Time Of Parental Separation Research Articles

Comparative Study of Intranasal Dexmedetomidine Versus Intranasal Ketamine as Premedicant in Children.

Background: Pre-operative anxiety in children not only makes induction difficult but it is also associated with an increase in the requirement of analgesics, the incidence of post-operative nausea and vomiting (PONV), emergence delirium (ED), and postoperative maladaptive behavioral changes. It can be reduced effectively by pharmacological interventions. In a quest to find the ideal premedicant and non-invasive way of its administration, we decided to compare intranasal (IN) dexmedetomidine with IN ketamine as a premedicant in pediatric patients.Aims and objectives: To compare sedation score, mask acceptance score (MAS) during induction, the incidence of ED, and other adverse events in both groups.Material and methods: Some 60 children, between 1 and 8 years of age of either sex undergoing surgical procedures were included in this study and randomly divided into two groups (Group D and Group K). Thirty minutes prior to induction of anesthesia, patients of Group D received dexmedetomidine 1 mcg kg-1 in 1 mL of 0.9% saline intranasally and patients of Group K received ketamine 5 mg kg-1 in 1 mL of 0.9% saline intranasally through calibrated dropper (0.5 mL in each nostril) in a recumbent position. Incidences of sneezing or coughing after IN administration of study drugs were recorded. The subsequent sedation scores were assessed using MOASS at 15 min, then at 30 min following premedication at the time of parental separation. After shifting patients to operation theater inhalation induction was done. MAS at induction and any adverse effects were recorded.Results: Children in Group K were found to be significantly more sedated at 30 min after administration of premedication and mask acceptance was also better (p value < 0.0001 with a confidence interval, CI=95%). But the incidence of ED and PONV was high.Conclusion: Intranasal dexmedetomidine (1 mcg kg-1) is clinically less effective as a premedicant in terms of sedation and mask acceptance in older children as compared to ketamine (5 mg kg-1), but associated with fewer incidence of ED and PONV. We recommend the usage of IN dexmedetomidine in a higher dose (1.5-2 mcg kg-1), through nebulization/atomizer for the desired level of sedation and mask acceptance.

Assessment of potential predictors affecting preoperative anxiety in Indian children- A prospective observational study.

Preoperative anxiety is a common problem among children undergoing surgery. The aim of the study was to assess the incidence and identify various predictors of preoperative anxiety in Indian children. A prospective, observational study was conducted on 60 children of the American Society of Anesthesiologists Physical status 1/2, aged 2-6 years and scheduled for elective surgery under general anesthesia in a tertiary care teaching hospital. Preoperative parental anxiety was assessed using the State-Trait Anxiety Inventory questionnaire. The children's anxiety was assessed in the preoperative room, at the time of parental separation, and at the induction of anesthesia using modified Yale Preoperative Anxiety Scale (mYPAS) scoring by an anesthesiologist and a psychologist. Sedative premedication was employed prior to parental separation. Logistic regression analysis was carried out to identify the possible predictors of anxiety. The incidence of high preoperative anxiety among the studied children was 76% in the preoperative room, 93% during parental separation, and 96% during anesthetic induction. Among the nine possible predictors identified on univariate regression, the presence of siblings was found to be a significant independent predictor on multivariate regression analysis (P = 0.04). The inter-rater agreement was excellent for the assessment of preoperative anxiety using mYPAS by the anesthesiologist and psychologist (weighted Kappa, k = 0.79). The incidence of preoperative anxiety in Indian children in the age group of 2-6 years is very high. The preop anxiety escalates progressively at parental separation and induction of anesthesia despite sedative premedication. The presence of siblings is a significant predictor of preoperative anxiety.

Parental Separation and Semen Quality in Young Men: A Population-Based Cohort Study.

PurposeParental separation may be a stressful life event with the potential to influence hormonal regulation of offspring reproductive health and thereby affect semen quality in young men. We aimed to study the association between parental separation in pregnancy or in childhood and semen quality in young men and to study whether the timing of parental separation in childhood was important.Patients and MethodsWe conducted a follow-up study of 1058 young men born 1998–2000 from the Fetal Programming of Semen Quality (FEPOS) cohort nested within the Danish National Birth Cohort. Data on parental separation were obtained longitudinal by self-report. Parental separation in pregnancy was dichotomized, and parental separation in childhood was both dichotomized and categorized according to the timing of parental separation (from birth, from early childhood (0–5 years), and from late childhood (6–10 years)). Semen volume, concentration, total sperm count, motility, morphology, and testes volume were analysed using multivariable negative binomial regression models.ResultsParental separation in pregnancy was not associated with semen quality. The association between parental separation in childhood and semen quality differed with the timing of parental separation. Parental separation from birth was associated with higher semen volume of 25%, 95% CI (−5; 64); higher total sperm count of 62%, 95% CI (−6; 179); and higher proportion of morphologically normal spermatozoa of 59%, 95% CI (20; 111). Parental separation in early childhood was associated with lower semen volume of −14%, 95% CI (−24; −3); lower concentration of −15%, 95% CI (−28; 1); lower total sperm count of −17%, 95% CI (−32; 2) and lower testes volume of −11%, 95% CI (−18; −3).ConclusionThe timing of parental separation was important, and parental separation from birth was associated with higher semen quality, and parental separation in early childhood was associated with lower semen quality.

Comparative Study of Oral Clonidine and Midazolam as Premedication in Pediatric Patients Undergoing Tonsillectomy

Background and Aim: Anxiety and fear of operation, injections, physicians, operation theatre environment and parental separation are all traumatizing experiences in children. The aim of the study was to compare the effects of oral midazolam and oral clonidine as premedication in children undergoing tonsillectomy .The preoperative sedation, anxiolytic, acceptance of mask for induction of anaesthesia, intravenous cannulation and post-operative recoverywere assessed in both groups. Methods: Aprospective randomized double blinded study of 100 patients of age group 4 -12 yrs undergoing tonsillectomy under general anaesthesia were selected. They were divided into 2 groups of 50 patients each. Group A (oral clonidine) received 4 mcg/kg 90 minutes before induction. Group B (oral midazolam) received 0.5 mg/kg 90 minutes before induction. The sedation and anxiety score was noted at the time of parental separation. The reaction to IV cannulation was assessed by sedation and anxiety scoring at the same time all of them were taken under GA with controlled ventilation. The Mask acceptance was graded by 5 point scoring system .Grade 3,4 and 5 are satisfactory.They were monitored throughout the surgery for any complications. Post operative status was assessed by Modified Objective Pain score. Results: The sedation score and anxiety score at venipuncture was better with clonidine group with statistical significance (p&lt; 0.000 and&lt;0.003). The mask acceptance was better with clonidine group with statistical significance (p &lt;0.000).Postoperative score was also better with clonidine group with statistical significance of p value &lt;0.000. Conclusion: We concluded that oral clonidine and midazolam can be used as better premedicants to produce optimal sedation and emotional state.Clonidine 4 μg / kg has been shown to be a more effective premedication for children undergoing elective tonsillectomy than midazolam 0.5mg/kg

Parental separation in childhood and adult smoking in the 1958 British birth cohort.

Parental separation or divorce is a known risk factor for poorer adult health. One mechanism may operate through the uptake of risky health behaviours, such as smoking. This study investigated the association between parental separation and adult smoking in a large British birth cohort and also examined potential socioeconomic, relational and psychosocial mediators. Differences by gender and timing of parental separation were also assessed. Multiply imputed data on 11 375 participants of the National Child Development Study (the 1958 British birth cohort) were used. A series of multinomial logistic regression models were estimated to investigate the association between parental separation (0-16 years) and adult smoking status (age 42), and the role of potential socioeconomic, relational and psychosocial mediators. Parental separation in childhood was associated with an increased risk of being a current (RRR = 2.14, 95% CI: 1.77, 2.60) or ex-smoker (RRR = 1.50, 95% CI: 1.22, 1.85) at age 42. This association remained after consideration of potential socioeconomic, psychosocial and relational mediators. Relational (parent-child relationship quality, parental involvement and adult partnership status) and socioeconomic factors (overcrowding, financial hardship, housing tenure, household amenities, free school meal receipt and educational attainment) appeared to be the most important of the groups of mediators investigated. No differences by gender or the timing of parental separation were observed. Parental separation experienced in childhood was associated with increased risk of smoking. Families undergoing separation should be further supported in order to prevent the uptake of smoking and to prevent later health problems.

Family Transitions and Children’s Well-Being During Adolescence

This study used longitudinal prospective data from a representative Canada-wide survey to assess the impact of childhood family experience on well-being during adolescence. First, we constructed family composition profiles to capture the number and type of changes in family structure that occurred in our sample over a 12-year period. Then, we examined links between initial family status, family composition profiles, timing of parental separation, and later behavioral outcomes during adolescence. Marital status at birth, as well as 2 different family transition profiles, were linked to externalized problems during adolescence. Timing of the first family transition suppressed the effect of family transition profiles on adolescent behavioral outcomes.

English

The current study compares intranasal and oral midazolam for effect on sedation for patients requiring dental procedure. Eighty subjects between the ages of 5 and 12 years were received randomly either intranasal (0.2 mg/kg) or oral (0.5 mg/kg) midazolam. The observer assessed the children for sedation level at the following time points: Immediately before the drug was administered, and 20 and 30 min after drug administration. There were significant differences in sedation level among the both groups at the time of parental separation and at the time of induction. 39 (97.5%) and 40 (100%) of the forty patients who received oral midazolam were calm, drowsy or asleep at 20 and 30 min after drug administration, respectively. For patients who received intranasal midazolam, 32 (80%) and 33 (82.5%) of the forty patients were either calm or drowsy at 20 and 30 min after drug administration, respectively.&nbsp; None of the patients from the intranasal group was rated as &lsquo;asleep&rsquo;. Oral midazolam was found to be statistically more effective in providing a better sedation level at the time of parental separation and at the time of induction than intranasal administration. Our findings indicate a tendency for oral midazolam to be more effective as a premedication in children before general anesthesia. &nbsp; Key words: Preoperative, midazolam, sedation, anesthesia, pediatrics.

Preoperative anxiolysis in pediatric population: A comparative study between oral midazolam and oral ketamine

Context:Preoperative anxiety is synonymous with pediatric surgery. Anxiolysis is of crucial importance and poses a significant challenge to the pediatric anesthesiologist. Orally administered midazolam and ketamine can be used as anxiolytic premedication in children.Aim:To compare the efficacy of orally administered midazolam and ketamine for preoperative sedation and anxiolysis in children and determine the minimum interval required between premedication and parental separation.Setting and Design:Prospective, randomized, double-blind study.Materials and Methods:A total of 70 children aged 2-8 years, belonging to ASA grade 1 and 2, scheduled to undergo elective infraumbilical and peripheral surgeries were randomized into two groups of 35 each to receive either midazolam (0.5 mg/kg) or ketamine (5 mg/kg) orally. They were assessed at an interval of 5 minutes up to 40 minutes, at the time of parental separation, intravenous cannulation, and application of face mask for ventilation. Sedation was noted according to Ramsay Sedation Scale and anxiolysis was noted according to Anxiolysis Scores used in previous published studies.Statistical Analysis Used:Skewed data between groups were analyzed by Mann Whitney U Test. Data within a group were analyzed using Friedman's Analysis of variance and a post hoc test.Results:No statistically significant difference in sedation and anxiolysis scores were obtained between the groups at any point of time. Maximum sedation score was achieved at 20 minutes in both the groups, with no statistically significant difference with scores obtained thereafter. Statistically significant difference occurred in anxiolysis score at study points in group receiving midazolam.Conclusion:The study documents the rapid achievement of preoperative sedation and anxiolysis in children with orally administered midazolam or ketamine, with the latter producing a superior quality of anxiolysis. An interval of 20 minutes is sufficient between premedication and parental separation.

A Comparison of Two Different Doses of Rectal Ketamine Added to 0.5 mg.kg-1 Midazolam and 0.02 mg.kg-1 Atropine in Infants and Young Children

In some circumstances, a high degree of sedation that results in a child being unconscious at the time of parental separation is desirable. We set out to investigate the efficacy and safety of a rectal premedication regimen designed to produce this increased level of sedation. Sixty-seven children aged two to 24 months were randomised into two groups. Group MK received 4 mg x kg(-1) ketamine, 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine and group MKK received 8 mg x kg(-1) ketamine, 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine per rectum. The sedation score at the time of parental separation 30 minutes after drug administration and the response to intravenous cannulation were evaluated on a four-point scale. Respiratory rate, heart rate and arterial oxygen saturation were recorded immediately before parental separation. More patients in group MKK were asleep during separation (62 vs 35%, P < 0.05). Fewer patients in group MKK cried during intravenous cannulation (37 vs 68%, P < 0.05). Sedation scores were significantly increased at both time points. There was no difference between groups in vital signs at the time of parental separation and no adverse respiratory events occurred during the study period. In cases where a high degree of sedation following premedication in infants and toddlers is desired, the addition of 8 mg x kg(-1) ketamine to 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine administered rectally is more efficacious than 4 mg x kg(-1) ketamine.

Young Adults' Relationship with Parents and Siblings

The long-term effects of divorce on adult relationships with parents and siblings were examined. Several variables, in addition to marital status, were simultaneously explored: gender, pre-divorce and post-divorce conflict, parental remarriage, post-divorce living arrangements and age at time of separation. A sample of 207 young adults from divorced and intact families completed demographic questionnaires as well as measures of parental conflict, parent-child and sibling relationships. Sibling relationships were not affected by marital status, conflict, or age at time of parental separation. Marital conflict exerted an effect independent of divorce negatively affecting relationships with both parents. Relationships with fathers (especially daughters) deteriorated while relationships with mothers improved as a function of divorce. An explanation of the differential impact of divorce on mothers' and fathers' relationships is offered in terms of our findings with respect to post-divorce conflict, post-divorce living arrangements and parental remarriage.

Trajectories of internalizing, externalizing, and grades for children who have and have not experienced their parents' divorce or separation.

This study examined whether the occurrence and timing of parental separation or divorce was related to trajectories of academic grades and mother- and teacher-reported internalizing and externalizing problems. The authors used hierarchical linear models to estimate trajectories for children who did and did not experience their parents' divorce or separation in kindergarten through 10th grade (N = 194). A novel approach to analyzing the timing of divorce/separation was adopted, and trajectories were estimated from 1 year prior to the divorce/separation to 3 years after the event. Results suggest that early parental divorce/separation is more negatively related to trajectories of internalizing and externalizing problems than is later divorce/separation, whereas later divorce/separation is more negatively related to grades. One implication of these findings is that children may benefit most from interventions focused on preventing internalizing and externalizing problems, whereas adolescents may benefit most from interventions focused on promoting academic achievement.

Father absence, parental care, and female reproductive development

This study examines female reproductive development from an evolutionary life history perspective. Retrospective data are for 10,847 U.S. women. Results indicate that timing of parental separation is associated with reproductive development and is not confounded with socioeconomic variables or phenotypic correlations with mothers' reproductive behavior. Divorce/separation between birth and 5 years predicted early menarche, first sexual intercourse, first pregnancy, and shorter duration of first marriage. Separation in adolescence was the strongest predictor of number of sex partners. Multiple changes in childhood caretaking environment were associated with early menarche, first sex, first pregnancy, greater number of sex partners, and shorter duration of marriage. Living with either the father or mother after separation had similar effect on reproductive development. Living with a stepfather showed a weak, but significant, association with reproductive development, however, duration of stepfather exposure was not a significant predictor of development. Difference in amount and quality of direct parental care (vs. indirect parental investment) in two- and single-parent households may be the primary factor linking family environment to reproductive development.

Family and legal indicators of child adjustment to divorce among families with young children.

This research used structural equation modeling to examine relations among family dynamics, attorney involvement, and the adjustment of young children (0-6 years) at the time of parental separation. The article presents baseline data (N = 102 nonresidential fathers and N = 110 primary caretaking mothers) from a larger longitudinal study. Results showed that the effects of parental conflict on child outcomes were mediated by paternal involvement, the parent-child relationship, and attorney involvement. A scale assessing parental gatekeeping yielded two significant factors: Spouse's Influence on Parenting and Positive View of Spouse. Paternal involvement was related to children's adaptive behavior, whereas negative changes in parent-child relationships predicted behavior problems. Mothers who experienced greater psychological symptomatology were less likely to utilize an attorney, which in turn predicted greater internalizing problems in their children.

Timing of Parental Separation and Attachment to Parents in Adolescence: Results of a Prospective Study from Birth to Age 16

Using prospective longitudinal data from the Christchurch Health and Development Study (CHDS), this paper examines the effects of parental separation on the quality of adolescents' attachment to parents and their perceptions of parental care and overprotection during childhood. Exposure to parental separation was significantly associated with lower attachment to parents in adolescence and more negative perceptions of maternal and paternal care and protection during childhood. When examined in relation to the developmental timing of first separation, a linear relationship between the age at first separation and later parental attachment and perceived parent–child relations was found. The younger the age of the child at the time of separation, the lower their subsequent parental attachment and the more likely they were to perceive both their mother and father as less caring and more overprotective. No gender differences were found in children's responses to parental separation. These findings persisted after control for the confounding effects of family social background, marital conflict, parenting, child behavior, and remarriage. Results supported the importance of the early childhood years for the development of a secure and enduring attachment relationship between children and their parents.

Double-blind Comparison of Oral Transmucosal Fentanyl Citrate with Oral Meperidine, Diazepam, and Atropine as Preanesthetic Medication in Children with Congenital Heart Disease

The effectiveness of oral transmucosal fentanyl citrate (OTFC) as preanesthetic medication was compared with oral meperidine, diazepam, and atropine (MDA) in 40 pediatric patients scheduled to undergo repair of congenital heart defects. In a double-blinded manner, patients received a fentanyl lollipop (20-25 micrograms/kg) and a placebo oral solution (0.4 ml/kg) (n = 20) or a placebo lollipop and an oral solution (0.4 ml/kg) of meperidine (1.5 mg/kg), diazepam (0.2 mg/kg), and atropine (0.02 mg/kg) (n = 20). The patient's vital signs, systolic and diastolic blood pressures, heart rate, respiratory rate, and oxyhemoglobin saturation (SpO2), as well as activity and apprehension scores were evaluated and recorded at baseline and at 10-min intervals. The patient's emotional status at the time of parental separation and at induction of anesthesia were also assessed. Side effects and onset of action were observed. After OTFC, onset of sedation was significantly faster than with the oral solution of meperidine, diazepam, and atropine. In both groups there was no significant change in heart rate. Although systolic blood pressure, diastolic blood pressure, and respiratory rate showed statistically significant decreases, these changes were not clinically significant. The child's emotional status at the time of separation from the parents and during induction was similar in both groups. Side effects with OTFC were more frequent: nose itching occurred in 65%, body itching in 10%, and vomiting in 30%. Two patients (10%) in the OTFC-treated group became hypoxemic (SpO2 less than 90) and required supplemental oxygen. In the group receiving oral meperidine, diazepam, and atropine, 10% had mild facial pruritus and 5% complained of a dry mouth.(ABSTRACT TRUNCATED AT 250 WORDS)