Saudi Cultural Missions Theses & Dissertations
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Item Restricted LOCOMOTOR EXPLORATORY BEHAVIORS OF INFANTS BORN PRETERM AND FULL-TERM(Saudi Digital Library, 2026) Almoadi, Nora; Barbara, SargentInfants born preterm (PT) typically experience delayed walking onset and differences in exploratory behavior and gait patterns compared to infants born full-term (FT), yet the mechanisms underlying these differences remain poorly understood. In particular, the relative contributions of biomechanical constraints, such as lower limb muscle strength, and social contexts, such as caregiver motivation, to early locomotor development are not well established. This dissertation addresses this gap by examining how pre-walking infants born PT and FT develop early locomotor abilities when afforded opportunities for supported upright exploration. To this end, a dynamic weight support (DWS) paradigm was used to systematically reduce lower limb loading and to investigate how biomechanical and social contexts influence the early locomotor exploratory behaviors of pre-walking infants born PT and FT, including the practice of both familiar and novel walking skills, spatial exploration, and the adaptation of emerging gait patterns. Data were collected from 17 infants born PT and 30 infants born FT over 2 consecutive days, across experimental conditions that manipulated lower limb unloading (with and without DWS) and social context (with and without caregiver motivation). This dissertation includes four studies: 1) Unweighting infants clarifies the role of strength and caregiver motivation in walking acquisition, 2) Unweighting pre-walking infants born preterm clarifies the role of strength and caregiver motivation in early walking skills, 3) Differences in locomotor spatial exploration in pre-walking infants born preterm and full-term, 4) Dynamic body-weight support reveals gait adaptation in infants born full-term but not infants born preterm. Results showed that: 1) Infants born FT increased practice of novel standing and walking skills when DWS was combined with caregiver motivation on the first day, and continued to xiii practice the novel skills in DWS on the second day both in conditions with and without caregiver motivation. 2) In contrast, infants born PT did not demonstrate increased practice of either novel or familiar skills in DWS, except increased practice of novel skills with caregiver motivation on the second day. 3) With respect to spatial exploration, on Day 1, infants born FT showed increases in both path length and explored area when caregiver motivation was provided. By Day 2, infants born FT exhibited increased spatial exploration in DWS without caregiver motivation and maintained the higher level following DWS removal. In contrast, infants born PT did not demonstrate changes in spatial exploration across days. Between-group comparisons indicated that differences emerged on Day 2 under DWS conditions without caregiver motivation and following DWS removal, with infants born FT covering longer distances and exploring greater areas. 4) In terms of gait adaptations, on Day 1, neither group changed their gait parameters. By Day 2, infants born FT demonstrated more mature gait parameters in DWS, specifically decreased step width and increased step length, whereas infants born PT did not demonstrate changes in gait parameters across days. Between-group comparisons indicated that differences emerged on Day 2 during the last DWS condition without caregiver motivation, with infants born FT demonstrating decreased step width. Collectively, these findings advance understanding of the biomechanical and behavioral mechanisms underlying early locomotor exploration and underscores the potential of integrating mechanical support and social context. Specifically, this work shows that reducing lower-limb load can reveal latent motor capabilities in infants born FT, but that the expression, refinement, and retention of these skills depend on caregiver motivation and repeated practice. In contrast, infants born PT show limited responsiveness to these manipulations, suggesting that delayed walking in this population cannot be explained by strength limitations alone, but likely reflects xiv additional neuromotor, behavioral, and social constraints. These findings have important implications to inform early intervention strategies for infants born PT, highlighting the need for approaches that integrate mechanical support with structured and socially enriched practice to promote motor development.3 0Item Restricted Temperature Extremes Exposure and Children’s Health: Extreme Heat- and Cold-Related Impacts in Edmonton, Alberta(University of Alberta, 2024) Alsunaidi, Sara; Jones, C. Allyson; Yamamoto, Shelby S.; Osornio-Vargas, AlvaroIn the current context of escalating climate change effects on public health, Canada's distinctive geographic position causes it to warm at double the global average rate. This phenomenon leads to potentially heightened health risks for its residents through direct and indirect mechanisms. Particularly at risk are the most vulnerable age groups, such as children aged 0-5 years. Extreme temperature events—both hot and cold—pose latent health threats, especially to this demographic. It is imperative to note that while all children within this age range are at risk, certain age-specific and sex-specific factors may exacerbate or mitigate their vulnerability. Given the transformative developmental stages within these early years and the pronounced physiological differences between sexes, these factors are crucial to understand. This study, focusing on Edmonton, AB, aims to explore the health ramifications of such temperature extremes on children aged 0-5. To achieve a comprehensive analysis, the research segments its investigation based on age brackets (0-1, 2-3, 4-5 years) and sex (male and female). The objective is to examine the association between outdoor exposure to extreme temperature conditions and the incidence rate of hospital admissions and emergency visits for children in this age group. It utilizes health data from Alberta Health Services (AHS) and environmental data from the Alberta Climate Information Service (ACIS) from 2015 to 2018, focusing on age- and sex-specific trends. Time-series analysis, including Poisson and negative binomial regression, were applied to examine the correlation between temperature extremes—quantified by the 95th and 5th percentiles of weekly average temperatures—and pediatric hospital admissions and emergency visits. The analyses were stratified by age and sex and adjusted for confounding variables such as air pollution, relative humidity, seasonality, and long-term trends. During the study period, we recorded 5,970 hospital admissions and emergency visits for the 0-5 age group, with a notable majority (92.2%) for respiratory diseases. A significant increase in health service utilization was found in the 2–3-year age group during extreme heat (IRR= 1.36, 95% CI 1.03-1.80, p=0.03) and cold (IRR= 1.30, 95% CI 1.01-1.67, p=0.05) events. No significant associations were found in the 0-1- and 4-5-year age brackets, nor were there sex-based differences in health outcomes. The study revealed that pediatric respiratory diseases, such as asthma, bronchiolitis, and pneumonia, were significantly associated with extreme temperature events in the 2–3-year age group. The effects of cold temperatures persisted up to four weeks post-exposure (IRR= 1.30, 95% CI 1.00-1.69, p=0.05), while the impact of heat was more immediate (IRR= 1.36, 95% CI 1.01-1.83, p=0.04), suggesting different temporal patterns of risk. These findings demonstrate a rising trend in the risk of negative respiratory health effects in young children linked to extreme hot and cold temperatures, highlighting the need for a more thorough assessment across various health outcomes. Additionally, they emphasize the need for ongoing research to refine our understanding of how these events affect pediatric health and develop comprehensive mitigation and adaptation strategies. Future studies should investigate more precise and direct methods for assessing the health impacts of such events, explore the contributing factors of these temperature extremes, including the role of climate change, and explore preventative strategies to mitigate their effects. This research is crucial for developing robust measures to protect our youngest and most vulnerable residents from the health hazards of extreme climate variability.14 0Item Restricted Nurses’ perspectives on the barriers to and facilitators of effective paediatric pain assessment and management: A systematic review(Saudi Digital Library, 2023-11-21) Gadi, Amirah Dawood M; Wilson, IseultBackground: Children’s pain is a universal problem that has far-reaching negative consequences. Despite the recognition that effective pain management is a fundamental human right, some children are still suffering from unrelieved pain. Nurses have a pivotal role in paediatric pain management; however, they are confronted by many barriers. It is therefore of value to explore the barriers and facilitators that nurses experience when caring for children in pain. Aim: This study aims to explore nurses’ perspectives regarding the barriers and facilitators related to the effective assessment and management of pain in children, infants, and neonates. Methodology: A search strategy was formulated, and five databases were searched for relevant articles including ProQuest, Scopus, CINAHL, PsycINFO and PubMed. Each paper identified by the search underwent a quality assessment using a predetermined tool. Relevant information to the research question was extracted, and the major themes were then identified by thematic analysis. Findings: Eighteen studies were included in this review. Recognised barriers and facilitators were categorised into three main themes related to: (i) healthcare professionals; (ii) the child and their parents; and (iii) the organisation. Prominent barriers included nurses' inadequate knowledge of the uses and side effects of medication, limited pain assessment experience, low prioritisation of pain, time constraints, communication and language difficulties with children, as well as uncooperative children, insufficient parental involvement, lack of guidelines and resources shortages, and nurses’ distrust in pain assessment tools. Key facilitators comprised robust knowledge, adequate experience, higher education, in-service training, parental involvement, effective communication with children and parents, clear guidelines, adequate resources, and nurses’ trust in and utilisation of pain assessment tools. Conclusions: This review provides valuable insights into the barriers and facilitators faced by nurses with respect to the assessment and management of pain in the paediatric population. There is a need for targeted educational interventions and policy changes to support nurses’ ability to deliver high-quality pain care. Further research is needed in order to investigate these factors and to examine any other potentially associated determinants amongst paediatric nurses.43 0