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According to the attachment theory, the establishment of emotional bonds with significant figures is an important process in human development throughout life. The quality of the relationships between adolescents and their caregivers in residential care (RC) may act as a protective factor for internal reorganisation and the development of emotional regulation skills. The present study aims to analyse the effect of insecure attachment orientation and the quality of relationships developed with caregivers in RC settings and adolescent emotion regulation. It also aims to assess the mediating role of emotion regulation in the association between attachment and the quality of the relationship with caregivers. The sample consisted of 249 adolescents, aged between 12 and 18 years old, living in RC facilities in Porto (Portugal). The results suggest that perceived insecurity of attachment to significant figures has a negative effect on emotional regulation and on the quality of the relationship with caregivers. We also found a negative mediating effect of the differentiating emotions dimension on the association between attachment and the quality of the relationship with caregivers. It is relevant to highlight the importance of close affective relationships in developing adolescents' ability to regulate their emotions and particularly the impact of caregivers and their work in residential care. [ABSTRACT FROM AUTHOR]

Objectives Increasingly, laboratories flag low serum alkaline phosphatase (sALP) that are age-and sex-specific in paediatrics. The aim of this study was to report clinical manifestations of paediatric patients with age-and sex-specific low sALP, thereby increasing awareness of its potential aetiologies. Methods This retrospective Canadian tertiary care paediatric hospital study assessed all sALP of ambulatory patients aged less than 18 years from 2015 to 2017. The hospital used a Beckman Coulter AU assay to measure sALP and compared values to the Canadian age-and sex-specific reference intervals from CALIPER. All children who had at least one subnormal age-and sex-specific sALP were evaluated. A review of medical charts of included patients was performed and demographic characteristics, medical history and diagnosis were collected, and categorized under groups of medical disorders. Results Of 11,874 included patients, 1,001 patients (9.2%) had low sALP. Of those, 48% (485/1,001) had transient low sALP activity and 9.6% (96/1,001) had persistently low sALP. Prolonged immobilization and inflammatory bowel disease represented the main aetiologies for persistently low sALP. Interestingly, 13.5% (13/96) of patients with persistently low sALP had no apparent aetiology. Conclusions Our results report aetiologies of low sALP in a Canadian paediatric population using age-and sex-specific Canadian reference ranges. This study highlights that healthcare providers should be aware that a low sALP may have clinical significance and should be repeated if warranted based on further clinical assessment. [ABSTRACT FROM AUTHOR]

Background and Objectives: Although peak oxygen uptake (VO2peak) is one of the most important measures in clinical practice, the high cost and time consumption have led to the search for simpler devices and the development of the estimating cardiopulmonary fitness (eCPF) equation. Since the lungs are one of the sites most affected by rheumatoid arthritis (RA), this study aimed to create a predictive equation for VO2peak obtained by simple sampling technology in women with RA‐associated interstitial lung disease (RA‐ILD). Methods: This cross‐sectional study evaluated 47 women with RA‐ILD. The participants underwent the following evaluations: computed tomography (CT); evaluation of disease activity through the Clinical Disease Activity Index (CDAI); measurement of physical function using the Health Assessment Questionnaire disability index (HAQ‐DI); pulmonary function testing, including spirometry, diffusing capacity for carbon monoxide (DlCO), nitrogen single‐breath washout (N2SBW) test, and impulse oscillometry; and cardiopulmonary exercise testing (CPET) using FitMate™. Results: VO2peak was correlated with age (r = −0.550, p < 0.0001), rheumatoid factor (r = −0.443, p = 0.002), anti‐cyclic citrullinated peptide antibodies (r = −0.410, p = 0.004), CDAI (r = −0.462, p = 0.001), HAD‐DI (r = −0.486, p = 0.0005), forced vital capacity (r = 0.491, p = 0.0004), DlCO (r = 0.621, p < 0.0001), phase III slope of N2SBW (r = −0.647, p < 0.0001), resonance frequency (Fres, r = −0.717, p < 0.0001), integrated low‐frequency reactance (r = −0.535, p = 0.0001), and the inhomogeneity of respiratory system resistance between 4 and 20 Hz (r = −0.631, p < 0.0001). In the CT examination, patients with extensive ILD had significantly lower VO2peak than patients with limited ILD (p < 0.0001). In the stepwise forward regression analysis, Fres, DlCO and age explained 61% of the VO2peak variability. Conclusions: As assessed by CPET, women with RA‐ILD show reduced cardiopulmonary fitness, which can be explained at least in part by the presence of small airway disease, deterioration of pulmonary gas exchange, and advanced age. These associations of pulmonary variables with eCPF may be clinically important and support the use of the eCPF equation to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to determine whether a Transversus Abdominis Plane (TAP) block can reduce donor site morbidity among pediatric patients undergoing iliac crest bone grafting for repair of their alveolar cleft. Design: This retrospective cohort study was carried out at the Division of Dentistry at the Montreal Children's Hospital. Medical charts of patients who underwent alveolar cleft bone grafting between January 2011 and January 2021 were reviewed and they were divided into two groups, intraoperative TAP block and intraoperative local anesthesia infiltration (control group). The outcomes measured were patients' post-operative pain at the donor site, in-hospital narcotics requirements and length of stay. Results: A total of 66 patients were included. There were no significant differences in pain scale among the TAP group and control group [1.9 (SD 2.5) and 1.3 (SD 2.1), respectively (p = 0.23)]. The mean length of stay for both groups was 1 day. Interestingly, there was a significant higher proportion of patients who required in-hospital opioids (morphine) in the TAP block group when compared to the control group (p = 0.03). Conclusions: The results of our study suggest there may be no role for a TAP block in reducing pain and improving opioid stewardship. [ABSTRACT FROM AUTHOR]

Functional disability affects a large percentage of adolescents with chronic pain. The functional disability inventory (FDI) has been widely described in the literature to assess functional disability, with good psychometric properties. To translate and adapt the FDI to European Portuguese language and assess the validity, reliability, and measurement error of this version in adolescents with chronic musculoskeletal pain and, specifically, with neck and low back pain. The translation and cross-cultural adaptation of the FDI was conducted according to international guidelines. After that, 1730 adolescents completed the following scales and questionnaires: FDI, Nordic Musculoskeletal Questionnaire, Numeric Pain Rating Scale, Pain Catastrophizing Scale, Depression, Anxiety and Stress Scale, Tampa Scale of Kinesiophobia, and Basic Scale on Insomnia complaints and Quality of Sleep. Sixty-three of these adolescents, with at least one painful body site, completed the questionnaire twice to assess reliability and measurement error. Exploratory factor analysis and hypothesis testing was used to assess construct validity. Cronbach's alpha ranged from 0.81 and 0.88, ICC was 0.86 (95%CI:0.77; 0.92), the SEM and the SDC were 2.50 and 6.93 (total score of 60 points), respectively. Fair to moderate correlations were obtained between FDI and pain intensity (rs = 0.33 to 0.43), catastrophizing (rs = 0.41 to 0.44) depression, anxiety, and stress (rs = 0.48 to 0.53), fear of movement (rs = 0.32 to 0.42), and sleep impairments (rs = 0.34 to 0.38). The factor analysis suggested a two-factor solution. The European Portuguese version of the FDI has very good internal consistency, good test–retest reliability, and construct validity when used in a sample of community adolescents with chronic pain. One of the most widely instruments used to assess functional disability is the Functional Disability Inventory (FDI), which in its original version has good psychometric properties and is recommended by the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials; However, the FDI has not been translated yet into European Portuguese language and its psychometric properties have not been assessed in adolescents with chronic spinal pain; This study suggests that the European Portuguese version of the FDI has very good internal consistency, good test–retest reliability as well as construct validity when used in a sample of community adolescents with chronic spinal pain; Therefore, these findings suggest the use of the European Portuguese version of the FDI to assess the functional disability in adolescents with chronic spinal pain. [ABSTRACT FROM AUTHOR]

This study aimed to assess the oral health status of refugee children in comparison with that of Canadian children. In addition, we investigated the extent to which demographic factors are associated with caries experience in this population. Children with a confirmed refugee status and Canadian children (control group) matched for age and sex composed the study population. A comprehensive review of dental charts was completed to assess children's demographic data, caries experience, oral hygiene and gingival health status. The majority of refugee children had never seen a dentist before their arrival to Canada. Refugee children had significant higher dmft/DMFT scores than Canadian children (7.29 ± 5.1 and 4.47 ± 5, respectively; p < 0.0001). Furthermore, individual factors, such as refugee status (OR = 5.08; 95% CI = 2.31–11.1) and child age (OR = 2.17; 95% CI = 1.04–4.51) were significantly associated with caries experience. Access to appropriate dental care to refugee children should be a key priority for health care providers and policy makers. [ABSTRACT FROM AUTHOR]

Background. Sialorrhea is a common manifestation of several neurological disorders. The use of intraglandular onabotulinum toxin A (OBTXA) injection has been recognized to effectively treat sialorrhea. As OBTXA injection reduces salivary flow rate and alters salivary quality, its use may have a detrimental effect on oral health. Aim. To examine the effect of OBTXA injection on caries experience and salivary pH of neurologically impaired children with sialorrhea. Design. Twenty-five children receiving OBTXA treatment and 25 control children were enrolled in the study. Whole saliva was collected to determine salivary pH. All participants underwent an interview on their dietary habits. Dental clinical examinations were carried out to evaluate caries experience and oral hygiene level. Results. Overall, mean salivary pH value was significantly lower in the OBTXA group (6.92 ± 0.77) compared with the control group (7.36 ± 0.70). Caries activity was significantly higher in the OBTXA group (P = 0.01). The regression analyses showed a significant association between OBTXA treatment and salivary pH value (P = 0.03). Results from the logistic regression show that dental caries was significantly associated with OBTXA treatment (OR = 1.73, CI = 1.14-27.3). Conclusions. The study showed an intricate relationship between OBTXA treatment and oral findings. Hence, special dental care should be given to children receiving OBTXA treatment. [ABSTRACT FROM AUTHOR]

• mHealth apps offer potential to assist the self-management of UI. • Apps for UI in Brazil are not credible and need major improvements. • None of the apps were used as an intervention in a RCT. Urinary incontinence (UI) is a serious condition for which often times insufficient non-surgical treatment options are provided or sought. Mobile health (mHealth) applications (apps) offer potential to assist with the self-management of UI. To perform a systematic review of available mHealth apps for UI in Brazil. A search for UI mHealth apps from the Google Play Store and AppStore in Brazil was performed by two independent reviewers on June 4 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS). Of the 1111 mHealth apps found, 12 were eligible for inclusion. Four offered exclusively exercise programs, six offered exercise and educational content, and two offered tools to track patient-reported symptoms. The included apps scored poorly on the MARS quality scale, with a mean ± standard deviation score of 2.7 ± 0.6 on a 0–5 scale. Most apps scored poorly based on credibility, user interface and experience, and engagement. Although there is growing interest in the development of mHealth technologies to support patients with UI, currently available tools in Brazil are of poor quality and limited functionality. Effective collaboration between industry and research is needed to develop new user-centered mHealth apps that can empower patients with UI. [ABSTRACT FROM AUTHOR]