Treating anxiety disorders in children with high functioning autism spectrum disorders: a controlled trial

A family-based, cognitive behavioural treatment for anxiety in 47 children with comorbid anxiety disorders and High Functioning Autism Spectrum Disorder (HFA) was evaluated. Treatment involved 12 weekly group sessions and was compared with a waiting list condition. Changes between pre- and post-treatment were examined using clinical interviews as well as child-, parent- and teacher-report measures. Following treatment, 71.4% of the treated participants no longer fulfilled diagnostic criteria for an anxiety disorder. Comparisons between the two conditions indicated significant reductions in anxiety symptoms as measured by self-report, parent report and teacher report. Discussion focuses on the implications for the use of cognitive behaviour therapy with HFA children, for theory of mind research and for further research on the treatment components.

Does completing a dental anxiety questionnaire increase anxiety? A randomised controlled trial with adults in general dental practice

The assessment of dental anxiety can be achieved by using brief multi-item scales.

OBJECTIVE

To test the null hypothesis that completing the Modified Dental Anxiety Scale had no immediate influence on patient state anxiety.

OUTCOME MEASURE

Speilberger State Anxiety Inventory-6 item Short Form.

STUDY DESIGN

Randomised controlled trial.

PARTICIPANTS

Patients (n = 1,028) attending 18 dental practices in Northern Ireland were invited to participate.

RESULTS

Twenty-four patients refused (response rate 98%) providing 1,004 patients (mean age = 41 years, range = 16 to 90 years; 65% female) for analysis. Patients who completed the dental anxiety scale were found to have a virtually identical state anxiety score: mean (SD) = 11.36 (4.33) compared to those who completed the state anxiety assessment only: mean (SD) = 11.01 (4.35). The mean (CI95%) difference was 0.35 (0.89 to -0.18), t = 1.29, df1002, p = 0.2.

CONCLUSION

The completion of a brief dental anxiety questionnaire before seeing the dentist has a non significant effect on state anxiety.

Prospective randomized clinical trial comparing the effects of a masticatory bite wafer and avoidance of hard food on pain associated with initial orthodontic tooth movement

INTRODUCTION

The purpose of this prospective, randomized clinical trial was to compare the use of masticatory bite wafers with the avoidance of mastication in reducing pain and discomfort associated with initial orthodontic tooth movement.

METHODS

Eighty-four subjects (mean age, 14.1 years), randomly allocated to a bite-wafer group (BWG) or a reduced-mastication group (RMG), completed the study. In each subject, 1 arch was bonded and ligated with a round austenitic active 0.016-in nickel-titanium wire, and placebo instructions were given. The subjects in the BWG then performed immediate supervised mastication of the wafers for 10 minutes, and they were instructed thereafter to bite on the wafers to prevent pain for the next 7 days. The subjects in the RMG were instructed not to masticate for 3 hours after placement of the fixed appliance and to avoid masticating hard food for 7 days. Each patient's level of anxiety was assessed before treatment with standard psychometric questionnaires. Each patient recorded the level of pain immediately after archwire ligation on a 100-mm visual analogue scale (VAS) and used a pain diary with a verbal rating scale for the next 7 days.

RESULTS

No statistically significant differences in the VAS immediately after ligation of the archwires were observed between the 2 groups. The median pain score for the BWG was higher for the first 4 days. The median peak difference was reached on the evening of the first day. At this maximum value, the median pain score of the BWG was higher and statistically significant (P = .006).

CONCLUSIONS

Although the amount of pain and discomfort reported by the patients undergoing fixed orthodontic therapy varied, more pain was reported by those using bite wafers than by those who avoided masticatory activity after placement of fixed appliances.).

Dental anxiety among adults in Turkey

AIM

This aim of this study was to investigate the prevalence of dental anxiety and related factors in a Turkish population.

METHODS AND MATERIALS

The Turkish translation of the Dental Fear Scale (DFS) and the Modified Dental Anxiety Scale (MDAS) were administered to 115 dental patients consisting of 21 subjects who had dental phobia and of 94 patients who did not. The scales were also administered to a non-clinical general population (N=183).

RESULTS

The Turkish version of the DFS was internally consistent and reproducible. The scale had strong correlations (r=0.80, p<0.001 ) with the MDAS. Female participants scored higher (45.2+/-18.1) on the scale than men (38.2+/-15.7). The DFS had a negative correlation (r=-0.25, p<0.001) with education level. There was a statistically significant difference between dental phobics and the remaining groups on the DFS total score. At a cut-off point 55, the sensitivity of the scale was 0.80, specificity 0.80, positive predictive value 0.48, and negative predictive value 0.95. Thirty-nine subjects (21.3%) in the general population had total scores above this cut-off point.

CONCLUSION

Dental fear is common in clinical and non-clinical settings in Turkey. The good psychometric characteristics of the DFS among Turkish participants supports its cross-cultural validity.

[Prefrontal and superior temporal lobe hyperactivity as a biological substrate of generalized anxiety disorders]

OBJECTIVE

To explore the potential mechanism of generalized anxiety disorders (GAD).

METHODS

Ten GAD patients and 10 sex- and age-matched healthy persons underwent functional magnetic resonance imaging (fMRI) study in 2 stages by block design: auditory presentation of the stimulation task. In experiment 1 emotionally neutral words were given and then alternated with a no word period for 8 cycles. In experiment 2 emotionally neutral words and threat-related words were given alternately for 8 cycles. The subjects were asked to listen carefully and then judge their subjective feeling in mind. By the end of experiment they were asked to fill in a state anxiety inventory (STAI-S) so as to calculate the STAI-S scores.

RESULTS

The mean STI-S score of the patients in the experiment 1 was 57 +/- 5, significantly higher than that of the healthy persons (37 +/- 3, P < 0.01); and the mean STAI-S score in the experiment 2 of the patients was 66 +/- 6, significantly higher than that of the healthy persons (41 +/- 4, P < 0.01). The fMRI findings showed that in the experiment 1 the activated cerebral regions of the 2 groups were mostly overlapped, including bilateral superior temporal gyri (BA22/42) and middle temporal gyri (BA21), premotor areas (B46), and supplementary motor areas (BA6), and cerebellar hemisphere, and left inferior prefrontal gyrus (BA44/45). However, the activation intensity levels (mean T values) of the bilateral superior temporal gyri of the patients were both significantly higher than those of the control (for the left side: P = 0.051, and for the right side: P = 0.035). In addition, activation of the dorsal lateral prefrontal cortex (BA8/9) and bilateral inferior parietal lobules (BA39/40). In the experiment 2 activation of brain areas could be seen only in the patients, including bilateral superior temporal gyri, middle temporal gyri, inferior prefrontal gyri, inferior parietal lobules, anterior motor areas, supplemental motor areas, and anterior cingulate gyri (BA8/24/32), and left dorsal lateral prefrontal cortex. No significantly activated brain area could be shown in the control at the same stringent statistic level (P < 0.01, uncorrected); however, when the threshold value (P value) was reduced to 0.01, the left anterior cingulate gyrus (BA24/32), posterior cingulate gyrus (BA29/30), and inferior parietal lobules (BA40) were all significantly activated.

CONCLUSION

Dysfunction of superior temporal lobe and dorsal prefrontal cortex, characterized by hyperactivity in response to outer stimuli, may play an important role in the psychopathologic mechanism of GAD.

Stability of mood states and biochemistry across pregnancy

Four hundred and thirty pregnant women were recruited during their second trimester of pregnancy (M=20 weeks). They were designated depressed (N=172) or nondepressed (N=258) on the Structured Clinical Interview of Depression (SCID) and the Center for Epidemiological Studies Depression scale (CES-D). They were given a second assessment when they were approximately 32 weeks gestational age. At both assessments they were given self-report measures (CES-D, the State Anxiety Inventory, and the State Anger Inventory) and provided urine samples for assays of cortisol, catecholamines (norepinephrine, epinephrine and dopamine) and serotonin. They were also given the VITAS scale for lower back pain and leg pain and a sleep disturbance scale. The stability of mood states and biochemistry across pregnancy (20 and 32 weeks) were assessed inasmuch as mood states, and biochemistry have been noted to predict prematurity and low birthweight. Significant correlations were noted for all variables except serotonin. Relationships between mood states and biochemistry were also noted but only between cortisol and depression, cortisol and anxiety, and epinephrine and anxiety. Significant stability was noted between the 20-week measures and the 32-week measures including depression, anxiety, anger, and cortisol. These were, in turn, correlated with each other and with, low back pain, leg pain, and sleep disturbance. These data suggest the stability of mood states and cortisol across pregnancy.

Surgical or Non-Surgical Periodontal Treatment: Factors Affecting Patient Decision Making

BACKGROUND

This study explored which factors affected patients' decisions to pursue either surgical or non-surgical periodontal treatment.

METHODS

Data were collected from 74 patients at a regularly scheduled periodontal appointment, at which each patient was told that periodontal treatment was needed, and 2 weeks following the actual treatment. The surveys assessed the patients' decisions and potential determinants of these decisions. The dental anxiety scale-revised, the state-trait anxiety inventory, and the Iowa dental control index were used to measure psychosocial factors.

RESULTS

Patients who decided to have surgery did not differ from patients who decided against surgery in sociodemographic variables such as gender, age, education, and socioeconomic status, nor in their desire for control over the treatment decision. However, they had less dental fear and less general anxiety than the non-surgery patients. Although the two patient groups did not differ in their responses concerning how well the dentists had informed them about the procedure, they differed in the degree of trust and rapport with their dentists.

CONCLUSIONS

The less dentally fearful and anxious patients were in general and the more they trusted their provider and felt they had good rapport, the more likely they were to accept surgical periodontal treatment. These results stress the importance of good patient-provider communication.

Dental anxiety, distress at induction and postoperative morbidity in children undergoing tooth extraction using general anaesthesia

OBJECTIVE

To report on the prevalence of postoperative morbidity in children undergoing tooth extraction under chair dental general anaesthetic (CDGA) in relation to pre-operative dental anxiety and anaesthetic induction distress.

DESIGN

A prospective national study.

SETTING

Twenty-five Scottish DGA centres in 2001.

SUBJECTS AND METHOD

Four hundred and seven children (mean age 6.6 years; range: 2.3 to 14.8 years; 52% male). Before CDGA, the Modified Child Dental Anxiety (MCDAS) and Modified Dental Anxiety (MDAS) Scales were completed for children and accompanying adult respectively; the latter also returned a morbidity questionnaire 24 hours and one week post-operatively. Anaesthetic induction distress was scored immediately before CDGA induction using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS).

RESULTS

The mean MCDAS score was 24.2 (population norm 18.2); 21% of adults were anxious. Forty-two per cent of children had induction distress; this related to their MCDAS scores (r=0.43, p<0.001, Pearson Product Moment Correlation Coefficient). Morbidity at 24 hours and seven days was 63% and 24% respectively; this related to MCDAS scores (r=0.15, p=0.029 and r=0.17, p=0.009, Pearson Product Moment Correlation Coefficient) and to induction distress (chi2=7.14, p=0.007 and chi2=11.70, p=0.001).

CONCLUSION

The majority of children suffered next day morbidity and many still had symptoms a week later. Most children were dentally anxious; this related to induction distress and postoperative morbidity.

An examination of worry in relation to anxious responding to voluntary hyperventilation among adolescents

This study examined the association between worry and fearful responding to a 3-min voluntary hyperventilation procedure. Participants were 160 adolescents (71 females) between the ages of 12 and 17 years (M=14.92 years). After accounting for the significant effects of state anxiety and anxiety sensitivity, results indicated that pre-challenge levels of worry indexed by the Penn State Worry Questionnaire-Child Version predicted post-challenge anxiety and intensity of panic symptoms. Results are discussed in terms of the role of worry in relation to panic-relevant emotional vulnerability among youth.

Disengagement and Social Support Moderate Distress among Women with a Family History of Breast Cancer

Using a cross-sectional, exploratory design, this pilot study analyzed the relationships between familial history of breast cancer and psychological distress in order to evaluate who is more distressed and to assess the possible need for intervention. Coping style, social support, and family relations were investigated as potential moderators of these relationships. Participants were 45 women with a familial history of breast cancer recruited from the Family Registry for Breast Cancer (FRBC) at the Northern California Cancer Center (NCCC). Contrary to previous reports of similar cohorts, the overall level of psychological distress in this cohort was comparable to normative samples. The number of relatives with breast cancer was related to distress as measured by the State-Trait Anxiety Inventory (STAI) scale, but there was no significant differentiation in distress associated with the number of first-degree as compared to second- and third-degree relatives with breast cancer. Having more relatives that had died from breast cancer was associated with greater distress on a number of measures. The number of first-degree relative deaths, including maternal death, was also associated with distress. Positive and network support, disengagement coping responses, and family cohesion were each significant moderators of the impact of family history on distress. This association between distress and disengagement is similar to that found in metastatic breast cancer patients themselves, and the findings suggest a subgroup that merits and might respond to more intensive intervention to provide support and facilitate emotional expression.

The effect of age, gender and socio-economic factors on perceived dental anxiety determined by a modified scale in children

PURPOSE

The aim of this study was to examine the validity and reliability of the Com-DAS (combined dental anxiety scale) as an indicator for children's perceived dental anxiety and to investigate the effect of age, gender and socio-economic factors on dental anxiety.

MATERIALS AND METHODS

A total of 258 children aged between 8 and 12 years, who had not visited a dentist before, were randomly selected from three different socio-economic status groups. A new scale was developed by combining the C-DAS (Corah's dental anxiety scale) and FIS (facial imaging scale), and named Com-DAS. Original C-DAS was used for validation.

RESULTS

There was a high correlation between C-DAS and Com-DAS (r = 0.69). The lowest correlation was in 8-year-old children (r = 0.46), however the mean difference between the scales in this age group was not statistically significant (p > 0.05). The Com-DAS scores showed no statistical difference according to gender, whereas there was a significant difference according to age and socio-economic status (p = 0.001 in both cases).

CONCLUSION

The Com-DAS used in this study may be of use in those communities where the children and their families have limited literacy skills and their understanding of modern dental procedures may be influenced by non-qualified dental practice.

Identifying anxiety states using broad sampling and advanced processing of peripheral physiological information

Advances in biosignal acquisition and processing have provided an effective window to the complex peripheral physiology related to human emotions. Numerous cardiovascular measures have been used for assessing the activity of the sympathetic and parasympathetic branches of the autonomic nervous system. More recently, respiratory parameters have shown promise for the assessment of anxiety. Current theoretical accounts of anxiety recommend a broad assessment of anxiety responses involving measures from the physiological, behavioral and verbal-cognitive domain. However, practical and statistical considerations put restrictions on the number of dependent variables used in studies on emotion. In a laboratory experiment we assessed a large number of psychophysiological parameters to identify their relative utility for differentiating between a neutral (quiet sitting) and an anxious state induced by threat of shock. High effect sizes were found in all psychophysiological systems with electrodermal and behavioral responses demonstrating the highest, and respiratory and cardiovascular responses yielding medium and small effect sizes. A linear combination of the six most powerful variables was highly significant in distinguishing the neutral from the anxious state and resulted in 83.3% correct classification. Results demonstrate the necessity to include measures from multiple response domains for an adequate assessment of anxiety states. Furthermore, our results point to the significance of respiratory parameters in anxiety assessment.

Developing a cancer-specific geriatric assessment: a feasibility study

BACKGROUND

As the U.S. population ages, there is an emerging need to characterize the "functional age" of older patients with cancer to tailor treatment decisions and stratify outcomes based on factors other than chronologic age. The goals of the current study were to develop a brief, but comprehensive, primarily self-administered cancer-specific geriatric assessment measure and to determine its feasibility as measured by 1) the percentage of patients able to complete the measure on their own, 2) the length of time to complete, and 3) patient satisfaction with the measure.

METHODS

The geriatric and oncology literature was reviewed to choose validated measures of geriatric assessment across the following domains: functional status, comorbidity, cognition, psychological status, social functioning and support, and nutritional status. Criteria applied to geriatric assessment measurements included reliability, validity, brevity, and ability to self-administer. The measure was administered to patients with breast carcinoma, lung carcinoma, colorectal carcinoma, or lymphoma who were fluent in English and receiving chemotherapy at Memorial Sloan-Kettering Cancer Center (New York, NY) or the University of Chicago (Chicago, IL).

RESULTS

The instrument was completed by 43 patients (mean age, 74 yrs; range, 65-87 yrs). The majority had AJCC Stage IV disease (68%). The mean time to completion of the assessment was 27 minutes (range, 8-45 mins). Most patients were able to complete the self-administered portion of the assessment without assistance (78%) and were satisfied with the questionnaire length (90%). There was no association noted between age (P = 0.56) or educational level (P = 0.99) and the ability to complete the assessment without assistance.

CONCLUSIONS

In this cohort, this brief but comprehensive geriatric assessment could be completed by the majority of patients without assistance. Prospective trials of its generalizability, reliability, and validity are justified.

[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.

Development of a computerised dental anxiety scale for children: validation and reliability

OBJECTIVE

To provide reliability and validity data on a computerised dental anxiety scale (the Smiley Faces Program or SFP) for children using faces as a response set.

SETTING

Five schools across Derby, Newcastle-upon-Tyne and Shropshire.

SUBJECTS AND METHOD

The SFP was completed by 464 children (mean age 10.8 years). For validity purposes, 241 children also completed two other children's dental anxiety measures (the Modified Child Dental Anxiety Scale and the Dental Fear Survey). For test-retest purposes 100 of the children completed the SFP two weeks later.

RESULTS

The SFP demonstrated good internal consistency (alpha = 0.8), test-retest reliability was good and significant correlations were found between the SFP and the other measures. The children rated the local anaesthetic and drill as the most anxiety-provoking items.

CONCLUSION

This study suggests that the SFP is a valid and reliable measure for assessing children's trait dental anxiety and may help encourage dentists to formally assess dental anxiety.

An investigation of language used by children to describe discomfort expected and experienced during dental treatment

OBJECTIVES

A study of dental pulp testing has shown that children's linguistic comprehension and chronological age independently influence their descriptions of pain. The present study sought first to demonstrate this for expectations and experience of routine dental treatment, and secondly, to determine whether the effect of age was the result of previous dental and medical experience.

SAMPLE

Forty-six children between 6 and 17 years of age attending two paediatric dental clinics for routine invasive procedures comprised the study sample.

METHODS

To describe their expectations of forthcoming treatment, each child selected words from a published list, and gave ratings on scales describing the degree of severity as 'sore' or 'tingly'. They also completed the Child Dental Anxiety Scale and the Spielberger State-Trait Anxiety Scale for Children. After treatment, they described the treatment with the same list and scales, then completed the British Picture Vocabulary Scale and a dental-medical history questionnaire.

RESULTS

The children, especially the most anxious ones, chose more words from the list for their expectations than for their experience of treatment, suggesting, as in previous studies, that they expected more discomfort than they experienced. Ratings of 'sore' and 'tingly' did not show this discrepancy. For both expectations and experience of treatment, the children with the largest vocabularies chose the fewest words, thus being more discriminating in their choices. However, vocabulary had no effect on ratings of 'sore' and 'tingly'. There were no significant relationships among age, estimates of discomfort and medical-dental histories.

CONCLUSIONS

The results suggest that a list of adjectives provides the most discriminating measure of discomfort. They also show that it is necessary to take into account children's linguistic development to evaluate their estimates of pain so as not to entertain the belief of many clinicians that children exaggerate such reports.

Initial Injection Pressure for Dental Local Anesthesia: Effects on Pain and Anxiety

This study quantitatively assessed injection pressure, pain, and anxiety at the start of injection of a local anesthetic into the oral mucosa, and confirmed the relationship between injection pressure and pain, as well as between injection pressure and anxiety. Twenty-eight healthy men were selected as subjects and a 0.5-inch (12 mm) 30-gauge disposable needle attached to a computer-controlled local anesthetic delivery system (the Wand) was used. A 0.5 mL volume of local anesthetic solution was injected submucosally at a speed of either 30 or 160 s/mL. Three seconds after the start of local anesthetic injection, injection pressure was measured and pain and anxiety were assessed. Injection pressure was measured continuously in real time by using an invasive sphygmomanometer and analytical software, and pain was assessed on the Visual Analogue Scale and anxiety on the Faces Anxiety Scale. A significant correlation was evident between injection pressure and pain (rs = .579, P = .00124) and between intensity of injection pressure and state anxiety (rs = .479, P = .00979). It is therefore recommended that local anesthetic be injected under low pressure (less than 306 mm Hg) to minimize pain and anxiety among dental patients.

[Dental fear scores of 12-19-year-old school children of the Hungarian minority in Transylvania]

In this study 549 school children of the Hungarian minority in Transylvania were investigated (n=549, 342 female, 207 male, age between: 12-19 years). Mean dental fear scores were high: DAS: 12.6 +/- 3.3, DFS: 50.6 +/- 25.1. Girls scored significantly higher (p< or =0.01) in both scales. Scores increased between age of 12 and 16 confluently in both scales (DAS, DFS; p< or =0.05). There was a strong Pearson's correlation between DAS and DFS scales: (r= 0.70; p< or =0.01), and a somewhat lower correlation between these scales and the general anxiety scores. Mean DBS score (n = 203 only) was: 44.9 +/- 10.2.

The Fear of Pain Questionnaire (FPQ): Further psychometric examination in a non-clinical sample

The present study sought to examine psychometric properties of the Fear of Pain Questionnaire (FPQ), a measure of pain-related fear, in a sample of undergraduates. Confirmatory factor analysis confirmed the previously reported three-factor model of the FPQ (e.g. severe pain, minor pain, medical pain), but some items may be redundant. With respect to the reliability of the FPQ, both the FPQ and the subscales showed good internal consistency and test-retest stability was moderate to good. Convergent and predictive validity of the FPQ (and the subscales) were partly supported by moderate correlations with related constructs and with self-reported fear associated with three experimental pain tests. Discriminant validity of the FPQ (and the subscales) was partly supported by low correlations with unrelated self-report measures. Moreover, modest correlation coefficients were found between the FPQ and other pain-related measures. Finally, the minor pain subscale of the FPQ accounted for pain intensity scores on the ischemic pain test and the remaining subscales and the FPQ total scores accounted for pain tolerance on the electrical stimulation test and the thermal pain test. Results are discussed and directions for future research are provided.

Anxiety and depression in adolescents and their relationship with signs and symptoms of temporomandibular disorders

PURPOSE

Several clinical studies suggest that psychologic factors may play an important role in the etiology and maintenance of temporomandibular disorder (TMD) signs and symptoms. The goal of this study was to verify the prevalence of anxiety and depression in adolescents, and their relationship with signs and symptoms of TMD.

MATERIALS AND METHODS

The sample comprised 217 nonpatient adolescents between 12 and 18 years of age. The subjective symptoms and clinical signs of TMD were evaluated, respectively, using a self-report questionnaire and the Craniomandibular Index (CMI, which has 2 subscales), the Dysfunction Index, and the Palpation Index. The Hospital Anxiety and Depression Scale (HADS), a 14-item self-administered rating scale that was developed specifically to identify anxiety and depression in nonpsychiatric medical outpatients, assessed levels of anxiety and depression.

RESULTS

In the total sample, anxiety and depression were present in 16.58% and 26.71% of subjects, respectively, including all levels of HADS. The results showed that there were positive correlations between CMI and Palpation Index and anxiety (HADSa) (P < .01) but not with depression (HADSd). An association between the number of TMD subjective symptoms and HADSa/HADSd was found (P < .01).

CONCLUSION

Anxiety and depression, although of mild intensity, are common in adolescents. In this study both HADSa and HADSd were associated with an increasing number of TMD subjective symptoms. However, only anxiety was correlated with clinical signs of TMD (CMI), primarily muscle tenderness (Palpation Index).

[Influence of maternal anxiety on the frequency of paediatric primary care visits]

AIM

To know the influence of mother's anxiety in the number of office visits made by the children al primary care paediatric setting.

DESIGN

Case control study.

SETTING

Primary care. 17th Health Area. Valencian Community. Spain.

PATIENTS

134 mothers. Overuse was defined as number of visits higher than the average of visits in all children plus one standard deviation in a certain period. 14.89% were over users. 46 mothers (35.12%) from over user children and 85 (64.88%) from non over users.

MEASURES

Anxiety scale STAI (Spielberger State-Trait Anxiety Inventory) short form. Mother's job and number of mother's children.

RESULTS

Mother's of over user's children score higher in STAI scale. Number of children or mother's job is not associated with STAI scores. In multivariate analysis anxiety is an important factor associated to over user's children.

CONCLUSIONS

Mother's anxiety is associated with over user's children in primary care paediatric setting. This is a modifiable factor to influence in the number of inappropriate office visits.

Dental anxiety among patients undergoing various dental treatments in a Nigerian teaching hospital

The aim of the present study is to evaluate the levels of dental anxiety among patients undergoing various dental treatments and to compare the anxiety levels with those of similar studies conducted with subjects from different socio-cultural backgrounds. Dental anxiety was evaluated by the administration of a questionnaire based on the Corah's Dental Anxiety Scale (DAS). Student t-test and analysis of variance (ANOVA) with Bonferoni correction was employed to compare the mean DAS scores. Females recorded higher total DAS scores than males (7.49 +/- 2.96 and 7.16 +/- 3.44, respectively). Patients in the 24-34 year age group showed the highest total DAS scores (8.25 +/- 3.20) followed by the <24 year age group. The total DAS scores for age groups 35-39 and >50 years differ significantly from those of age groups <24 and 24-34 years. The highest DAS score was recorded for root canal therapy (9.30 +/- 2.84) followed by extraction. The level of dental anxiety among this study population is lower than those reported elsewhere. The observed avoidance of dental treatment among Nigerians, despite the seemingly low mean DAS scores, may be related to dental anxiety. The authors are, however, of the opinion poor dental awareness may be a contributory factor.

A study to assess the validity of clinical judgement in determining paediatric dental anxiety and related outcomes of management

OBJECTIVE

The aim of the present study was to determine the validity of subjective anxiety assessment and the outcomes of management of children receiving operative dental treatment.

SETTING

The study was conducted at the Departments of Sedation and Child Dental Health, Newcastle Dental Hospital, Newcastle upon Tyne, UK.

SUBJECTS AND METHODS

One hundred children and adolescents aged between 8 and 15 years participated in the study. Clinicians subjectively allocated 50 children for treatment with local analgesia alone (low anxiety), and identified 50 children who had the potential to benefit from nitrous oxide and oxygen sedation (high anxiety). Participants then completed the State-Trait Anxiety Inventory for Children (STAIC), the Venham Picture Test (VPT) and the Child Fear Survey Schedule-Dental Subscale (CFSS-DS). A global rating scale classified behaviour during dental treatment.

RESULTS

State anxiety and dental fear prior to treatment were significantly higher in children allocated to receive inhalation sedation (P = 0.004 and P = 0.005, respectively). There was no significant difference in trait anxiety or post-treatment state anxiety between the two groups (P = 0.69 and P = 0.06, respectively). Only 11% displayed 'negative' behaviour during treatment: 82% of this group represented those allocated to receive sedation.

CONCLUSION

Children receiving inhalation sedation were significantly more anxious prior to treatment than children receiving treatment with local analgesia alone. The findings support the subjective assessment of anxiety in children; however, objective anxiety measures may assist clinicians in identifying specific fears, which may ultimately aid patient management.

Relaxation techniques for reducing pain and anxiety during screening mammography

OBJECTIVE

The purpose of this study was to determine whether listening to a relaxation audiotape before and during mammography decreases subjective reports of pain and anxiety.

CONCLUSION

Listening to a relaxation or music audiotape before and during mammography does not reduce subjective reports of anxiety or pain. Women undergoing screening mammography report minimal levels of distress.

Validation of a Chinese version of the Dental Anxiety Inventory

OBJECTIVES

To translate the English version of Dental Anxiety Inventory (DAxI) and its short-form (SDAxI) and to validate their use in Hong Kong Chinese.

METHODS

The DAxI and SDAxI were translated into Chinese. A total of 500 adults (18-64 years) were interviewed, the Chinese DAxI, Symptom Checklist 90 (SCL-90), Depression Anxiety Stress Scales (DASS) and State-Trait Anxiety Inventory (STAI) were completed. Based on their initial DAxI scores, 135 interviewees were invited to attend a dental examination 1 month later. Then, the subjects completed the DAxI again, together with Beck Anxiety Inventory (BAI) which measured the state anxiety level of the participants. Two months after the initial interview, all 500 subjects were asked to complete the DAxI again. Another 300 adults were recruited and interviewed for the SDAxI validation.

RESULTS

Cronbach's alpha of the Chinese DAxI and SDAxI were 0.77 and 0.80 and the test-retest correlation coefficients were 0.90 and 0.84, respectively. High correlation between BAI and DAxI scores and its stability over time supported construct validity of the Chinese DAxI. Small positive correlations between the DAxI and other subscales of the SCL-90, DASS and STAI supported discriminant validity of the instrument. The SDAxI demonstrated comparable validity and reliability with DAxI.

CONCLUSION

The translated Chinese DAxI demonstrated good validity and reliability. It is available for use in dental anxiety research in adult Chinese. In situations where a short-form is desirable, the Chinese SDAxI is a simple, valid, reliable and interpretable scale for measuring dental anxiety in both research and dental practice.