[Reasons for anxiety in primary care professionals. A resident-tutor comparison]

[Article in Spanish]

Saura Llamas J, Leal Hernandez M, Garcia Mendez MM, Lopez Pinera M, Ferrer Mora A, de la Viesca Cosgrove S.

Centro de Salud Barrio del Carmen, Murcia.

OBJECTIVES: 1) To find the reasons for PC professionals' anxiety when going about their normal work. 2) To check whether training and experience affect the assessment of the reasons of Family Doctors for anxiety. DESIGN: A descriptive study using a questionnaire. SETTING: PC health centres with second-year family and community medicine (FCM) residents from the Murcia Teaching Unit. PARTICIPANTS: All second-year FCM residents from the Teaching Unit (28) in December 1995 and their tutors. MEASUREMENTS: Open questionnaire based on three points: Causes of anxiety in on-demand consultations; causes of anxiety in scheduled consultations; other reasons for anxiety connected with the Health Centre. RESULTS: The three most anxiety-producing causes in relation to each question were: a) on-demand consultation: residents (R)--unfinishable consultations, lack of time, clinical problems; tutors (T)--unfinishable consultations, a lot of patients waiting outside, manipulative patients. b) Scheduled consultation: R--clinical problems, consultation too long, difficulties in reaching a solution; T--consultation too long, patients without an appointment and interruptions in the middle of the consultation. c) Other reasons for anxiety: R--not being off the day after being on call, having to do research work, and emergency calls; T--emergency calls, research work and temperature problems. CONCLUSIONS: Clinical problems are the causes of anxiety with the greatest difference between tutors and residents. Regulated training in the health centre and professional experience seem to act positively on some of the causes of anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9303674&dopt=Abstract anxiety medicine




[Study on anxiety levels of patients' families in the emergency department]

[Article in Chinese]

Pi HY, Yang XQ.

Emergency Department, PLA General Hospital, Beijng.

The psychological investigation and evaluation of 222 patients' families were done in emergency department by using State Anxiety Inventory. The results showed the anxiety level of families of emergency patients was significantly higher than that of normal individual and anxiety level of families of severe cases was also significantly higher than that of mild cases. On the other hand, anxiety level of families was related to the gender, age, profession, educational level, and familial role. The anxiety levels of the female and retired were higher than that of the male and nonretired respectively. In addition, the anxiety level of families was increased with ages and decreased with educational level. It suggested that the proper nursing interventions according to different condition could reduce the anxiety level of patient's families and could get more family support. It is also benefit to the patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9304917&dopt=Abstract anxiety medicine




Maternal anxiety in late pregnancy and fetal hemodynamics.

Sjostrom K, Valentin L, Thelin T, Marsal K.

Department of Psychiatry, University of Lund, Malmo University Hospital, Sweden.

The aim of this study was to investigate if fetal circulation is affected by maternal anxiety. 37 nulliparous women were studied prospectively in the third trimester of pregnancy, with self-rate tests of anxiety (STAI). Doppler ultrasound examination of the umbilical artery and fetal middle cerebral artery was performed at 37-40 gestational weeks. The pulsatility index (PI) was calculated and corrected for heart rate. The women were divided into groups of increasing levels of anxiety. The fetuses of women with high trait anxiety scores had significantly higher PI values in the umbilical artery (p = 0.0056), significantly lower PI values in the fetal middle cerebral artery (p = 0.0029) and significantly lower cerebro-umbilical PI ratios (p = 0.0002), suggesting a change in blood distribution in favor of brain circulation in the fetuses. Maternal weight, weight-increase, height, age, marital status, smoking habits, drinking habits and socio-economic factors known to affect fetal well-being did not interfere with these findings. No significant differences in birth-weight, length and head circumference were found between infants born to mothers with higher trait anxiety levels compared to mothers with lower trait anxiety levels. Our results suggest that maternal stress, in terms of trait anxiety, influences fetal cerebral circulation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9306108&dopt=Abstract anxiety medicine




Use of health services for anxiety disorders: a multisite study in Quebec.

McCusker J, Boulenger JP, Boyer R, Bellavance F, Miller JM.

Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, Montreal, Quebec.

OBJECTIVE: We investigated patient characteristics and use of services for anxiety disorders among patients seeking care from participating clinicians at 7 anxiety clinics in Quebec: 3 general hospital clinics, 3 psychologist-run clinics, and one psychiatric hospital clinic. METHODS: Persons eligible for the study were those who were visiting the clinics for the first time, had a current diagnosis of an anxiety disorder, and could communicate in French or English. Subjects recruited through advertisements were excluded. Data, collected by a self-administered questionnaire, included demographics, treatment history, use of services for anxiety, and the Beck Anxiety Inventory (BAI). RESULTS: The sample comprised 235 subjects: 146 seen at 3 general hospital clinics, 54 at 3 psychologist-run clinics, and 35 at a psychiatric hospital clinic. There were statistically significant differences by clinic type in the prevalence of specific anxiety diagnoses, BAI score, referral source, antidepressant use, and use of services. High-intensity use (10 or more consultations during the previous year) was reported by 23.4% of the sample for medical services and 19.6% for mental health services. Multiple logistic regression identified variables associated with high-intensity use of medical services (higher BAI score, 1 to 4 years since first sought treatment, and less than 12 years of education) and high-intensity use of mental health services (clinic type, obsessive-compulsive disorder [OCD], and 5 or more years since first sought treatment). CONCLUSIONS: The patient populations seen at different types of anxiety clinics differ in several respects, including referral source, previous treatment, and severity of symptoms. Regardless of type of clinic, patients with a longer time since they first sought treatment use more services, particularly mental health services. Those with less education use more medical services than those with greater education.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9307833&dopt=Abstract anxiety medicine




Development of a pediatric burn pain and anxiety management program.

Sheridan RL, Hinson M, Nackel A, Blaquiere M, Daley W, Querzoli B, Spezzafaro J, Lybarger P, Martyn J, Szyfelbein S, Tompkins R.

Shriners Burns Institute, Boston, MA 02114, USA.

To facilitate effective management of pain and anxiety, and to permit more objective assessment of changes in this management, a pain and anxiety guideline was developed and has been followed uniformly for 3 years. The guideline describes four patient care categories: (1) ventilated acute, (2) nonventilated acute, (3) chronic acute, and (4) reconstructive. A small and consistent formulary was emphasized. A specific guideline for background, procedural, and transition pain and anxiety management was developed for each patient care category. All pain and anxiety medications given to all acutely burned children admitted to the Institute for 12 consecutive months were recorded, and daily pain and anxiety discomfort scores were noted using a 5-level action-based bedside scoring system. Doses of individual pain and anxiety medications were calculated as mg per kg per patient-day in each category, and all doses were found to be within guideline specifications. The efficacy of the guideline was judged by four discomfort scores: (1) background pain, (2) procedural pain, (3) background anxiety, and (4) procedural anxiety, and were adequate in all patient categories. There were no complications related to overmedication experienced during the interval. Our objective was to develop a guideline for pain and anxiety management that: (1) was safe and effective over a broad range of ages and injury acuities seen in the unit, (2) was explicit in its recommendations, (3) had a limited formulary to optimize staff familiarity with agents used, and (4) took advantage of the presence of a bedside nurse to continuously evaluate efficacy and intervene when needed through dose-ranging. Although many drugs are appropriate, our choices were based on institutional familiarity and simplicity. This process of developing a clear and consistent guideline can be duplicated in any unit.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9313130&dopt=Abstract anxiety medicine




Anxiety in long-term cancer survivors influences the acceptability of planned discharge from follow-up.

Thomas SF, Glynne-Jones R, Chait I, Marks DF.

Health Research Centre, Middlesex University, Queensway, UK.

Anxiety levels in a sample of 65 long-term cancer survivors were assessed in a study of the effects of a planned discharge from an oncology clinic. Thirty-one percent of patients scored > or = 8, and 12% > or = 11 on the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS), indicating that anxiety rates in patients in long-standing remission do not greatly differ from patients with active disease. Despite the provision of continued support and guaranteed fast-access return to the clinic if necessary, 28% of patients refused to be discharged. Fear that recurrence would not be detected was the reason most frequently cited. Seventy-five percent of these patients were HADS anxiety cases. A second assessment 4-5 months later of the 41 patients who were discharged showed a slight, but non-significant increase in anxiety rates suggesting that anxiety in cancer survivors may be persistent and not related to clinic attendance.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9313284&dopt=Abstract anxiety medicine




The Yale Preoperative Anxiety Scale: how does it compare with a "gold standard"?

Kain ZN, Mayes LC, Cicchetti DV, Bagnall AL, Finley JD, Hofstadter MB.

Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510-8051, USA. kain biomed.med.yale.edu

Evaluating the effectiveness of interventions directed toward the treatment of preoperative anxiety in children has been hindered by the absence of a statistically valid measurement tool. In a previous investigation, we developed an instrument (Yale Preoperative Anxiety Scale [YPAS]) that can be used to assess anxiety in children undergoing induction of anesthesia. The purpose of the present investigation was to modify and expand the applicability of the instrument to the preoperative holding area and to validate the modified instrument (m-YPAS) against a recognized "gold standard" (State-Trait Anxiety Inventory for Childrens [STAIC]). Videotapes of children in a preoperative holding area were analyzed by the investigators. The existing five categories of the YPAS were found to reflect most of the behaviors observed. Several items, however, were modified to describe new behaviors observed. Reliability analysis using weighted kappa statistics revealed that inter-observer agreement ranged from 0.68 to 0.86, whereas intraobserver weighted kappa ranged from 0.63 to 0.90. Concurrent validity between the YPAS and the STAIC was acceptable (P = 0.01, r = 0.79). Construct validity was high as assessed by increased m-YPAS scores from the preoperative holding area (28 +/- 8) to entering the operating room (35 +/- 12), to introduction of the anesthesia mask (43 +/- 15;F [1,36] = 0.6, P = 0.001]. Showing good to excellent observer reliability and high concurrent and construct validity, the m-YPAS proved to be an appropriate tool for assessing children's anxiety during the perioperative period. Implications: The absence of a statistically valid measurement tool that can be applied easily in perioperative settings hinders the evaluation of interventions directed toward treatment of preoperative anxiety in children. The authors describe the development of such a tool, the modified Yale Preoperative Anxiety Scale.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9322455&dopt=Abstract anxiety medicine