Caring for a child with cancer during COVID-19 pandemic: an assessment of the parents' perception and stress level.

Background: The emergence of COVID-19 pandemic has led to heightened fear and uncertainty among parents of children with cancer. This study was conducted to evaluate the parental perceptions toward effects of COVID-19 infection to children with cancer, determine their stress level and factors contributing to high stress level during the pandemic. Methods: This cross-sectional study was conducted in three paediatric oncology centres in Malaysia from September 2020 until December 2022. A total of 167 parents were recruited. Parents completed a set of questionnaires to assess their perception on effect of COVID-19 infection to children with cancer and COVID Stress Scale (CSS) to assess the parents' stress level. Results: Patients' mean age at study entry was 8.75 years (SD 4.38). Ninety-one (54.5%) patients were still on active treatment. More than 80% of the parents obtained information regarding COVID-19 infection from mass media and social networking. Fear of their children contracting COVID-19 infection was high especially among patients who were still on treatment. Forty-nine (29.3%) parents were significantly affected by the pandemic leading to loss of job or monthly income. Twenty-nine (17.4%) patients required treatment modification during the pandemic. The median total score for CSS was 78.0 (IQR 25th 64.0; 75th 95.0). Ninety-one (54.5%) respondents were very/extremely stressed based on the CSS scores. Components with high scores were xenophobia (median score 18.0; IQR 25th 13.0, 75th 22.0), fear of danger (median score 17.0; IQR 25th 14.0, 75th 20.0) and contamination fears (median score 16.0; IQR 25th 12.0, 75th 19.0). Lower household income was associated with higher stress level (p = 0.006). Conclusion: Our study demonstrated high awareness regarding risk of COVID-19 infection among parents of oncology children. Half of the parents had high stress level, with low household income identified as a factor associated with high stress level.

The psychological costs of behavioral immunity following COVID-19 diagnosis.

Prior COVID-19 infection may elevate activity of the behavioral immune system-the psychological mechanisms that foster avoidance of infection cues-to protect the individual from contracting the infection in the future. Such "adaptive behavioral immunity" may come with psychological costs, such as exacerbating the global pandemic's disruption of social and emotional processes (i.e., pandemic disruption). To investigate that idea, we tested a mediational pathway linking prior COVID infection and pandemic disruption through behavioral immunity markers, assessed with subjective emotional ratings. This was tested in a sample of 734 Mechanical Turk workers who completed study procedures online during the global pandemic (September 2021-January 2022). Behavioral immunity markers were estimated with an affective image rating paradigm. Here, participants reported experienced disgust/fear and appraisals of sickness/harm risk to images varying in emotional content. Participants self-reported on their previous COVID-19 diagnosis history and level of pandemic disruption. The findings support the proposed mediational pathway and suggest that a prior COVID-19 infection is associated with broadly elevated threat emotionality, even to neutral stimuli that do not typically elicit threat emotions. This elevated threat emotionality was in turn related to disrupted socioemotional functioning within the pandemic context. These findings inform the psychological mechanisms that might predispose COVID survivors to mental health difficulties.

Assessment of Preoperative Anxiety and Influencing Factors in Patients Undergoing Elective Surgery: An Observational Cross-Sectional Study.

Background and Objectives: Preoperative anxiety is a common emotional response before elective surgery that influences postoperative outcomes and can increase analgesic requirements. However, clinicians frequently overlook these concerns. This study aimed to quantify preoperative anxiety and evaluate its association with patient-related factors. Materials and Methods: Anxiety levels were evaluated in adult patients awaiting elective surgery using the Korean-translated version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Inventory-Korean YZ form (STAI-KYZ). The patients were also surveyed regarding the subjective causes of preoperative anxiety. Results: The study found that a total of 55 adult patients had a well-balanced subject distribution. Both questionnaires showed high internal consistency (Cronbach's alpha values of 0.85 and 0.93). Significant correlations were observed in situational anxiety scores from the questionnaires, indicating differences between groups with high trait anxiety and those with normal anxiety levels (p < 0.05). Notably, female sex was the only patient-related factor that significantly affected the anxiety scores (p < 0.05). Furthermore, when considering additional patient factors stratified by sex, it became evident that younger females and females with prior general anesthesia experience displayed higher anxiety levels than their male counterparts. The most commonly reported subjective concern related to anesthesia was the fear of not regaining consciousness, followed by concerns about postoperative pain, intraoperative emergence, and other issues. Conclusions: This study confirms that being female is a significant risk factor for preoperative anxiety. Therefore, it is necessary to provide enhanced preoperative anxiolytic therapies, including preoperative patient education and other interventions, to individuals undergoing surgical procedures.

Can routine assessment of older people's mental health lead to improved outcomes: A regression discontinuity analysis.

OBJECTIVE: To assess whether case finding for depression among people aged 65 and above improves mental health. DESIGN: Opportunistic evaluation using a regression discontinuity analysis with data from a randomised controlled trial. SETTING: The REFORM trial, a falls prevention study that recruited patients from NHS podiatry clinics. PARTICIPANTS: 1010 community-dwelling adults over the age of 65 with at least one risk factor for falling (recent previous fall or fear of falling). INTERVENTION: Letter sent to patient's General Practitioner if they scored 10 points or above on the 15-item Geriatric Depression Scale (GDS-15) informing them of the patient's risk of depression. MAIN OUTCOME MEASURE: GDS-15 score six months after initial completion of GDS-15. RESULTS: 895 (88.6%) of the 1010 participants randomised into REFORM had a valid baseline and six-month GDS-15 score and were included in this study. The mean GDS-15 baseline score was 3.5 (SD 3.0, median 3.0, range 0-15); 639 (71.4%) scored 0-4, 204 (22.8%) scored 5-9 indicating mild depression, and 52 (5.8%) scored 10 or higher indicating severe depression. At six months follow-up, those scoring 10 points or higher at baseline had, on average, a reduction of 1.08 points on the GDS-15 scale (95% confidence interval -1.83 to -0.33, p = 0.005) compared to those scoring less than 10, using the simplest linear regression model. CONCLUSION: Case finding of depression in podiatry patients based on a GDS-15 score of 10 or more followed by a letter to their General Practitioner significantly reduced depression severity. Whether this applies to all older patients in primary care is unknown. Further research is required to confirm these findings. Regression discontinuity analyses could be prespecified and embedded within other existing research studies.

Temporal dynamics of costly avoidance in naturalistic fears: Evidence for sequential-sampling of fear and reward information.

Excessive avoidance is characteristic for anxiety disorders, even when approach would lead to positive outcomes. The process of how such approach-avoidance conflicts are resolved is not sufficiently understood. We examined the temporal dynamics of approach-avoidance in intense fear of spiders. Highly fearful and non-fearful participants chose repeatedly between a fixed no spider/low reward and a spider/high reward option with varying fear (probability of spider presentation) and reward information (reward magnitude). By sequentially presenting fear and reward information, we distinguished whether decisions are dynamically driven by both information (sequential-sampling) or whether the impact of fear information is inhibited (cognitive control). Mouse movements were recorded to assess temporal decision dynamics (i.e., how strongly which information impacts decision preference at which timepoint). Highly fearful participants showed stronger avoidance despite lower gains (i.e., costly avoidance). Time-continuous multiple regression of their mouse movements yielded a stronger impact of fear compared to reward information. Importantly, presenting either information first (fear or reward) enhanced its impact during the early decision process. These findings support sequential sampling of fear and reward information, but not inhibitory control. Hence, pathological avoidance may be characterized by biased evidence accumulation rather than altered cognitive control.

Reducing fear and avoidance of memory loss improves mood and social engagement in community-based older adults: a randomized trial.

BACKGROUND: Alzheimer's disease and related dementias (ADRD) are among the most feared age-related conditions. The aim of this study was to evaluate a brief psychological intervention to promote adaptive coping in older adults experiencing heightened fear of ADRD and investigate positive downstream effects on health-related secondary outcomes, including frequency of reported memory failures, psychosocial functioning, and quality of life. METHODS: Eighty-one older adults were recruited and randomized into REFRAME or active control intervention arms. Both groups received psycho-education and training in mindful monitoring of fears related to ADRD. The REFRAME group received an additional behavioral activation component intended to disrupt maladaptive avoidant coping (i.e., avoidance) strategies. Both groups completed 3-weeks of intervention exercises with accompanying questionnaires (baseline, mid- and post-intervention and 4-week follow-up). RESULTS: Adherence was strong (> 75%). We observed a significant reduction in ADRD-related fear and avoidance in both groups. Significant reductions were also observed for frequency of self-reported memory failures, anxiety, and depression. Depression was significantly reduced in the REFRAME group compared to the control group. Significant increases in participants' ability to participate in social activities and well-being were also observed. CONCLUSIONS: Findings suggest that a brief psychological intervention can mitigate ADRD-related fears and avoidant coping in older adults, and that benefits extend to broader health-related outcomes including anxiety, depression, social functioning, and well-being. Addressing ADRD-related fear has implications for healthy aging and risk reduction, as individuals may be more likely to engage in activities that are protective against ADRD but were previously avoided. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT04821960 .

A rigorous behavioral testing platform for the assessment of radiation-induced neurological outcomes.

Behavioral testing is a popular and reliable method of neurocognitive assessment of rodents but the lack of standard operating procedures has led to a high variation of protocols in use. Therefore, there exists a strong need to standardize protocols for a combined behavioral platform in order to maintain consistency across institutions and assist newcomers in the field. This paper provides details on the methodology of several behavioral tasks which have been validated in identifying radiation induced cognitive impairment as well as provide guidance on timescales and best practices. The cognitive assessments outlined here are optimized for rodent studies and either target learning and memory (open field task, object in updated location, novel object recognition, object in place, and temporal order) or mood and cognition (social interaction, elevated plus maze, light dark box, forced swim test, and fear extinction). We have utilized this platform successfully in evaluating cognitive injury induced by various radiation types, doses, fractionation schedules and also with ultra-high dose rate FLASH radiotherapy. Recommended materials and software are provided as well as advice on methods of data analysis. In this way a comprehensive behavioral platform is described with broad applicability to assess cognitive endpoints critical to therapeutic outcome.

Objective assessment of mobility among adults with diabetes and end-stage renal disease using walking aid: A cross-sectional cohort study.

BACKGROUND: This cross-sectional study aimed to compare physical activity levels, plantar sensation, and fear of falling between individuals with diabetes undergoing hemodialysis, with or without walking aids. METHODS: Sixty-four participants were recruited, with 37 not using walking aids (age = 65.8 ± 0.7 years, 46% female) and 27 using walking aids (age = 69.2 ± 1.2 years, 63% female). Physical activity was measured using validated pendant sensors over two consecutive days. Concern for falling and plantar numbness were assessed using the Falls Efficacy Scale-International and vibration perception threshold test, respectively. FINDINGS: Participants using walking aids exhibited a greater fear of falling (84% vs. 38%, p < 0.01) and fewer walking bouts (p < 0.01, d = 0.67) and stand-to-walk transitions (p < 0.01, d = 0.72) compared to those not using walking aids. The number of walking bouts was negatively correlated with concern for falling scores (ρ = -0.35, p = 0.034) and vibration perception threshold (R = -0.411, p = 0.012) among individuals not using walking aids. However, these correlations were not significant among those using the walking aid. There was no significant group difference in active behavior (walking + standing %) and sedentary behavior (sitting + lying %). INTERPRETATION: Those undergoing hemodialysis often lead sedentary lives, with mobility affected by fear of falling and plantar numbness. Using walking aids can help, but it doesn't guarantee more walking. A combined psychosocial and physical therapy approach is key for managing fall concerns and improving mobility.

Family context as a double-edged sword for psychological distress amid the COVID-19 pandemic with the mediating effect of individual fear and the moderating effect of household income.

Background: The COVID-19 pandemic drives psychological distress. Previous studies have mostly focused on individual determinants but overlooked family factors. The present study aimed to examine the associations of individual and family factors with psychological distress, and the mediating effect of individual fear and the moderating role of household income on the above associations. Methods: We conducted a population-based cross-sectional survey on Chinese adults in Hong Kong from February to March 2021 (N = 2,251) to measure the independent variables of anti-epidemic fatigue, anti-epidemic confidence, individual and family members' fear of COVID-19, and family well-being (range 0-10), and the dependent variable of psychological distress (through four-item Patient Health Questionnaire, range 0-4). Results: Hierarchical regression showed that anti-epidemic fatigue was positively (ß = 0.23, 95% CI [0.18, 0.28]) while anti-epidemic confidence was negatively (ß = -0.29, 95% CI [-0.36, -0.22]) associated with psychological distress. Family members' fear of COVID-19 was positively (ß = 0.11, 95% CI [0.05, 0.16]) while family well-being was negatively (ß = -0.57, 95% CI [-0.63, -0.51]) associated with psychological distress. Structural equation model showed that individual fear mediated the above associations except for family well-being. Multi-group analyses showed a non-significant direct effect of anti-epidemic confidence and a slightly stronger direct effect of family well-being on psychological distress among participants with lower incomes, compared to those with higher incomes. Conclusion: We have first reported the double-edged effect of family context on psychological distress, with the positive association between family members' fear of COVID-19 and psychological distress fully mediated by individual fear and the negative association between family well-being and psychological distress moderated by income level. Future studies are warranted to investigate how the contagion of fear develops in the family and how the inequality of family resources impacts family members' mental health amid the pandemic.

Fear of COVID-19, food insecurity and anxiety in women dwelling in João Pessoa, Paraíba: a cross-sectional study / Medo da COVID-19, insegurança alimentar e ansiedade em mulheres residentes em João Pessoa, Paraíba: um estudo transversal

ABSTRACT Objective: To describe the fear caused by the COVID-19 pandemic and to analyze the association of food insecurity and fear of COVID-19 as anxiety predictors in women who are Sistema Único de Saúde users. Method: A cross-sectional study was conducted in 2021 with 73 women out of 118 who were followed up in a cohort study in the municipality of João Pessoa, Paraíba, Brazil. The women were selected in health units before the pandemic and their telephone contact enabled remote data collection. Socioeconomic and demographic information, food insecurity, fear of COVID-19, and anxiety were assessed. The Brazilian Food Insecurity Scale, the State-Trait Anxiety Inventory, and the Fear of COVID-19 Scale were used. An association between variables was performed using the chi-square test and a logistic regression verified the independent effect of variables concerning anxiety. A 5% significance level was considered. Results: The median age of the women was 33 years and the median per capita family income was BRL 665.33. Most of them lived with a partner and declared themselves mostly black or brown. Lower income and greater severity of food insecurity were associated with greater fear of COVID-19, and this feeling increased the probability of women being in a high anxiety state (OR=3.167). Conclusion: The most vulnerable women, with lower income and greater food insecurity had more fear of COVID-19 which increased their anxiety. Even after the pandemic is over, the effects of these events can maintain a state of mental distress that must be considered and properly cared for.

RESUMO Objetivo: O estudo teve como objetivo descrever o medo causado pela pandemia da COVID-19 e analisar a associação da insegurança alimentar e do medo da COVID-19 como preditores da ansiedade em mulheres usuárias do Sistema Único de Saúde. Métodos: Trata-se de um estudo transversal realizado em 2021 com 73 mulheres de um total de 118 que foram acompanhadas em um estudo de coorte no município de João Pessoa, Paraíba, Brasil. As mulheres foram selecionadas em unidades de saúde antes da pandemia, e o contato telefônico possibilitou a coleta de dados de forma remota. Informações socioeconômicas e demográficas, sobre insegurança alimentar, medo da COVID-19 e ansiedade foram avaliadas. Utilizou-se a Escala Brasileira de Insegurança Alimentar, o Inventário de Ansiedade Traço-Estado e a Escala de Medo de COVID-19. A associação entre variáveis foi realizada com teste qui-quadrado, e a regressão logística verificou o efeito independente das variáveis com relação à ansiedade. Considerou-se significância de 5%. Resultados: A mediana da idade das mulheres foi de 33 anos, e a renda familiar per capita foi de R$ 665,33. As mulheres, em sua maioria, conviviam com companheiro e se autodeclararam pretas ou pardas. Menor renda e maior severidade da insegurança alimentar estiveram associadas a maior medo da COVID-19, e esse sentimento aumentou as chances de as mulheres estarem em estado de alta ansiedade (OR=3,167). Conclusão: As mulheres mais vulneráveis, com menor renda e maior insegurança alimentar tiveram mais medo da COVID-19, e isso colaborou para o aumento da ansiedade dessas mulheres. Mesmo com o fim da pandemia, os efeitos dessa fase podem manter um estado de sofrimento mental que precisa ser considerado e cuidado apropriadamente.

Ecological momentary assessment of post-event processing in between two speech tasks: Relationships with cognitive and affective factors involved in the maintenance of social anxiety.

Socially anxious individuals tend to review past distressing social situations, a process called post-event processing. The goal of this 4-day study was to investigate how PEP evolved over time in between two speech tasks in a sample of 101 students using ecological momentary assessment (EMA). In addition, we examined the relationships between post-event processing and other cognitive and affective processes involved in social anxiety, including anticipatory processing, anxiety, performance appraisals, and memory. Results from EMA showed that post-event and anticipatory processing decreased over time. Higher anxiety during the speech and poorer performance appraisals predicted more post-event processing, though post-event processing was unrelated to changes in performance appraisals over time. Post-event processing the day following the first speech was positively associated with anticipatory processing the day before the second speech. Participants who engaged in more post-event processing also remembered the first speech differently (e.g., more negative and emotionally intense). Implications for the cognitive-behavioural treatment of social anxiety are discussed.

Validation of the fear of COVID-19 scale in a central Balkan country - Serbia.

Validation of the fear of introduction: High levels of fear of COVID-19 may be associated with increased levels of stress, anxiety, and depression, as well as decreased resilience and life expectancy. Objective: This study aimed to translate and confirm the Serbian version of the Fear of COVID-19 scale as well as to investigate its psychometric properties. Methods: The translation and intercultural adaptation of the Fear of COVID-19 scale was performed by the leading standard of the International Society for Pharmacoeconomics and Outcome Research. When the distribution was normal, the Kolmogorov-Smirnov test was used. The reliability of the Serbian version of FCV-19S was tested by measuring the internal consistency through the value of Cronbach's alpha. Results: The original version of the Fear of COVID-19 scale was tested on a sample of 256 subjects with a mean age of 25.38 ± 12.47. The Cronbach's alpha value was 0.864. We divided the scale by the split-half method (Spearman-Brown), and the value of the coefficient for the questionnaire as a whole was 0.882. Divergent criterion validity was tested through the non-parametric correlation between the scores of the Fear of COVID-19 scale and the Fear of Hospitalization scale. A score of the Fear of COVID-19 scale was calculated as the sum of each question for each of the respondents. Convergent criterion validity was tested through the non-parametric correlation between the scores of the Fear of COVID-19 scale and the Emotional Regulation Questionnaire. Conclusion: The validated version of the scale in Serbia complements versions available in other cultures and other languages and facilitates global studies related to mental health during the COVID-19 pandemic.

Threat belief determines the degree of costly safety behavior: Assessing rule-based generalization of safety behavior with a dimensional measure of avoidance.

Excessive generalization of safety behavior to innocuous stimuli that resemble a feared stimulus is oftentimes pathological especially with inflicted impairments. Safety behavior is conventionally assessed dichotomously, requiring multiple presentations of each test stimulus for assessing the proportion of safety behavior executed. Thus, the generalization gradient confounds with ongoing extinction learning during non-reinforced test trials. The present study employed a recently developed dimensional measure of avoidance to examine the extent of safety behavior generalization. We found that a dimensional measure of avoidance was able to assess the generalization gradients of safety behavior even when each test stimulus was presented once, thus minimizing the effect of ongoing extinction learning. Of equal importance is whether higher-order cognitive processes shape generalization of safety behavior. We found a range of distinct generalization gradients in safety behavior, which were highly consistent with participants' verbally reported relational rules. This rule-based generalization parallels to how clinically anxious individuals develop different threat beliefs after trauma exposure, and models how these distinct threat beliefs determine the extent of safety behavior engagement.

Interventions addressing fear of cancer recurrence: challenges and future perspectives.

PURPOSE OF REVIEW: Fear of cancer recurrence (FCR) is a common concern among cancer survivors and support for FCR is one of the most cited unmet needs. High FCR was found to be related to increased use of healthcare services, specifically primary healthcare and medical consultations, and lower quality of life. In the past decade screening instruments for FCR and interventions have been developed and proven effective. RECENT FINDINGS: Systematic reviews and meta-analyses have shown that psychological treatments are effective for reducing FCR. The cost-effectiveness of FCR interventions could be increased by considering stepped or matched models for supportive care. Despite availability of evidence-based interventions, the proposed care models are not implemented and most cancer survivors still do not benefit from supportive care. SUMMARY: The time is right to focus on implementation of FCR interventions into clinical practice. The complexity of optimizing FCR care is characterized by barriers and facilitators in the domains of patients, healthcare professionals, healthcare organizations and the broader economic, and political context. The main challenge for future research is to address these issues so that former investments in high-quality FCR intervention research will pay out in actual practice changes in the benefit of cancer survivors.

Factors associated with and 1-year outcomes of fear of falling in a geriatric post-hip fracture assessment.

BACKGROUND: Hip fracture causes not only physical injury but also psychological trauma. Fear of falling (FoF) is related to poor recovery, loss of mobility and mortality. There is limited data on the clinical factors affecting post-hip fracture FoF and its consequences. OBJECTIVE: To investigate the factors associated with and 1-year outcomes of post-hip fracture FoF. METHODS: An observational prospective cohort study. Data were collected on hospital admission, at a geriatric outpatient assessment 4-6 months post-hip fracture and by telephone interviews 1 year after the index fracture. FoF was assessed with a dichotomous single-item question. Logistic regression analyses were conducted to examine the age, gender and multivariable-adjusted association between baseline and the geriatric assessment domains with FoF. Follow-up outcomes included changes in mobility, living arrangements and mortality. RESULTS: Of the 916 patients included, 425 (49%) had FoF at the time of their geriatric assessment. These patients were predominantly female and were living alone in their own homes with supportive home care. They scored lower on tests of physical performance. Less FoF was documented in patients with diagnosed cognitive disorders before the index fracture and in those with Clinical Dementia Rating ≥ 1. After adjusting for age and gender, no association was observed between FoF and any of the 1-year follow-up outcomes. CONCLUSION: Post-hip fracture FoF is common and associated with female gender, polypharmacy, poor daily functioning, poor physical performance and depressive mood. Patients with cognitive disorders have less FoF than those without. FoF appears to have no impact on the follow-up outcomes.

Cognitive risk factors and the experience of acute anxiety following social stressors: An ecological momentary assessment study.

To better understand how social anxiety develops, it is crucial to identify mechanisms that influence anxiety following social stressors. Anxiety sensitivity social concerns (ASSC; fear of publicly observable anxiety symptoms) and fear of negative evaluation (FNE; distress arising from concerns about negative judgment) are constructs that amplify anxiety following social stressors. However, it is unclear how ASSC and FNE influence acute anxiety following stressors in naturalistic settings. In the current study, the impact of ASSC and FNE on anxious arousal and anxious apprehension following stressors was examined in community adults (N = 83; M age = 29.66 years, SD = 12.49, 59.0% female) who completed questionnaires five times per day for two-weeks. Dynamic structural equation modeling was used to examine predictors of overall levels of anxiety as well as anxiety following social and nonsocial stressors. ASSC interacted with the presence of social stressors, such that ASSC positively predicted anxious arousal following social stressors. FNE interacted with the presence of nonsocial stressors to predict both forms of anxiety, such that FNE positively predicted anxiety following nonsocial stressors. These findings suggest ASSC may specifically amplify anxious arousal following social stressors, whereas FNE may broadly amplify anxiety following nonsocial stressors.

Posttraumatic growth and its association with unmet supportive care needs and fear of cancer progression among head and neck cancer patients.

BACKGROUND AND AIMS: The assessment of supportive care needs and fear of cancer progression are important variables to be considered when evaluating the psychological aspects of cancer patients. However, data on how these variables affect posttraumatic growth (PTG) are lacking. This study aimed to investigate the level of PTG among head and neck cancer (HNC) patients within the first year of cancer diagnosis and to determine the association between unmet supportive care needs, fear of cancer progression, and the level of PTG. METHODS: Participants were administered socio-demographic and clinical characteristics questionnaire; the 34-item Supportive Care Needs Survey (SCNS-34) to measure the unmet needs; 12-item Fear of Progression Questionnaire-Short Form (FoP-Q-SF) to measure the fear of progression of cancer; and the Posttraumatic Growth Inventory-Short Form (PTGI-SF) to measure the degree of PTG. RESULTS: A total of 190 HNC participants reported a mean total PTGI-SF score of 39.3 (standard deviation = 9.5). General linear model revealed that higher degree of patients' physical and daily living unmet needs and fear of cancer progression significantly predicted lower PTG, after controlling for sociodemographic and clinical factors. CONCLUSION: HNC patients within the first year of cancer diagnosis reported a high level of PTG. Despite that, psychosocial intervention for HNC patients should emphasize on counteracting patients' physical and daily living unmet needs and fear of cancer progression to improve the psychological well-being of patients.

Sex Differences between Medical Students in the Assessment of the Fear of COVID-19.

Background: Differing expressions of the fear of COVID-19 between men and women can potentially increase both immediate and long-term physical health risks. We predicted that women students would express greater fear of COVID-19. Methods: We used an Internet-delivered Fear of COVID-19 Scale (FCV-19S) to assess fear among men (n = 100) and women (n = 272) from a larger population of academic medical center members (n = 1761). Sex differences in emotional and physical symptoms were assessed as subcategories within fear scores. Results: Women reported greater fear of COVID-19 than men (p < 0.001). Women reported greater emotional fear (p < 0.001) on specific scale items (thinking of COVID-19, watching news stories about COVID-19, and losing sleep due to fear of contracting COVID-19). Discussion/Conclusions: These results provide a better understanding of how fear of COVID-19 can differ based on sex and how that fear may be expressed differently through emotional and physical symptoms. This information will inform academic health centers of COVID-19 prevention and management policies that may include a gender-specific focus.

Psychometric properties of a self-assessment fear scale in children aged 4 to 12 years. Scary Scale.

BACKGROUND: Caregivers encounter difficulties differentiating fear and pain experienced by children and tend to interpret what children may feel, often resulting in inadequate pain management. While many pain self-assessment scales are available, there is no validated self-assessment fear scale for children. METHODS: The aim of this prospective study was to validate, in children aged 4 to 12 years, the psychometric properties of our scale. In a first part, in a school setting, five exercises were given to 484 children in order to validate the expression of fear, grade the intensity of the faces, the ability to discriminate the faces and the equality of the intervals. The scale's reproducibility was studied by assessing the children's fear in everyday situations at two different time points. In a second part, in a hospital setting, the aim was to test the scale's feasibility. Sixty children admitted to one emergency care department self-assessed their fear with the Scary Scale. FINDINGS: The expression of fear was validated by 57.64% (p < 0.0001) of the children in comparison with three other emotions (pain, surprise, sadness).The 7-9 year-olds validated the other properties (gradation, discrimination, equality, reproducibility). The 4-6 year-olds failed to validate the gradation exercise, but succeeded with the others. In the hospital, 95% of children self-assessed their fear using the scale. DISCUSSION: Our self-assessment fear scale was validated in children aged 7-12 years specifically and was readily feasible in the hospital. We recommend its use in that age group in every care situation triggering fear. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02675504.

Psychometric properties of The COVID-19 Fears Questionnaire for Chronic Medical Conditions in patients with pre-existing medical conditions.

Fear of COVID-19 can have adverse mental health consequences in vulnerable patients with pre-existing conditions. We aimed to validate The COVID-19 Fears Questionnaire for Chronic Medical Conditions in Lithuania and to evaluate fears of COVID-19 in patients with pre-existing conditions. Between October and December, 2020, 371 respondents with pre-existing conditions completed an online survey including the 10-item COVID-19 Fears Questionnaire for Chronic Medical Conditions (COVID-19 fears), Patient Health Questionnaire-8 (PHQ-8; depressive symptoms), Generalised Anxiety Disorders-7 (GAD-7; anxiety symptoms) and Impact of Events Scale Revised (IES-R; posttraumatic stress symptoms). The majority of participants were women (84%) and from 41 to 60 years old (46%). The most common pre-existing conditions were respiratory diseases (33%) and diabetes (22%). Mean total score on the COVID-19 Fears Questionnaire was 24.89 ± 8.79. Exploratory factor analysis yielded one-factor solution with the Cronbach's coefficient alpha of 0.913. The highest rated COVID-19 fears were infection of close people, inability to receive treatment for COVID-19 and pre-existing condition and fear of severe complications because of the pre-existing condition. There was moderate to strong correlation of the 10-item COVID-19 Fears Questionnaire for Chronic Medical Conditions score with scores on the PHQ-8 (r = 0.371), GAD-7 (r = 0.358) and IES-R (r = 0.553; all p < 0.001). Test-retest reliability was adequate. The 10-item COVID-19 Fears Questionnaire for Chronic Medical Conditions has good psychometric properties in patients with pre-existing conditions and greater fear is associated with worse mental health. Consideration of COVID-19 fears is important for optimised care of patients with pre-existing during the pandemic.