The effect of interventions in vaginal birth on fear of childbirth: A multicentre study.

AIM: This cross-sectional multicentre study aimed to determine the effect of interventions during vaginal birth for fear of childbirth. METHODS: In this cross-sectional and analytical study, 852 women who had a vaginal birth between 2019 and 2020 were enrolled. Data were collected using the Descriptive Questionnaire and Wijma Birth Expectation/Experience Scale Version B. RESULTS: The mean total Wijma Birth Expectation/Experience Scale Version B score of the women was 97.00 ± 24.24, indicating severe and clinical levels of fear of childbirth. Moreover, 69.4% of the women had clinical, 18.6% had severe and 12% had moderate levels of fear of childbirth. During birth, women who had close supporters, who were allowed to move and who did not undergo amniotomy, enema, perineal shaving and electronic foetal monitoring had a low level of fear of childbirth. As the number of pregnant women in the labour room, frequency of vaginal examinations, duration of delivery/hour, severity of labour pain and negative perception of the approach of health professionals increased, the women's fear of childbirth increased. Fear of childbirth decreased as the frequency of antenatal follow-ups, number of births and satisfaction levels of the women increased (p < 0.05). Low income perception, irregular prenatal follow-up, severe labour pain and a long duration of labour were strong predictors of increased fear of childbirth. Increasing number of births, high birth satisfaction level and positive perception of the approach of health professionals were strong predictors of reduced fear of childbirth. CONCLUSIONS: The reduction of interventions in vaginal delivery and support from health care providers during delivery can be effective in reducing fear of childbirth.

A Biofeedback Based Virtual Reality Game for Pediatric Population (BioVirtualPed): A Feasibility Trial.

OBJECTIVE: This trial aims to assess the acceptability, feasibility, and safety of BioVirtualPed, a biofeedback-based virtual reality (VR) game designed to reduce pain, anxiety, and fear in children undergoing medical procedures. METHODS: An Oculus Quest 2 headset was used in the VR experience, respiratory data was captured using an ADXL354 accelerometer, and these data were integrated into the game with ArdunioUno software. The sample of this study consisted of 15 pediatric oncology patients aged 6 to 12 years between July and August 2023. BioVirtualPed's acceptability, feasibility, and safety were evaluated through child and expert feedback, alongside metrics including the System Usability Scale, Wong-Baker Pain Rating Scale, Child Fear Scale, Child Anxiety Scale-Status, Satisfaction Scoring, and various feasibility and safety parameters. RESULTS: Regarding the acceptability, the expert evaluation showed a mean score of 122.5 ± 3.53, indicating high usability for the system. All children provided positive feedback, and both children and their mothers reported high satisfaction with using BioVirtualPed. The BioVirtualPed was feasible for reducing children's pain, fear, and anxiety levels. All the children complied with the game, and no one withdrew from the trial. BioVirtualPed did not cause symptoms of dizziness, vomiting, or nausea in children and was found to be safe for children. CONCLUSION: The findings showed that BioVirtualPed meets the following criteria: feasibility, user satisfaction, acceptability, and safety. It is a valuable tool to improve children's experience undergoing port catheter needle insertion procedures. IMPLICATION FOR NURSING PRACTICE: Integration of VR interventions with BioVirtualPed into routine nursing care practices has the potential to effectively manage the pain, anxiety, and fear experienced by children undergoing medical procedures. The safety, feasibility, and acceptability results are promising for further research and integration into pediatric healthcare practice.

Efficacy of music therapy on stress and anxiety prior to dental treatment: a systematic review and meta-analysis of randomized clinical trials.

Introduction: Stress and anxiety are emotional states that often accompany patients who have to receive dental treatments, leading them to postpone or avoid treatments with the consequent deterioration of their oral health and, hence, their general condition. Music therapy has been shown to be an alternative to other treatments that are invasive and not without danger, such as anxiolytics or sedation. This systematic review and meta-analysis evaluated the effect of music therapy on anxiety and stress prior to dental treatments. Methods: Studies published in PubMed (through Medline), Web of Science (WOS), Embase, and Cochrane Library databases were consulted up to October 2023. The inclusion criteria were established for intervention studies (randomized controlled trials, RCTs) according to the PICOS (population, intervention, comparison, outcomes, and study) strategy in subjects with dental stress and anxiety (participants) treated with music therapy (intervention) in comparison with patients without music therapy (control) and evaluating the response to treatment (outcomes). Results: A total of 154 results were obtained, with 14 studies finally selected. The risk of bias and the methodological quality were assessed using the Cochrane Risk of Bias Tool and the Jadad scale, respectively. A random-effects meta-analysis was used to quantify the results of the pooled studies, while a fixed-effects meta-analysis was used for studies in the pediatric population. The meta-analysis of pooled studies found statistical significance in the subgroups of anxiety and anxiety-stress (p = 0.03 and p = 0.05, respectively), with an overall effect in favor of the intervention group (p = 0.005). Meta-analysis of the studies in the pediatric population showed considerable statistical significance for the experimental group (p < 0.00001). Conclusion: Music therapy as a treatment for stress and anxiety, prior to dental treatment, proved to be effective in both children and adults although more well-designed randomized clinical studies are needed to validate its efficacy. Systematic review registration: INPLASY, identifier 202312000.

Protective role of Eugenol against the destructive effects of lead on conditioned fear memory in male rats with post-traumatic stress disorder-related behavioral traits.

Introduction: Post-traumatic stress disorder (PTSD) is a consequence of living in today's stressful society. Patients have difficulty forgetting traumatic events. lead pollution has many effects on the nervous system, one of which is memory and learning disorders. The herbal medicine Eugenol has a beneficial effect on memory. Aim: This study aims to investigate the protective effect of Eugenol on lead-induced memory impairments in stressed rats. Methods: In the first experiment, the animals were divided into three groups: SPS+Saline, SPS+Pb, and naïve. The SPS+Saline, SPS+Pb groups received normal saline and lead through gavage for 21 days, while the sham group remained untreated. Rats were subjected to the modified single prolonged stress model. Memory tests were conducted one week later, evaluating freezing levels in three consecutive tests over three days. In the second experiment, rats were divided into a SPS+Pb+Saline and three treatment groups. The SPS+Pb+Saline group received daily saline injections, while the other groups received different doses of Eugenol (25, 50, and 100 mg/kg). Memory tests similar to the first experiment were conducted. Results: The results showed significantly higher immobility levels in the SPS+Saline and SPS+Pb groups compared to the sham. Additionally, the SPS+Pb group had a significant higher immobility compared to the SPS+Saline group. In the second experiment, the SPS+Pb+EU 25 group showed a significant lower freezing compared to the SPS+Pb+Saline group. Additionally, freezing in the SPS+Pb+EU 50 and SPS+Pb+EU 100 groups was significantly higher than in the SPS+Pb+EU 25 group. The SPS+Pb+EU 50 group showed a significant higher freezing compared to the SPS+Pb+Saline group. Conclusion: lead acetate exacerbated memory impairments in stressed rats and Eugenol, particularly at a dose of 25 mg/kg, improved these impairments. Therefore, Eugenol has the potential to partially reduce the negative effects of lead on memory in individuals with PTSD.

Spirituality, Intolerance and Fear of COVID-19: Psychological Distress Among Older Adults in Pakistan.

The present study aimed to investigate the role of spirituality, intolerance of uncertainty (IU), and fear of COVID-19 as correlates and predictors of psychological distress among older adults in Pakistan and also assess the gender differences among research variables. Using a quantitative correlational survey research design, a sample of 150 (75 = Men, 75 = Women) older adults aged 55 years and above from different cities of Pakistan were approached through a non-probability purposive sampling strategy. Participants completed the Daily Spiritual Experience Scale, Intolerance of Uncertainty Scale IUS-12, Fear of COVID-19, and Kessler Psychological Distress Scale-K10. Spirituality has a significant negative relationship with psychological distress. Whereas, IU (Inhibitory anxiety and prospective anxiety) and fear of COVID-19 have a significant positive relationship with psychological distress. Results also showed that spirituality, IU dimensions, and fear of COVID-19 emerged as significant predictors of psychological distress among older adults after controlling for the effect of covariates. In addition, elderly females significantly showed more spirituality, less IU, and fear of COVID-19 as compared to elderly males. It is proposed that mental health care plays an important role in treating the psychological needs of older adults in pandemic situations and that further study is needed to develop effective solutions for older persons in stressful situations such as pandemics.

Gender-Based Heat Map Images of Campus Walking Settings: A Reflection of Lived Experience.

Fear of crime can influence our view of and experience with the world around us. This can be problematic for individuals seeking physical activity, including from walk commuting. Prior work shows fear is especially evident among women, who report fear of rape and sexual abuse by men as a primary concern. We present the results of a cross-sectional survey (n = 571) where participants were shown images from college campus (n = 4 campuses) depicting different lighting (daytime, nighttime), and entrapment levels (high, low; i.e., able to easily escape if needed, with high entrapment being difficult and low being easy), and using the Qualtrics heat map tool, selected features that stood out to them most. Data were segregated by gender and analyzed to determine similarity of heat maps for the same base image. Heat map images were analyzed using canonical correlation (Rc) to determine the relationship between the two groups; dispersion testing to decipher spatial uniformity within the images; the Structural Similarity Index (SSIM) to characterize the nature of image patterns differences; and, the Breslow-Day Test to specify pattern locations within images. Several heat map images are also presented in the results. Overall, female and male participants appear to "see" different things when imagining walk-commuting (as seen by poor Rc values) and the nature of what they were looking at were different (as seen by poor SSIM values). Female participants tended to focus on areas outside the walking path, such as bushes and dark areas, whereas men's focus was on the path ahead [χ2(1) = 4.29, p = 0.04]. Furthermore, women were more likely to select areas outside the walking path during high entrapment settings [χ2(1) = 15.49, p < 0.001] and at nighttime [χ2(1) = 4.98, p = 0.02]. Our study demonstrates point-of-view differences in female-male walking space assessments. Viewing walking safety through the lens of lived experience could be productive for holistic community walking safety.

Validación de la escala Short FES-I en población española mayor de 70 años / Validation of the short FES-I scale in Spanish population over 70 years

Introducción Las caídas deterioran la calidad de vida de los ancianos y el miedo a estas ha demostrado ser un factor de riesgo independiente para fragilidad, por lo que es prioritario disponer de herramientas para su evaluación. La escala ShortFalls Efficacy Scale-International (FES)-I, versión corta (siete ítems) de la escala FES-I (16 ítems), evalúa el miedo a caer (MC). El objetivo de este estudio es validar la escala Short FES-I en población española mayor de 70 años y analizar la relación entre el miedo a las caídas, el riesgo de las mismas y la fragilidad. Material y métodos Se trata de un estudio observacional transversal. La muestra consistió en 227 sujetos (50,7% varones; edad media 75,8 años). La ubicación fue en el norte de España. Las variables empleadas fueron sociodemográficas, clínicas, pruebas de ejecución Short Physical Performance Battery (SPPB) y Timed Up and Go Test (TUG), FES-I y Short FES-I. Se analizaron las propiedades psicométricas: validez y fiabilidad. Resultados La escala Short FES-I muestra excelentes consistencia interna (alfa de Cronbach = 0,90, coeficiente correlación intraclase = 0,89) y reproducibilidad test-retest (Rho Spearman = 0,76). Tiene una elevada validez de criterio concomitante analizada por su correlación con FES-I (Rho Spearman = 0,90). La validez de constructo discriminante ha sido confirmada tanto para SPPB como TUG. Short FES-I presenta buena capacidad de clasificación de fragilidad (definida por SPPB) con área bajo la curva [AUC] = 0,715; como punto de corte se propone un valor Short FES-I>8 para miedo moderado/alto de caídas. Conclusiones La escala Short FES-I es un buen instrumento para estudiar el miedo a las caídas en población española mayor de 70 años y es válida para su uso clínico y en investigación. (AU)

Introduction Falls deteriorate the quality of life of the elderly and the fear of falling has been shown to be an independent risk factor for frailty, so having tools for its evaluation is a priority. The short FES-I scale, short version (7 items) of the FES-I scale (16 items), assesses fear of falling. The objective of this study is to validate the short FES-I scale in the Spanish population over 70 years and to analyze the relationship between fear of falling, risk of falls and frailty. Material and methods Cross-sectional observational study. Sample: 227 subjects (50.7% male; mean age 75.8 years). Setting: northern Spain. Variables: sociodemographic, clinical, short physical performance battery (SPPB) and timed up and go test (TUG) execution tests, FES-I and short FES-I. Analysis of psychometric properties: validity and reliability. Results The short FES-I scale shows excellent internal consistency (Cronbach's alpha = 0.90, intraclass correlation coefficient = 0.89) and test–retest reliability (rho Spearman = 0.76). It has a high concomitant criterion validity analyzed by its correlation with FES-I (rho Spearman = 0.90). The discriminant construct validity has been confirmed for both SPPB and TUG. Short FES-I presents good capacity for frailty classification (defined by SPPB) with AUC = 0.715. As a cut-off point, a short FES-I value > 8 is proposed for moderate/high fear of falling. Conclusions The short FES-I scale is a good instrument to study fear of falling in the Spanish population over 70 years and is valid for clinical and research use. (AU)

Fear of Cancer Recurrence in Differentiated Thyroid Cancer Survivors: A Systematic Review.

Background: Despite excellent survival rates, health-related quality of life detriments are common in differentiated thyroid cancer survivors and can be driven by fear of cancer recurrence (FCR). This review aims to report the incidence of FCR in thyroid cancer survivors and synthesize evidence regarding contributing factors. An overview and appraisal of the range of tools used to measure FCR is presented. Methods: A systematic review of the English literature was performed. The search across six electronic databases generated 3414 studies. Two reviewers independently screened the citations and full-text articles, of which 31 were included. The data were extracted independently by two reviewers. Results: The incidence of FCR was reported in 27/31 studies and ranged from 15% to 91%. Direct comparisons regarding incidence and severity of FCR were not possible due to heterogeneity in cut-points used to define FCR. A total of eight validated tools were used to measure FCR across all studies, with five studies using self-developed nonvalidated items. There was minimal repetition of validated tools and no clear consensus as to a preferred survey tool. Factors influencing FCR were reported in 11 studies. There was minimal overlap of factors influencing FCR. Risk factors contributing to increased FCR reported in more than one study included young age and an upcoming clinical appointment. Male gender and higher education levels were reported in more than one article as protective. No literature evaluating interventions to address FCR in thyroid cancer survivors was found. Conclusion: FCR is common in thyroid cancer survivors, but significant heterogeneity in the current evidence base limits assessment of incidence, severity, or risk factors. There is a need to use validated tools to assess FCR in both research and clinical contexts. Reliable assessment of FCR may permit routine assessment of FCR in clinical practice and allow interventions to be prospectively evaluated to optimize the holistic well-being of thyroid cancer survivors.

Prevalence and Factors Contributing to Fear of Recurrence in Breast Cancer Patients and Their Partners: A Cross-Sectional Study.

Objective: The fear of cancer recurrence (FCR) is a generalized psychological problem among cancer patients and their spouses. The purpose of this study is to investigate the current status of cancer recurrence fear among breast cancer patients and their spouses, as well as its predictive factors. Methods: A total of 155 breast cancer patients and their partners between March 2022 to Feb 2023 were selected from Affiliated Hospital of Jiangnan University. The survey was investigated by fear of progression questionnaire-short form (FoP­Q­SF), fear of progression questionnaire-short form for partners (FoP-Q-SF/P), family resilience questionnaire (FaRE), and health literacy management scale (HeLMS). Predictors were assessed using univariate and multivariable regression analyses. Results: 52.9% (n=82) of breast cancer patients and 51.6% (n=80) of their spouses experienced high levels of fear of cancer recurrence (FCR). There was a positive correlation between the FCR of the patients and their spouses, while family resilience and health literacy were statistically significant negative predictive factors for breast cancer patients' fear of cancer recurrence. Conclusion: In summary, the study found that the partner's FCR, health literacy and family resilience were closely related to the FCR in breast cancer patients. Therefore, healthcare workers can reduce the patient's FCR by reducing the FCR in spouses, improving patients' health literacy and family resilience in the future. In practical application, these findings hold significant implications for developing comprehensive care plans and interventions targeting FCR in breast cancer patients. By focusing on patients' partners and providing appropriate support and resources, healthcare professionals can promote patients' psychological well-being and overall health, leading to improved quality of life.

Health-related quality of life and fear of progression in individuals with Li-Fraumeni syndrome.

Li-Fraumeni syndrome (LFS) is a rare autosomal dominant cancer predisposition syndrome associated with a highly elevated lifetime cancer risk. This and the recommended intense surveillance program represent a large psychological burden on families. In order to develop targeted psychosocial interventions, we conducted a needs assessment. Adults (≥18 years) with LFS were included via regular hospital visits and online support groups and newsletters. Individuals filled out a questionnaire addressing among others: fear of progression (FoP-questionnaire, short-form), health-related quality of life (HRQoL, Short-Form Health Survey-12), distress (National Comprehensive Cancer Network distress thermometer), perceived cancer risk, and aspects of surveillance adherence. Collecting data over a 14-month period (March 2020 - June 2021), 70 adults were recruited (female = 58, 82.9%; mean age = 41.53 years). With mean mental component scores (MCS) of 42.28 (SD = 10.79), and physical component scores (PCS) of 48.83 (SD = 10.46), HRQoL was low in 34.8% (physical) and 59.4% (mental) of individuals when applying a mean cut-off of 45.4 (PCS) and 47.5 (MCS) to indicate poor HRQoL. High levels of FoP and distress were present in 68.6% and 69.1% of the participants, respectively. Performing a multiple linear regression on MCS and PCS, no sociodemographic variable was shown to be significant. FoP (ß = -0.33, p < 0.05) and distress (ß = -0.34, p < 0.05) were significantly associated with MCS. Individuals in our sample were burdened more than expected, with the majority reporting low levels of (mental) HRQoL, high distress, and FoP. Psychosocial support is necessary to help individuals with LFS (survivors as well as "previvors") increase their HRQoL, as it is crucial to survival.

Childbirth-related posttraumatic stress disorder: definition, risk factors, pathophysiology, diagnosis, prevention, and treatment.

Psychological birth trauma and childbirth-related posttraumatic stress disorder represent a substantial burden of disease with 6.6 million mothers and 1.7 million fathers or co-parents affected by childbirth-related posttraumatic stress disorder worldwide each year. There is mounting evidence to indicate that parents who develop childbirth-related posttraumatic stress disorder do so as a direct consequence of a traumatic childbirth experience. High-risk groups, such as those who experience preterm birth, stillbirth, or preeclampsia, have higher prevalence rates. The main risks include antenatal factors (eg, depression in pregnancy, fear of childbirth, poor health or complications in pregnancy, history of trauma or sexual abuse, or mental health problems), perinatal factors (eg, negative subjective birth experience, operative birth, obstetrical complications, and severe maternal morbidity, as well as maternal near misses, lack of support, dissociation), and postpartum factors (eg, depression, postpartum physical complications, and poor coping and stress). The link between birth events and childbirth-related posttraumatic stress disorder provides a valuable opportunity to prevent traumatic childbirths and childbirth-related posttraumatic stress disorder from occurring in the first place. Childbirth-related posttraumatic stress disorder is an extremely distressing mental disorder and has a substantial negative impact on those who give birth, fathers or co-parents, and, potentially, the whole family. Still, a traumatic childbirth experience and childbirth-related posttraumatic stress disorder remain largely unrecognized in maternity services and are not routinely screened for during pregnancy and the postpartum period. In fact, there are gaps in the evidence on how, when, and who to screen. Similarly, there is a lack of evidence on how best to treat those affected. Primary prevention efforts (eg, screening for antenatal risk factors, use of trauma-informed care) are aimed at preventing a traumatic childbirth experience and childbirth-related posttraumatic stress disorder in the first place by eliminating or reducing risk factors for childbirth-related posttraumatic stress disorder. Secondary prevention approaches (eg, trauma-focused psychological therapies, early psychological interventions) aim to identify those who have had a traumatic childbirth experience and to intervene to prevent the development of childbirth-related posttraumatic stress disorder. Tertiary prevention (eg, trauma-focused cognitive behavioural therapy and eye movement desensitization and reprocessing) seeks to ensure that people with childbirth-related posttraumatic stress disorder are identified and treated to recovery so that childbirth-related posttraumatic stress disorder does not become chronic. Adequate prevention, screening, and intervention could alleviate a considerable amount of suffering in affected families. In light of the available research on the impact of childbirth-related posttraumatic stress disorder on families, it is important to develop and evaluate assessment, prevention, and treatment interventions that target the birthing person, the couple dyad, the parent-infant dyad, and the family as a whole. Further research should focus on the inclusion of couples in different constellations and, more generally, on the inclusion of more diverse populations in diverse settings. The paucity of national and international policy guidance on the prevention, care, and treatment of psychological birth trauma and the lack of formal psychological birth trauma services and training, highlight the need to engage with service managers and policy makers.

Neuropharmacological and anxiolytic effects of extracts of Passiflora tripartita var. mollissima on mice / Efecto neurofarmacológico y ansiolítico de extractos de Passiflora tripartita var. mollissima en ratones

Anxiety and depression cause alterations in the physiology of an organism. Extracts from the leaves of several Passiflora species are traditionally use d Peru and in many countries as anxiolytic and in treatment for inflammatory problems. T his study aimed to determine the neuropharmacological effect of the ethanolic extract of Passiflora tripartita var. mollissima (Kunth) Holm - Niels. & P. Jørg. and its an xiolytic effect on mouse ( Mus musculus var. albinus ). A nxiety was evaluated with the marble burying test and the depressant effect with the Irwin test (locomotor activity, base of support, wobbly gait, immobility, escape, ease of handling, muscular strengt h, tight rope, inclined plane, catatonia, nociceptive reflex and death). Doses of 100 mg/Kg/body weight and 200 mg/kg/body weight by intraperitoneal route (i.p.) significantly decreased anxiety levels (p<0.05) in mice, and had a non - significant depressant effect in 11 of the 12 tests, showing a similar direction of correlation between diazepam and Passiflora extract effect. A greater anxiolytic and anti - depressant effects in mice was observed with the extract dose of 200 mg/kg/body weight with neuropharmaco logical manifestations found where no death was observed at any dose used.

L a ansiedad y la depresión provocan alteraciones fisiológicas. Las especies de Pa ssiflora se utilizan tradicionalmente en Perú como ansiolíticos y para tratar problemas inflamatorios. D eterminar el efecto neurofarmacológico del extracto etanólico de Passiflora tripartita var. mollissima (Kunth) Holm - Niels. & P. Jørg. y su efecto ansiol ítico en ratones. S e evaluó la ansiedad con el test de enterramiento de canicas y el efecto depresor con el test de Irwin . Las dosis de 100 mg/kg/peso corporal y 200 mg/kg/peso corporal por vía intraperitoneal (i.p.) disminuyeron significativamente la ansi edad ( p <0,05) con efecto depresor no significativo en 11 de las 12 pruebas, mostrando una correlación similar entre el diazepam aplicado a dosis de 1 mg/Kg/p.c. (i.p) y el efecto de Passiflora . S e observó un mayor efecto ansiolítico y antidepresivo en rato nes con 200 mg/kg/peso corporal encontrándose manifestaciones neurofarmacológicas pero no se observó muerte a ninguna de las dosis empleadas.

The relationship between perception of COVID-19, fear of COVID-19 and self-care management in individuals with chronic diseases during the pandemic process in Turkey.

AIMS: To determine the relationship between perception of COVID-19, fear of COVID-19 and self-care management in individuals with chronic diseases during the pandemic process. BACKGROUND: Individuals with chronic diseases are a sensitive group during the COVID-19 pandemic process; it is thought that self-care management may be adversely affected as a result of their more intense exposure to the psychological, physiological and economic effects of the pandemic. In the literature, there is no study examining the effect of perception of COVID-19 and fear of COVID-19 on self-care management in individuals with chronic diseases. DESIGN: Descriptive study. METHODS: The study was conducted with 322 individuals who applied to the internal medicine outpatient clinics of a university's Health Practice and Research Center, met the inclusion criteria, agreed to participate in the study and had a chronic disease. Questionnaire form, Perception of COVID-19 Scale (P-COVID-19), The Fear of COVID-19 Scale (FCV-19S) and Self-Care Management Process in Chronic Illness Scale (SCMP-G) were used to collect data. STROBE checklist was used to report the present study. RESULTS: In the study, it can be stated that individuals with chronic diseases had a moderate to the high perception of contagiousness and dangerousness of COVID-19, they had a moderate-high level of fear of COVID-19 and their self-care care management was above moderate level. There was a significant positive correlation between P-COVID-19, FCV-19S and SCMP-G in the study. CONCLUSIONS: It was found that the perception of COVID-19 contagiousness and the fear of COVID-19 had a positive effect on the self-care management of individuals with chronic diseases. RELEVANCE TO CLINICAL PRACTICE: Determining the level of COVID-19 perception and fear of COVID-19 and their effects on the life of the individual, and evaluating self-care management during the difficult pandemic process will increase the success in the holistic nursing care and management of chronic diseases.

Mindfulness training and exercise differentially impact fear extinction neurocircuitry.

BACKGROUND: The ability to extinguish a maladaptive conditioned fear response is crucial for healthy emotional processing and resiliency to aversive experiences. Therefore, enhancing fear extinction learning has immense potential emotional and health benefits. Mindfulness training enhances both fear conditioning and recall of extinguished fear; however, its effects on fear extinction learning are unknown. Here we investigated the impact of mindfulness training on brain mechanisms associated with fear-extinction learning, compared to an exercise-based program. METHODS: We investigated BOLD activations in response to a previously learned fear-inducing cue during an extinction paradigm, before and after an 8-week mindfulness-based stress reduction program (MBSR, n = 49) or exercise-based stress management education program (n = 27). RESULTS: The groups exhibited similar reductions in stress, but the MBSR group was uniquely associated with enhanced activation of salience network nodes and increased hippocampal engagement. CONCLUSIONS: Our results suggest that mindfulness training increases attention to anticipatory aversive stimuli, which in turn facilitates decreased aversive subjective responses and enhanced reappraisal of the memory.

Implementation feasibility of animal-assisted therapy in a pediatric intensive care unit: effectiveness on reduction of pain, fear, and anxiety.

Animal-assisted therapies are an innovative strategy within health care humanization initiatives, and they could play a role in the reduction of pain or anxiety. The main objective of this work was to evaluate the feasibility of implementing animal-assisted therapy in a pediatric intensive care unit and its effectiveness for the reduction of pain, fear, and anxiety. A prospective, quasi-experimental study of animal-assisted therapy was designed in the pediatric intensive care unit of the Hospital Universitario 12 de Octubre of Madrid, from January 2019 to December 2019. The study sample included patients who had been admitted to the unit and were over 3 years old. Satisfaction surveys were collected from the patients, family, and health personnel involved. Physiological variables and the level of pain (visual analog scale or Wong-Baker scale), fear (Child Medical Fear Scale), and anxiety (modified Yale Preoperatory Anxiety Scale) were evaluated before and after each session. Any existence of adverse events was recorded. A total of 74 therapy sessions were performed on 61 patients. All sessions were completed without any adverse effects. A total of 164 surveys were collected, providing an overall project rating of 9.69 out of a possible 10. The survey comments were found to be positive in most cases. No differences were found in the physiological variables measured before and after each session. There was a statistically significant decrease in pain, fear, and anxiety levels (p < 0.01).   Conclusion: The implementation of an animal-assisted therapy project in a pediatric intensive care unit is feasible and safe and has a high degree of acceptance among both participants and healthcare staff. Animal-assisted therapy is effective for the reduction of pain, fear, and anxiety, and therefore, it could be considered an adjunct to non-pharmacological therapy. What is Known: • Animal assisted therapies (AAT) are an innovative strategy that could be beneficial to help pediatrics patients cope with admission difficulties and could even play a role in reducing pain, anxiety and/or delirium. • To date there are not studies to analyze the effectiveness of AAT in the field of Pediatric Intesive Care. What is New: • Our study confirms the feasibility and effectiveness of the implementation of an AAT in the field of Pediatric Intensive Care with a high degree of acceptance by participants, caregivers and healthcare personnel. • AAT demonstrated a reduction in pain, fear and anxiety in pediatrics patients admitted to Pediatric Intensive Care Unit.

Cost-Effectiveness of the Mindfulness-Based Childbirth and Parenting Program for Pregnant Women With Fear of Childbirth.

OBJECTIVE: To examine the cost-effectiveness of the Mindfulness-Based Childbirth and Parenting (MBCP) program compared with enhanced care as usual (ECAU). DESIGN: Randomized controlled trial. SETTING: Midwifery settings in the Netherlands, April 2014 to July 2017. PARTICIPANTS: Subset of pregnant women with high levels of fear of childbirth (N = 54: randomized to MBCP, n = 32, or to ECAU, n = 22) who were selected from the parent study because they completed all four cost questionnaires. METHODS: We measured self-reported health care and non-health care costs. A subset of participants from the parent study completed the questionnaires at all four assessment points. We used the Wijma Delivery Expectancy Questionnaire to measure fear of childbirth and used the EuroQol-5D to measure quality of life. We used these measures of effect together with societal costs in the primary cost-effectiveness analyses. In the secondary cost-effectiveness analyses, we used different estimates of effects and costs to test the robustness of the primary analyses. RESULTS: In all but one scenario, MBCP was more effective and cost less than ECAU. As indicated by the acceptability curves, the likelihood of MBCP being cost-effective varied within a range of 70% to 98%. CONCLUSION: Our findings indicate that MBCP is a cost-effective intervention to reduce fear of childbirth in pregnant women. Important next steps are to replicate the study in countries with different health care systems and to explore the potential for further integration of MBCP into midwifery care.

Post-operative cognitive dysfunction is exacerbated by high-fat diet via TLR4 and prevented by dietary DHA supplementation.

Post-operative cognitive dysfunction (POCD) is an abrupt decline in neurocognitive function arising shortly after surgery and persisting for weeks to months, increasing the risk of dementia diagnosis. Advanced age, obesity, and comorbidities linked to high-fat diet (HFD) consumption such as diabetes and hypertension have been identified as risk factors for POCD, although underlying mechanisms remain unclear. We have previously shown that surgery alone, or 3-days of HFD can each evoke sufficient neuroinflammation to cause memory deficits in aged, but not young rats. The aim of the present study was to determine if HFD consumption before surgery would potentiate and prolong the subsequent neuroinflammatory response and memory deficits, and if so, to determine the extent to which these effects depend on activation of the innate immune receptor TLR4, which both insults are known to stimulate. Young-adult (3mo) & aged (24mo) male F344xBN F1 rats were fed standard chow or HFD for 3-days immediately before sham surgery or laparotomy. In aged rats, the combination of HFD and surgery caused persistent deficits in contextual memory and cued-fear memory, though it was determined that HFD alone was sufficient to cause the long-lasting cued-fear memory deficits. In young adult rats, HFD + surgery caused only cued-fear memory deficits. Elevated proinflammatory gene expression in the hippocampus of both young and aged rats that received HFD + surgery persisted for at least 3-weeks after surgery. In a separate experiment, rats were administered the TLR4-specific antagonist, LPS-RS, immediately before HFD onset, which ameliorated the HFD + surgery-associated neuroinflammation and memory deficits. Similarly, dietary DHA supplementation for 4 weeks prior to HFD onset blunted the neuroinflammatory response to surgery and prevented development of persistent memory deficits. These results suggest that HFD 1) increases risk of persistent POCD-associated memory impairments following surgery in male rats in 2) a TLR4-dependent manner, which 3) can be targeted by DHA supplementation to mitigate development of persistent POCD.

Attenuation of Anxiety-Potentiated Startle After Treatment With Escitalopram or Mindfulness Meditation in Anxiety Disorders.

BACKGROUND: Biological markers for anxiety disorders may further understanding of disorder pathophysiology and suggest potential targeted treatments. The fear-potentiated startle (FPS) (a measure of startle to predictable threat) and anxiety-potentiated startle (APS) (startle to unpredictable threat) laboratory paradigm has been used to detect physiological differences in individuals with anxiety disorders compared with nonanxious control individuals, and in pharmacological challenge studies in healthy adults. However, little is known about how startle may change with treatment for anxiety disorders, and no data are available regarding alterations due to mindfulness meditation training. METHODS: Ninety-three individuals with anxiety disorders and 66 healthy individuals completed 2 sessions of the neutral, predictable, and unpredictable threat task, which employs a startle probe and the threat of shock to assess moment-by-moment fear and anxiety. Between the two testing sessions, patients received randomized 8-week treatment with either escitalopram or mindfulness-based stress reduction. RESULTS: APS, but not FPS, was higher in participants with anxiety disorders compared with healthy control individuals at baseline. Further, there was a significantly greater decrease in APS for both treatment groups compared with the control group, with the patient groups showing reductions bringing them into the range of control individuals at the end of the treatment. CONCLUSIONS: Both anxiety treatments (escitalopram and mindfulness-based stress reduction) reduced startle potentiation during unpredictable (APS) but not predictable (FPS) threat. These findings further validate APS as a biological correlate of pathological anxiety and provide physiological evidence for the impact of mindfulness-based stress reduction on anxiety disorders, suggesting that there may be comparable effects of the two treatments on anxiety neurocircuitry.

Goldfish or aquatic turtle? Impact of two animal assisted interventions on children's pain, anxiety, and fear during IV catheterization: A randomized controlled trial.

PURPOSE: This study aimed to determine the effect of goldfish and aquatic turtle nursing interventions on children's pain, anxiety, and fear during IV catheter insertion. DESIGN AND METHODS: The randomized controlled trial included 98 children (control group = 32, goldfish group = 33, aquatic turtle group = 33) aged 5-6 years, attending outpatient clinic for blood sampling and catheterisation procedures. Pain was measured using the Wong Baker Facial Pain Scale, anxiety was measured using the Child Anxiety Scale-State, and child fear was measured using the Child Fear Scale, before, during, and after catheterization. RESULTS: When analyzing the pain, anxiety, and fear findings, no statistical difference was found between the scores of the mother, child, and researcher before the procedure. During the catheterization procedure, the pain, anxiety, and fear scores of the children in the fish and turtle groups increased statistically less than those in the control group. When analyzing the post-procedure findings, the pain, anxiety, and fear scores of the control group were similar to those before the procedure. In the fish and turtle groups, anxiety and fear scores were statistically the lowest (p < 0.05). CONCLUSION: It can be concluded that animal-assisted practices reduce anxiety and fear during and after the catheterization procedures while diverting attention from pain. PRACTICE IMPLICATIONS: Goldfish or aquatic turtle intervention improve children's attitudes toward pain, anxiety, and fear during IV catheter insertion. Pediatric nurses could consider incorporating, such as the animal assisted intervention, into their clinical practice to reduce the pain, anxiety, and fear experienced by children during medical/nursing procedures.

Population dynamics of a stoichiometric aquatic tri-trophic level model with fear effect.

In this paper, a stoichiometric aquatic tri-trophic level model is proposed and analyzed, which incorporates the effect of light and phosphorus, as well as the fear effect in predator-prey interactions. The analysis of the model includes the dissipativity and the existence and stability of equilibria. The influence of environmental factors and fear effect on the dynamics of the system is particularly investigated. The key findings reveal that the coexistence of populations is positively influenced by an appropriate level of light intensity and/or the dissolved phosphorus input concentration; however, excessive levels of phosphorus input can disrupt the system, leading to chaotic behaviors. Furthermore, it is found that the fear effect can stabilize the system and promote the chances of population coexistence.