Perceptions of exercise behavior and well-being in anomalous aortic origin of coronary arteries.

Anomalous aortic origin of a coronary artery (AAOCA) is associated with sudden death in the young. Risk stratification and management decision-making remain challenging. Data addressing post-diagnosis perceptions of exercise behavior and safety are lacking. We aimed to determine how AAOCA affects exercise behaviors, safety perceptions, and emotional well-being of patients/parents. Qualitative and quantitative analysis of AAOCA patient-/parent-specific survey was conducted to examine exercise frequency/restrictions, perceived safety of competitive/recreational exercise, and psychosocial well-being. Subgroups stratified by AAOCA subtype, surgical intervention, and physician-driven restrictions were compared using chi-squared and Fisher's exact tests. Cohen's kappa determined agreement in parent/child responses. AAOCA subtypes included 13 (24%) left AAOCA, 36 (67%) right AAOCA, and 5 (9%) other/unknown. Of 54 parents and 41 paired child responses, 22% of patients were physician-restricted from exercise. Parents imposed restrictions on competitive/recreational exercise 34%/26% of the time, respectively. Children without physician restrictions still self-restricted exercise 35% of the time. Parents reported feeling their child was unsafe exercising 61% competitively and 33% recreationally. Twenty-two percent of children reported feeling unsafe exercising, with good agreement to parental perceptions of competitive exercise safety (kappa = 0.779, p < 0.001). One-third of parents and children reported feeling sad, angry, or lonely, and about half reported feeling different. Importantly, 47% of children desired to exercise more. No difference was seen across restriction status, AAOCA subtype, or surgical management strategy. CONCLUSION: There are different perceptions of exercise behavior and safety following AAOCA evaluation, regardless of risk category or management strategy, impacting their well-being. These unmet needs should be at the forefront of care. WHAT IS KNOWN: • AAOCA is one of the leading causes of sudden cardiac death in the young. • Exercise restriction varies according to AAOCA subtype and its perceived risk of inducing myocardial ischemia. WHAT IS NEW: • There are different perceptions of exercise behavior and safety in patients and parents following a diagnosis of AAOCA, impacting their well-being. • Risk category or management strategy has no effect in patients' and parents' perception of exercise safety. • These unmet needs in this population should be at the forefront of care.

The impact of scaffolded and non-scaffolded suicidal virtual human interaction training on clinician emotional self-awareness, empathic communication, and clinical efficacy.

BACKGROUND: Clinicians working with patients at risk of suicide often experience high stress, which can result in negative emotional responses (NERs). Such negative emotional responses may lead to less empathic communication (EC) and unintentional rejection of the patient, potentially damaging the therapeutic alliance and adversely impacting suicidal outcomes. Therefore, clinicians need training to effectively manage negative emotions toward suicidal patients to improve suicidal outcomes. METHODS: This study investigated the impact of virtual human interaction (VHI) training on clinicians' self-awareness of their negative emotional responses, assessed by the Therapist Response Questionnaire Suicide Form, clinicians' verbal empathic communication assessed by the Empathic Communication and Coding System, and clinical efficacy (CE). Clinical efficacy was assessed by the likelihood of subsequent appointments, perceived helpfulness, and overall interaction satisfaction as rated by individuals with lived experience of suicide attempts. Two conditions of virtual human interactions were used: one with instructions on verbal empathic communication and reminders to report negative emotional responses during the interaction (scaffolded); and the other with no such instructions or reminders (non-scaffolded). Both conditions provided pre-interaction instructions and post-interaction feedback aimed at improving clinicians' empathic communication and management of negative emotions. Sixty-two clinicians participated in three virtual human interaction sessions under one of the two conditions. Linear mixed models were utilized to evaluate the impact on clinicians' negative emotional responses, verbal empathic communication, and clinical efficacy; and to determine changes in these outcomes over time, as moderated by the training conditions. RESULTS: Clinician participants' negative emotional responses decreased after two training sessions with virtual human interactions in both conditions. Participants in the scaffolded condition exhibited enhanced empathic communication after one training session, while two sessions were required for participants in the non-scaffolded condition. Surprisingly, after two training sessions, clinical efficacy was improved in the non-scaffolded group, while no similar improvements were observed in the scaffolded group. CONCLUSION: Lower clinical efficacy after virtual human interaction training in clinicians with higher verbal empathic communication suggests that nonverbal expressions of empathy are critical when interacting with suicidal patients. Future work should explore virtual human interaction training in both nonverbal and verbal empathic communication.

How the Degree of Anthropomorphism of Human-like Robots Affects Users' Perceptual and Emotional Processing: Evidence from an EEG Study.

Anthropomorphized robots are increasingly integrated into human social life, playing vital roles across various fields. This study aimed to elucidate the neural dynamics underlying users' perceptual and emotional responses to robots with varying levels of anthropomorphism. We investigated event-related potentials (ERPs) and event-related spectral perturbations (ERSPs) elicited while participants viewed, perceived, and rated the affection of robots with low (L-AR), medium (M-AR), and high (H-AR) levels of anthropomorphism. EEG data were recorded from 42 participants. Results revealed that H-AR induced a more negative N1 and increased frontal theta power, but decreased P2 in early time windows. Conversely, M-AR and L-AR elicited larger P2 compared to H-AR. In later time windows, M-AR generated greater late positive potential (LPP) and enhanced parietal-occipital theta oscillations than H-AR and L-AR. These findings suggest distinct neural processing phases: early feature detection and selective attention allocation, followed by later affective appraisal. Early detection of facial form and animacy, with P2 reflecting higher-order visual processing, appeared to correlate with anthropomorphism levels. This research advances the understanding of emotional processing in anthropomorphic robot design and provides valuable insights for robot designers and manufacturers regarding emotional and feature design, evaluation, and promotion of anthropomorphic robots.

Symptoms of the suicide crisis syndrome and therapist emotional responses: associations to self-harm and death by suicide within 18-months post-discharge among patients at an acute psychiatric department.

BACKGROUND AND AIMS: This study explored the associations between symptoms of the Suicide Crisis Syndrome (SCS) at admission and self-harm and death by suicide post-discharge. The association between clinicians' emotional responses toward inpatients at admission and post-discharge self-harm and suicide death was also explored. METHODS: Within the first 24-h of admission, patients completed a self-report measure of symptoms of SCS, and clinicians reported their emotional responses toward the patients. Follow-up data were obtained from the Norwegian Patient Registry and the Norwegian Cause of Death Registry. RESULTS: Within 18 months post-discharge, 44 (12.7%) out of 347 patients had self-harmed, and five patients (1.4%) had died by suicide. At admission, patients who later self-harmed reported higher symptoms of SCS compared to the other patients. Clinicians reported more negative emotional responses toward the self-harm group. In a regression analysis, previous suicidal behavior and a diagnosis of "emotionally unstable personality disorder" (EUPD; F60.3) were associated with increased risk of self-harm post-discharge. CONCLUSION: The results indicated that patients with post-discharge episodes of self-harm are significantly different from patients who do not self-harm in terms of more intense symptoms of SCS during admission. Clinicians' negative emotional responses may be relevant in the assessment of the risk of post-discharge self-harm.

From Fear to Resilience: A Scoping Review of Psychological Components in Anterior Cruciate Ligament Rehabilitation.

CONTEXT: Anterior cruciate ligament (ACL) injuries, prevalent in athletic contexts have profound physical and psychological impacts. Despite extensive research on the physiological aspects of ACL recovery, the psychological dimensions of this process have gained increased attention. This scoping review delves into the intricate landscape of psychological factors influencing ACL rehabilitation. DESIGN: Scoping review. METHODS: A literature search across multiple databases was conducted to identify relevant published studies that provide insight into the psychological aspects of ACL recovery. This search spanned various study designs, enabling a nuanced understanding of the psychological intricacies surrounding ACL recovery. Overall, a total of 1830 unique articles were screened, of which 66 were included in this review. Our findings are further contextualized through alignment with insights from prior reviews on similar themes. Through a comprehensive analysis of diverse literature, we explore 3 key themes: psychological challenges, current rehabilitation programs, and the integration of psychological support. RESULTS: Psychological challenges emerged as a pervasive aspect of ACL rehabilitation, encompassing fear, anxiety, motivation, and depression. The nuanced emotional responses, particularly the fear of reinjury, impact treatment adherence and overall well-being. Contemporary rehabilitation programs revealed inconsistencies in incorporating psychological support, emphasizing the need for standardized, multidisciplinary approaches. The alignment with prior reviews in the literature reinforced the importance of psychological traits, such as knee self-efficacy, in predicting positive outcomes. CONCLUSION: This scoping review provides a comprehensive overview of psychological factors within ACL rehabilitation, highlighting the importance of tailored interventions and standardized approaches. The integration of multidisciplinary expertise emerges as crucial for optimizing patient outcomes. Our findings not only contribute to a nuanced understanding of psychological nuances in ACL rehabilitation but also offer valuable implications for clinical practice and policy development.

Children's Experiences of Death Anxiety and Responses to the Covid-19 Pandemic.

The aim of this study was to explore children's experience and responses to the Covid-19 pandemic through their illustrations and short narrations. During October 2020 and January 2021 data was collected from thirteen children aged 9-10 years old in a primary school in the North-West of England. Children were asked to draw their thoughts and feelings about the pandemic and to write a short narration to accompany the drawing. Thematic analysis of data revealed that during the pandemic children at this age have an understanding of death, experience death anxiety and are able to use creative expression to facilitate meaning of the impact of lockdown on their lives such as feeling isolated, lonely, sad and bored. Creative expression also facilitated adaptive coping mechanisms derived from being able to spend more time with family. The data on primary school children is part of a larger study which involved surveys and interviews with children aged 12-16 years in secondary schools.

Coping strategies and emotional responses adopted by health care workers during COVID-19 pandemic-braving the storm.

Background and Aims: Health care workers (HCWs) are caught in the middle of the COVID-19 pandemic storm and are exposed to a large degree of physical and emotional stress. This study was planned to describe the stressors, stress levels, emotional responses, and coping strategies adopted by HCWs amidst this pandemic. Material and Methods: This cross-sectional, web-based survey was conducted after ethics approval, using a structured performa incorporating standardized stress (PSS-10 C), emotional responses (PANAS-10), and coping strategy (Brief COPE) scales. The snowball sampling technique was used to conduct the study and collect data. Data were analyzed using SPSS 26 version (SPSS Inc., Chicago, IL, USA) statistical software. A P value of <0.05 was considered significant. Results: Out of 402 participants (65% doctors and 35% nurses), 87% perceived moderate stress levels, and nearly half of the participants were interns, residents, and medical officers. Infection to self or family members (77.1%), survival of sick patients (75.6%), aggression by patients and relatives (70.3%), and long duty hours (67%) were some of the major stressors as reported by HCWs. The most common positive emotion felt was being alert (19.17 ± 5.57) and negative emotion perceived was being upset (15.6 ± 6.06). Many participants adopted emotion and problem-focused coping strategies such as planning and strategization (68%) and positive reframing (67.6%), whereas dysfunctional coping strategies such as venting and denial were adopted less commonly. Conclusion: Moderate stress levels perceived by HCWs are a cause for concern. Emotional responses of HCWs to stress vary; however, appropriate coping strategies including emotional and problem-focused coping strategies are the need of the hour to tackle pandemic-related stress.

Latent profiles of adolescents' relationships with parents and siblings: Associations with emotional and behavioral responses during the COVID-19 pandemic.

The purpose of this study is to identify the latent profiles of Chinese adolescents' family (parent-adolescent and sibling) relationships prior to and during the COVID-19 pandemic, as well as associations between those profiles and adolescents' emotional and behavioral responses. A total of 2,305 adolescents from China aged between 10 and 18 years completed measures of parent-adolescent relationships, sibling relationships, and emotional and behavioral responses during the pandemic. Four profiles of family relationships were identified via latent profile analysis and categorized as Cohesive-Decline, Mild-Decline, Conflictual-Stable, and Indifferent-Stable. Adolescents with a Conflictual-Stable profile reported more emotional and behavioral responses compared to the other profiles. In contrast, adolescents with a Cohesive-Decline profile exhibited fewer emotional responses compared to the other profiles. Adolescents with a Mild-Decline profile had fewer emotional responses than those with an Indifferent-Stable profile. These results shed light on the patterns and consequences of family relationships during the COVID-19 pandemic and have substantial implications for interventions involving family relationships in the context of regular epidemic prevention and control.

Emotional responses and perceived stressors of frontline medical staffs in case of COVID-19 treatment centers and obstetrics emergency in Ethiopia.

BACKGROUND: the rapid spread of COVID-19, its lethality in severe cases and the absence of specific medicine poses a huge threat to human life and health, as well as huge impact on the mental health. Facing this critical situation, health care workers on the front line who are directly involved in the diagnosis, treatment, and care of patients with COVID-19 are at risk of developing psychological distress and other mental health symptoms including emotional disturbance. OBJECTIVE: the aim of this study will be to assess the current state of emotional responses and perceived stressors of frontline medical staffs in case of Addis Ababa COVID-19 Treatment Centers and obstetrics emergency and abortion care, Ethiopia 2020. METHODS: Hospital based comparative cross-section study design was conducted by using self-administered questionnaire survey from June 1st to 30th of 2020 among 133 and 266 frontline medical staffs from obstetric emergency and abortion care clinic and COVID-19 treatment centers respectively. The data were collected after getting written consent from each participant and it entered into the computer using Epi-data version 7, then exported to SPSS version 20 for further analysis. Descriptive analysis was done using frequencies & percent. All independent determinants with P-value < 0.05 were used to identify important predictors of emotional responses and perceived stressors. RESULT: A total of 399 frontline medical staffs were included in the study. The mean age of the respondents of those who were working in obstetrics emergency and abortion care clinic was 27.47 (SD, 3.46) years and it was 28.12 (SD, 4.09) years for the other groups. This study revealed that, 72.9 and 5.6% of the study participant from obstetrics emergency and abortion clinic and COVID-19 treatment centers had a positive emotional response, respectively. Factors such as having a low level of motivational factors (AOR 2.78, 95% CI (1.13, 6.84)), being a nurse (AOR 10.53, 95% CI (1.31, 85.26)) and working at triage (AOR 8.61, 95% CI (1.15, 64.81))) had statistically significant association with negative emotional response. CONCLUSION: The current study revealed that a high proportion of front line a negative emotional responses had negative emotional response. Further, almost all of the medical staffs working in COVID-19 treatment centers and at obstetrics emergency and abortion care unit had perceived the outbreak related stressors. So, providing comprehensive psychological support is warranted for health care providers working in such kinds of department or units.

Efficiency of Illusory Choice Used as a Variant of Situation Selection for Regulating Emotions: Reduction of Positive Experience But Preservation of Physiological Downregulation.

Situation selection is an emotion regulation strategy consisting in choosing a future emotional situation. Past research showed that Situation selection triggers a decrease in negative experience, exocrine reactions and respiratory activity, while maintaining stable positive experience. In this study, we wanted to replicate these observations and test emotional responses that follow an Illusory choice, i.e., when the chosen situation is not available and replaced by another. Sixty-eight participants watched emotional pictures, either in a condition in which the images were imposed, or in a condition in which they could perform a choice. In these latter trials, participants saw either the chosen option (Situation selection) or the non-selected option (Illusory choice). Continuous recordings of experience and physiological arousal showed that, unlike Situation selection, Illusory choice decreased positive experience but not negative experience. Strikingly, however, we showed that having the choice decreased skin conductance and respiratory arousal, regardless of whether the choice was respected or not. These results have important implications regarding emotion regulation through Situation selection, since having the choice about the upcoming emotional situation, no matter if we really end up in this situation, gives a sense of control that may be sufficient to alleviate physiological responses to stressors.

Self-Compassion and Reactions to a Recalled Exercise Lapse: The Moderating Role of Gender-Role Schemas.

Exercise is good for health and well-being, yet people experience lapses when trying to adhere to exercise. Self-compassion may help people cope with exercise lapses. Most research on self-compassion and exercise has been conducted with women; men may also benefit from self-compassion. No research has examined whether gender-role schema influences responses to exercise lapses. The authors examined both male and female adult exercisers (N = 220) who reported their self-compassion, recalled an exercise lapse, their reactions to the lapse, and their self-identification of masculinity and femininity. After controlling for self-esteem, age, and lapse importance, self-compassion negatively related to emotional responses (p < .001), rumination (p < .001), extrinsic motivation (p = .004), and positively related to intrinsic motivation (p < .001). Masculinity moderated the relationships between self-compassion and amotivation (p = .006), and identified regulation (p = .01). Self-compassion may be an effective resource for exercisers, especially those who identify as highly masculine.

Lesbian adoptive mothers' emotional responses and adaptation in the wake of relational dissolution.

Relational dissolution is often characterized by heightened feelings, especially around co-parenting and child custody. Lesbian mothers may experience their emotions in uniquely nuanced ways due to intersections among female gender, minority sexual orientation, and family structural change. Framed by a critical feminist perspective, we conducted a qualitative analysis of telephone interview and online survey responses by 17 lesbian adoptive mothers whose relationship ended. Four emotional response patterns emerged - mostly positive, mixed feelings, mostly negative, very negative - corresponding to four adaptation patterns: adapted, improving, stalled, and stuck. We provide implications for individuals, families, and societal change related to LGBTQ divorcing families.

Culture and Sexuality: Cognitive-Emotional Determinants of Sexual Dissatisfaction Among Iranian and New Zealand Women.

BACKGROUND: Several studies have demonstrated that culture plays a fundamental role in individuals' beliefs, attitudes, and values toward sexuality, and influences their ability to enjoy sex. It follows that culture may influence sexual satisfaction or dissatisfaction. AIM: To examine and compare cognitive-emotional variables related to women's sexual dissatisfaction in Iran and New Zealand. METHODS: In total, 196 Iranian women and 207 New Zealand women participated in the study, answering questionnaires evaluating dysfunctional sexual beliefs, automatic thoughts, emotional and sexual response during sexual activity, as well as sexual satisfaction. OUTCOMES: Sexual beliefs were measured by the Sexual Dysfunctional Beliefs Questionnaire, thoughts and emotional responses were measured by the Sexual Modes Questionnaire, and sexual satisfaction was measured by the Sexual Satisfaction Index. RESULTS: Findings indicated that in both Iranian and New Zealand women, failure and disengagement thoughts, lack of erotic thoughts, and emotions of fear during sexual activity were significant predictors of sexual dissatisfaction. Besides these common predictors, results also indicated that sexual conservatism and women's sexual passivity beliefs, sexual abuse thoughts, and fear during sexual activity were significant predictors of sexual dissatisfaction in Iranian women. Beliefs of sexual desire and pleasure as a sin; age-related beliefs; and emotions such as sadness, disillusion, and hurt were significant predictors of sexual dissatisfaction in New Zealand women. CLINICAL TRANSLATION: The present findings could facilitate a better understanding of cultural differences in the roles played by dysfunctional sexual beliefs, negative automatic thoughts, and negative emotions during sexual activity, and the value of these beliefs, thoughts, and emotions in predicting sexual dissatisfaction. CONCLUSIONS: The strength of this study is in providing an examination of the role of culturally bound beliefs in predicting sexual dissatisfaction in women from different cultural backgrounds. Limitations include the lack of evaluation of psychological and interpersonal variables that may impact on women's sexual dissatisfaction. These findings suggest that there may be a role of culture in shaping beliefs, attitudes, and values toward sexuality; and provide evidence for the effect of cognitive-emotional variables in predicting women's sexual dissatisfaction. Abdolmanafi A, Nobre P, Winter S, et al. Culture and Sexuality: Cognitive-Emotional Determinants of Sexual Dissatisfaction Among Iranian and New Zealand Women. J Sex Med 2018;15:687-697.

Cancer-Diagnosed Individuals' Use of Television and the Internet as a Source for Peer Stories and Associated Emotional Responses.

When people are confronted with a potentially life-threatening disease such as cancer, they are likely to feel an urgent need for information about the disease and support from peers. Studies have shown that the mass media contain a lot of experiential information (i.e., peer stories) about cancer, either from real individuals or from fictional characters. To date, most studies have focused on using the Internet for peer support. This study aimed to extend this line of research by investigating (1) whether cancer-diagnosed individuals use both television and the Internet to access peer stories, (2) whether exposure to these stories results in different emotional outcomes, and (3) whether this differs depending on gender. A cross-sectional survey among 621 cancer-diagnosed individuals in Flanders (Belgium) showed that both television and the Internet were used as a source for following peer stories. Respondents indicated feeling fearful and concerned when following peer stories on entertainment television, but following peer stories on online forums was associated with feeling supported. These different emotional responses could be the result of the differences between these two content categories (i.e., fictional versus non-fictional peer stories). Future research should further examine these relationships by investigating the role of mass media content and how different psychological coping styles and personality traits moderate these associations.

Alterations of emotional reactivity following righttemporal lobectomy.

To learn if a right temporal lobectomy altered a patient's autonomic and cognitive responses to aversive and appetitive pictures, we investigated a man whose right anterior temporal lobe and amygdala had been resected to remove an arteriovenous malformation. This patient revealed unusually low self-reports of arousal with a lack of heightened skin conductance responses to aversive pictures. For pleasant pictures, his self-reports of arousal and his physiological responses were similar to healthy men. This patient's responses are consistent with a bivalent model of emotional processing, with a right temporal lobectomy compromising the activation of his defensive action response system.

Alternatives to the fixed-set model: A review of appraisal models of emotion.

Over several decades, appraisal theory has emerged as a prominent theoretical framework explaining the elicitation and differentiation of emotions, and has stimulated a great deal of theorising and empirical research. Despite the large amount of research in this area, there are many aspects of appraisal theory and research that remain unclear or problematic. In this review, we identify a common assumption of many appraisal theories-the fixed appraisal set-and argue that this assumption, combined with a lack of explicit theorising about the predicted relationship between appraisals and emotions, leads to a lack of clarity in both appraisal models and the empirical testing of those models. We recommend that appraisal theorists move in a direction already taken by a small number of theorists, and adopt the starting assumption of a variable appraisal set. We further suggest that theories of concepts and categorisation may inform theorising about appraisal-emotion relationships.

Determinants of Women's Sexual Dissatisfaction: Assessing a Cognitive-Emotional Model.

INTRODUCTION: Recent studies have demonstrated the role of sexual dysfunctional beliefs, negative automatic thoughts, and emotional responses in relation to sexual functioning. Nevertheless, no studies seem to have evaluated the role of these cognitive-emotional factors in determining sexual dissatisfaction. AIM: To test a cognitive-emotional model of sexual dissatisfaction in women. METHODS: In total, 207 women answered questionnaires assessing sexual dissatisfaction and cognitive and emotional variables that might affect sexual dissatisfaction. MAIN OUTCOME MEASURES: Sexual dissatisfaction was measured by the Index of Sexual Satisfaction, sexual beliefs were measured by the Sexual Dysfunctional Beliefs Questionnaire, and thoughts and emotional responses were measured by the Sexual Modes Questionnaire. RESULTS: A path analysis was conducted to assess the conceptual model proposed. Results indicated that dysfunctional sexual beliefs work as predisposing factors by eliciting negative automatic thoughts and emotions, which impair the processing of erotic stimuli and interfere negatively with sexual satisfaction. CONCLUSION: This finding suggests a role for cognitive and emotional factors in predisposing and maintaining sexual dissatisfaction in women, suggesting relevant implications for intervention.

Emotional responses during repeated sprint intervals performed on level, downhill and uphill surfaces.

The purpose of this study was to test emotional responses during sprint intervals performed on a level, down and up surface. Fifty trained participants performed a maximal effort during a 60-m sprint and 10 repetitions of 60 m running sprints on a level, down and up surface on a 5.9% slope. Running speeds, emotional responses and heart rate were measured. Self-selected speeds were correlated with the rating of perceived exertion, the affective balance, the desire to stop and the resources needed for the task in all conditions whereas the pleasure, the desire to continue and the capacity to realise the task were correlated with speeds only during level and uphill running. Mean values of emotional parameters were significantly different (P < 0.05) during running on a flat surface, downhill and uphill. When the gradient of running surface is changed, the pattern of emotional responses was just translated, i.e. most of the slope between the evolution of emotional parameters and the repetitions were not significantly different whereas Y-intercepts were different. Consented effort is highly correlated with the resources needed for the task (P < 0.001, r(2) = 0.72). We propose that the difference in the resources needed for the task between level, downhill and uphill running (F 2, 1499 = 166.5, P < 0.001, Eta(2) = 0.18) is the most important key that explains our results.

'I don't care whether it's HPV or ABC, I just want to know if I have cancer.' Factors influencing women's emotional responses to undergoing human papillomavirus testing in routine management in cervical screening: a qualitative study.

OBJECTIVE: To explore emotional responses, and predictors of negative reactions, among women undergoing human papillomavirus (HPV) tests in routine clinical practice. DESIGN: Exploratory qualitative interview study. SETTING: A large busy colposcopy clinic in a Dublin hospital. SAMPLE: Twenty-seven women who had had an HPV DNA test in the previous 6 months following one or more low-grade cytology tests or treatment for cervical intraepithelial neoplasia (CIN). METHODS: In-depth semi-structured interviews were conducted. Interview transcripts were analysed using a thematic approach (Framework Analysis). MAIN OUTCOME MEASURES: Women's emotional responses and predictors of negative emotional reactions. RESULTS: For most women, having a test for high-risk HPV types generated little negative or positive emotional impact. Adverse emotional responses related to HPV infection rather than testing. Factors that influenced whether women experienced negative emotional responses were: concerns over abnormal cytology or diagnosis of CIN; HPV knowledge; awareness of HPV being sexually transmitted; awareness of HPV prevalence; and HPV information needs. Women's concerns about abnormal cytology/CIN dominated all other issues. CONCLUSIONS: These qualitative data suggest that in the context of follow up of abnormal cytology or treatment for CIN, the emotional impact of HPV testing may be modest: women's primary concerns at this time relate to abnormal cytology/CIN.

Psychometric validation of Emotional Reaction Instrument-English to measure American children's emotional responses to hospitalisation.

AIMS AND OBJECTIVES: The aim of this study was to test the initial psychometric properties of the Emotional Reactions Instrument-English with hospitalised American children, ages 7-12 years, in the USA. BACKGROUND: Children's negative emotional responses have been a subject of concern for paediatric clinicians and researchers, especially because negative emotional responses following or during hospitalisation are associated with adverse patient outcomes. Existing self-report paediatric instruments have a number of limitations including lack of clinical feasibility and psychometric evidence. DESIGN: A survey and psychometric approach was used to test initial reliability and validity of the Emotional Reactions Instrument-ENGLISH. METHODS: Two hundred hospitalised American children, 7-12 years of age, who were admitted to a Children's Hospital in the USA were recruited for this study. The children were administered the Emotional Reactions Instrument-English, the Facial Affective Scale, and a demographic form. RESULTS: Internal consistency was supported by a Cronbach's alpha of 0·83 for the total scale. Alpha coefficients for subscales ranged from 0·59-0·82. Construct validity was tested with exploratory factor analysis. Through principal component analysis, four factors were identified that explained 64% of the variance. Concurrent validity was supported by most items in the Emotional Reactions Instrument-English being significantly correlated with the Facial Affective Scale (r = 0·18-0·59). The instrument can be administered to hospitalised children in 5-10 minutes. CONCLUSIONS: The results of this exploratory study provide initial support for the psychometric adequacy of the Emotional Reactions Instrument-English with hospitalised American children ages 7-12 years. Further testing of the Emotional Reactions Instrument-English is required to validate the subscales and evaluate the instrument's use with children of different ages, race and ethnicity. RELEVANCE TO CLINICAL PRACTICE: This study introduces a new, clinically feasible instrument to measure children's diverse emotional responses to hospitalisation.