Enhancing attachment-based aspects of PCIT for young children with a history of maltreatment

Disruptive behavior difficulties, such as aggression, non-compliance, and emotional outbursts, are common among children exposed to maltreatment. Parent–Child Interaction Therapy (PCIT) is an effective parenting intervention for addressing child behavior difficulties, however, treatment retention and engagement among parents remain a concern in the clinical setting. This paper describes how the delivery of an intervention that teaches attachment theory concepts (Circle of Security-Parenting, COS-P) prior to PCIT can increase engagement and retention among parents of maltreated children and inform new coaching practices. A detailed description of how to extend and integrate COS-P concepts with PCIT for maltreated families using specific strategies is provided. Recommendations, limitations, and next steps for research are presented

The relationship between caregiver sensitivity and infant pain behaviors across the first year of life.

Recent research has begun to examine discrete caregiver pain management behaviors in the infant immunization context. However, there is a dearth of research exploring more global caregiving constructs, such as emotional availability, which can be used to examine the overall sensitivity of caregiver pain management. The aim of the present study was to examine the relationships between caregiver sensitivity (emotional availability) and infant pain behavior (baseline, immediately postneedle, 1 minute after needle) over the first year of life. Parents and infants were a part of a Canadian longitudinal cohort (The OUCH cohort) followed during their 2-, 4-, 6- and 12-month immunizations (current n=731). Both 'within-age' group analyses and 'over-age' analyses were performed. Results indicated that: 1) over age, previous infant pain behavior predicts future infant pain behavior, but this varied depending on timing of pain response and age of infant; 2) over age, previous caregiver sensitivity strongly predicts future caregiver sensitivity; and 3) the concurrent relationship between caregiver sensitivity and every type of infant pain response is only consistently seen at the 12-month immunization. Caregiver sensitivity to the infant in pain is predicted most reliably from previous caregiver sensitivity, not infant pain behaviour. The significant concurrent relationship between caregiver sensitivity and infant pain behaviours is not seen until 12 months, replicating patterns in the infant development literature regarding the time at which the attachment relationship between parent and child can be reliably measured. Discussion addresses implications for both researchers and clinicians who work with infants in pain

Vécu et contraintes lors de l'application d'une nouvelle approche pédagogique: Une étude de cas québécoise en comptabilité.

This paper presents the experience of faculty members of the accounting department at Université Laval in designing and implementing a new curriculum. These changes have resulted from the new requirements of the profession as well as the growing gap between employers' expectations and skills and professional attitudes of graduating accounting students. In addition to presenting the context of these changes, the paper discusses some of the difficulties faced during the implementation of the new curriculum and, more importantly, those faced when introducing a new teaching approach. The new curriculum is focused on a collaborative approach whereby student participation is solicited. However, several difficulties have been met during the implementation. For instance, faculty members face a higher level of uncertainty in the classroom and must devote more time in developing teaching material. Students' perceptions, obtained through focus groups, were that the new program did not prepare them properly and that some courses were not useful. Throughout the paper, we offer some strategies that can be used to minimize the impact of the difficulties faced when implementing a new teaching approach that can overturn previously firmly held beliefs about appropriate pedagogical methods.Cet article présente l'expérience vécue au Département des sciences comptables de l'Université Laval lors de la réforme des cours du baccalauréat. Cette réforme s'explique par les changements importants qui bouleversent la profession comptable et par l'écart grandissant entre les besoins des employeurs et les compétences et les attitudes professionnelles des finissants en comptabilité. En plus de présenter le contexte dans lequel s'est effectué la réforme, l'article fait état des obstacles rencontrés tout au long des modifications apportées au contenu des cours et, surtout, de l'implantation d'une nouvelle approche pédagogique. Le nouveau programme est centré sur une approche collaborative par problèmes où la participation de l'étudiant est fortement sollicitée. Un tel changement ne s'est pas fait sans rencontrer de nombreux obstacles. Par exemple, l'approche choisie a créé un niveau d'incertitude élevé chez les professeurs et a exigé, de leur part, d'allouer une partie importante de leur allouée au développement de matériel didactique. La perception des étudiants, obtenue à l'aide d'entrevues de groupe, était que les cours ne les préparaient pas adéquatement et que parfois, ils étaient inutiles. Nous proposons certains éléments de solution qui peuvent réduire l'impact des problèmes rencontrés lors de l'implantation d'une nouvelle approche pédagogique qui bouleverse certaines conceptions fortement ancrées

Predicting preschool pain-related anticipatory distress: the relative contribution of longitudinal and concurrent factors

Anticipatory distress prior to a painful medical procedure can lead to negative sequelae including heightened pain experiences, avoidance of future medical procedures, and potential non-compliance with preventative healthcare such as vaccinations. Few studies have examined the longitudinal and concurrent predictors of pain-related anticipatory distress. This paper consists of two companion studies to examine both the longitudinal factors from infancy, as well as concurrent factors from preschool that predict pain-related anticipatory distress at the preschool age. Study 1 examined how well preschool pain-related anticipatory distress was predicted by infant pain responding at 2, 4, 6 and 12 months of age. In Study 2, using a developmental psychopathology framework, longitudinal analyses examined the predisposing, precipitating, perpetuating, and present factors that led to the development of anticipatory distress during routine preschool vaccinations. A sample of 202 caregiverchild dyads was observed during their infant and preschool vaccinations (OUCH Cohort) and was used for both studies. In Study 1, pain responding during infancy was not found to significantly predict pain-related anticipatory distress at preschool. In Study 2, a strong explanatory model was created whereby 40% of the variance in preschool anticipatory distress was explained. Parental behaviours from infancy and preschool were the strongest predictors of child anticipatory distress at preschool. Child age positively predicted child anticipatory distress. This strongly suggests that the involvement of parents in pain management interventions during immunization is one of the most critical factors in predicting anticipatory distress to the preschool vaccination

Transitioning from pediatric to adult healthcare with an inborn error of immunity: a qualitative study of the lived experience of youths and their families

IntroductionTransition from pediatric to adult healthcare is a multifaceted and consequential process with important health implications for youth. Although research on transition has grown significantly, research on transition for patients living with an inborn error of immunity (IEI) is scarce. We undertook a qualitative study to better understand the perspectives of youths and parents in an outpatient immunology clinic.MethdosSemi-structured interviews were conducted with 9 youths, 6 parents and 5 clinicians, all recruited from the same clinic. All youths recently transferred to adult care with or without an established diagnosis of IEI. Interviews were transcribed verbatim and thematic analysis was conducted. Two sets of themes were generated. The first set captured the positive and negative aspects experienced during transition, as well as recommendations to facilitate the process. The second set focused on key topics discussed in the interviews that were merged into overarching themes.ResultsPerspectives of participants were clustered into 6 overarching themes: (1) lack of knowledge about IEIs; (2) scattered transitions; (3) changing healthcare teams; (4) approaching an unknown environment; (5) transitioning to adulthood; (6) assuming responsibility for the management of the condition. Overall, the challenges encountered with respect to these themes had profound clinical and humanistic implications for patients such as generating significant distress.DiscussionWe discuss the unique challenges of the youths in our study in comparison to common problems reported by youths with chronic illness in the broader transition literature (for example: the change of healthcare team, the lack of information about the transition process and navigating the adult care system, growth towards self-management and the co-occurring developmental transition to adulthood). There is an urgency to attend to the specific problems created by the rarity of IEIs and related lack of knowledge about them as well as the need for multidisciplinary cross-clinic care during transition and beyond

Physicians' attitudes toward medical and ethical challenges for patients in the vegetative state: comparing Canadian and German perspectives in a vignette survey

Background: Physicians treating patients in the vegetative state (VS) must deal with uncertainty in diagnosis and prognosis, as well as ethical issues. We examined whether physicians' attitudes toward medical and ethical challenges vary across two national medical practice settings. Methods: A comparative survey was conducted among German and Canadian specialty physicians, based on a case vignette about the VS. Similarities and differences of participants' attitudes toward medical and ethical challenges between the two samples were analyzed with non-parametric tests (Mann-Whitney-U-Test). Results: The overall response rate was 13.4%. Eighty percent of all participants correctly applied the diagnostic category of VS with no significant differences between countries. Many of the participants who chose the correct diagnosis of VS attributed capabilities to the patient, particularly the ability to feel pain (70%), touch (51%) and to experience hunger and thirst (35%). A large majority of participants (94%) considered the limitation of life-sustaining treatment (LST) under certain circumstances, but more Canadian participants were in favor of always limiting LST (32% vs. 12%; Chi-square: p < 0.001). Finding long-term care placement was considered more challenging by Canadian participants whereas discontinuing LST was much more challenging for German participants. Conclusions: Differences were found between two national medical practice settings with respect to physicians' experiences and attitudes about treatment limitation about VS in spite of comparable diagnostic knowledge

Infant pain-regulation as an early predictor of childhood temperament

BACKGROUND: There is considerable variability in infants’ responses to painful stimuli, including facial and vocal expressions. This variability in pain-related distress response may be an indicator of temperament styles in childhood. OBJECTIVE: To examine the relationships among immunization pain outcomes (pain reactivity, pain regulation and parent ratings of infant pain) over the first year of life and parent report of early temperament. METHODS: A subset of parent-infant dyads in an ongoing Canadian longitudinal cohort was studied. Infant pain behaviours were coded using the Modified Behavior Pain Scale. Parental judgments of infant pain were recorded using the Numeric Rating Scale. Infant temperament was measured using the Infant Behaviour Questionnaire-Revised. Correlational analyses and multiple regressions were conducted. RESULTS: Multiple regressions revealed that the 12-month regulatory pain scores predicted parent ratings of the Negative Affectivity temperament dimension at 14 months of age. Parent ratings of infant pain at 12 months of age predicted parent ratings of the Orienting/Affiliation temperament dimension, with sex differences observed in this substrate. CONCLUSION: Pain-related distress regulation at one year of age appears to be a novel indicator of parent report of temperament ratings. Pain outcomes in the first six months of life were not related to parent temperament ratings

Systematic review: predisposing, precipitating, perpetuating, and present factors predicting anticipatory distress to painful medical procedures in children.

Objective To conduct a systematic review of the factors predicting anticipatory distress to painful medical procedures in children. Methods A systematic search was conducted to identify studies with factors related to anticipatory distress to painful medical procedures in children aged 0–18 years. The search retrieved 7,088 articles to review against inclusion criteria. A total of 77 studies were included in the review. Results 31 factors were found to predict anticipatory distress to painful medical procedures in children. A narrative synthesis of the evidence was conducted, and a summary figure is presented. Conclusions Many factors were elucidated that contribute to the occurrence of anticipatory distress to painful medical procedures. The factors that appear to increase anticipatory distress are child psychopathology, difficult child temperament, parent distress promoting behaviors, parent situational distress, previous pain events, parent anticipation of distress, and parent anxious predisposition. Longitudinal and experimental research is needed to further elucidate these factor

Far from just a poke : Common painful needle procedures and the development of needle fear

Background: Vaccine injections are the most common painful needle procedure experienced throughout the lifespan. Many strategies are available to mitigate this pain; however, they are uncommonly utilized, leading to unnecessary pain and suffering. Some individuals develop a high level of fear and subsequent needle procedures are associated with significant distress. Objective: The present work is part of an update and expansion of a 2009 knowledge synthesis to include the management of vaccinerelated pain across the lifespan and the treatment of individuals with high levels of needle fear. This article will provide a conceptual foundation for understanding: (a) painful procedures and their role in the development and maintenance of high levels of fear; (b) treatment strategies for preventing or reducing the experience of pain and the development of fear; and (c) interventions for mitigating high levels of fear once they are established. Results: First, the general definitions, lifespan development and functionality, needle procedure-related considerations, and assessment of the following constructs are provided: pain, fear, anxiety, phobia, distress, and vasovagal syncope. Second, the importance of unmitigated pain from needle procedures is highlighted from a developmental perspective. Third, the prevalence, course, etiology, and consequences of high levels of needle fear are described. Finally, the management of needle-related pain and fear are outlined to provide an introduction to the series of systematic reviews in this issue. Discussion: Through the body of work in this supplement, the authors aim to provide guidance in how to treat vaccination-related pain and its sequelae, including high levels of needle fear