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      Impact of an animal-assisted therapy programme on physiological and psychosocial variables of paediatric oncology patients

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          Abstract

          The objective of this study was to propose an intervention and safety protocol for performing animal-assisted therapy (AAT) and evaluating its efficacy in children under outpatient oncological treatment based on psychological, physiological, and quality of life indicators for the children and caregivers. The sample consisted of 24 children diagnosed with leukaemia and solid tumours (58% girls with a mean age of 8.0 years) who underwent an AAT programme consisting of three 30-min sessions in an open group. Two dogs (one Labrador retriever and one golden retriever) were used, and activities such as sensory stimulation, gait training, and socialization were conducted. The exclusion criteria were severe mental problems, inability to answer the questions included in the instruments used, allergy to animals, unavailability/lack of interest, isolation precaution, surgical wound, use of invasive devices, ostomy, no current blood count for evaluation, neutropaenia, infection, fever, diarrhoea, vomiting, respiratory symptoms at the beginning of the intervention or 1 week before the intervention, hospitalization or scheduled surgery, and non-completion of the AAT programme. The variables analysed using validated self or other evaluations were stress, pain, mood, anxiety, depression, quality of life, heart rate, and blood pressure. A quasi-experimental study design was used. We observed a decrease in pain (p = 0.046, d = –0.894), irritation (p = 0.041, d = –0.917), and stress (p = 0.005; d = –1.404) and a tendency towards improvement of depressive symptoms (p = 0.069; d = –0.801). Among the caregivers, an improvement was observed in anxiety (p = 0.007, d = –1.312), mental confusion (p = 0.006, d = –1.350), and tension (p = 0.006, d = –1.361). Therefore, the selection criteria and care protocols used for the AAT programme in the oncological context were adequate, and the programme was effective.

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          Social evolution. Oxytocin-gaze positive loop and the coevolution of human-dog bonds.

          Human-like modes of communication, including mutual gaze, in dogs may have been acquired during domestication with humans. We show that gazing behavior from dogs, but not wolves, increased urinary oxytocin concentrations in owners, which consequently facilitated owners' affiliation and increased oxytocin concentration in dogs. Further, nasally administered oxytocin increased gazing behavior in dogs, which in turn increased urinary oxytocin concentrations in owners. These findings support the existence of an interspecies oxytocin-mediated positive loop facilitated and modulated by gazing, which may have supported the coevolution of human-dog bonding by engaging common modes of communicating social attachment.
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            Attentional Routes to Conscious Perception

            The relationships between spatial attention and conscious perception are currently the object of intense debate. Recent evidence of double dissociations between attention and consciousness cast doubt on the time-honored concept of attention as a gateway to consciousness. Here we review evidence from behavioral, neurophysiologic, neuropsychological, and neuroimaging experiments, showing that distinct sorts of spatial attention can have different effects on visual conscious perception. While endogenous, or top-down attention, has weak influence on subsequent conscious perception of near-threshold stimuli, exogenous, or bottom-up forms of spatial attention appear instead to be a necessary, although not sufficient, step in the development of reportable visual experiences. Fronto-parietal networks important for spatial attention, with peculiar inter-hemispheric differences, constitute plausible neural substrates for the interactions between exogenous spatial attention and conscious perception.
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              The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement.

              The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to revise the original scale and validate the adapted version. In the first phase, the FPS was revised from its original seven faces to six, while maintaining its desirable psychometric properties, in order to make it compatible in scoring with other self-rating and observational scales which use a common metric (0-5 or 0-10). Using a computer-animated version of the FPS developed by Champion and colleagues (Sydney Animated Facial Expressions Scale), psychophysical methods were applied to identify four faces representing equal intervals between the scale values representing least pain and most pain. In the second phase, children used the new six-face Faces Pain Scale-Revised (FPS-R) to rate the intensity of pain from ear piercing. Its validity is supported by a strong positive correlation (r=0.93, N=76) with a visual analogue scale (VAS) measure in children aged 5-12 years. In the third phase, a clinical sample of pediatric inpatients aged 4-12 years used the FPS-R and a VAS or the colored analogue scale (CAS) to rate pain during hospitalization for surgical and non-surgical painful conditions. The validity of the FPS-R was further supported by strong positive correlations with the VAS (r=0.92, N=45) and the CAS (r=0.84, N=45) in this clinical sample. Most children in all age groups including the youngest were able to use the FPS-R in a manner that was consistent with the other measures. There were no significant differences between the means on the FPS-R and either of the analogue scales. The FPS-R is shown to be appropriate for use in assessment of the intensity of children's acute pain from age 4 or 5 onward. It has the advantage of being suitable for use with the most widely used metric for scoring (0-10), and conforms closely to a linear interval scale.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                4 April 2018
                2018
                : 13
                : 4
                : e0194731
                Affiliations
                [1 ] Pio XII Foundation–Barretos Cancer Hospital, Barretos, São Paulo, Brazil
                [2 ] Department of Neurosciences and Behavioural Sciences, Faculty of Medicine of Ribeirão Preto–USP, Ribeirão Preto, São Paulo, Brazil
                Istituto Superiore Di Sanita, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-7621-1790
                Article
                PONE-D-17-40971
                10.1371/journal.pone.0194731
                5884536
                29617398
                dab85cf0-4d23-48f6-965d-0e15a025ba76
                © 2018 Silva, Osório

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 November 2017
                : 8 March 2018
                Page count
                Figures: 1, Tables: 3, Pages: 15
                Funding
                Funded by: Pio XII Foundation – Barretos Cancer Hospital
                Award ID: Master Scholarship
                Award Recipient :
                Funded by: National Council for Scientific and Technological Development - CNPq
                Award ID: Productivity Grants (PQ-CNPq-2 -number 301321/2016-7)
                Award Recipient :
                This work was supported by Pio XII Foundation – Barretos Cancer Hospital, Barretos, São Paulo, Brazil. Prof. Osório was supported by productivity grants (PQ-CNPq-2 -number 301321/2016-7). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Oncology
                People and Places
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                Children
                People and Places
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                Families
                Children
                Biology and Life Sciences
                Organisms
                Eukaryota
                Animals
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                Psychology
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                Social Sciences
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                Medicine and Health Sciences
                Oncology
                Cancer Treatment
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                Mental Health and Psychiatry
                Psychological Stress
                Biology and Life Sciences
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                Psychology
                Psychological Stress
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                Custom metadata
                Data are restricted by the Comitê de Ética em Pesquisa – Fundação Pio XII – Hospital de Câncer de Barretos and cannot be shared publicly. The Ethics Committee does not authorize the public disclosure of data without access control in agreement with a Brazilian resolution that governs research with human beings in Brazil (RESOLUÇÃO Nº 466, DE 12 DE DEZEMBRO DE 2012, Ministério da Saúde, Brasil). Interested, qualified researchers can send data requests to: cep.hcb@ 123456hcancerbarretos.com.br .

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