Interactive versus Passive Distraction and Parent Psychoeducation as pain management techniques during pediatric venepuncture: A Randomized Controlled Trial

Objectives The aim of this research was twofold: to explore 1) the efficacy of active vs. passive distraction on self-reported pain and distress of children during a venepuncture; and 2) the impact ofparental psychoeducation on child and parent outcomes, parental knowledge of distraction procedures and parental engagement in effective pain management strategies.  Methods This cross-sectional study included 213 children scheduled for a venepuncture, and one of their parents, who were randomly allocated to one of four conditions; interactive distraction, passive distraction, interactive distraction with parent psychoeducation and passive distraction with parent psychoeducation. ANCOVA’s were used to investigate the impact of distraction type and the use of parent psychoeducation on child and parent pain related outcome variables.  Results Statistical analyses revealed no significant differences between groups for child-reported pain and distress. Parents who received parent psychoeducation had a significantly higher level of knowledge than parents who did not receive psychoeducation, but did not engage in more effective pain management behaviour.  Conclusions The results indicated that passive vs. active distraction does not have a significantly different influence on child pain-related outcome variables. In addition, while psychoeducation was demonstrated to be effective in increasing parental knowledge, it was not sufficient to change parental behaviour

Future research directions on the "elusive" white shark

White sharks, Carcharodon carcharias, are often described as elusive, with little information available due to the logistical difficulties of studying large marine predators that make long-distance migrations across ocean basins. Increased understanding of aggregation patterns, combined with recent advances in technology have, however, facilitated a new breadth of studies revealing fresh insights into the biology and ecology of white sharks. Although we may no longer be able to refer to the white shark as a little-known, elusive species, there remain numerous key questions that warrant investigation and research focus. Although white sharks have separate populations, they seemingly share similar biological and ecological traits across their global distribution. Yet, white shark’s behavior and migratory patterns can widely differ, which makes formalizing similarities across its distribution challenging. Prioritization of research questions is important to maximize limited resources because white sharks are naturally low in abundance and play important regulatory roles in the ecosystem. Here, we consulted 43 white shark experts to identify these issues. The questions listed and developed here provide a global road map for future research on white sharks to advance progress toward key goals that are informed by the needs of the research community and resource managers

The assessment and treatment of toileting difficulties in individuals with autism spectrum disorder and other developmental disabilities

In 2009, Kroeger and Sorensen-Burnworth published a comprehensive review of the literature on toilet training individuals with autism spectrum disorder and other developmental disabilities. Their review highlighted that the majority of toilet training programs were modelled after Azrin and Foxx s Rapid Toilet Training (RTT) method. The current study will review toilet training programs for the developmental disability population since 2009. Behaviourally based components of these programs will be described and their contribution to toilet training discussed. This study will also review the questionnaires available to assess toileting difficulties in this population, and their contribution to toilet training programs will also be reviewed

Toileting problems in children and adolescents with parent-reported diagnoses of autism spectrum disorder

The current study investigated toileting problems in one hundred and twenty-seven children and adolescents with parent-reported diagnoses of autism spectrum disorder. Toileting refers to the accomplishment of various unprompted behaviors, including recognising the need to go to the toilet, and waiting before eliminating. The relationship between toileting problems and age, gender, intellectual disability, gastrointestinal symptoms, sleep problems, comorbid psychopathology, quality of life, and adaptive functioning were examined using parent-report questionnaires. The most common toileting problems were, "Does not independently perform most self-help tasks", "Has toilet accidents during the day", and "Parent/caregiver notices smears in underwear". Gender, presence of intellectual disability, gastrointestinal symptoms, and comorbid psychopathology were significant predictors of toileting problems in this study. The gastrointestinal symptoms of constipation and bloating were found to be significant predictors of toileting difficulties. Specifically, constipation predicted accidents and physical problems associated with toileting, and bloating predicted social/emotional factors and physical problems. A small negative correlation was observed between total toileting problems and total health related quality of life. An increase in physical toileting difficulties was associated with lower quality of life.2019-03-2

Mobile health technology interventions for suicide prevention: systematic review.

BACKGROUND: Digital interventions are proposed as one way by which effective treatments for self-harm and suicidal ideation may be improved and their scalability enhanced. Mobile devices offer a potentially powerful medium to deliver evidence-based interventions with greater specificity to the individual when the intervention is needed. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice. OBJECTIVE: This review aimed to examine the effectiveness of currently available mobile health (mHealth) technology tools in reducing suicide-specific outcomes. METHODS: The following databases were searched: Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, and relevant sources of gray literature. All published and unpublished randomized controlled trials (RCTs), pseudo-RCTs, and pre-post observational studies that evaluated the effectiveness of mHealth technology in suicide prevention delivered via mobile computing and communication technology were included. Studies were included if they measured at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, and suicidal behavior). A total of 2 review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, on July 31, 2018. Owing to the heterogeneity of outcomes found across studies, results were not amenable for pooled synthesis, and a meta-analysis was not performed. A narrative synthesis of the available research is presented here. RESULTS: A total of 7 studies met criteria for inclusion . Four published articles that reported on the effectiveness of the following mobile phone apps were included: iBobbly, Virtual Hope Box, BlueIce, and Therapeutic Evaluative Conditioning. Results demonstrated some positive impacts for individuals at elevated risk of suicide or self-harm, including reductions in depression, psychological distress, and self-harm and increases in coping self-efficacy. None of the apps evaluated demonstrated the ability to significantly decrease suicidal ideation compared with a control condition. In addition, 3 unpublished and recently completed trials also met criteria for inclusion in the review. CONCLUSIONS: Further research is needed to evaluate the efficacy of stand-alone mHealth technology-based interventions in suicide prevention. The small number of studies reported in this review tentatively indicate that such tools may have a positive impact on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing the following 3 main methodological limitations : (1) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies; (2) ecological validity: the tendency to exclude potential participants because of the elevated suicide risk may reduce generalizability within clinical settings; and (3) app regulation and definition: the lack of a standardized classification system for mHealth intervention type points to the need for better definition of the scope of such technologies to promote safe practice

Mobile health technology interventions for suicide prevention: protocol for a systematic review and meta-analysis

Background: Previous research has reported that two of the major barriers to help-seeking for individuals at risk of suicide are stigma and geographical isolation. Mobile technology offers a potential means of delivering evidence-based interventions with greater specificity to the individual, and at the time that it is needed. Despite documented motivation by at-risk individuals to use mobile technology to track mental health and to support psychological interventions, there is a shortfall of outcomes data on the efficacy of mobile health (mHealth) technology on suicide-specific outcomes. Objective: The objective of this study is to develop a protocol for a systematic review and meta-analysis that aims to evaluate the effectiveness of mobile technology-based interventions for suicide prevention. Methods: The search includes the Cochrane Central Register of Controlled Trials (CENTRAL: The Cochrane Library), MEDLINE, Embase, PsycINFO, CRESP and relevant sources of gray literature. Studies that have evaluated psychological or nonpsychological interventions delivered via mobile computing and communication technology, and have suicidality as an outcome measure will be included. Two authors will independently extract data and assess the study suitability in accordance with the Cochrane Collaboration Risk of Bias Tool. Studies will be included if they measure at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, suicidal behavior). Secondary outcomes will be measures of symptoms of depression. Where studies are sufficiently homogenous and reported outcomes are amenable for pooled synthesis, meta-analysis will be performed. A narrative synthesis will be conducted if the data is unsuitable for a meta-analysis. Results: The review is in progress, with findings expected by summer 2018. Conclusions: To date, evaluations of mobile technology-based interventions in suicide prevention have focused on evaluating content as opposed to efficacy. Indeed, previous research has identified mobile applications that appear to present harmful content. The current review will address a gap in the literature by evaluating the efficacy of stand-alone mobile technology tools in suicide prevention. It is imperative that research identifies the evidence base for such tools in suicide prevention in order to inform policy, guide clinical practice, inform users and focus future research