An experience sampling study of physical activity and positive affect: investigating the role of situational motivation and perceived intensity across time

The nature of the association between physical activity and positive affect is complex, prompting experts to recommend continued examination of moderating variables. The main purpose of this 2-week field study was to examine the influence of situational motivational regulations from self-determination theory (SDT) on changes in positive affect from pre- to post- to 3-hours post-physical activity. Another purpose was to clarify the relationship between physical activity intensity [i.e., Ratings of Perceived Exertion (RPE)] and positive affect at the stated time points. This study employed an experience sampling design using electronic questionnaires. Sixty-six healthy and active, multiple-role women provided recurrent assessments of their physical activity, situational motivation, and positive affect in their everyday lives over a 14-day period. Specifically, measures were obtained at the three time points of interest (i.e., pre-, post-, 3-hours post-physical activity). The data were analyzed using multilevel modeling. Results showed that intrinsic motivation was related to post-physical activity positive affect while the influence of identified regulation appeared 3-hours post-physical activity. In addition, RPE, which was significantly predicted by levels of introjection, was more strongly associated with an increase in positive affect post-physical activity than three hours later. The theoretical implications of these findings vis-à vis SDT, namely in regards to a viable motivational sequence predicting the influence of physical activity on affective states, are discussed. The findings regarding the differential influences of RPE and motivational regulations carries applications for facilitating women’s well-being

A Randomized Trial Examining Preoperative Sedative Medication and Post-operative Sleep in Children

Study Objective Midazolam has been found to have beneficial effects on anxiety in children in the preoperative setting. Prior studies have examined various postoperative behaviors of children, but little research has examined the effects of preoperative use of midazolam with postoperative sleep. The purpose of this investigation was to compare postoperative sleep in children as a function of preoperative sedative medication use. Design This study was a 2-group randomized controlled trial. Setting Participants were recruited from Yale-New Haven Children\u27s Hospital. Patients Participants included a convenience sample of 70 children between the ages of 3 to 12 years undergoing ambulatory tonsillectomy and adenoidectomy. Interventions Children were randomly assigned to 1 of 2 groups: a control group who received preoperative acetaminophen only (n = 32) and an experimental group who received both acetaminophen and midazolam preoperatively (n = 38). Measurements Parents completed measures of postoperative behavioral recovery and a subset of children wore actigraphs to examine objective sleep data. Main Results Children who received midazolam experienced similar sleep changes compared to children in the control group. The actigraph data revealed that children who received midazolam were awake significantly less during the night compared to the control group (P= .01). Conclusion Children who received midazolam before surgery had similar postoperative sleep changes compared to children who did not receive midazolam. Further understanding of the postoperative behavioral effects of midazolam on children will help guide healthcare providers in their practice

Promoting physical activity: development and testing of self-determination theory-based interventions

A growing number of studies have pulled from Deci and Ryan's Self-Determination Theory to design interventions targeting health behavior change. More recently, researchers have begun using SDT to promote the adoption and maintenance of an active lifestyle. In this review, we aim to highlight how researchers and practitioners can draw from the SDT framework to develop, implement, and evaluate intervention efforts centered on increasing physical activity levels in different contexts and different populations. In the present paper, the rationale for using SDT to foster physical activity engagement is briefly reviewed before particular attention is given to three recent randomized controlled trials, the Canadian Physical Activity Counseling (PAC) Trial, the Empower trial from the UK, and the Portuguese PESO (Promotion of Health and Exercise in Obesity) trial, each of which focused on promoting physical activity behavior. The SDT-based intervention components, procedures, and participants are highlighted, and the key findings that have emanated from these three trials are presented. Lastly, we outline some of the limitations of the work conducted to date in this area and we acknowledge the challenges that arise when attempting to design, deliver, and test SDT-grounded interventions in the context of physical activity promotion

Changing Healthcare Provider and Parent Behaviors in the Pediatric Post‐Anesthesia‐Care‐Unit to Reduce Child Pain: Nurse and Parent Training in Postoperative Stress (NP‐TIPS)

Background Children who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain. Methods In Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically‐based intervention which was then evaluated by experienced nurses (N = 8) and parents (N = 9) during focus groups. After revising the intervention based on focus group feedback, it was tested in Phase 2 using a pre‐post study design. Nurses (N = 23) who worked in the recovery room were recruited to be part of both pre‐ and post‐intervention data collection periods. Parents were recruited to be part of either the pre‐ (N = 52) or post‐intervention (N = 60) data collection periods. Nurses and parent‐child dyads were recorded in the post anesthesia care unit and videos were coded for the desired (i.e., behaviors that may decrease child pain) and non‐desired (i.e., behaviors that may increase child pain) behaviors. Pain data was collected from the children\u27s medical records to assess pain after surgery. The intervention was given to the nurses and parents in the post‐intervention data collection period. Results Nurses significantly increased their rate of desired behaviors by 231% (p = 0.001; Somer\u27s D = 1) and significantly decreased their rate of non‐desired behaviors by 62% (p = 0.004, Somer\u27s D = ‐0.88, 95% CI [‐1.74, ‐0.03]). Parents significantly increased their rate of desired behaviors by 124% (p = 0.033). Moreover, the intervention significantly decreased child pain in the post anesthesia care unit (b = ‐2.19, SE = 0.63, z = ‐3.46, p = .001, 95%CI [‐3.43, ‐0.95]). Conclusions The intervention was effective in changing nurse and parent behaviors as well as child pain after surgery

Revisiting a Common Measure of Child Postoperative Recovery: Development of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS)

Background The Post Hospitalization Behavior Questionnaire (PHBQ) was designed for assessing children\u27s posthospitalization and postoperative new‐onset behavioral changes. However, the psychometric properties of the scale have not been re‐evaluated in the past five decades despite substantial changes in the practice of surgery and anesthesia. In this investigation, we examined the psychometric properties of the PHBQ to potentially increase the efficacy and relevance of the instrument in current perioperative settings. Method This study used principal components analysis, a panel of experts, Cronbach\u27s alpha, and correlations to examine the current subscale structure of the PHBQ and eliminate items to create the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ‐AS). Data from previous investigations (N = 1064, Mage = 5.88) which utilized the PHBQ were combined for the purposes of this paper. Results A principal components analysis revealed that the original subscale structure of the PHBQ could not be replicated. Subsequently, a battery reduction, which utilized principal components analysis and a panel of experts, was used to eliminate the subscale structure of the scale and reduce the number of items from 27 to 11, creating the PHBQ‐AS. The PHBQ‐AS demonstrated good internal consistency reliability and concurrent validity with another measure of children\u27s psychosocial and physical functioning. Conclusion Revising the former subscale structure and reducing the number of items in the PHBQ to create the PHBQ‐AS may provide a means for reducing the burden of postoperative behavioral assessment through decreasing time of administration and eliminating redundancy of items and allow for more accurate measurement of child postoperative behavioral changes

Children and Their Parents’ Assessment of Postoperative Surgical Pain: Agree or Disagree?

Objective The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration. Methods This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain Scale-Revised, children; Numeric Rating Scale, parents) on postoperative recovery days 1, 2, and 3, reflecting an overall pain level for the past 24 h. Parents also completed a log of analgesic administration. Based on postoperative pain scores, parent-child dyads were classified as overestimators (i.e., parents rated their child\u27s pain higher than children rated their own pain), in agreement (i.e., rating in agreement), or underestimators (i.e., parents rated their child\u27s pain lower than children rated their own pain). Results A significant proportion of parent-child pairs disagreed on pain ratings on postoperative days 1–3 (30.05%–35.95%). Of those pairs in disagreement, the majority of parents overestimated their child\u27s pain on all three postoperative days, specifically such that a total of 24–26% parents overestimated their child\u27s pain on postoperative days 1, 2, and 3. Repeated measures ANOVA demonstrated that parents in the overestimator group administered higher, though still within safe limits, amounts of ibuprofen and oxycodone (mg/day) than did the underestimator or agreement groups. Multiple regression models showed hospital site as the only independent predictor for postoperative pain rating disagreement between children and parents. Conclusions Since parents overestimate their child\u27s postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A

Parental Satisfaction of Child\u27s Perioperative Care

Background Satisfaction in the hospital setting is an important component of both hospital funding and patient experience. When it comes to a child\u27s hospital experience, parent satisfaction of their child\u27s perioperative care is also necessary to understand. However, little research has been conducted on the predictors of this outcome. Therefore, the purpose of this current study was to validate a priori selected predictors for parental satisfaction in their child\u27s perioperative process. Methods Eight hundred and ten pediatric patients who underwent tonsillectomy and adenoidectomy surgery and their parents were included in this study. The primary outcome was assessed using a 21‐item parent satisfaction questionnaire resulting in three satisfaction scores: overall care satisfaction, OR/induction satisfaction, and total satisfaction. Results Descriptive statistics and correlational analysis found that sedative‐premedication, parental presence at anesthesia induction, child social functioning, parental anxiety, and language were all significant predictors of various components of the satisfaction score. Regression models, however, revealed that only parent anxiety and child social functioning remained significant predictors such that parents who reported lower state anxiety (OR/induction satisfaction: OR = 0.975, 95% CI [0.957, 0.994]; total satisfaction: OR = 0.968, 95% CI [0.943, 0.993]) and who had higher socially functioning children (overall care satisfaction: OR = 1.019, 95% CI [1.005, 1.033]; OR/induction satisfaction: OR = 1.011, 95% CI [1.000, 1.022]) were significantly more satisfied with the perioperative care they received. Conclusion Lower parent anxiety and higher child social functioning were predictive of higher parental satisfaction scores

A Comprehensive Examination of the Immediate Recovery of Children Following Tonsillectomy and Adenoidectomy

Objectives Using multiple well-validated measures and a large sample size, the goal of this paper was to describe the immediate clinical and behavioral recovery of children following tonsillectomy with or without an adenoidectomy (T&A) during the first two weeks following surgery. Study design Observational, longitudinal study. Setting Four major pediatric hospitals in the U.S. consisting of Children\u27s Hospital of Orange County, Children\u27s Hospital of Los Angeles, Lucile Packard Children\u27s Hospital, and Children\u27s Hospital Colorado. Subjects and Methods: Participants included 827 patients between 2 and 15 years of age who underwent tonsillectomy with or without adenoidectomy surgery. Baseline and demographic information were gathered prior to surgery, and measures of clinical, behavioral, and physical recovery were recorded immediately following and up through two weeks after surgery. Results Pain following T&A was clinically significant through the first post-operative week and nearly resolved by the end of the second week. Negative behavioral changes were highly prevalent after surgery (75.6% of children at Day 0) through the first week (63.9% at Week 1), and over 20% of children continued to evidence new onset negative behavioral changes at two weeks post-operatively. Children were rated as experiencing significant functional impairment in the immediate three days following surgery and most children returned to baseline functioning by the end of the second week. Conclusions Results of this study suggest that children show immediate impairment in functioning and experience clinically significant pain throughout the first week following T&A, and new onset maladaptive behavioral changes persisting even up to the two-week assessment period

Improving Physical Activity and Dietary Behaviours with Single or Multiple Health Behaviour Interventions? A Synthesis of Meta-Analyses and Reviews

Since multiple health behaviour interventions have gained popularity, it is important to investigate their effectiveness compared to single health behaviour interventions. This synthesis aims to determine whether single intervention (physical activity or dietary) or multiple interventions (physical activity and dietary) are more effective at increasing these behaviours by synthesizing reviews and meta-analyses. A sub-purpose also explored their impact on weight. Overall, reviews/meta-analyses showed that single health behaviour interventions were more effective at increasing the targeted behaviours, while multiple health behaviour interventions resulted in greater weight loss. This review may assist policies aiming at improving physical activity and nutrition and reversing the obesity epidemic