Anxiety is associated with unfulfilled information needs and pain at the informed consent consultation of spine surgery patients: a longitudinal study.

PURPOSE: Meeting the information needs of patients adequately is of high importance in informed consent consultations in surgery. However, information needs often remain unmet in the informed consent consultation. The aim of this study was to assess anxiety and pain in relation to the patients' information needs fulfillment perioperatively. METHODS: We applied a question prompt list (QPL) for patients undergoing spine surgery (SN-QPL) before (t1) and a question answering list (SN-QAL) after (t2) the informed consent consultation. The patients additionally completed the "State-Trait Anxiety Operation Inventory" (STOA, cognitive and affective scale) at t1, as well as a pain numerical rating scale (NRS) at t2 and postoperative (t3). We analyzed (1) the association between anxiety, information needs and pain and (2) anxiety and pain scores regarding information needs fulfillment after the consent consultation. RESULTS: A total of n = 118 patients was included. Affective and cognitive state anxiety was only reduced postoperatively (affective p < .001, cognitive p < .05). The higher trait anxiety was, the more patients longed for information at t1-t3 (t1: r = .58/r = .74, each p < .001), (t2: r = .38/r = .49, each p < .001) and (t3: r = .29, p < .01/r = 34, p < .001). Higher grades of trait anxiety resulted in lower information needs fulfilment. Higher state anxiety levels were associated with higher pain levels. Information needs more often remained unfulfilled in high trait and state anxiety patients. CONCLUSION: Patients' anxiety was associated with (un)fulfilled information needs. Meeting information needs should be optimized in the process of surgeon-patient communication. Adapting the information to the patients' anxiety levels seem to be an effective way to reduce anxiety.

Short STAI-Y anxiety scales: validation and normative data for elderly subjects.

OBJECTIVES: The aim of this study was to develop short forms of the STAI-Y trait and state scales and associated norms suitable for the screening of anxiety in elderly populations. METHOD: This study was based on population-based cohorts of older persons from two epidemiological French studies that each included one subscale of the STAI-Y, i.e. state and trait anxiety scales. For both scales, the most discriminative items were retained and their factorial structure was examined using principal components analysis. Internal consistency (Cronbach's alpha) was estimated and cut-offs and norms were computed. RESULTS: A 10-item STAI-Y version produced scores similar to those obtained with the full form of the STAI-Y. The factorial structure of the shortened form is comparable to that of the full scales. Results showed good internal consistency (alpha coefficients were 0.92 and 0.85 for short STAI-Y state and trait scales, respectively). Moreover, both short STAI-Y state and trait scales correctly classified 88% of the participants using a cut-off point of 23. Norms for both short trait and state anxiety scales are provided according to age, gender, educational level and depressive symptoms. CONCLUSION: Both shortened scales have similar factorial structure and internal consistency to the longer scales and classify anxious/non-anxious elderly with acceptable accuracy. The shorter form is likely to be more acceptable to elderly persons through reduction of fatigue effects.

Hearing laughter: a prescription for anxiety relief.

Anxiety can have adverse effects on cognition such as impairing test performance or restricting working memory. One way of reducing anxiety is through humor, and the present research investigated if the perception of laughter, which is often seen as a reaction to humor, could impact self-reported anxiety. Participants completed the STAI battery containing subscales for both state and trait anxiety before and after one of three manipulations: a laughter sounds rating task, a neutral sounds rating task, or a working memory span task. Results showed that perceiving laughter decreased both state and trait anxiety, taking a working memory test increased state anxiety, and perceiving neutral sounds had no effect on either type of anxiety. These findings are interpreted as evidence that the positive emotions induced by hearing laughter help to regulate anxiety by undoing arousal, even when negative emotions are not present.

Efficacy of Integrated Yoga and Naturopathy With Physiotherapy or Acupuncture for Low Back Pain: A Parallel, Two-Arm, Randomized Trial.

INTRODUCTION: Low back pain (LBP) is a musculoskeletal condition that affects many individuals. While physiotherapy and acupuncture are frequently used treatments, determining their specific contributions when used alongside integrated yoga and naturopathy (IYN) therapy for relieving chronic LBP symptoms and enhancing quality of life is important. METHODOLOGY: In the present prospective randomized comparative trial, a total of 60 participants were divided into the following two groups: physiotherapy with IYN and acupuncture with IYN. The treatment duration was 10 days, and assessments were conducted both before (baseline) and after the intervention. Various assessment tools, such as the visual analog scale (VAS), Oswestry Disability Index (ODI), fingertip-to-floor test (FTF), State-Trait Anxiety Inventory (STAI), and Short Form 36 (SF-36), were utilized. The statistical analysis was performed using SPSS version 21.0 (Armonk, NY: IBM Corp). RESULTS: The results revealed significant differences in VAS score, ODI, FTF score, STAI score, and SF-36 score between the physiotherapy and acupuncture groups (p<0.001). A t-test for the equality of means and a Mann-Whitney U test were used to compare the two groups; these tests revealed a significant difference in disability levels, range of motion, and state of anxiety. The acupuncture group showed a significant difference in the ODI (15.9 {12.6, 19.3}; p <0.001) and state anxiety (23.0 {20.0, 26.0}; p<0.001) compared to the physiotherapy ODI (22.4 {18.5, 26.4}) and state anxiety (27.5 {25.0, 30.0}). The physiotherapy group showed a significant difference in range of motion (7.7 {5.7, 9.7}; p<0.001) compared to the acupuncture group (11.6 {9.8, 13.5}). CONCLUSION: The present study findings revealed that both physiotherapy and acupuncture, as interventions along with integrated yoga and naturopathy may be considered an effective treatment strategy for chronic LBP.

Brief tele-mindfulness-based intervention: A multicenter randomized controlled trial.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has proven to be detrimental to the psychological well-being of healthcare providers (HCP). This study was a psychological intervention during the COVID-19 pandemic to check extent to which brief mindfulness-based interventions (MBIs) and progressive muscle relaxation (PMR) affect psychological well-being, resilience, and anxiety of HCPs. MATERIALS AND METHODS: A randomized trial study conducted from July to August 2020. One hundred and forty-seven COVID-19 frontline HCPs were randomized to a 2-week virtual intervention with a brief MBI or a PMR. Pre- and postintervention assessments were done using the State-Trait Anxiety-20-Item Scale, the Connor-Davidson Resilience Scale-10, and WHO-5 Well-Being Index. RESULTS: The final sample included 125 HCPs (64 in BMI group and 61 in PMR group) who completed pre- and post-intervention assessment. The results showed a significant improvement in the psychological well-being and reduction of the state anxiety of the two groups, but not in the trait anxiety or resiliency. Improvement was more in the group's brief MBI (81.3%) than in the group's PMR (51.8%) (P = 0.0001), concerning psychological well-being. CONCLUSION: Both the brief MBI and PMR improved the psychological well-being and reduced the anxiety of frontline healthcare providers during the COVID-19 pandemic with a slightly better improvement in the brief MBI.

Economic expectations and anxiety during the COVID-19 pandemic: a one-year longitudinal evaluation on Italian university students.

The COVID-19 pandemic has produced an extensive aggravation of people's anxiety level. Different policies aimed at fighting the spread of the virus could affect anxiety in various ways. We built an ad hoc web-based survey, administered to the student population of three Italian universities at the beginning of the pandemic and at one year's distance, to collect information on retrospective and current anxiety levels and the underlining reasons. The survey also included questions concerning sociodemographic, economic, labor, lifestyle, academic career, and on-line teaching features, which prevents students from identifying the main survey topic to be anxiety. This research aims at assessing the change in anxiety levels between the analyzed periods and the main determinants of such change, focusing on students' economic expectancies. Results from a Poisson regression model show that anxiety has increased compared to both the pre-pandemic level and the one quantified during the first lockdown. This increase is revealed to be mostly driven by economic and career-related uncertainties, rather than by job loss and proximity to COVID-19. Thus, policymakers should take action to provide certainties both in terms of economic prospects and reopening strategies, especially to avoid that the resulting increase in anxiety translates into an amplified suicide risk.

Gastrointestinal distress, State and Trait anxiety, and dietary intake among college students during the COVID-19 pandemic.

OBJECTIVE: This study examined the impact of State and Trait anxiety and dietary intake on college students' gastrointestinal symptoms during the COVID-19 pandemic. PARTICIPANTS: A total of 455 students, aged 18-23, from two residential colleges in the midwestern United States participated in the study during April 2021. METHODS: An online questionnaire that included the National Cancer Institute Dietary Screener, State-Trait Inventory for Cognitive and Somatic Anxiety, and an adapted version of the Gastrointestinal Symptoms Questionnaire was used. Stepwise multiple regression analyses and Spearman rho correlation coefficients were used to analyze the data. RESULTS: High rates of State-somatic, State-cognitive, and Trait-somatic anxiety were present in our study population. These anxiety subscales and dietary intake predicted 26% and 3.8% of the GI symptoms variance, respectively. CONCLUSION: State-anxiety and Trait-somatic anxiety are large factors in predicting GI symptoms compared to dietary intake. College students could seek anxiety-reducing techniques to ease GI symptoms.

Effects of COVID-19 lockdown on university students' anxiety disorder in Italy.

The COVID-19 pandemic has highlighted the vulnerability of specific population sections, with regards to economic and work conditions, mental and physical well-being, and context-based factors, emphasizing the need for timely policy measures aimed at counteracting the Italian economic framework's fragility-which poorly adapts to unexpected circumstances. Identifying the most vulnerable groups is, therefore, essential with a view to carrying out targeted measures. Concerning University, the economic downturn caused by COVID-19 could likely result in a decrease in enrollments to both the first and further years of study, with significant consequences on the future of students and the system as a whole. The class of students is of great interest, as it is made up of individuals differing from each other in many ways. Our investigation is aimed at observing anxiety levels filtering the perception of one's anxiety state in a highly stressful time such as the pandemic from the usual anxiety levels. This evaluation allows us to evaluate the similarity of individual behaviors during the lockdown period with those from the previous period.

Preoperative anxiety as predictor of perioperative clinical events following carotid surgery: a prospective observational study.

BACKGROUND: Psychological factors like anxiety and depression are recognised to play a causal role in the development of cardiovascular disease and they may also influence outcome after vascular surgery procedures. The aim of this study was to investigate the association of anxiety and depression with postoperative outcome following elective carotid surgery. METHODS: Single centre prospective observational study of patients treated for asymptomatic carotid artery stenosis at an academic vascular surgery centre. Preoperative anxiety and depression were evaluated using self-reporting questionnaires: Spielberger State-Trait Anxiety Inventory (STAI-S/-T) and Hospital Anxiety and Depression Scale (HADS-A/-D). Postoperative morbidity and mortality were assessed with the primary composite endpoint of stroke, myocardial infarction (MI) and death. Standard reporting guidelines for carotid disease were applied. RESULTS: From June 2012 to November 2015, 393 carotid endarterectomies (CEA) were performed at our institution. Out of those, 98 asymptomatic patients were available for analysis (78% male; median age, 71.1 years). Median scores of self-reporting questionnaires did not differ from published data of the general population (STAI-T, trait component, median, 36; IQR, 31-42.75; STAI-S, state component, median, 38; IQR, 32-43; HADS-A median, 6; IQR, 3-8; HADS-D median, 4; IQR, 2-7). Cardiovascular risk factors were similar in anxious and non-anxious patients. The composite endpoint of stroke, MI and death occurred significantly more often in patients presenting with a preoperative HADS-A score higher than 6 (10.5%, 95% CI, 3-25; p =.020). CONCLUSIONS: The present study indicates that preoperative anxiety is associated with the occurrence of intra- and postoperative neurological events in patients undergoing CEA. Patients who had a preoperative HADS-A score of 6 or less had a very low probability of experiencing these complications.

High- and Low-conditioned Behavioral effects of midazolam in Carioca high- and low-conditioned freezing rats in an ethologically based test.

The selective breeding of laboratory rodents with different anxiety-related traits is the subject of growing interest. The present study compared the effects of the benzodiazepine midazolam in the elevated plus maze (EPM) test of anxiety in two lines of Wistar rats that were selectively bred in our laboratory for either high or low anxiety-like traits based on a contextual freezing conditioning paradigm. After phenotyping anxiety-like traits (i.e., conditioned freezing behavior), Carioca High-Freezing [CHF], Carioca Low-Freezing [CLF]) and control rats were intraperitoneally injected (1.0 ml/kg) with .9 % saline or midazolam (.25, .5, .75, and 1.0 mg/kg) and subjected to the EPM 30 min later. After the saline injection, the CHF and CLF groups exhibited lower and higher open-arm exploration in the EPM, respectively, compared with control rats. These results indicate that anxiety-related traits previously selected from an associative learning paradigm can also be phenotypically expressed in an ethologically based animal model of anxiety. All midazolam doses significantly increased open-arm exploration in both CHF and control animals, but this anxiolytic-like effect in CLF rats was only observed at the lowest dose tested (.25 mg/kg). The present findings indicate that these two breeding lines of rats are a useful model for studying anxiety, and the anxiolytic effect of midazolam depends on genetic variability that is associated with basal reactions to threatening situations.

Association of State and Trait Anxiety Between Patients Who Had Undergone Traumatic Amputation and Their Family Caregivers.

The purpose of this research was to explore the association between state and trait anxiety experienced by patients who had undergone traumatic amputation and their family caregivers. The sample studied consisted of 50 hospitalized patients who had undergone traumatic amputation and 50 family caregivers. The collected data included patients' and caregivers' characteristics and the State Trait Anxiety Inventory scores. Fifty percent of patients and caregivers scored below 50 and 47, respectively (median), in trait anxiety. In terms of state anxiety, at least 50% of patients and caregivers scored below 56 and 50.5, respectively. These values indicate moderate to high levels of the impact of amputation on the trait and state anxiety of amputees and their caregivers. A positive linear correlation was found between the trait and state anxiety of the patients as well as between the trait and state anxiety of caregivers, as expected (ρ = 0.915, P < .001, and ρ = 0.920, P < .001, respectively). A statistically significant positive correlation was also observed between state patient anxiety and state anxiety of caregivers (ρ = 0.239 and P = .039) and between trait patient anxiety and trait anxiety of caregivers (ρ = 0.322 and P = .030). More specifically, as the patient's anxiety score (either trait temporary) increases, the score of the caregivers' anxiety increases and vice versa. Nurses should be aware of the association between anxiety of amputees and caregivers and, therefore, work in multidisciplinary teams to maximize clinical outcomes for patients after amputation and their families.

Hepatitis C virus eradication with directly acting antivirals improves health-related quality of life and psychological symptoms.

BACKGROUND: Alterations in health-related quality of life (HRQoL) and neuropsychological disorders were described in the hepatitis C virus (HCV) patients. Although several studies investigated the modifications of HRQoL after HCV eradication, no data exists on the modifications of neuropsychological symptoms. AIM: To investigate the effect of directly acting antivirals (DAAs) treatment on HRQoL and neuropsychological symptoms. METHODS: Thirty nine patients with HCV infection underwent a neuropsychological assessment, including Zung-Self Depression-Rating-Scale, Spielberg State-Trait Anxiety Inventory Y1-Y2 and the Toronto-Alexithymia Scale-20 items before and after DAAs treatment. HRQoL was detected by Short-Form-36 (SF-36). RESULTS: All HRQoL domains, but role limitation physical and bodily pain, significantly improved after treatment. Interestingly, after DAAs treatment, all domains of HRQoL returned similar to those of controls. Each neuropsychological test significantly improved after HCV eradication. A significant correlation was observed among each psychological test and the summary components of SF-36. At multiple linear regression analysis including each psychological test as possible covariates, Zung-Self Depression Rating Scale (Zung-SDS) score was independently and significantly related to summary components of the SF-36 in the basal state and the difference between Zung-SDS score before and after treatment was the only variable significantly and independently related to the modification of HRQoL induced by the treatment. CONCLUSION: Neuropsychological symptoms strongly influenced HRQoL in HCV patients and there was a significant improvement of neuropsychological tests and HRQoL after DAAs treatment.

The Influence of Stress and Anxiety on the Expectation, Perception and Memory of Dental Pain in Schoolchildren.

The aim of this study was to investigate the association of stress and anxiety with the expectation, perception and memory of dental pain among schoolchildren. A follow-up study involving 46 children aged 9 to 12 years was conducted in a public school in the city of Petropolis (RJ), Brazil. Demographic characteristics, stress (children's stress scale), and state and trait anxiety (state⁻trait anxiety inventory) were recorded before a dental procedure to restore the occlusal surface of a permanent first molar under local anaesthetic. Dental pain was assessed using the faces pain scale before (dental pain expectation), immediately after (dental pain perception) and six weeks after (memory of dental pain) the dental procedure. Dental pain expectation scores were significantly higher than dental pain perception, independent of the levels of stress, state anxiety and trait anxiety. Children with high scores of stress (OR 1.05 95%CI 1.02⁻1.09), state anxiety (OR 1.15 95%CI 1.05⁻1.27) and trait anxiety (OR 1.18 95%CI 1.07⁻1.30) were more likely to report greater scores of dental pain expectation. Children anticipated more dental pain than what was actually perceived after the dental restoration. Children with greater levels of stress and anxiety have a distorted evaluation of expected dental pain before the dental procedure.

Factors associated with preoperative anxiety levels of Turkish surgical patients: from a single center in Ankara.

BACKGROUND: Preoperative anxiety and stress are undoubtedly a difficult experience in patients undergoing elective surgery. These unpleasant sensations depend on several factors. The objective of this study was to evaluate the preoperative anxiety levels in a sample of Turkish population, as well as the underlying causes using the Spielberger State-Trait Anxiety Inventory (STAI anxiety) scale. METHODS: The study was conducted according to the Declaration of Helsinki and was approved by the local ethical committee. All participants gave written informed consent upon having received detailed information on the study. Upon entry in the study, state and trait anxiety questionnaires were completed by 186 patients scheduled for elective surgery. The influencing factors in regard to age, sex, educational status and others were also reported. RESULTS: There was a statistically significant positive correlation between state and trait anxiety scores in this Turkish population. While the most important predictive factors that affected state-STAI scores were age, sex and duration of sleep the night before surgery; educational status and age were the best predictors for determining the variation in trait-STAI scores. CONCLUSION: The factors affecting anxiety levels in different populations might vary among different countries. Interestingly, in this sample of Turkish population, the trait anxiety levels were found to be higher from state-anxiety levels, especially in women and less educated people. Thus, doubts about operation and anesthesia are overlooked. This could be attributed to the low to intermediate life standards of people admitted to our hospital.

The adaptive psychological changes of elective induction of labor in breastfeeding women.

BACKGROUND: Labor induction has been associated with breastfeeding suppression, but reasons for why this association exists have not been well determined. METHODS: We examined the influence of elective labor induction by vaginal prostaglandin at gestational week 41+3days on affective, cognitive, and behavioural adaptations early in puerperium and on breastfeeding pattern at 1 and 3months. RESULTS: One hundred and eighty consecutive puerperae were assigned to two groups: mothers having received vaginal prostaglandin E2 gel (Prepidil®, dinoprostone) before labor (PGE group, n=90) and mothers having received no treatment (unmedicated group, n=90). The day of discharge mothers completed the Edinburg Postnatal Depression Scale, (EPDS), State and Trait Anxiety Inventory (STAI-Y), and Mother to-Infant Bonding Scale (MIBS). Later they participated in telephone interviews concerning their breastfeeding practices at 1 and 3months, which were classified according to WHO definitions. When compared with unmedicated, PGE group puerperae scored [median, (IQR)] significantly higher EPDS [9 (7-13) vs 5 (3-8), p 0.003], STAI-state [46 (39-51) vs 39 (34-48), p 0.002], STAI-trait [39 (36-48) vs 34 (32-45), p 0.04], and MIBS [10 (5.25-10) vs 5 (3-4), p 0.002] scores. In addition, while the breastfeeding practices were similar at hospital discharge, at follow-up the labor induced mothers were less likely to maintain full breastfeeding with respect to untreated mothers: 1month (p 0.001); and 3months (p 0.003). CONCLUSION: We present evidence that elective induction of labor by prostaglandins at gestational week 41+3days is associated with reduced exclusive breastfeeding rates at 1 and 3months after discharge and higher EPDS, STAI, and MIBS scores.