Physical activity is associated with a host of health benefits across childhood. Despite this, most children are not engaging in enough physical activity to achieve health benefits, and there is growing evidence that lifelong physical activity habits may be established in childhood. Theories suggest that physical literacy may be associated with health benefits due to its reciprocal relationship with physical activity participation. The associations between physical literacy, physical activity and health in children remain largely unstudied. The purpose of this thesis was to explore the relationships between physical literacy, physical activity and health across early and middle childhood. The first study assessed the measurement properties of the Physical Literacy Assessment for Youth Tools, an assessment battery for physical literacy. We determined that this assessment had acceptable internal consistency, construct validity, and offered unique perspectives of a child’s physical literacy. We then determined that physical literacy was associated favourably with body composition, blood pressure, quality of life, and aerobic fitness in school-age children. Moderate-to-vigorous physical activity mediated the associations between physical literacy and aerobic fitness. Finally, the third study observed that physical activity trajectories from preschool to school-age were associated with school-age physical literacy. These results highlight the importance of physical literacy in childhood, given its associations with physical activity and health indicators. Physical literacy was associated with favourable health indicators, supporting its position as a determinant of health. The participants in the lowest physical activity trajectory groups had the lowest physical literacy. These finds suggest that physical activity across early and middle childhood may play a formative role in the development of physical literacy. Future work should determine if these results are applicable to other age groups, such as early years or adolescents, and if changes in physical activity over time are associated with changes in physical literacy over time. / Thesis / Doctor of Science (PhD) / Kids who are active every day will be healthier that those who aren’t. Unfortunately, most Canadian kids are not active enough to be healthy. We still don’t really know why some kids are active and some kids aren’t active. We think that physical literacy might be the missing piece to help kids be more active as they grow. This thesis studied the links between physical literacy, physical activity and health in kids. We found that we could measure physical literacy well in school-age kids. We also found that physical literacy was linked to health in kids. Kids who were the most active as they grew had the highest physical literacy. We saw that boys were more active than girls as they grew. Kids should start being active as preschoolers to help develop physical literacy. We need more programs and activities for kids to be more active to help develop physical literacy.

Background: Managing pain is challenging, especially in neonates. Uncontrolled pain and opioid exposure are associated with short- and long-term adverse events. Adequately controlling pain while reducing opioid exposure is paramount in the neonatal population. This thesis presents three studies, all aiming to determine if IV acetaminophen is an appropriate adjunct to current opioid-based postoperative pain regimens. The population of interest is neonates admitted to the neonatal intensive care unit (NICU) treated with major abdominal and thoracic surgery. Chapter 1 provides the scientific framework underpinning this work and the rationale for performing the included studies. Chapter 2 presents the results of a systematic review and meta-analysis assessing the effect of IV acetaminophen on postoperative pain in pediatric patients. This chapter further expands on gaps and opportunities for future research. Chapter 3 reports the results of a national survey in which pediatric surgeons, anesthesiologists, and neonatologists reported their postoperative pain prescribing practices in the NICU and their perspectives on the use of IV acetaminophen. Chapter 4 describes the protocol for a pilot randomized controlled trial (RCT). This study will assess the feasibility of a multicenter RCT to evaluate the effectiveness of IV acetaminophen for postoperative pain in neonates recovering from major abdominal and thoracic surgery. Chapter 5 summarizes the results of the studies in context and details how the results of each study informed the others. It also discusses areas of future research. / Thesis / Master of Science (MSc) / All patients experience some amount pain after major surgery. Babies who are born too early (i.e., preterm) may experience more pain than babies those who are born close to their due date. Opioid drugs such as Fentanyl are commonly used to manage pain after surgery, but they have side effects, such as slowing down breathing and causing problems with gut function. Using non-opioid drugs (such as acetaminophen) and opioid drugs together may reduce the amount of opioids needed. This combination may also help with pain control. We want to know if using intravenous (IV) acetaminophen will reduce the rate of side effects, decrease the amount of opioids given, and still control pain well. To answer this question, we completed three studies. The first study reviewed all the published data on IV acetaminophen in children who need surgery. In the second study, we surveyed pediatric surgeons, anesthesiologists, and neonatologists to see how they manage pain after surgery and what they thought about IV acetaminophen. The last study is the plan for our pilot trial, where we will see if giving IV acetaminophen and opioids together is better than opioids alone.

Acne is one of the most common skin conditions worldwide, affecting 80% of people between the ages of 11 and 30 with over $3 billion dollars spent annually on treatment in the United States alone. While the visible symptoms of acne (comedones and inflammatory lesions) are well-known, acne is more than skin-deep. Up to 85% of adolescents with acne will experience a negative psychosocial outcome related to their skin condition. The most common negative outcomes are anxiety, depression, body dysmorphic disorder, decreased self-esteem, and decreased quality of life. These comorbidities can be extremely detrimental if unrecognized and untreated; acne is the second-most common skin condition to end in suicide. One of the major difficulties in providing well-rounded care for the acne patient beyond their dermatologic needs has been the identification of these psychosocial comorbidities. There is no current standard for evaluating for the presence of these symptoms and they can be difficult to elicit in a pediatric population. While surveys can screen for symptoms (the Children’s Dermatology Life Quality Index; the Cardiff Acne Disability Index), they are infrequently used. Subsequently, necessary treatment for these symptoms is foregone when the problem goes unrecognized. In order to better identify and treat the negative psychosocial impacts of acne, a multidisciplinary approach involving a concurrent medical and psychological approach is recommended. Examples include support groups, educational interventions, and multidisciplinary clinics. The aim of this proposed study is to evaluate the utility of a multidisciplinary behavioral health clinic in which patients are seen by a dermatologist and a psychologist at the same session. With this model, the dermatologist can evaluate the patients’ skin and encourage them to discuss how their acne may be impacting their life. Then, the psychologist can offer advice on what may help each patient’s individual symptoms. This advice may include coping strategies or referrals to specialists for further support. Patients will attend the clinic monthly and their progress will be recorded via Children’s Dermatology Life Quality Index scores, acne severity, and psychological diagnoses made at the clinic. It is predicted that the multidisciplinary behavioral health clinic will reveal previously undiagnosed psychological conditions in acne patients, improve patients’ quality of life, and improve the severity of their acne. This is clinically significant in providing a comprehensive treatment approach to the pediatric acne patient, recognizing that the symptoms and outcomes of acne are more than skin deep.

Abstract available through the Journal of Investigative Medicine.

No description available.

Abstract available in the Journal of Investigative Medicine.

No description available.

No description available.

No description available.

Introduction: Pediatric health care settings are high risk environments for spreading communicable and vaccine preventable diseases from health care workers to susceptible patients. Methods: All managers of pediatric clinics operating in the state of Utah were included. Participants were invited to complete a two-page questionnaire regarding their clinic vaccination policies. Results: Half (n = 23, 50%) of Utah pediatric outpatient clinics recommend employee vaccinations, although employee refusal is allowed without consequence. Of all adult vaccines, influenza was most often included as part of the employee vaccination policy. Some clinics required unvaccinated employees to wear masks in the event of illness, but many had no additional requirements for unvaccinated and ill employees. Discussion: Vaccination of health care workers is an effective approach to reduce disease transmission. Mandatory vaccination policies can significantly improve vaccination rates among health care workers.