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Pain is common in paediatric populations and is best treated with a multi-disciplinary approach. Art therapy interventions are gaining popularity in paediatrics; however, there is limited evidence on its impact on pain outcomes in children and adolescents. The objective of this scoping review is to map current research on art therapy’s impact as an intervention in paediatric populations experiencing any type of pain (i.e., acute, recurrent, and chronic). Electronic searches were conducted by a medical librarian to identify studies that used art therapy interventions in paediatric populations with pain as an outcome measure. Four reviewers independently screened and selected articles for extraction using Covidence and data were extracted from articles using study objectives. There were five studies that met the inclusion criteria. Four of the five studies reported on pain intensity and all studies reported on emotional functioning. Findings suggest art therapy interventions can be helpful for reducing pain, anxiety, stress, and fear associated with treatment. Further, there is emerging evidence that art therapy can support the management of acute and procedural pain in children. Future research should examine the impacts of integrating art therapy interventions into the multidisciplinary management of paediatric pain.

BACKGROUND: In clinical practice, children are often asked to rate their pain intensity on a simple 0 to 10 numerical rating scale (NRS). Although the NRS is a well‐established measure for adults, no study has yet evaluated its validity for children with chronic pain. OBJECTIVES: To examine the convergent and discriminant validity of the NRS as it is used within regular clinical practice to document pain intensity for children with chronic pain. Interchangeability between the NRS and an analogue pain measure was also assessed. METHODS: A cohort of 143 children (mean [± SD] age 14.1±2.4 years; 72% female) rated their pain intensity (current, usual, lowest and strongest levels) on a verbally administered 0 to 10 NRS during their first appointment at a specialized pain clinic. In a separate session that occurred either immediately before or after their appointment, children also rated their pain using the validated 0 to 10 coloured analogue scale (CAS). RESULTS: NRS ratings met a priori criteria for convergent validity (r>0.3 to 0.5), correlating with CAS ratings at all four pain levels (r=0.58 to 0.68; all P<0.001). NRS for usual pain intensity differed significantly from an affective pain rating, as hypothesized (Z=2.84; P=0.005), demonstrating discriminant validity. The absolute differences between NRS and CAS pain scores were small (range 0.98±1.4 to 1.75±1.9); however, the two scales were not interchangeable. CONCLUSIONS: The present study provides preliminary evidence that the NRS is a valid measure for assessing pain intensity in children with chronic pain.

Hereditary haemorrhagic telangiectasia (HHT) is supposedly rare in Africa, with only three pathogenic variants documented to date. We describe the clinical and genetic features of HHT patients in central South Africa, who fulfilled the Curaçao criteria. Sixteen patients (median age 38.5 years, range 12–65 years), from six families were included. Fifteen patients were of African descent and one was of Afrikaner descent. The mean epistaxis severity score was 3.18, and the median haemoglobin was 9.5 g/dL (range 3.5–13.5 g/dL). On transthoracic contrast echocardiography 69% had a shunt grade ≥ 1, but only 20% had pulmonary arteriovenous malformations (AVMs) on computed tomography of the chest. Hepatic AVMs were found in 13% of patients, while 13% had brain vascular malformations. Four patients were HIV positive, of whom two had worsening epistaxis while they had opportunistic infections and poor HIV control. We identified six pathogenic variants (four in ENG and two in ACVRL1 ) in the six probands, three of which had been described previously. Three variants have apparently not been reported previously: ENG c.[1336_1337dup];[ =] p.[(Asp446fs)];[( =)], ENG c.[ 690?_816+?del] p.[(?)], and ACVRL1 c.[268_274delins57];[ =] p.[(Cys90fs)];[( =)]. We confirmed the diagnosis of HHT in sixteen patients and identified pathogenic variants in ENG or ACVRL1 in all six probands in central South Africa, where HHT has been underreported. We describe three pathogenic variants: two of ENG and one of ACVRL1 . We will be able to implement pre-symptomatic screening of patients in our area, and improve their management.

Studies have been conducted describing the potential for using virtual care software during disasters and public health emergencies. However, limited data exist on ways in which the Canadian health care system utilizes virtual care during disasters or public health emergencies. Due to the need for social distancing and reduction of nonessential ambulatory services during the COVID-19 pandemic, the SickKids Chronic Pain Clinic sought to transition care delivery from in person to virtual. The virtual clinic aimed to reduce risks associated with physical contact and environmental exposure without reducing access to care itself. Harnessing of various digital tools including Ontario Telemedicine Network Guestlink, Zoom, and Microsoft Teams. The Chronic Pain Clinic Team worked together to communicate with patients and families, schedule virtual visits, establish remote access to clinical data collection tools, digitize the after-visit summary, and add resources on pain self-management to the clinic's website. The Chronic Pain Clinic successfully transitioned all clinic appointments (multidisciplinary and individual; 77 appointments) over a 2-week period to virtual care. Virtual clinics did not surpass the usual time taken pre-COVID-19, suggesting that the clinic workflow was readily adaptable to virtual care. Access to quality virtual care is essential to prevent chronic pain from taking a toll on the lives of patients and families. Rapid establishment of a virtual clinic without gaps in service delivery to patients is possible given institutional support and a team culture centered around collaboration and flexibility.

Responses to climate change can vary across functional groups and trophic levels, leading to a temporal decoupling of trophic interactions or “phenological mismatches.” Despite a growing number of single-species studies that identified phenological mismatches as a nearly universal consequence of climate change, we have a limited understanding of the spatial variation in the intensity of this phenomenon and what influences this variation. In this study, we tested for geographic patterns in phenological mismatches between six species of shorebirds and their invertebrate prey at 10 sites spread across ~13° latitude and ~84° longitude in the Arctic over three years. At each site, we quantified the phenological mismatch between shorebirds and their invertebrate prey at (1) an individual-nest level, as the difference in days between the seasonal peak in food and the peak demand by chicks, and (2) a population level, as the overlapped area under fitted curves for total daily biomass of invertebrates and dates of the peak demand by chicks. We tested whether the intensity of past climatic change observed at each site corresponded with the extent of phenological mismatch and used structural equation modeling to test for causal relationships among (1) environmental factors, including geographic location and current climatic conditions, (2) the timing of invertebrate emergence and the breeding phenology of shorebirds, and (3) the phenological mismatch between the two trophic levels. The extent of phenological mismatch varied more among different sites than among different species within each site. A greater extent of phenological mismatch at both the individual-nest and population levels coincided with changes in the timing of snowmelt as well as the potential dissociation of longterm snow phenology from changes in temperature. The timing of snowmelt also affected the shape of the food and demand curves, which determined the extent of phenological mismatch at the population level. Finally, we found larger mismatches at more easterly longitudes, which may be affecting the population dynamics of shorebirds, as two of our study species show regional population declines in only the eastern part of their range. This suggests that phenological mismatches may be resulting in demographic consequences for Arctic-nesting birds. Arctic invertebrates; phenology; spatial gradient; structural equation modeling; timing of breeding; trophic interactions.

BACKGROUND: Converging lines of evidence suggest that anxiety sensitivity and fear of pain may be important vulnerability factors in the development of avoidance behaviours and disability in adults with chronic pain. However, these factors have not been evaluated in children with chronic pain. OBJECTIVES: To examine the relationships among anxiety sensitivity, fear of pain and pain‐related disability in children and adolescents with chronic pain. METHODS: An interview and five questionnaires (Childhood Anxiety Sensitivity Index, Pain Anxiety Symptoms Scale, Functional Disability Inventory, Multidimensional Anxiety Scale for Children, and Reynolds Child or Adolescent Depression Scale) were administered to 21 children and adolescents eight to 17 years of age (mean ± SD 14.24±2.21 years) who continued to experience pain an average of three years after discharge from a specialized pain clinic for children. RESULTS: Anxiety sensitivity accounted for 38.6% of the variance in fear of pain (F[1,20]=11.30; P=0.003) and fear of pain accounted for 39.9% of the variance in pain‐related disability (F[1,20]=11.95; P=0.003), but anxiety sensitivity was not significantly related to pain disability (R 2 =0.09; P>0.05). CONCLUSIONS: These findings indicate that children with high levels of anxiety sensitivity had a higher fear of pain, which, in turn, was linked to increased pain disability. The results of this study suggest that anxiety sensitivity and fear of pain may play important and distinct roles in the processes that maintain chronic pain and pain‐related disability in children.

Aim Site network approaches to waterbird conservation are easily biased towards species that occur in high densities and locations and periods of the annual cycle with dense concentrations of birds, thereby potentially failing to address underlying factors driving certain population declines. Here, for shorebird populations that migrate along the East Asian–Australasian Flyway, we examine the extent to which recent conservation efforts at key sites in the Yellow Sea—that is, sites that are vital for stabilising densely concentrated, rapidly declining shorebird species—might address factors underlying low adult survival and steep population declines in shorebird species that migrate and winter along a broad front (i.e., the East China Sea, Yellow Sea and Japan). Location East Asia. Methods and Results Using geolocator‐derived migration tracks, an integrated survival model and a population matrix model to estimate winter‐population‐specific survival rates and population trends in a quintessential East Asian shorebird population—the arcticola subspecies of the Dunlin (Calidris alpina)—we show that in 2010–2014 differences between arcticola winter populations in the intensity of their declines were most likely linked to conditions on their wintering grounds, with individuals that wintered in the East China Sea or Japan showing the steepest population declines (mean: −12% year−1 [50% credible interval: −3%, −22%] and −17% year−1 [−6%, −30%], respectively) and individuals that wintered in the Yellow Sea surprisingly stable (+4% year−1 [−5%, +14%]). Main Conclusions For shorebird populations that winter in East Asia and migrate along a broad front, additional conservation efforts in the East China Sea and Japan are likely necessary to reverse population declines.

Aim Many populations of migratory birds are currently declining. Understanding space use throughout the entire annual cycle, as well as migratory connectivity (i.e., geographic linkage of individuals and populations across different stages of the annual cycle), can improve our ability to identify factors driving population declines and influencing extinction risk. The main objectives of our study were to (i) document the space use and phenology of migration during the non‐breeding period and (ii) quantify the degree of migratory connectivity across the range of the American Golden‐Plover (Pluvialis dominica) breeding across the North American Arctic. Location American Golden‐Plovers that breed across their entire breeding range (northern North America) and migrate up to their main wintering site located in South America. Methods We used archival light‐level geolocators to track the migration. We quantified migratory connectivity based on the non‐breeding range spread of all individuals and the breeding population spread. We used Mantel tests to evaluate whether the relative spatial configuration of the sampled breeding area was preserved on the non‐breeding ground. Results We identified 13 and 7 stopover sites used during the fall (post‐breeding, southbound) and spring (pre‐breeding, northbound) migrations, respectively, and one main site used during the wintering period. We highlight stopover sites that were previously unknown and show the transatlantic and transpacific routes used by plovers during migration. We found that individuals breeding in proximity tended to be closer to each other during brief and highly limited portions of the non‐breeding period. Broadly, individuals from different breeding populations were well mixed during the wintering period and throughout most of the spring and fall migrations. Main Conclusions Overall, the migratory connectivity of American Golden‐Plovers is relatively low for most of the non‐breeding period, suggesting that breeding populations separated by large distances should be similarly affected by disturbances and changes encountered at some migratory stopovers and in the wintering area.