Portuguese Psychologists.

INTRODUCTION: The rise of mental health problems in youth highlights the need for accessible and cost-effective psychological interventions. Blended interventions, which combine face-to-face and online sessions, can be an adequate response to the increase in demands for youth mental health services. Although this can be a promising approach, effective dissemination depends on the professionals´ acceptance. OBJECTIVES: This study aimed to explore the acceptability of and intention to use blended interventions by psychologists working with children with emotional disorders and to examine their predictors, including previous knowledge, expectancies (i.e., performance expectancy, effort expectancy, social influence, and facilitating conditions), and attitudes toward evidence-based practices. METHODS: The sample consisted of 76 Portuguese psychologists (Mage = 37.26 years, SD = 10.47; 92.1% female) working in youth mental health services. The participants completed an online protocol to evaluate the different dimensions included in the study. RESULTS: The results showed that most participants demonstrated moderate to high acceptability of blended psychological interventions for emotional disorders in youth and intend to use them in the future. Regression analysis showed that performance expectancy and positive attitudes toward evidence-based practices were significant predictors of acceptance of blended interventions and that social influence was a significant predictor of both acceptance of and intention to use blended interventions. CONCLUSION: These results emphasize the importance of sharing the findings of blended interventions, changing professionals' attitudes toward evidencebased practices, and collaborating more closely with organizations and institutions to advance standards that encourage the adoption of this intervention format.

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).

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.

Sufentanil Sublingual Tablet System vs. Intravenous Patient-Controlled Analgesia with Morphine: Postoperative Pain Control and Its Impact in Quality of Recovery.

CONTEXT: Patient-controlled analgesia (PCA) is commonly used for postoperative pain control. Although widely used, intravenous (IV) morphine PCA may not be suitable for all patients. Sufentanil sublingual tablet system (SSTS) PCA is a recent technique that has had success as a safe and effective alternative for acute pain management. AIMS: This study aims to compare both the efficacy and safety of SSTS PCA versus IV morphine PCA in postoperative pain control and the quality of recovery in adult patients following scheduled gynecological or orthopedic surgery. SETTINGS AND DESIGN: Open-label, parallel-group, randomized controlled trial with 54 patients. The primary outcome was postoperative pain control, while the secondary outcomes included adverse effects associated with two analgesic modalities, total opioid dose required, patient satisfaction, and impact on the quality of postoperative recovery. METHODS AND MATERIAL: Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The chi-squared test was used in categorical variables. When distribution was normal, T-student (mean ± standard deviation) was used in continuous variables. In contrast, when distribution was not normal, the Mann-Whitney test (median (minimal-maximal)) was used. RESULTS: The results showed that there was a statistically significant difference in the total dose of opioid used by patients at 24 hours postoperatively, with patients receiving SSTS PCA requiring a higher total dose when compared to those receiving IV morphine PCA. However, there were no statistically significant differences in pain scores, adverse events, or patient satisfaction. CONCLUSIONS: The study suggests that both IV morphine and sublingual sufentanil are safe and effective for postoperative pain management.

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.

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.

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.

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.

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.

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.