BackgroundSurgery can generate significant stress and anxiety in up to 70% of the paediatric population. There are several pharmacological and non-pharmacological strategies to reduce pre-operative anxiety in children, however, they have several side effects and the available information about them is contradictory. The role of clowns and hydroxyzine in the management of anxiety is controversial, with some studies supporting and others contraindicating both strategies.MethodsWe propose a randomised double-blind, controlled clinical trial that will evaluate the effectiveness of both interventions (hydroxyzine and clowns), alone or in combination, to reduce pre-operative anxiety (using the modified Yale scale of preoperative anxiety) in children aged 2–16 years undergoing outpatient surgery (n = 188).Subjects will be randomised into two groups – (1) standard procedure (parental accompaniment) combined with placebo or (2) standard procedure combined with preoperative hydroxyzine. After randomisation, they will be divided by chance into two further groups, depending on the presence of clowns on the patient’s surgery day. Control of pre-operative anxiety will be determined in the four groups by a modified Yale scale of preoperative anxiety and cortisol levels. Compliance of children during induction of anaesthesia, time until anaesthesia recovery, presence of postoperative delirium and use of analgesia until discharge will be also assessed. For additional information, the children, parents and healthcare professionals involved in the study will complete a satisfaction survey.ConclusionsThis study aims to gather evidence on which of these four therapeutic options achieves the highest reduction of pre-operative anxiety with the best safety profile to allow paediatricians and anaesthesiologists to use the most effective and safe option for their patients.Trial registrationClinicalTrials.gov identifier: NCT03324828. Registered 21 September 2017.

Introduction Social media use has grown dramatically since its inception in the early 2000s and has further increased during the COVID-19 pandemic. Problematic use of social media (PUSM) is a type of behavioural addiction which has generated increasing interest among mental health clinicians and scholars in the last decade. PUSM is associated with multiple psychiatric conditions and is known to interfere with patients’ daily functioning. There is no single accepted definition of PUSM, nor means of measuring it, in the literature. The Bergen Social Media Addiction Scale (BSMAS) is a helpful tool for identifying PUSM. This paper aims to validate BSMAS and to translate it from English into French, with the goal of making this clinical screening tool for PUSM available in French-language contexts. Method This study explored the psychometric validity of the French version of the BSMAS in a sample of 247 adolescents, who were either psychiatric inpatients (the hospitalized group, n = 123) or recruited in local high schools (the community group, n = 124). Results The adolescents in the sample reported an increase in their social media use during the COVID-19 pandemic. This increase was more pronounced in the hospitalized group. Confirmatory factorial analysis showed an excellent fit, very good internal consistency and established convergent validity for the French version of the BSMAS. A total of 15.4% of the hospitalization group and 6.5% of the community group met the recommended clinical cutoff of 24 on the BSMAS, suggesting problematic use of social media. Conclusions The French version of BSMAS is a psychometrically validated and clinically useful tool to screen for PUSM in adolescents.