Fear Survey Research Articles

Development and validation of fear of hypoglycemia screener: results from the T1D exchange registry

BackgroundFear of Hypoglycemia (FoH) in people with diabetes has a significant impact on their quality of life, psychological well-being, and self-management of disease. There are a few questionnaires assessing FoH in people living with diabetes, but they are more often used in research than clinical practice. This study aimed to develop and validate a short and actionable FoH screener for adults living with type 1 diabetes (T1D) for use in routine clinical practice.MethodsWe developed an initial screener based on literature review and, interviews with healthcare providers (HCPs) and people with T1D. We developed a cross-sectional web-based survey, which was then conducted to examine the reliability and validity of the screener. Adults (aged ≥ 18 years) with diagnosis of T1D for ≥ 1 year were recruited from the T1D Exchange Registry (August–September 2020). The validation analyses were conducted using exploratory factor analyses, correlation, and multivariable regression models for predicting cut-off scores for the final screener.ResultsThe final FoH screener comprised nine items assessing two domains, “worry” (6-items) and “avoidance behavior” (three items), in 592 participants. The FoH screener showed good internal consistency (Cronbach’s α = 0.88). The screener also demonstrated high correlations (r = 0.71–0.75) with the Hypoglycemia Fear Survey and moderate correlations with depression, anxiety, and diabetes distress scales (r = 0.44–0.66). Multivariable regression analysis showed that higher FoH screener scores were significantly associated with higher glycated hemoglobin (HbA1c) (b = 0.04) and number of comorbidities (b = 0.03).ConclusionsThis short FoH screener demonstrated good reliability and validity. Further research is planned to assess clinical usability to identify patients with FoH and assist effective HCP-patient conversations.

An Interactive Augmented and Virtual Reality System for Managing Dental Anxiety among Young Patients: A Pilot Study

Dental anxiety is a common health problem among children. It creates major issues for patients, parents, and dental professionals. Children who cancel or otherwise miss their dental appointments generally do so due to fear of the unknown and lack of understanding of what they can expect from the environment and treatment when they arrive there. Some distraction interventions are already used by dental professionals, such as using clown doctors, watching cartoons, and utilizing the tell–show–do (TSD) technique. Still, the problem is common, and the fail to attend (FTA) rates at clinics are high. Familiarizing children with the dental setting and procedures in advance may help to manage their anxiety. This paper aims to help in managing children’s dental anxiety in a simple, attractive, and age-appropriate way through the use of augmented reality (AR) and virtual reality (VR) technologies. The developed system is named “Dr. Barea”. It targets Arabic-speaking children aged from 7 to 10 years old. It uses model–view–control (MVC) as its architectural design pattern. The proposed solution consists of three main sections: a 360° VR video that simulates a dental clinic environment, an educational description on dental tools using AR technology, and interactive educational stories that educate children about dental hygiene. The system performance was evaluated using unit, integration, performance, and user acceptance testing. The results demonstrate that the proposed solution, which performed reasonably, achieved the usability requirements and was engaging for learning information about dental hygiene. A feasibility study with 16 children was conducted to evaluate the effectiveness of the proposed system. The Child Fear Survey Schedule—Dental Subscale (CFSS-DS) was used to measure children’s dental anxiety level. The T test was used to evaluate the differences between groups, and Fisher’s exact test was used to compare the distributions of gender and age between the groups. The CFSS-DS index in the VR group decreased after dental consultation (35.04 ± 9.14 before consultation and 32.32 ± 8.32 after consultation, p = 0.041). The implications of this study shall be beneficial to patients, parents, and dental professionals.

Fear of hyperglycemia in parents of children with type 1 diabetes mellitus - a multi-center multi-national study.

Study aims: (1) developing and validating a novel questionnaire for measuring fear of hyperglycemia among parents of children with type 1 diabetes (T1D) - the Hyperglycemia Fear Survey - Parent version (FoHyper-P); (2) investigating correlations between parental fear of hyperglycemia and objective measures of glycemic control. A multi-center, multi-national study of 152 parents of children with T1D was conducted in three large diabetes clinics from Israel, Poland, and Greece. Inclusion criteria were parents of children aged 6-16 years, at least 6 months from diagnosis, at least 3 months of CGM use and parental involvement in care. Parents filled the FoHyper-P and the Hypoglycemia Fear Survey - Parent Version (HFS-P). Patient data were obtained via electronic medical records and informative questionnaires. Bonferroni correction was performed to counteract multiple comparisons. Significant strong-moderate correlations were found between FoHyper-P and HFS-P including total questionnaires scoring (r=0.747, PBonf. <0.001), worries subscales (r=0.735, PBonf <0.001), and behavior subscales (r=0.532, PBonf <0.001). Using linear regression models we found a positive association between the worry subscale and HbA1C. Weak correlations (P<0.05, not significant after Bonferroni correction) were found between time in range, time above range and parental fear of hyperglycemia as well as between worry subscales and a higher HbA1C in the past year, percent of hyperglycemia and lower TIR. The FoHyper-P is a novel, validated tool for assessing parental fear of hyperglycemia. Integrating it into clinical practice addresses an underestimated aspect of parental diabetes management, enabling better care for children with T1D.

Pathways to dental fear from childhood to adolescence: A 10-year cohort study.

Dental fear affects children's oral health; there is, however, no evidence regarding the pathways linking possible predictors for its occurrence. This study aimed at exploring the direct and indirect effects of sociodemographic, clinical, behavioural and psychosocial factors on the development of dental fear in schoolchildren over time. This is a prospective cohort study, with 10 years of follow-up. The first assessment started in 2010 (T1) with a sample of 639 children aged 1-5 years from Southern Brazil. For this study, the follow-up (T2) of these individuals was performed in 2020. Dental fear was assessed at T2 using the Brazilian version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Socio-economic, demographic, psychosocial and oral health measures were collected in both assessments. A structural equation model was performed to assess the direct and indirect pathways among variables at T1 and T2 to predict the CFSS-DS scores at T2. Of the 639 children, 429 were re-evaluated at T2. Higher levels of untreated dental caries, younger individuals, dental visits for nonroutine reasons and low sense of coherence at T2 directly impacted dental fear at T2. Considering the indirect effects, the presence of dental caries and low household income at T1 indirectly impacted higher levels of dental fear over 10 years via dental caries at follow-up. Our findings suggest that socio-economic, demographic, clinical, psychosocial and behavioural conditions can influence dental fear from childhood to adolescence.

Relationship between depressive and anxiety symptoms and fear of hypoglycemia among adolescents and adults with type 1 diabetes mellitus

Background and aimsEmotional problems including anxiety, depression and fear of hypoglycemia (FOH) are common in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to determine the prevalence of depressive and anxiety symptoms among patients with T1DM and their relation to glycemic control, diabetes complications and to FOH. MethodsThis study included 325 patients with T1DM. Anxiety and depressive symptoms were assessed by Hospital Anxiety and Depression Scale (HADS) and FOH was assessed by Hypoglycemia Fear Survey II (HFS-II). Glycemic control was assessed by both fasting plasma glucose and HbA1c. A subsample of 75 patients was screened for diabetes complications. ResultsThe prevalence of anxiety symptoms, depressive symptoms and FOH was 76.3%, 61.8% and 20% respectively. Female sex was related to depressive symptoms but not to anxiety symptoms. Logistic regression analysis showed that both HbA1c and HFS-II total score were independently correlated with both anxiety symptoms and depressive symptoms. Age showed independent correlation with both HFS-II (total score) and with Hypoglycemia Fear Survey-worry (HFS-W) while HbA1c showed independent correlation with Hypoglycemia Fear Survey-behavior (HFS-B). Both anxiety and depressive symptoms were positively correlated to HFS-B score, HFS-W score and HFS-II total score. ConclusionsFOH is not uncommon among Egyptian patients with T1DM and it seems to be one of the factors contributing to the increased prevalence of anxiety and depressive symptoms among those individuals. Addressing and managing the different psychological aspects of diabetes should be integrated within the routine diabetes care services for people with T1DM.

Effectiveness of educational and behavioural interventions for reducing fear of hypoglycaemia among adults with type 1 diabetes: Systematic review and meta-analyses.

To summarize and critically appraise evidence regarding the effectiveness of educational and/or behavioural interventions in reducing fear of hypoglycaemia among adults with type 1 diabetes. Systematic searches of medical and psychology databases were conducted. Risk-of-bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools. Data were synthesized using random-effects meta-analyses for randomized controlled trials (RCTs) and narrative synthesis for observational studies. Five RCTs (N=682) and seven observational studies (N=1519) met the inclusion criteria, reporting on behavioural, structured education and cognitive-behavioural therapy (CBT) interventions. Most studies assessed fear of hypoglycaemia using the Hypoglycaemia Fear Survey Worry (HFS-W) and Behaviour (HFS-B) subscales. Mean fear of hypoglycaemia at baseline was relatively low across studies. Meta-analyses showed a significant effect of interventions on HFS-W (SMD=-0.17, p=0.032) but not on HFS-B scores (SMD=-0.34, p=0.113). Across RCTs, Blood Glucose Awareness Training (BGAT) had the largest effect on HFS-W and HFS-B scores, and one CBT-based program was as effective as BGAT in reducing HFS-B scores. Observational studies showed that Dose Adjustment for Normal Eating (DAFNE) was associated with significant fear of hypoglycaemia reductions. Current evidence suggests that educational and behavioural interventions can reduce fear of hypoglycaemia. However, no study to date has examined these interventions among people with high fear of hypoglycaemia.

Psychometric properties of the Chinese (Cantonese) version of the Upper Extremity Functional Index in people with chronic stroke.

To culturally adapt and examine the psychometric properties of the Chinese (Cantonese) version of the Upper Extremity Functional Index (C-UEFI) in people with chronic stroke. Cross-sectional study. University-affiliated neurorehabilitation research laboratory. The participants (N = 151) were people with chronic stroke (N = 101) and healthy controls (n = 50). We assessed the C-UEFI, Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Six-Minute Walk Test (6MWT), Motor Activity Log (MAL), Activity-Specific Balance Confidence (ABC) scale, Lawton Instrumental Activities of Daily Living (IADL) scale, Survey of Activities and Fear of Falling in the Elderly (SAFFE), Stroke Impact Scale (SIS) and Community Integration Measure (CIM) as outcome measures. The C-UEFI items demonstrated good test-retest reliability (intraclass correlation coefficient [ICC]3, 1 = 0.872) and excellent internal consistency (Cronbach's α = 0.922). People with chronic stroke had poorer C-UEFI scores than the healthy controls. The overall C-UEFI mean score of 101 people with stroke was significantly correlated with the mean scores of the FMA-UE, WMFT, MAL, ABC scale, IADL scale, SAFFE, SIS and CIM and the distance covered in the 6MWT. The C-UEFI cut-off score to distinguish between people with chronic stroke and healthy older adults according to upper extremity function was 57.5 out of 59 (sensitivity: 88.1%; specificity: 84%). The C-UEFI had good content validity, with an acceptable fit to the two-factor structure model. The C-UEFI is reliable and valid for assessing functional recovery of upper extremity activity in Chinese people with chronic stroke.

The impact of fear of hypoglycaemia on sleep in adolescents with type 1 diabetes.

Fear of hypoglycaemia (FOH) can contribute to impaired sleep for adults with type 1 diabetes (T1D) and parents of children with T1D, although it is unknown how FOH may affect sleep for adolescents with T1D. This study examines the relationship between adolescent FOH and sleep and assessed the influences of continuous glucose monitor (CGM) and insulin pump use. Adolescents ages 14-18 years with T1D completed questionnaires evaluating FOH (Child Hypoglycemia Fear Survey) and sleep (Pittsburgh Sleep Quality Index, PSQI). Analyses included linear and logistic regression, t-tests and Fisher's exact tests. Participants included 95 adolescents (52 female) with a median (IQR) age of 16.5 (15.3-17.7) years and a T1D duration of 5.7 (2.5-9.6) years. Analyses showed increased FOH-Worry subscale scores were associated with reduced sleep duration (β= -0.03, p= 0.042, adjusting for BMI z-score, race and ethnicity) and increased sleep disturbances (OR=1.1, p= 0.038, adjusting for race and ethnicity). Frequent CGM users had longer sleep duration (average 7.5h) compared with infrequent or non-CGM users (average=6.8h; p= 0.029), and pump users had overall improved sleep health as determined by PSQI score (p= 0.019). Technology use did not have significant interactions in the relationships between FOH and sleep duration or sleep disturbances. Worrying about hypoglycaemia was associated with impaired sleep for adolescents with T1D. Diabetes technology users have some sleep improvements, but CGM and pump use do little to alter the relationship between FOH and sleep outcomes.

The prevalence and influencing factors of gag reflex in children aged 7-14 years in the dental setting.

Gag reflex may occur in patients of all ages and often considered having a multifactorial aetiology. The aim of the study was to evaluate the prevalence and influencing factors of gag reflex in Turkish children aged 7-14 years in the dental setting. This cross-sectional study was carried out among 320 children aged between 7 and 14 years. First, an anamnesis form which include sosyodemographic status, monthly level of income, children past medical and dental experiences was filled by mothers. Children's fear levels were evaluated using the Dental Subscale of Children's Fear Survey Schedule(CFSS-DS) while mother's anxiety levels using the Modified Dental Anxiety Scale(MDAS). The revised dentist section of gagging problem assessment questionnaire (GPA-R-de) was used for both children and mothers. Statistical analysis was done with SPSS program. The prevalence of gag reflex among children was 34.1%, among mothers was 20.3%. The association between child and mother gagging was found statistically significant (χ2 =53.121, p < 0.001). When the mother of the child gagged, the risk of child gagging increases 6.83 times (p < 0.001). Higher CFSS-DS scores of children increase risk of gagging (OR=1.052, p=0.023). Children who were previously treated mostly in public hospitals significantly more likely to gag compared with private dental clinics (OR=10.990, p < 0.001). It was concluded that negative past dental experiences, previous dental treatments with local anaesthesia, history of hospital admission, number and place of previous dental visits, dental fear level of children, and low education level and gagging of mother have an influence on the gagging of children.

Evaluating Dental Fear and Anxiety in Pediatric Patients Visiting a Private and a Public Dental Hospital in Lahore, Pakistan.

Background One of the biggest hurdles in treating pediatric patients is managing dental fear and anxiety. Some factors that contribute to an increase in dental anxiety are fear of pain, the presence of unknown individuals, a change in the setting of an environment, and separation from parents. Aim The aim of this study was to evaluate dental fear and anxiety in pediatric patients, between the ages of 6 and 12 years, visiting private and public dental hospitals using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Methods A total of 280 children, 140 in a private dental hospital setting and 140 in a public dental hospital setting, were enrolled in this study. The purpose of the study was explained to the accompanying guardian of the patient and written consent was taken. The CFSS-DS was explained verballyin Urdu and the questionnairewas given to guardians alongside the patients which they were asked to fill out following their dental treatment. Result The data obtained from the questionnaires were analyzed using the unpaired t-test. The highest dental fear mean scores and standard deviation in a private dental hospital were for "choking" (3.25 ± 1.21), "the noise of the dentist drilling" (3.24 ± 1.04), and "having somebody put instruments in your mouth" (3.19 ± 1.06), whereas, for a public dental hospital, the highest fear score was recorded in "choking" (3.17 ± 1.69), "injections" (3.07 ± 1.72), and "people in white uniforms" (1.90 ± 1.21). Conclusion The study showed a higher prevalence of dental fear and anxiety in a private dental setting when compared to a public dental setting. Factors responsible for an increase in dental fear need to be assessed for each patient and thentreatment given accordingly.

Evaluating the effect of yoga as an adjunct therapy in type 1 diabetes care: Study protocol for randomised control trial

BackgroundIndividuals with type 1 diabetes mellitus (T1DM) confront serious lifestyle alterations that include an absolute daily requirement for exogenous insulin, monitoring their glucose control, and paying attention to dietary intake. Yoga is an ancient mind-body practice increasingly recognized to have health benefits in various clinical and non-clinical conditions. The current trial was intended to evaluate the efficacy of yoga therapy on glycemic variability and physical activity among patients with T1DM. MethodsThis is a single-centre, parallel-group prospective, randomized, open-blind end-point trial to evaluate the effectiveness of yoga therapy as an adjunct to T1DM care. 88 Patients aged between 12 and 17 years will be recruited from a charitable hospital for patients with T1DM and randomly allocated either to the intervention or control arm with an allocation ratio of 1:1. The control group will continue the standard care provided by the treating physicians, and the yoga group will be administered an additional Yoga module for three months. The monitoring of glycemic fluctuation will be assessed by the continuous glucose monitor, HbA1c, C-peptide, Insulin dose, lipid profile, and using psychological questionnaires such as Peds QL 3.0 Type-1 Diabetes Module, Peds QL 4.0 Generic Core Sale, Hypoglycemic fear survey, Kutcher Adolescent depression scale, Type 1 Diabetes stress scale, Physical Activity Questionnaire for Adolescents, will be done at baseline and three months. DiscussionThe study is intended to address the physical and other risk factors among patients with T1DM. The study is prospectively registered on the India Clinical Trial Registry.

Association between Intelligence Quotient Dental Anxiety and Oral Health-related Quality of Life in Children: A Cross-sectional Study.

Determining the intelligence quotient (IQ) grades of children help in managing dental anxiety (DA) and maintaining the good oral health-related quality of life (OHRQoL). To assess the association between IQ, DA, and OHRQoL in children aged 10-11 years. This cross-sectional study was carried out among 202 children aged 10-11 years in the Southern part of Tamil Nadu, India. The IQ level, DA, and OHRQoL were measured using Raven's Coloured Progressive Matrices (RCPM), Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and Child Oral Health Impact Profile Short Form (COHIP-SF) 19, respectively. Chi-squared test and Spearman rank order correlation test were used for analysis. The results revealed a significant negative correlation (p < 0.05; r = -0.239) between IQ and OHRQoL. DA was negatively correlated with IQ (r = -0.093) and OHRQoL (r = -0.065), but it was not statistically significant. The gender-based comparison revealed no significant difference in the distribution of girls and boys within different grades of IQ levels (p = 0.74), DA (p = 0.29), and OHRQoL (p = 0.85). Children with higher IQ showed low OHRQoL scores. DA was negatively correlated with IQ and OHRQoL. Asokan S, PR GP, Mathiazhagan T, et al. Association between Intelligence Quotient Dental Anxiety and Oral Health-related Quality of Life in Children: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(6):745-749.

The Relationship Between Parent Fear of Hypoglycemia and Youth Glycemic Control Across the Recent-Onset Period in Families of Youth with Type 1 Diabetes.

This study aims to examine the relationship between parents' fear of hypoglycemia (FH) over a 1-year period and child glucose metrics in 126 families of youth recently diagnosed with type 1 diabetes (T1D). Parents completed the Hypoglycemia Fear Survey for Parents (HFS-P) and uploaded 14days of glucose data at a baseline, 6-month, and 12-month assessment. Parents' HFS-P total and worry scores increased to a clinically meaningful degree from baseline to 6-month assessment, while multilevel models revealed within- and between-person variability in parents' HFS-P worry and behavior scores over time associated with child glycemia. Specifically, a significant negative relationship for within-person worry scores suggested that when parents reported higher than their average worry scores, their children recorded fewer glucose values in the target range, while within-person behavior scores suggested that when parents reported lower than their average behavior scores, their children recorded more values above the target range. There was also a negative relationship for between-person behavior scores with child glycated hemoglobin and a positive relationship for between-person behavior scores with child glucose values in the target range. In the recent-onset period of T1D, parental FH worry and behavior associated with child glycemia possibly due to changes in parents' perceptions of their child's hypoglycemia risk. The clinically meaningful increases in parent FH in the recent-onset period and the negative association for between-person behavior scores with child glycated hemoglobin suggest that clinics should consider screening parents for FH, especially among parents of children with lower glycemic levels.

Study of dental phobia, psychological resilience, and related factors in children aged 8-9 years in Weifang city.

To investigate the influencing factors of children's dental fear (CDF) and the relationship of CDF with resilience in children aged 8-9 years in Weifang city to provide evidence for the early prevention and intervention of CDF. Random cluster sampling method was applied. A total of 1 995 children aged 8-9 years from 10 primary schools in four districts of Weifang city were selected from June to October 2021 as the survey objects. General information questionnaire, the children's fear survey schedule-dental sub-scale, and adolescent resilience scale were used in the investigation. The CDF detection rate was 31.78% (634 cases) in children aged 8-9 years in Weifang city, including 28.41% (296 cases) in boys and 35.47% (338 cases) in girls. Multivariate logistic analysis showed that female gender [odds ratio (OR)=1.329, 95% confidence interval (CI)=1.062-1.665], dental caries (OR=1.961, 95%CI=1.330-2.891), dental pain (OR=2.133, 95%CI=1.700-2.676), and dental treatment experience (OR=3.621, 95%CI=2.888-4.540) are risk factors for CDF. Parents with tertiary education or higher (OR=2.123, 95%CI=1.546-2.916; OR=3.304, 95%CI=2.368-4.612), high scores in the positive cognition factor of the psychological resilience-personal strength dimension (OR=1.520, 95%CI=1.141-2.025), high scores in the interpersonal assistance factor of the psychological resilience-support strength dimension (OR=3.819, 95%CI=2.743-5.318), and high scores in the family support factor (OR=5.634, 95%CI=4.047-7.844) were protective factors for CDF occurrence (P<0.05). Children with high psychological resilience scores have low CDF incidence, and good parenting practices are beneficial in reducing CDF incidence.

Real-World Diabetes Technology: Overcoming Barriers and Disparities.

Real-World Diabetes Technology: Overcoming Barriers and Disparities.

The relationship between fear of hypoglycemia and health-related quality of life in diabetic patients with heart disease.

Individuals with Diabetes Mellitus (DM) frequently experience hypoglycemia, which has significant implications for the possibility of cardiovascular complications. The relationship between fear of hypoglycemia (FoH) and health-related quality of life (HRQoL) in diabetic heart patients was investigated in this study. This was a descriptive study, and 260 diabetic inpatients with heart disease were enrolled. The "Data Gathering Form", the "Hypoglycemia Fear Survey" (HFS), and the "Short-Form Health Survey (SF-36)" were used to collect research data. The mean age of the patients was 63.46±11.73 (min 21-max 90) years, and 76.2% of them had type 2 DM. The mean FoH total score of the patients was 70.87±8.03 (min 45-max 113). The mean FoH behavior sub-dimension score was 35.41±4.07 (min 20-max 57), and the mean worry sub-dimension score was 35.55±5.26 (min 20-max 61). The mean total FoH score was found to be significantly higher in patients of 65 years of age and older, not working, with diabetes duration over 10 years, with HbA1c <7%, and with microvascular complications (p<0.05). Of the sub-dimensions of SF-36, "mental health" had the lowest mean score. There was a significant but very weak negative correlation between the other sub-dimensions of SF-36, "physical functioning", "role physical", "role emotional" and "vitality", with the FoH total score. FoH and HRQoL in diabetic patients with heart disease were found to be negatively correlated in this study. Prevention of hypoglycemia will improve patients' HRQoL by reducing their anxiety and fears.

Diabetes Technology and the Human Factor.

Diabetes Technology and the Human Factor.

Effect of switching from intermittently scanned to real-time continuous glucose monitoring in adults with type 1 diabetes: 24-month results from the randomised ALERTT1 trial

Comparing Continuous With Flash Glucose Monitoring In Adults With Type 1 Diabetes (ALERTT1) examined whether switching from first-generation intermittently scanned continuous glucose monitoring (isCGM) without alerts to real-time continuous glucose monitoring (rtCGM) with alert functionality offers additional benefits to adults with type 1 diabetes. The extension of the randomised ALERTT1 trial assessed the effect of switching from isCGM to rtCGM up to 24 months. In this 6-month, double-arm, parallel-group, non-masked, randomised, controlled trial, done across six hospitals in Belgium, 254 adults aged 18 years or older with type 1 diabetes previously using isCGM were randomly assigned (1:1) to rtCGM with alerts (intervention; n=127) or isCGM without alerts (control; n=127). Upon completion of the 6-month trial, the control group switched to rtCGM (is-rtCGM group), and the intervention group continued rtCGM (rt-rtCGM group). The extension focused on within-group changes in time in range (TIR; 3·9-10·0 mmol/L; primary outcome), HbA1c, time in clinically significant hypoglycaemia (<3·0 mmol/L), and Hypoglycaemia Fear Survey worry (HFS-worry) score (all prespecified key secondary outcomes). Mean within-group change versus the start of rtCGM is reported, with a positive value referring to a lower value at start of rtCGM. This trial is registered at ClinicalTrials.gov (NCT03772600). 119 participants were assigned to the is-rtCGM group of whom 112 (94%) completed the 24-month trial, and 123 participants were assigned to the rt-rtCGM group of whom 117 (95%) completed the 24-month trial. TIR increased from 51·8% (95% CI 49·1-54·5) at start of rtCGM (month 6) to 63·5% (60·7-66·3) at month 12 in the is-rtCGM group, and remained stable up to month 24 (change 11·7 percentage points [pp] [9·4-14·0; p<0·0001). In the rt-rtCGM group, TIR increased from 52·5% (95% CI 49·8-55·1) at start of rtCGM (month 0) to 63·0% (60·3-65·8) at month 12, also remaining stable up to month 24 (change 10·5 pp [8·2-12·8]; p<0·0001). HbA1c decreased from 7·4% (57 mmol/mol; month 6) to 6·9% (52 mmol/mol) at month 24 (change -0·54 pp [95% CI -0·64 to -0·44]; -5 mmol/mol [95% CI -6 to -4]; p<0·0001) in the is-rtCGM group, and from 7·4% (57 mmol/mol; month 0) to 7·0% (53 mmol/mol) at month 24 (change -0·43 pp [95% CI -0·53 to -0·33]; -4 mmol/mol [95% CI -5 to -3]; p<0·0001) in the rt-rtCGM group. The change in HFS-worry score was -2·67 (month 24 vs month 6; p=0·0008) in the is-rtCGM group and -5·17 points (month 24 vs month 0; p<0·0001) in the rt-rtCGM group. Time in clinically significant hypoglycaemia was unchanged in both groups after month 12. Severe hypoglycaemia decreased from 31·0 to 3·3 per 100 patient-years after switching to rtCGM. Glycaemic control and hypoglycaemia worry improved significantly up to 24 months after switching from isCGM without alerts to rtCGM with alerts, supporting the use of rtCGM in the care of adults with type 1 diabetes. Dexcom.

Gender differences in children’s fears: A meta-analysis study

ABSTRACT Children’s fears have received scholarly attention for well over 50 years. A considerable amount of literature has focused on such fear variables as fear intensity and fear prevalence scores and age and gender differences. We used meta-analysis to systematically review the findings related to gender differences in children’s fear intensity scores and fear prevalence scores and to examine the moderator effect of sample, year of study, and type of instrument on gender differences. Research studies that used the Fear Survey Schedule for Children (FSSC) or an updated version of the FSSC, were included in this meta-analysis. The findings from 58 intensity and 17 prevalence studies suggest that females have 11.4% higher total fear scores than males and females have 7.2% more fears than males. Results of sub-group analyses indicate that moderator variables of sample, year of publication, and type/version of FSSC cause significant variability in gender differences.

Dentophobia, Exploring Parental Factors - A Cross-sectional Survey

Aim To examine the relationship between parentsrsquo socioeconomic status parental dental anxiety parenting style on childrenrsquos oral health behaviour childrenrsquos dental anxiety and dental visit frequency.Methods A cross-sectional study was designed with a sample of 101 physically and mentally healthy children in the age group of 6-13 years. Two google forms were formulated. One for the parents to fill out and the other form for the child. Form 1 to be filled by the parent included four sections - Socio-demographic details Dental anxiety scale CORAHrsquoS revised DAS-R Parenting style and dimension questions PSDQ Childrenrsquos fear survey schedule CFSS-DS. Form 2 to be filled by the child included three sections - Dental anxiety scale CORAHrsquoS revised DAS-R Oral health behaviour perception scale and Childrenrsquos fear survey schedule CFSS-DS.Using the results of the two formsThe proportion of children with dental anxiety was assessed.Comparison of childrenrsquos dental anxiety to those of their parents was done.The correlation between parenting style to a childrsquos dental anxiety was assessed.Childrsquos oral health behaviour was correlated to their anxiety.Socioeconomic status with oral health behaviour was assessed.Childrsquos degree of anxiousness was determined.Results This study investigated the association between childrenrsquos dental fear and anxiety DFA and family-related factors. It showed significant correlation between dental anxiety of children and dental anxiety of parents oral health behaviour of parents fear in parents. Oral health behaviour perception of children was found to be significantly associated with dental anxiety of parents oral health behaviour perception of parents and fear in parents. Fear in children was found associated with dental anxiety of parents oral health behaviour perception of parents.Conclusion It can be concluded that parentsrsquo dental fear and anxiety are reflected in their children. It in turn affects the childrsquos oral hygiene behaviour