Parental Separation Research Articles

Parents' Separation: What is the Effect on Parents' and Children's Time Investments?*

AbstractThis paper investigates the effect of parental separation on children's allocation of their time and on the time spent with their parents. Based on detailed time‐use diaries from the Panel Study of Income Dynamics – Child Development Supplement, I estimate an individual fixed‐effect model and find that being in a single‐parent family decreases time with a parent accessible by 18% of a standard deviation (3 hours 30 minutes per week). Time spent with both parents together and alone with the non‐custodial parent is greatly affected, but the custodial parent partially compensates for this decrease. The decrease in time with a parent actively engaged in activities is, however, not statistically significant. Younger children continue spending as much time with their parents after separation. Effects on boys and girls differ, but this difference depends on the type of parental time investment we consider. Time spent with a grandparent acts as a recovery channel in single‐mother families. Time with a step‐parent increases but does not lead to an accumulation of parental time.

Dexmedetomidine-Ketamine or Dexmedetomidine-Midazolam Nebulised Drug Combination as a Premedicant in Children: A Randomised Clinical Trial.

This study was designed to evaluate the clinical efficacy of 2 low-dose nebulised drug combinations of dexmedetomidine-ketamine and dexmedetomidine-midazolam as a premedication in children scheduled for surgery under general anaesthesia. Sixty children classified as American Society of Anesthesiologists physical status I, aged between 3 and 10, listed to undergo elective surgeries under general anaesthesia were enrolled in this prospective, randomised, and double-blind trial. Patients were randomly allocated to receive nebulised premedication approximately 30 minutes before the induction of anaesthesia. Group DK (n=30) received combined nebulised dexmedetomidine and ketamine (1 μg kg-1+1 mg kg-1 ) and the dexmedetomidine-midazolam (DM) group (n=30) received combined nebulised dexmedetomidine and midazolam (1 μg kg-1+0.1 mg kg-1 ). All children were anaesthetised with a protocolised anaesthesia technique. The primary end point was the level of sedation when the child was first seen in the operating room 30 minutes after nebulisation. The secondary end points were parental separation and ease of induction, ease of acceptance of IV cannula, mask acceptance, postoperative analgesia, and wake-up behaviour. Studied groups were comparable in demographic data (age, weight, and sex) and duration of anaesthesia. Level of sedation at 30 minutes was significantly greater in the DM group than in the DK group (P =.013) while the two were comparable in parental separation and ease of induction (P =.808). Group DK exhibited superior ease of acceptance of IV cannula (P =.001), mask acceptance score (P =.001), and postoperative analgesia (P =.021). Hemodynamic parameters and oxygen saturation remained comparable at all time intervals as also the wake-up behaviour. The nebulised combination of low-dose ketamine and dexmedetomidine was a superior combination producing acceptable sedation with enhanced ease of IV acceptance, mask acceptance, and postoperative analgesia in children.

Childhood adversity and risk of later labor market marginalization in young employees in Sweden

Abstract Background The present study examined the independent and combined effects of childhood adversity (CA) and occupational class on the risk of future labor market marginalization (LMM) in young employees in Sweden. Occupational class (non-manual/manual workers) was also explored as a potential mediator. Methods This population-based longitudinal cohort study included 556,793 employees, 19-29 years, residing in Sweden in 2009. CAs included parental death, parental mental and somatic disorders, parental separation, household public assistance, single-parent household and residential instability. Measures of LMM included long-term unemployment (LTU), long-term sickness absence (LTSA) and disability pension (DP). Estimates of risk of each LMM measure, between 2010 and 2016 were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI), using a Cox regression analysis. Results Those exposed to CA had an elevated risk for all measures of LMM. Manual workers with a history of household public assistance had the highest risk estimates compared to non-manual workers with no CAs (adjusted HR spanning from 1.59 (LTSA) to 2.50 (LTU). Regardless of occupational class, the risk of LMM grew higher with increasing number of CAs (e.g. adjusted HR of LMM in manual workers with 3+ CAs: 1.87, 95% CI: 1.81-1.94). These patterns persisted after adjustments for a range of confounders, including psychiatric and somatic morbidity. Last, we found a small but significant mediating effect of occupational class in the association between CA and LMM. Conclusions Information on CAs are important determinants of LMM in young adults, and especially in manual workers. Key messages • Those exposed to childhood adversity had an elevated risk of labor market marginalization, in terms of long-term unemployment, long-term sickness absence and disability pension. • Information on childhood adversity is an important determinant of labor market marginalization in young adults, and especially in manual workers.

43 Impact of a Virtual Behavioural Support Intervention on improving behaviour, mental health, and Academic Engagement and Motivation for children with ADHD and their families: a Pilot Study

Abstract Background Children with ADHD struggle with their academic achievement, well-being, and social functioning. COVID-19 restrictions negatively impacted families of children with ADHD and limited their access to services. This led to the creation of the online ADHD-VIBES program (VIrtual BEhavioural Support Intervention for Children with ADHD). Objectives To determine the efficacy of the ADHD-VIBES program to support families of children with ADHD in behavioural, mental health, academic motivation, and engagement challenges. Design/Methods The ADHD-VIBES program was an online program created to support children with ADHD and their families. It consisted of separate parent and child sessions (1-hour each) for six weeks, targeting the development of self-regulation, positive thinking, communication, problem-solving and executive function skills. To our knowledge, there was no other online program offering the same program content during the pandemic. All children met the following criteria: confirmed ADHD based diagnosis of child on parent ratings on Conners-3 Rating Scale (T-score > 65); IQ score > 80 on the WASI-II abbreviated; and access to technology to join virtual groups. Parents completed the Behavior Assessment System for Children (BASC-3) and the Parenting Stress Index (PSI-4-SF) questionnaires. Children completed the BASC-3, the Executive Skills Questionnaire (ESQ), and the Motivation and Engagement Scale (MES). All questionnaires were completed at three different time-points: pre-intervention, post-intervention, and two-months after intervention. A survey was completed at the end of the intervention to determine level of satisfaction of parents towards the ADHD-VIBES. Results A total of 12 boys between the ages of 8 to 11 years old (M = 9.62, SD = 0.94), and their caregivers, took part in this program (summer 2021). On the BASC-3, parents reported significantly lower levels of depression and anxiety (F:5.65, p=.016; F:6.21, p=.012) after completion of the ADHD-VIBES program. No significant difference was reported by the children on the BASC-3. On the PSI-4-SF, there was no statistical difference observed (parental distress p=0.244). Improvement associated with executive skills (ESQ) were noticed related to Planning/Preparation (F:4.86, p=.019), Time Management (F:7.08, p=.005) and Goal Directed Persistence (F:5.71, p=.011). On the MES, negative Motivation subscales scores demonstrated a decrease in raw scores (T1=40.78; T2=35.75; T3=30.98; p=.103). Finally, all parents (100%) were satisfied/very satisfied with the ADHD-VIBES intervention. Conclusion The ADHD-VIBES online intervention showed promising improvement on some behavioural issues, and executive function skills. However, future randomized controlled studies with a larger sample size are required to better understand the impact of the intervention for children with ADHD and their parents.

Understanding child support arrangements in Colombia: A social exchange theory perspective

AbstractObjectiveIn this research, we examine the characteristics of custodial‐mother families with a child support arrangement in Colombia and how key concepts from social exchange theory are associated with having these arrangements.BackgroundA significant proportion of custodial‐mother families do not receive financial support from noncustodial fathers. Prior research has identified processes behind low rates of child support receipt, but little is known about which factors determine whether separated parents make a child support arrangement in the first place, especially in less affluent countries.MethodsUsing data on custodial mothers interviewed in the Colombian Longitudinal Survey, we used descriptive statistics to examine the characteristics of custodial mothers with a child support arrangement and estimated logistic regression models to examine how economic dependence and commitment before separation are associated with having a child support arrangement.ResultsOnly 35.7% of custodial‐mother families had a child support arrangement, typically a private one. Mothers with an arrangement were more socioeconomically advantaged than those who did not have one. Only economic independence factors were significantly associated with having an arrangement, and a custodial mother's economic independence discouraged having any child support arrangement.ConclusionEconomic factors may bear more weight than interpersonal ties in decisions to pursue a child support arrangement in Colombia.ImplicationsAn assessment of the costs associated with pursuing a child support arrangement in Colombia is an important step to improve the child support system's outreach to custodial mothers, current programming, and type of services provided at different stages of the process.

What About the Children? Co-Occurrence of Child Maltreatment and Parental Separation.

The aim of this study was to investigate (a) the extent to which child maltreatment co-occurs with parental separation and (b) associations between different types of child maltreatment and various types of separation-associated interparental conflict. Professionals working with children (N = 785) reported each case of suspected child maltreatment they observed during a 3-month period and indicated whether parental divorce or separation was about to take place or had taken place. This resulted in 530 reported cases that matched the definitions of child maltreatment for which information on parental relationship status was available. Most of the maltreated children (60%) also experienced (impending) parental separation. In 69% of these cases child maltreatment was associated with parental separation. Particularly, cases of emotional neglect, and emotional abuse co-occurred with parental separation. In addition, four clusters of separation-associated interparental conflict were distinguished- No observed conflict, Non-physical conflict, Verbal and physical conflict, and Multiple conflict-which were associated with child and family characteristics and specific types of child maltreatment. The results of this study suggest that child maltreatment often co-occurs with parental separation, especially when there is a considerable amount of interparental conflict.

Adverse childhood experiences and child behavioral health trajectory from early childhood to adolescence: A latent class analysis

BackgroundAdverse childhood experiences (ACEs) profoundly influence child development. Different patterns of ACEs among boys and girls may be associated with different developmental trajectories. ObjectiveThis study aimed to identify patterns of ACEs at age three and tested the associations of these patterns with child behavioral health problems from age three to age fifteen. Participants and settingThis study used data (N = 4898) from the Fragile Families Child Wellbeing Study. MethodsFirst, this study conducted latent class analysis (LCA) across ten indicators of ACEs at age 3. LCA was conducted separately for boys and girls. Second, class membership was tested for associations with child internalizing symptoms and externalizing behaviors (ages three, five, nine, and fifteen years). ResultsLCA identified five classes of ACEs for girls: low ACEs, parental separation, financial difficulty, chaotic home, and child maltreatment. LCA for boys, however, identified a six-class solution, in which there was a physical abuse-only class, while also a sixth high ACEs class that included both physical and emotional abuse. Classes with the most ACEs often had the highest symptomology (internalizing symptoms ranging from 0.24 to 0.56; externalizing ranging from 0.36 to 1.00; ps < .05). However, differences in behavioral health were detected depending on the patterns of ACES. At ages nine and fifteen, the financial difficulty group also had high symptomatology (internalizing symptoms ranging from 0.23 to 0.43; externalizing from 0.23 to 0.46; ps < .05). ConclusionsFindings provide implications including the need to examine ACEs heterogeneity and address financial difficulty as a substantial ACE.

The mental load in separated families

Objective: This paper asks how evolving contact and gendered working lives, gendered identities, and conflict and parental relationships influence cognitive labour in separated families.&#x0D; Background: The fact that the often-invisible work of planning, researching, and executing decisions concerning children and household maintenance is borne by women/mothers, receives growing research attention, yet, the bulk of this research focuses on the gendered division of the mental load in intact families. Given the high prevalence of separated families with high levels of father contact, more work is needed to understand how cognitive labour is divided by parents residing in separate households.&#x0D; Method: This paper draws on 31 semi-structured interviews of separated parents, including 7 former couples. Interviews were sampled from a nationally representative longitudinal survey, Understanding Society, professionally transcribed and thematically analysed with Nvivo.&#x0D; Results: Analysing the interviews reveals both continuity and change in the division of the mental load following separation. For some families, gendered identities and working lives continue to justify an unequal division of the mental load, even when children spend large amounts of time solely with fathers. In others, conflict can reduce communication between parents, either increasing fathers cognitive labour through parallel parenting or decreasing it when fathers are excluded from decision-making altogether. Finally, separation can present a turning point where working lives and identities are re-evaluated, and the mental load can be negotiated anew.&#x0D; Conclusion: We provide new evidence that the mental load remains gendered even among those practicing a relatively "modern" family form of shared care post-separation, while highlighting possibilities for variation and change.

The mediating pathways between parental separation in childhood and offspring hypertension at midlife

The mediating pathways between parental separation in childhood and offspring hypertension at midlife

Influence of Parental Separation Anxiety-Induced Traumatic Stress on Substance Use among the Youth in Private and Public Universities in Lang’ata Constituency, Nairobi County

Substance use among the youth has been on the rise in Kenya; leading to a lot of psychosocial problems. In spite of varied initiatives by the Kenya Government, Non-Governmental Organizations (NGOs) as well as the local and international community to control substance use, very little, less progress has been achieved hence, the need to study in detail the psychosocial factors associated with substance use among the youths in private and public Universities. The study investigated the influence of separation anxiety on substance use among the youths in private and public universities in Lang’ata Constituency, Nairobi County specifically, the Co-operative University of Kenya and Jomo Kenyatta University of Agriculture and Technology (JKUAT, Karen Campus), The Catholic University of Eastern Africa (CUEA) and Tangaza University College (TUC). The research employed descriptive survey design and the target population of 140 comprising: students, counsellors, and deans of students. A sample size of 104 participants was selected using stratified random sampling followed by Simple random sampling and Purposive sampling. The research instruments for data collection were pre-tested using Spearman’s rank-order formula for test-retest to compute the correlation coefficient to establish reliability. A correlation coefficient of + 0.65 and above was considered high enough for reliability. The study had a correlation coefficient of + 0.7 and hence, determined the reliability of the instruments, and the validity was perfected by experts. Data were collected using questionnaires, interview schedules, and the PTSD checklist to access trauma among the students. A pilot study was conducted in a neighboring public university of 14% target population participants to correct the instruments and for triangulation purposes. Descriptive statistics including mean, frequency tables, percentages, and ratios as well as inferential statistics including Pearson’s correlation was used to analyze the data with the help of the Advanced Microsoft Excel Package for Data Analysis. The study established that the interaction between parental separation anxiety significantly influenced university students on substance use (dependent variable) (r=0.570). Based on the study findings, it is recommended that there should be strong therapeutic interventions for students suffering from separation anxiety. This can be done by the universities as well as civil society organizations through guidance and counselling as well as social support interventions. The government, through security agencies, should provide strong bulwarks against physical violence targeted at students.

Child Parent Relationship Therapy: Reunification with Children and Parents with Substance Use Disorders

ABSTRACT Exposure to parental substance use disorder (SUD) has significant and lasting effects on the development of children emotionally, physically, within the educational environment, as well as within the parent-child relationship. The separation of parent and child within families with SUDs is commonplace as child protective services involve due to the increased frequency of child abuse, neglect, and criminal activity. To date, no specific reunification approach for working with parents with SUDs has been identified or suggested. Given that child parent relationship therapy (CPRT) centers on enhancing secure attachment between parents and children and promoting parents’ understanding of the needs of their children, the authors discussed CPRT as an innovative intervention with parents with SUDs to reestablish or establish a healthy connection with their children. A brief clinical case example was given followed by implications for clinicians.

Validity and reliability of the persian version of the world health organization quality of life disabilities module.

This study aimed to assess the validity and reliability of the world health organization quality of life questionnaire for people with intellectual disability (WHOQOL-DIS-ID). This was a cross-sectional study of 118 adults with intellectual disability. Internal consistency and temporal reliability were evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Construct validity of the structure was assessed using confirmatory factor analysis. Multiple linear regression analysis was performed to determine the factors associated with the quality of life. Cronbach's alpha for all, but not for discrimination area, as well as ICC for all questions except for 23 and 6, were higher than 0.7. The variables such as periodic check-up, number of friends, entertainment outside the home, parental separation, physical activity, unmet needs score, caregiver's mental health status, and available facilities were the predictors of QOL. The Persian version of the WHOQOL-DIS-ID shows acceptable validity and reliability.

Comparison of different sedatives in children before general anaesthesia for selective surgery: A network meta-analysis.

It is estimated that 60% of children undergoing anaesthesia develop severe preoperative anxiety. The anxiety is associated with adverse reactions. Sedatives such as dexmedetomidine, midazolam, clonidine, ketamine, and melatonin can be used as premedication against preoperative anxiety. However, no consensus has been reached on the choice of pre-anaesthetic sedatives in children before selective surgery. Therefore, the current network meta-analysis (NMA) was carried out to evaluate different sedatives in children aged between 1 and 7 before general anaesthesia for selective surgery. Randomized clinical trials (RCTs) were retrieved from Pubmed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases from inception to October 22, 2021. Primary outcomes showed satisfactory sedation at parent separation and also at induction or mask acceptance. Secondary outcomes were those related to added benefits and side effects. The present NMA was conducted using the R software. Results of the study were reported as Relative Risk (RR) or Mean Difference (MD) at a 95% credible intervals (CrIs). A total of 48 trials were included in the present study. It was found that the effectiveness of dexmedetomidine, midazolam, clonidine, and ketamine were superior to that of placebo in satisfactory sedation at parent separation and induction or mask acceptance. There was no significant difference between melatonin and placebo in satisfactory sedation at induction or mask acceptance. Dexmedetomidine, ketamine, clonidine, and melatonin were superior to placebo in reducing emergence delirium (ED). In addition, midazolam prolonged the length of stay in the post anaesthesia care unit (PACU) as compared with placebo. Dexmedetomidine caused a significant reduction in systolic blood pressure (SBP) and heart rate (HR). Nevertheless, it was noted that the hemodynamic changes were roughly within safety limits. It was evident that the studied drugs can provide effective sedation with exception of melatonin and placebo. However, it was found that midazolam, ketamine, and clonidine lead to several side effects. The findings of the present study supported that dexmedetomidine, especially intranasal administration, has potential in the optimal selection of the sedatives for premedication in children. This is because the drug has effective sedation, reduced incidence of ED, side effects, and onset time.

Negative Life Experiences, Substance Use, Well-Being, and Resilience: A Comparison of Deaf and Hearing Adults

Individuals who are deaf and use American Sign Language (ASL) as their primary mode of communication experience unique negative life experiences, such as lack of communication, limited access to services, marginalization, and discrimination, that can adversely impact resilience and psychological well-being. In addition, deaf individuals experience higher rates of intimate partner violence, poly-victimization, sexual, physical, and emotional abuse, and unemployment. These negative life experiences can sometimes be accompanied by maladaptive behaviors, such as substance use. Resilience and a positive sense of well-being can help to mitigate adverse life events. This survey research utilizes a sample of 206 deaf participants, whose primary language is ASL, and hearing participants to examine the relationships between negative life experiences, substance use, resilience, and well-being. Findings indicate: 1) deaf participants reported experiencing several negative life events significantly more often than their hearing counterparts, specifically being sent to jail or prison, having a serious physical illness, and sexual abuse by a partner than hearing participants; 2) deaf participants reported more experiences of having an abortion or miscarriage and parental separation or divorce as children than their hearing counterparts; 3) deaf individuals reported higher marijuana use than their hearing counterparts, but less use of stimulants, inhalants, and prescription drug abuse; 4) experiences of mental illness was significantly associated with resilience and well-being; and 5) deaf and hearing participants had similar scores in resilience and well-being. The author identifies strengths and limitations of the study and discusses implications for future research.

Childhood Adversity and Mental Health Outcomes Among University Students: A Longitudinal Study.

Mental health concerns are common among university students and maybe elevated among those with specific risk exposures. The study examined the association between childhood adversities and mental health outcomes among undergraduate university students and assessed whether psychosocial and behavioral factors mediate those associations. The Queen's University Student Well-Being and Academic Success Survey identified two large cohorts of first-year undergraduate students entering university in Fall 2018 and 2019 (n = 5,943). At baseline, students reported sociodemographic information, family-related mental health history, childhood physical abuse, sexual abuse, peer bullying, and parental separation or divorce. Baseline and follow-up surveys in Spring 2019, Fall 2019, and Spring 2020 included validated measures of anxiety (7-item Generalized Anxiety Disorder) and depressive symptoms (9-item Patient Health Questionnaire ), non-suicidal self-harm, and suicidality, along with psychological processes and lifestyle variables. Repeated measures logistic regression using Generalized Estimating Equations was used to characterize the associations between childhood adversities and mental health outcomes and examine potential mediation. Adjusting for age, gender, ethnicity, familial mental illness, and parental education, any childhood abuse (odds ratio: 2.89; 95% confidence interval, 2.58 to 3.23) and parental separation or divorce (odds ratio: 1.29; 95% confidence interval, 1.12 to 1.50) were significantly associated with a composite indicator of mental health outcomes (either 9-item Patient Health Questionnaire score ≥10 or 7-item Generalized Anxiety Disorderscore ≥10 or suicidality or self-harm). The association with childhood abuse weakened when adjusted for perceived stress, self-esteem, and insomnia (odds ratio: 2.05; 95% confidence interval, 1.80 to 2.34), and that with parental divorce weakened when adjusted for self-esteem (odds ratio: 1.17; 95% confidence interval, 1.00 to 1.36). Childhood abuse and parental separation or divorce were associated with mental health concerns among university students. Childhood adversities may impact later mental health through an association with stress sensitivity, self-esteem, and sleep problems. The findings suggest that prevention and early intervention focusing on improving sleep, self-esteem, and coping with stress while considering the individual risk profile of help-seeking students may help support student mental health.

Adverse childhood experiences and premature mortality through mid-adulthood: A five-decade prospective study

Adverse childhood experiences (ACEs) can have lasting effects on adult health and survival. In this study, we aimed to examine how the cumulative number and clustering patterns of ACEs were related to premature mortality. Participants (N=46 129; 45% White, 48% Black; 49·5% females) were offspring (born in 1959-1966) of participants enrolled in the Collaborative Perinatal Project (CPP). We conducted latent class analysis to examine the clustering patterns of ACEs assessed between children's birth and age seven. We also calculated the cumulative ACE scores of 13 individual ACEs. Cox regression models were used to examine the associations of ACE clusters and scores with risk of premature mortality from adolescence to mid-adulthood. At the start of the follow-up for mortality in 1979, participants were 12-20 years old (Mean=15·99 years), and within the 38-year follow-up through 2016, 3 344 deaths were observed among the 46 129 CPP offspring. Five latent classes of ACEs were identified. Compared to children with Low Adversity (48% of the sample), children in Family Instability (9%, HR=1·28, 95%CI 1·07-1·53), Poverty & Crowded Housing (21%, HR=1·41, 95%CI 1·24-1·62), and Poverty & Parental Separation (19%, HR=1·50, 95%CI 1·33-1·68) classes had higher hazards of premature mortality. In addition, children with 2 (HR=1·27, 95%CI 1·14-1·41), 3 (HR=1·29, 95%CI 1·15-1·45), and 4+ (HR=1·45, 95%CI 1·30-1·61) ACEs had higher hazards of mortality than those with no ACE. The clusters of Poverty & Crowded Housing (HR=1·28, 95%CI 1·10-1·49) and Poverty & Parental Separation (HR=1·23, 95%CI 1·02-1·48) remained associated with higher risk of premature mortality, beyond the cumulative risk of higher number of ACEs (HR=1·05, 95%CI 1·01-1·08). About half of the CPP cohort experienced early life adversities that clustered into four distinct patterns, which were associated with different risk of premature mortality. It is important to deepen our understanding of how specific clusters of childhood adversities affect health and premature mortality to better inform approaches to prevention and interventions.

Virtual Reality Glasses versus Midazolam in Alleviation of Child’s Anxiety during Dental Rehabilitation: Randomized Controlled Clinical Trial

Objective: To evaluate virtual reality glasses versus premedication with oral midazolam, and their effect on separation anxiety and postoperative behavioural changes in children experiencing dental rehabilitation under general anaesthesia. Introduction: Several children suffer anxiety when experiencing dental rehabilitation under general anaesthesia, which may be caused by separation from parents, and negative anticipation of surgical procedures. Midazolam (MDZ) is a generation of Benzodiazepines that have been widely used as a premedication. Whereas distraction is a common technique used to reduce pain and anxiety during short invasive procedures. Methodology: This was a randomized clinical trial; children aged 4-6 years who were healthy, uncooperative, and planned to be treated using general anaesthesia were randomly distributed between two groups (Group I), using the Virtual glasses and (Group II), given oral midazolam. The baseline heart rate (HR) was recorded twice. Ease of separation was assessed for all the participants using the Parental Separation Anxiety Scale (PSAS). The Postoperative behavioural changes were scored using (PHBQ) Questionnaire after 24 hours and 14 days after the operation. Results: Regression analysis showed that the type of intervention was non-significantly associated with the acceptability of separation. Males showed significantly less acceptable separation than females. There was a statistically significant increase in the heart rate readings in both groups when compared before and after separation. The parent-reported child morbidity following the surgery showed no significant difference except when regarding the children “who were upset at mentioning doctors, dentists or hospitals” where (P=0.000). Conclusion: VR and premedication with oral midazolam were both effective strategies for controlling preoperative anxiety in children during parental separation, with lots of advantages when using the VR distraction approach.

Parental Attitude Towards the Prescription of Psychotropic Medications for Mental Disorders in Children in a Tertiary Care University Hospital in Oman.

This study aimed to investigate parental attitude towards psychotropic drugs' use for children's mental disorders. This cross-sectional study was conducted from December 2020 to March 2021 at the Department of Behavioural Medicine, Sultan Qaboos University Hospital, Muscat, Oman. A questionnaire was used to determine parents' opinions and attitudes about use of psychotropic medications on their children and, in a small proportion, other caregivers if the child attended with them. Risk factors associated with parents who preferred to consult a folk healer (FH) for children with mental disorders were identified by the logistic regression model. A total of 299 parents participating in the study (response rate: 95.2%). Most (n = 244, 81.6%) agreed to give their child psychotropic medications if necessary, but 25.4% (n = 76) would consult an FH before a psychiatrist. Married parents were 14.5 times (P = 0.011) more likely than separated or divorced parents to consult an FH. Caregivers with a monthly income below 500 OMR and between 500 and 1,000 OMR were 2.5 (P = 0.016) and 3.2 times (P <0.001), respectively, more likely than those with more than 1,000 OMR to consult an FH. Parents who disagreed with giving their children psychotropic medications were 3.8 times (P <0.001) more likely to consult an FH than parents who agreed to give them if necessary. Most parents agreed to give their children psychotropic medications if necessary. However, a proportion of parents and caregivers preferred to consult an FH before accessing mental health services.

Efficacy and safety of intranasal ketamine compared with intranasal dexmedetomidine as a premedication before general anesthesia in pediatric patients: a systematic review and meta-analysis of randomized controlled trials.

To compare the efficacy and safety of intranasal ketamine with intranasal dexmedetomidine as a premedication in pediatric patients undergoing general anesthesia for elective surgery or other procedures. We conducted a systematic literature search in PubMed, PubMed Central, Scopus, LILACS, Google Scholar, the Cochrane Database of Systematic Reviews, and trial registries for randomized controlled trials (RCTs) comparing intranasal ketamine with intranasal dexmedetomidine as preanesthetic medication in elective surgery or other procedures in pediatric patients. We used Review Manager software version 5.4.1 for statistical analysis and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed the methodological quality of the included studies with the RoB 2 risk of bias tool. All outcomes were pooled using the Mantle-Haenszel method and a random-effects model. The quality of evidence was assessed using the GRADE approach. Out of 2,445 full texts assessed, we included ten RCTs in the analysis. The efficacy outcomes did not fulfill the comparability criteria between intranasal ketamine and intranasal dexmedetomidine for sedation at parental separation (risk ratio [RR], 0.90; 95% confidence interval [CI], 0.79 to 1.04; I2 = 89%; GRADE evidence, low), mask acceptance (RR, 0.86; 95% CI, 0.66 to 1.13; I2 = 50%; GRADE evidence, low), and iv canulation (RR, 1.16; 95% CI, 0.79 to 1.69; I2 = 69%; GRADE evidence, very low). Intranasal ketamine-treated patients showed a higher incidence of nausea and vomiting (RR, 2.47; 95% CI, 1.24 to 4.91; I2 = 0; GRADE evidence, moderate). Significantly more bradycardia was observed in the intranasal dexmedetomidine group (RR, 0.16; 95% CI, 0.04 to 0.70; I2 = 40%; GRADE evidence, moderate) than in the ketamine group. The low to very low-quality evidence in this systematic review and meta-analysis of RCTs neither confirmed nor refuted comparable premedication efficacy of intranasal ketamine and dexmedetomidine in terms of parental separation, mask acceptance, and iv cannulation in a pediatric population. Clinical decision-making is likely to be influenced by differences in gastrointestinal and cardiovascular safety profiles. PROSPERO (CRD42021262516); registered 22 July 2021.

Emergence agitation in children: A comparison of effect of intravenous midazolam and ketamine

Background- Emergence agitation (EA) is one of the most challenging conditions to manage in pediatric patients undergoing general anesthesia with sevoflurane as it can even lead to physical harm. Various pharmacological interventions are being used in anesthesia to manage this condition. So, the objective of this study is to compare the effects of intravenous midazolam and intravenous ketamine given as premedication, on the incidence and severity of EA and to assess parent separation anxiety and postoperative pain and analgesic requirement in the 2 groups. Methodology- This is a randomized control trial consisting of 70 children aged 3-7years, 35 in each midazolam and ketamine group that received 0.05mg/kg of i.v. inj. midazolam and 1mg/kg of i.v. inj. ketamine respectively, undergoing general anesthesia with sevoflurane. Emotional status of the child assessed and then allocated into either group through a computer-generated programme. A blinded anesthesiologist assessed the incidence and severity of emergence agitation based on WATCHA scale and Children and Infant Postoperative Pain Scale (CHIPPS). Results- The mean WATCHA and CHIPPS scores were lower in ketamine group at all timepoints versus midazolam group (p&lt;0.05 which is statistically significant).