Dental anxiety and trait anxiety: an investigation of their relationship

Background Anxiety related to dental treatment is a fairly common phenomenon. Some studies have shown that there is an association between dental anxiety and general fears and anxiety, neuroticism and general psychological distress. Aim This study was designed to examine the relationship between dental anxiety and trait anxiety. Subjects and methods The sample consisted of 1,030 individuals (688 women; 342 men), aged 30.8 +/- 11.7 years. The Portuguese version of Corah`s Dental Anxiety Scale (DAS) and State-Trait Anxiety Inventory (STAI-T) were used. Results A statistically significant association between high DAS and high STAI-T, but not between high STAI-T and high DAS, was found. The data indicated that subjects with high dental anxiety tend to present with high trait anxiety, but high trait anxiety seems not to predispose to high dental anxiety. Conclusions Our results indicate that dental anxiety is specific, with its own features, and its development is not necessarily associated with trait anxiety.

Environmental modulation of ethanol-induced locomotor activity: Correlation with neuronal activity in distinct brain regions of adolescent and adult Swiss mice

Drug abuse is a concerning health problem in adults and has been recognized as a major problem in adolescents. induction of immediate-early genes (IEG), such as c-Fos or Egr-1, is used to identify brain areas that become activated in response to various stimuli, including addictive drugs. It is known that the environment can alter the response to drugs of abuse. Accordingly, environmental cues may trigger drug-seeking behavior when the drug is repeatedly administered in a given environment. The goal of this study was first to examine for age differences in context-dependent sensitization and then evaluate IEG expression in different brain regions. For this, groups of mice received i.p. ethanol (2.0 g/kg) or saline in the test apparatus, while other groups received the solutions in the home cage, for 15 days. One week after this treatment phase, mice were challenged with ethanol injection. Acutely, ethanol increased both locomotor activity and IEG expression in different brain regions, indistinctly, in adolescent and adult mice. However, adults exhibited a typical context-dependent behavioral sensitization following repeated ethanol treatment, while adolescent mice presented gradually smaller locomotion across treatment, when ethanol was administered in a paired regimen with environment. Conversely, ethanol-treated adolescents expressed context-independent behavioral sensitization. Overall, repeated ethanol administration desensitized IEG expression in both adolescent and adult mice, but this effect was greatest in the nucleus accumbens and prefrontal cortex of adolescents treated in the context-dependent paradigm. These results suggest developmental differences in the sensitivity to the conditioned and unconditioned locomotor effects of ethanol. (C) 2008 Elsevier B.V. All rights reserved.

Role of glutamate NMDA receptors and nitric oxide located within the periaqueductal gray on defensive behaviors in mice confronted by predator

The midbrain periaqueductal gray (PAG) is part of the brain system involved in active defense reactions to threatening stimuli. Glutamate N-methyl-d-aspartate (NMDA) receptor activation within the dorsal column of the PAG (dPAG) leads to autonomic and behavioral responses characterized as the fear reaction. Nitric oxide (NO) has been proposed to be a mediator of the aversive action of glutamate, since the activation of NMDA receptors in the brain increases NO synthesis. We investigated the effects of intra-dPAG infusions of NMDA on defensive behaviors in mice pretreated with a neuronal nitric oxide synthase (nNOS) inhibitor [N omega-propyl-l-arginine (NPLA)], in the same midbrain site, during a confrontation with a predator in the rat exposure test (RET). Male Swiss mice received intra-dPAG injections of NPLA (0.1 or 0.4 nmol/0.1 mu l), and 10 min later, they were infused with NMDA (0.04 nmol/0.1 mu l) into the dPAG. After 10 min, each mouse was placed in the RET. NMDA treatment enhanced avoidance behavior from the predator and markedly increased freezing behavior. These proaversive effects of NMDA were prevented by prior injection of NPLA. Furthermore, defensive behaviors (e.g., avoidance, risk assessment, freezing) were consistently reduced by the highest dose of NPLA alone, suggesting an intrinsic effect of nitric oxide on defensive behavior in mice exposed to the RET. These findings suggest a potential role of glutamate NMDA receptors and NO in the dPAG in the regulation of defensive behaviors in mice during a confrontation with a predator in the RET.

Stärkande omvårdnad : En litteraturstudie om förlossningsrädsla under graviditet och förlossning

Förlossningsrädsla utgör en speciell utmaning för mödrahälsovården och förlossningsvården.En konsekvens av rädslan är att kvinnor allt oftare kräver kejsarsnitt utan medicinsk indikation. Syftet med denna studie var att belysa faktorer som ligger till grund för förlossningsrädsla samt att ta reda på hur omvårdnadspersonal kan ge stärkande omvårdnad till denna sårbara grupp. Metoden var en systematisk litteraturstudie som omfattade fjorton vetenskapliga artiklar. Materialet till litteraturstudien identifierades via datoriserad och manuell sökning i databaser och tidsskrifter på Högskolan Dalarnas bibliotek samt sjukhus biblioteket på Falu Lasarett. Sökningen gjordes i databaserna ELIN@dalarna, Pub Med, Swe Med, Libris och Google sholar. Sökord som användes var: Fear of childbirth. Resultatet visade att rädslans innehåll och natur hänger samman med kvinnans personliga förutsättningar samt den sociala situation hon lever i. En slutsats blev att många kvinnor behöver hjälp för sin oro inför förlossningen och många har i högre grad än andra väntande kvinnor haft besvär med psykisk ohälsa. En viktig förutsättning för ett optimalt och professionellt bemötande av den förlossningsrädda kvinnan är ett gott samarbete mellan hela vårdkedjan, så alla har samma synsätt. Genom att alla säger samma saker skapas en trygghet.

Förlossningsrädda kvinnors erfarenheter av Aurorasamtal ett till två år efter förlossning

Bakgrund: Av alla gravida kvinnor räknas omkring 5 % lida av svår förlossningsrädsla. Kvinnor med förlossningsrädsla löper högre risk för komplikationer under och efter graviditeten. I Sverige läggs idag mycket resurser på Auroraverksamhet för att hjälpa kvinnor med förlossningsrädsla. Det saknas omfattande utvärdering av Auroraverksamheten. Syfte: Syftet med detta fördjupningsarbete var att undersöka upplevelse och effekt av Aurorasamtal inför förlossning samt upplevelse av den efterföljande förlossningen bland först- och omföderskor. Metod: Studien har en retrospektiv studiedesign där datainsamling skedde via en enkätundersökning. Datamaterialet sammanställdes därefter i SPSS. Resultat: Majoriteten av kvinnorna upplevde att samtalen hjälpte dem till en mer positiv förlossningsupplevelse. Fler förstföderskor än omföderskor önskade planerat kejsarsnitt när de kom till Auroramottagningen. De flesta kvinnor som önskade vaginal förlossning blev vaginalt förlösta. Över hälften av kvinnorna som deltog i studien var mindre rädda för förlossning 1 – 2 år efter förlossningen än de upplevde att de var innan Aurorasamtalet och förlossningen. Konklusion: Aurorasamtal förefaller ha störst betydelse för omföderskor och för de kvinnor som önskar vaginal förlossning.

Att vårda patienter i rättspsykiatrisk vård som uppvisar självskadebeteende : sjuksköterskors erfarenheter och upplevelser

Deliberate self harm as defined pathologically as well as socially is becoming an increasing phenomenon within forensic psychiatry. Nurses working with patients who have self harm behaviour and are confined to forensic psychiatry face different challenges which affect their feelings and attitudes in different ways, in their nursing practice. Purpose: To explore nurses’ experiences of caring for patients who suffer from deliberate self harm behaviour and are confined to forensic psychiatry. Method: Qualitative semi- structured interview s from eight nurses working within the forensic psychiatric clinic. Interviews were analysed by using a qualitative content analysis. Results: They worked strategically and emphasized the importance of teamwork, good communication and urged for the need to get necessary education, staff focused tutoring and patient focused therapy. Conclusion: Need for necessary education, patient focused therapy and staff focused tutor is needed to empower staff working with patients who are confined within forensic psychiatry and suffer from deliberate self harm behaviour.

The facial affective scale as a predictor for pain unpleasantness when children undergo immunizations.

Needle fear is a common problem in children undergoing immunization. To ensure that the individual child's needs are met during a painful procedure it would be beneficial to be able to predict whether there is a need for extra support. The self-reporting instrument facial affective scale (FAS) could have potential for this purpose. The aim of this study was to evaluate whether the FAS can predict pain unpleasantness in girls undergoing immunization. Girls, aged 11-12 years, reported their expected pain unpleasantness on the FAS at least two weeks before and then experienced pain unpleasantness immediately before each vaccination. The experienced pain unpleasantness during the vaccination was also reported immediately after each immunization. The level of anxiety was similarly assessed during each vaccination and supplemented with stress measures in relation to the procedure in order to assess and evaluate concurrent validity. The results show that the FAS is valid to predict pain unpleasantness in 11-12-year-old girls who undergo immunizations and that it has the potential to be a feasible instrument to identify children who are in need of extra support to cope with immunization. In conclusion, the FAS measurement can facilitate caring interventions.

PANA V : Evaluation of a Literacy Project

PANA V Evaluation of a Literacy ProjectSUMMARY AND CONCLUSIONSThis evaluation set out to explore the impact of the literacy work carried out through PANA V. It focussed on clarifying effects such as empowerment and poverty reduction in relation to the civil society. Two specific objectives were to evaluate the methodological approach and the didactic materials and to evaluate the sustainability of the project.Although the focus of the evaluation has been PANA V, the project has been evaluated in its context, as one in a series of five projects located in Rwanda ten years after the war and genocide. The conclusion will consider future plans in this field.The evaluator has striven to create a holistic picture of the effects of the project, although the given time for the evaluation was short. Only three weeks were spent in the field study and only ten days in the actual field. Although there were some organisational and logistic problems, as is common when carrying out a study like this in a poor country, many literacy sites were visited and quite many participators were interviewed. The overall impression from the study is overwhelmingly positive. So many people commit themselves in this task of teaching Rwandans reading, writing and numeracy. Despite harsh conditions learners strive to learn and group leaders devote themselves to the task. Many leaders on different levels try their very best to manage their difficult and demanding task. The main objective was to explore the impact of the project on poverty reduction, particularly on empowerment and strategies for everyday life. Women were to be regarded particularly. From the results it is clear that the project has a strong, positive impact both on poverty reduction and empowerment of marginalised groups. Among those who have benefited from the alphabetisation are mainly women. Unfortunately, when it comes to leaders in PANA, who may also be said to have benefited from the project, only a small minority is women. This is something that is recommended that it be reconsidered inside the organisation. As a majority of the targeted learners are women, and as the economic and social situation of women in Rwanda is generally weak, this is a question that I recommend the Pentesostal church and ADEPR to look particularly into. With many women being single breadwinners of their households, it is important that also women get access to positions that may bring benefits of different kind.It is also clear that the project has positive effects for the civil society. In the present situation in Rwanda, during the process of reconciliation and rapid progress, basic education for the poor majority is a democratic issue. In a country with a plethora of internet-cafés in the capital and a small minority that use cars and mobile-telephones to communicate nation-wide, it is of outmost importance that the majority acquires basic education, of which literacy is a central part. To strengthen the civil society in Rwanda literacy is important. One central issue is then that Rwanda develops toward becoming a country where literacy is used for the benefit of the citizens and it is a democratic issue that all citizens get an opportunity to participate. Crucial for this is that strong efforts are put into primary schools nation-wide. Literacy projects for adults, like PANA, may only complement these efforts, but they constitute important and necessary complements. Other relevant ways to promote literacy are campaigns in Radio and TV and through cultural events such as festivals, music and theatre. News papers, magazines and books are natural parts of such campaigns as well as adult education. As stated under the results not much can be said about the didactics in this evaluation. On the whole the methodology and the materials fill their function well and receive a high reputation. As people learn to read and write under very simple conditions, obviously the approach is appropriate. A few suggestions may be given from the study:•Focus groups leaders’ attention on clearness, that they show very clearly what is to be read. Good structuring is probably of great importance for many learners.•Make clear what is tested in the tests and consider the possibility to use a holistic test that would be more congruent with the methodology. The possibility to use only one grade, pass, would enable a more practical test, such as reading a short, relevant text, writing something relevant and solving practical mathematic problems. Avoid tests that demand school knowledge.•Avoid using methaphors such as “fight against illiteracy” and connections between illiteracy/literacy and darkness/light. It is not true that illiteracy causes bad things and that literacy only brings good. •Be prepared that it may be more difficult in the future to achieve the goals as it may be the case that the early learners where the ones who achieved easily. The goal of “literacy in six month” in PANA will probably hold only for some learners but also those who do not manage in six months need literacy skills.A third objective was to secure sustainability. As for sustainability of the project in itself, and of the literacy process, the main conclusion is that there is a good potential. The commitment and devotedness among many involved in PANA proves good. One weakness is individual leaders in ADEPR who do not see this as an important task for the Pentecostal church in Rwanda. Other weaknesses are the unwillingness to mention explicitly the wish, for example among group leaders, to get some kind of incentive and the fear of loosing believers by cooperation with other organisations. A higher degree of transparency in this issue would probably solve some irritations and tensions.As for the sustainability of the literacy skills much may be done to improve. The acquired skills seem to be comparably relevant. The level achieved, and the level tested, may be defined as basic literacy skills, consisting of basic reading, writing and numeracy skills. However, these skills are very restricted and there is a high risk that the skills will decline, which means that there is a high risk that people will forget how to read and write because of lack of exercising. From these conclusions a few suggestions for future development will be given.

Manoeuvring between anxiety and control : Patients experience of learning to live with diabetes: a lifeworld phenomenological study

Research shows that people with diabetes want their lives to proceed as normally as possible, but some patients experience difficulty in reaching their desired goals with treatment. The learning process is a complex phenomenon interwoven into every facet of life. Patients and healthcare providers often have different perspectives in care which gives different expectations on what the patients need to learn and cope with. The aim of this study, therefore, is to describe the experience of learning to live with diabetes. Interviews were conducted with 12 patients afflicted with type 1 or type 2 diabetes. The interviews were then analysed with reference to the reflective lifeworld research approach. The analysis shows that when the afflicted realize that their bodies undergo changes and that blood sugar levels are not always balanced as earlier in life, they can adjust to their new conditions early. The afflicted must take responsibility for balancing their blood sugar levels and incorporating the illness into their lives. Achieving such goals necessitates knowledge. The search for knowledge and sensitivity to changes are constant requirements for people with diabetes. Learning is driven by the tension caused by the need for and dependence on safe blood sugar control, the fear of losing such control, and the fear of future complications. The most important responsibilities for these patients are aspiring to understand their bodies as lived bodies, ensuring safety and security, and acquiring the knowledge essential to making conscious choices.

Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden

Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden. Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied. Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war. Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and enhancement of well-being and sexual and reproductive health and rights in receiving countries after migration.

Kvinnors erfarenheter av sjuksköterskors bemötande i vårdandet av deras bröstcancer En litteraturöversikt

Bakgrund: Bröstcancer är den vanligaste cancerformen bland kvinnor i Sverige. Att drabbas av bröstcancer beskrivs som en utmaning för kvinnans självkänsla, självbild, kvinnlighet och existens. Kvinnorna vill bli bemötta som en enskild individ och inte som en diagnos samt uppleva känslomässigt stöd från sjuksköterskorna. Syfte: Syftet är att genom en vetenskaplig litteraturöversikt beskriva vad kvinnor med bröstcancer har för erfarenheter av sjuksköterskors bemötande. Metod: Underlaget till denna litteraturöversikt består av 15 kvalitativa artiklar varav två delvis kvantitativa. Litteraturen har sökts via databaserna PubMed och Cinahl. Resultatet har sammanställts med hjälp av en analysmetod för kvalitativ forskning. Resultat: Majoriteten av kvinnorna var nöjda och tillfreds med sjuksköterskornas bemötande. Få kvinnor uttryckte missnöje. Kvinnorna uttryckte att sjuksköterskorna hade en viktig roll under deras sjukdomstid och kunde tillmötesgå deras behov. Sjuksköterskornas bemötande uppfattades empatiskt, hänsynsfullt och omtänksamt. De negativa erfarenheter vissa kvinnor beskrev var dålig uppföljning, obesvarade frågor om psykiska besvär, brist på emotionellt stöd och en rädsla av att vara till besvär. Slutsats: Sjuksköterskorna spelar en central roll i mötet med- och i tillfrisknandet hos kvinnor med bröstcancer.

Sjuksköterskors upplevelser av att vårda patienter med smärta En litteraturöversikt

Bakgrund: Smärta är en individuell upplevelse och smärta är en stor orsak till att befolkningen söker vård. För att ge säker och god vård krävs det att sjuksköterskor ska kunna bedöma och utvärdera patienternas smärta. Sjuksköterskors upplevelser kan orsaka ett flertal hinder som kan göra att en god och säker vård inte kan uppnås. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda patienter med smärta. Metod: Litteraturöversikt som är baserad på 15 vetenskapliga artiklar med både kvalitativ- och kvantitativansats. Resultat: Denna litteraturstudies resultat visade att sjuksköterskor upplever kunskapsbrist när det gäller att vårda patienter med smärta. Sjuksköterskor upplever sig otillräckliga och frustrerade över att inte kunna ge en optimal smärtlindring samt en stor rädsla att starta ett missbruk hos patienterna. Slutsats: Det är viktigt att fortsätta forska på sjuksköterskors upplevelser för att kunna tydliggöra eventuella hinder som försvårar arbetet med att ge god och säker vård till patienter med smärta.

Sjuksköterskors upplevelser av att ge palliativ vård till patienter på somatiska vårdavdelningar En litteraturöversikt

Bakgrund: Många patienter har behov av palliativ vård innan de avlider. I Sverige finns idag flera olika alternativ för specialiserad palliativ vård. Dessa räcker dock inte till för att vårda alla palliativa patienter vilket leder till att sjuksköterskor som arbetar på somatiska vårdavdelningar på sjukhus ofta möter dessa patienter. Syfte: Att beskriva sjuksköterskors upplevelser av att ge palliativ vård till patienter som vårdas på somatiska vårdavdelningar. Metod: Studien genomfördes som en litteraturöversikt där 15 artiklar ingick i resultatet. Datainsamling har gjorts i databaserna Cinahl, PubMed och Web of Science. Resultat: Sjuksköterskor upplevde att kommunikationen vid vård av palliativa patienter var svår på flera sätt. Rädsla att bemöta existentiella frågor, tidsbrist och en dysfunktionell kommunikation mellan vårdpersonal upplevdes som svårigheter för sjuksköterskorna. Detta ledde till att sjuksköterskor upplevde ett stort behov av utbildning och kompetensutveckling. Slutsats: Ett stort utbildningsbehov finns hos sjuksköterskor då de upplever många svårigheter i att vårda palliativt. För att kunna utveckla denna vårdform på somatiska avdelningar behövs mer utbildning och forskning inom området.

Barnmorskans uppfattning om indikationer och effekter av förlossning med elektiva kejsarsnitt på humanitär indikation utifrån arbetslivserfarenhet : En intervjustudie

Bakgrund: Statistik visar på ökat antal elektiva kejsarsnitt internationellt och nationellt. Ett kejsarsnitt kan rädda liv på mor och barn om komplikationer uppstår, elektivt kejsarsnitt är även liksom andra stora operationer förenat med risker för komplikationer. Antalet elektiva kejsarsnitt på humanitär indikation har ökat i Sverige och cirka 17 % av alla förlossningar sker via kejsarsnitt. Att vårda och stödja kvinnor före, under och efter en förlossning med kejsarsnitt hör till barnmorskans arbete. Syftet med studien var att beskriva barnmorskors uppfattning om indikationer och effekter av förlossning med elektiva kejsarsnitt på humanitär indikation belyst utifrån arbetslivserfarenheter. Metod: kvalitativ metod: semistrukturella intervjuer med nio barnmorskor. Materialet analyserades via fenomenografisk analys i sju steg. Resultat: Fyra beskrivningskategorier framkom, Elektivt kejsarsnitt på humanitär indikation är ett etiskt dilemma, Elektivt kejsarsnitt på humanitär indikation är en stor operation, Elektivt kejsarsnitt på humanitär indikation påverkar organisation och barnmorskans arbetsmiljö och Elektivt kejsarsnitt på humanitär indikation påverkar kvinnans förlossningsupplevelse. Vidare framkom nio kategorier som beskriver barnmorskors uppfattningar. Slutsats Barnmorskor uppfattar elektiva kejsarsnitt som något komplext, att de med sina yrkeskunskaper värnar det naturliga vid kejsarsnitt på humanitär indikation och att de har brist på mandat att stödja och stärka kvinnors informerade val om elektivt kejsarsnitt på humanitär indikation. Klinisk tillämpbarhet: Resultatet kan användas vid undervisning kring barnmorskans stödjande och vårdande arbete i samband med förlossning via kejsarsnitt. Vidare kan resultatet vara underlag till diskussioner inom mödrahälsovård och förlossning i syfte att ge barnmorskor stärkt mandat till sina stödjande och informativa uppgifter.

Medical students are afraid to include abortion in their future practices : in-depth interviews in Maharastra, India

BACKGROUND: Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education. METHOD: We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach. RESULTS: The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future. CONCLUSIONS: To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.