[The stress-reducing effect of cigarette smoking and the influence of trait-anxiety on its manifestation]

The purpose of the present study was to clarify the stress-reducing effect of cigarette smoking and the involvement of other factors such as trait-anxiety on the above effect of smoking. The subjects were 32 smokers who met DSM-IV criteria for substance dependence and 16 nonsmokers. The smokers were randomly assigned to a smoking group or a sham-smoking group. Immediately after the subjects performed a laboratory task, the State-Trait-Anxiety Inventory was administered for evaluating the levels of state-anxiety and trait-anxiety. The subjects were required to smoke a cigarette in a smoking group, sham-smoke in a sham-smoking group, or take a rest in a nonsmokers's group. After that, the same inventory was again administered. The decrease of state-anxiety in a smoking group was significantly more marked in degree than in a sham-smoking group and was comparable to that in a nonsmokers' group. A stepwise regression analysis revealed that the trait-anxiety levels significantly contributed to a decrease of state-anxiety levels in a smoking group. The present study indicated that cigarette smoking exhibited a stress-reducing effect and that the trait-anxiety levels were related to the effect of smoking.

[Personality and characteristics of couples in infertile marriage]

OBJECTIVE

To estimate the basic personality and couple characteristics of men and women from infertile marriages.

DESIGN

Research psychodiagnostical study.

SETTING

Institute of Sexology, 1st Medical Faculty, Charles University, Prague, Iscare IVF, Prague.

METHODS

38 couples applying for assisted fertilization were psychologically examined by standard psychodiagnostical methods.

RESULTS

Men and women from infertile couples displayed moderate anomal behavioral characteristics, men from these couples are more neurotic than general population, women display more anxiety and social desirability. The relations in these marriages are not substantially disturbed and are even less conflictuous and the consistency of the male and female roles is even better than in general population. Men from infertile couples are perceived by themselves as well as by their wives as less masculine.

CONCLUSION

In men and women from examined couples there were no serious personality anomalies and the relations in these marriages were not substantially disturbed by infertility.

Pre- and postsurgical psycho-emotional aspects of the orthognathic surgery patient

The current study represents an attempt to examine psychologic changes, emotional impact, expectations, and satisfaction in patients before and after orthognathic surgery. Levels of presurgical anxiety, postsurgical depression, body concept, and all the important changes in physiologic functions were measured by 4 questionnaires, which were self-administered before and after surgery. The results of this study suggest that surgery does, in fact, produce improvements in self-esteem and body image (patient's evaluation of his or her facial attractiveness) and in mastication and speech, and therefore in their lifestyle. All patients experienced a medium to high level of presurgical anxiety, but no major problems after surgery.

Effects of anaesthesia on the psychological function of patients

The psychological effects of halothane, methoxyflurane, combined analgesic-relaxant anaesthesia, and epidural anaesthesia were assessed before one, and seven days after anaesthesia in 72 patients having operations for varicose veins. Subjective anxiety evaluation (Hamilton Anxiety Rating Scale) and personality tests of self-appraisal (Minnesota Multiphasic Personality Inventory) as well as of superficial (Wartegg's test) and profound (Rorschach's test) projection showed no significant differences among these methods of anaesthesia. Performance tests measuring memory for designs (modified Graham-Kendall memory for designs), short-term memory (digit span of Wechsler Adult Intelligence Scale), learning (nonsense word series), perception (symmetry-drawing), speed of observation (Bourdon-Wiersma) and visualization also revealed no significant psychological changes compared to the control (epidural anaesthesia) group. The methods of anaesthesia used therefore showed no harmful psychological effects and are in this respect safe in clinical use.

The West Coast Study. II: Dental anxiety and satisfaction with dental services

Dental anxiety is common, and is a notable factor in the avoidance of dental care. The dental satisfaction of users is an important indicator of the quality of dental care. A postal survey (response rate 76.6 percent) was used to investigate dental anxiety and dental satisfaction among a representative sample of 249 dentate adults living on the West Coast of the South Island of New Zealand. Dental anxiety was reported by 20.8 percent of respondents, and was more prevalent among beneficiaries (individuals in receipt of a Social Welfare benefit) and younger people. Dental satisfaction was lower among younger people and those who were dentally anxious, and was higher among people with a tertiary education. Differences in consumers' expectations were considered responsible for the latter findings. Where appropriate, dentists should be prepared to adapt their manner of communicating with patients.

[Epidemiologic study of dental fear in school children 8-15 years of age]

Authors investigated the dental fear scores (DAS, DFS) of 139 primary school children in Budapest, Hungary (72 females, 67 males, ages between 8-15 years). Sex and age had no effect on the scales. Mean dental fear scores were high (DAS: 10.7 +/- 3.7, DFS: 40.4 +/- 15.3). A strong correlation between DAS and DFS, and somewhat lower correlation between these scales and the general anxiety scales were demonstrated. Children's evaluation of the dental fear of the family and relations strongly correlated with dental fear and moderately with general anxiety. The results indicate that, dental fear is influenced by dental fear of family and relations, and general anxiety, but much less influenced by other demographic variables (i.e. age, sex) in primary-school children.

Stress in elective dental treatment: epinephrine, norepinephrine, the VAS, and CDAS in four different procedures

This study focuses on progressive stress during defined, elective dental treatments, expressed in VAS, CDAS, and catecholamine excretion in urine. Fourteen male patients had avoided dental treatment for years; all were classified as ASA risk score I. The different dental sessions were: first visit after many years; check-up (nonpainful and nontraumatic); drilling and restoring under local anesthetics; drilling and restoring without local anesthesia; and extractions. Urine collection was performed directly before and after the sessions to measure epinephrine and norepinephrine concentrations. Anticipation stress was registered in the VAS, CDAS, and epinephrine excretion. Progressive stress was reflected in epinephrine increase, which discriminated between the different elective dental treatments.

Dental anxiety and behavioural problems: what is their influence on the treatment plan?

AIM

This was to investigate the influence of emotional and behavioural problems on the choice of treatment type. In addition, the actual contents of the treatment of dentally fearful children was studied in an attempt to develop dental treatment protocols for children with such problems.

METHODS

The parents of 265 children (144 girls, mean age 88.4 months, SD+/-34.2 months), referred to a centre for special dental care, were asked to complete the Child Behaviour Check List (CBCL) before their first appointment. The CBCL was used to assess behavioural problems. All selected children were dentally anxious (score >or=35 on the Children's Fear Survey Schedule Dental Subscale, CFSS-DS). After treatment, the children's records were analysed on treatment type and contents.

RESULTS

The CBCL score was related to the type of treatment. Children treated with the aid of nitrous oxide sedation scored significantly higher on the CBCL than children treated with behavioural management or under intravenous anaesthesia (IVA). In the IVA group more surfaces were treated than in the other groups. The CBCL score was not related to the treatment contents (number of surfaces filled, amount of radiographs, sealants, stainless steel crowns or pulpotomies), the time spent on the child's treatment or the number of sessions.

CONCLUSION

Dentally anxious children with behavioural problems as assessed by the CBCL have dental treatment (contents and length) comparable with that of dentally anxious children without those problems. However, anxious children with behavioural problems are more often treated with nitrous oxide sedation. Therefore, there seems to be an urgent need for access to nitrous oxide sedation for dentists working in special dentistry.

[Comparison of the psychological effects of standard exercises with those of space exercises in autogenic training: from the perspective of passive concentration]

The purpose of this study was to compare the psychological effects of the heaviness and the warmth Standard Exercises (SE) with those of the first Space Exercises (SP) in Autogenic Training (AT) on college students. This study was conducted by the repeated practice of two experimental groups (SE, SP) and one control group (CT). The participants in the experimental groups practiced once a week, for three weeks. All the participants were assessed with State-Trait Anxiety Inventory-Trait Anxiety (STAI-T), Autogenic Training Clinical Effectiveness Scale (ATCES), and Rosenberg's Self-Esteem Scale. The results showed that the SE group showed more decreases in STAI-T and more increases in ATCES than the SP group, while the more neurotic, showed more increases in self-esteem in both the SE and SP groups. It is possible that non-clinical adults with high neuroticism might be able to enhance their STAI-T and ATCES in the SE group than in the SP group if their SE trainers respected their bodily abilities in readily responding to changes in sensations.

A short-term follow-up of treatment outcome in groups of uncooperative child dental patients

AIM

To evaluate the short-term follow-up outcome in four subgroups of uncooperative child dental patients referred to a specialist paediatric dental clinic in Sweden.

METHODS

Seventy children, classified into four groups (based on fear, temperament, behaviour and verbal intelligence), were followed-up at their public dental clinics after termination of specialist dental treatment. Questionnaire assessments of children's dental and general fear, parental dental fear, emotional stress, locus of control and parenting efficacy were made by parents pre and post treatment and at follow-up and were analysed within and between groups. At follow-up, parents rated their children's coping and procedure stress, while treatment acceptance was rated by the dentists.

RESULTS

Decreases in child dental fear were maintained at follow-up, although a third of children still had moderate or high dental fear. For those children who had been classified into the externalising, impulsive group, an increased risk of non-acceptance (RR=3.7) was indicated. The risk of dental fear at follow-up was increased for the group of fearful, inhibited children (RR=3.8). For the study group as a whole a poorer follow-up outcome could be predicted by avoidance behaviour (OR 12.9-16.6) and moderate or high post treatment dental fear (OR 6.5- 21.3).

CONCLUSIONS

Fearful, inhibited child dental patients may need, due to dental fear, extra attention even after successful dental treatment at a specialist clinic. Externalising, impulsive children constitute a special challenge for dentistry. The continued need for adjusted management after termination of specialist treatment can be predicted from avoidance behaviour and post treatment dental fear scores.

Identified factors in child-dentist relationship important for the management of dental anxiety in Nigerian children

AIM

To investigate the effects and interrelationship between dental anxiety and dentist's experience, dentist's behaviour, type of treatment received and the behaviour of Nigerian children during treatment.

METHODS

Pre- and post-dental treatment anxiety levels of 69 child patients, who were attending the dental clinic to receive dental treatment for the first time, were assessed using the DFSS-SF. The dentist's and child's behaviour during treatment procedures were unobtrusively observed and recorded. The pre- treatment anxiety levels were classified as high (HAC) and low (LAC), while those of the dentists who managed the children were categorized as experience or inexperienced. The interrelationship between a child's dental anxiety level, dentist's behaviour during child management, dentist's experience and the type of treatment the child received were analysed.

RESULTS

The anxiety level of the children decreased significantly post-treatment when experienced dentists managed the child in comparison to inexperienced dentists (Z=3.22, p<0.02). The dentist's behaviour did not significantly affect the anxiety level of the child. However, physical contact was used more frequently with HAC than LAC (z=2.27;p<0.023). There was no association between a child's behaviour in the dental chair and their anxiety level (chi(2)=0.08, p<0.93). Also, the more invasive the procedure, the less the tendency for a noted decrease in anxiety level of a child post-treatment, though this was statistically insignificant (z=1.34; p<0.44).

CONCLUSION

The dentist's behaviour played no role in changing the anxiety level of a child nor did it have any influence on anxiety-related behaviour of a child. However, the experience of the dentist was a very significant factor for effecting a decrease in the dental anxiety level change for children.

[Background data about the dental fear scores of Hungarian secondary school students]

Free association (coupling) of 139 Hungarian secondary school students (90 females, 49 males, age between 14-18 yr.) about their teeth was collected. Dental fear (DAS, DFS) and general anxiety scores were measured. Typical dental events (i.e.: simple and traumatising dental treatments, etc.) were coupled by the participants in 36,7% of the cases. Functions and importance of the teeth and oral hygiene were described in 7,2% of the cases. Simple, grotesque, or magical stories and tales about teeth were found in 16,5% of the cases. No answer was found in 39,6% of the cases. Highest dental fear and general anxiety scores were found in the group coupled traumatising dental treatment. Age had no influence on the sense of the association (coupling).

Objective and subjective measures for assessing anxiety in paediatric dental patients

AIM

Anxiety has been defined as a nonspecific feeling of apprehension towards a concrete situation that does not necessarily involve a previous experience. Dental anxiety can prevent patients from cooperating fully during dental treatment. Given that there is a connection between dental anxiety and uncooperative behaviour, it is important for dentists to be able to assess anxiety in their patients. There are many methods for such assessment, and in children they depend on age and intellectual development. These measures can be objective or subjective, depending on the method used to quantify the degree of anxiety. The aim of this literature review was to analyse the objective and subjective scales that are used most commonly to assess the degree of anxiety of children in a dental setting.

CONCLUSION

Knowing the degree of anxiety of dental children is important in order to guide them through their dental experience. Their level of cooperation will also improve and anxiety will be reduced as well.

[Clinical effects of theophylline in the therapy of intractable asthmatic children. II. Theophylline therapy and behavior problems in children with asthma]

This study examined the relationship between long-term theophylline therapy and behavior problems in 14 asthmatic children that includes 5 intractable cases and 24 non-asthmatic children. Asthmatic children have received theophylline therapy and cromolyn inhalation for 3.6 +/- 3.8 years. Subjects were tested on neuropsychologic batteries; behavior problems and personality of children questionnaire, child behavior checklist, caffeine-like side effects questionnaire, manifest anxiety scale, visual attention test, Uchida-Kraepelin test and soft neurological signs. These tests were repeated with an interval of 1 to 12 weeks. Parents noted caffeine-like side effects, stomach ache and difficulty in sleeping, in their child during the theophylline therapy. The caffeine-like side effects decreased after stopping theophylline therapy. The rate of mistake in Uchida-Kraepelin test for the asthmatic group and for the intractable cases was significantly higher than that of the control group. Time of the sequential finger thumb opposition of the soft neurological signs was significantly prolonged in asthmatic group. There was no significant change in the other tests between asthmatic and non-asthmatic children and before and after stopping theophylline therapy. It seems that behavior problems and learning disability observed in the asthmatic children are due to the pathogenesis or symptoms of asthma rather than the effect of long-term theophylline therapy.

Oral triazolam pretreatment for intravenous sedation

This double-blind, controlled clinical trial assessed the anxiety relief provided by oral triazolam given before intravenous sedation. Twenty-two healthy adults undergoing third-molar surgery with intravenous sedation were enrolled in this study. Subjects were randomly assigned to receive either 0.25 mg of triazolam p.o. or an identically appearing placebo 45 to 60 min before venipuncture. Immediately before test drug administration, subjects completed the Corah Anxiety Scale, a Visual Analog Scale (VAS) assessing state anxiety, and the Interval Scale of Anxiety Response (ISAR). The VAS and ISAR were repeated immediately before venipuncture. Intravenous sedation medications consisted of fentanyl, midazolam, and methohexital. At 24 hr, assessments of the venipuncture and global experience were obtained. Results indicated that the characteristics of the triazolam and placebo patients were similar at baseline. With triazolam pretreatment, both the VAS and ISAR scores decreased significantly. Dose requirements for conscious sedation medications were decreased in the triazolam group. Patients rated the venipuncture experience significantly less unpleasant when pretreated with triazolam, and global ratings of the overall surgical experience favored triazolam. An oral-intravenous combination sedation technique using 0.25 mg of triazolam may have a significant therapeutic advantage for outpatient oral surgery.