Injection Fear Research Articles

The Cost-Effectiveness of Saxagliptin Versus NPH Insulin When Used in Combination with Other Oral Antidiabetes Agents in the Treatment of Type 2 Diabetes Mellitus in Poland

This study compared the health and economic benefits of saxagliptin versus insulin as second-line therapy with either metformin (MET) or sulfonylurea (SU) after failure of the respective monotherapies for patients with type 2 diabetes in Poland. The cost-effectiveness was assessed using a previously published diabetes model. Disease progression, utilities, and effects of changes in glycosylated hemoglobin (HbA1c), weight, and hypoglycemic events were taken from published studies, and Polish sources were used where possible. MET + saxagliptin reduced severe hypoglycemic complications and weight versus MET + insulin, with an incremental benefit of 0.13 quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) of 27,454 Polish zloty (PLN) ($9,966 U.S.) per QALY gained. SU + saxagliptin showed an incremental benefit of 0.14 QALYs and ICER of 24,663 PLN ($8,953 U.S.) per QALY gained versus SU + insulin, with reduced incidence of symptomatic and severe hypoglycemias. Results were most sensitive to disutilities associated with weight gain, hypoglycemia, injection fear, HbA1c changes, threshold for switching treatment, and patients' age. Results were robust to various model assumptions and inputs. Using a willingness-to-pay threshold of 100,000 PLN ($36,300 U.S.) per QALY gained, the probability that saxagliptin is cost-effective in these analyses was 74% (MET) and 76% (SU). Saxagliptin in combination with MET or SU is likely to represent a cost-effective treatment option in Polish patients with type 2 diabetes failing first-line treatment.

Development and Initial Validation of the Medical Fear Survey–Short Version

The present investigation employs item response theory (IRT) to develop an abbreviated medical fear survey (MFS). Application of IRT analyses in study 1 (n = 931) to the original 50-item MFS resulted in a 25-item shortened version. Examination of the location parameters also resulted in a reduction of the Likert-type scaling of the MFS by removing the last response category ("terror"). The five subscales of the original MFS were highly correlated with those of the MFS-short version. The short version also displayed comparable convergent and discriminant validity with the original MFS in relation to measures of fear, disgust, and anxiety. Confirmatory factor analysis in Study 2 revealed that the five-factor structure of the MFS-short form fit the data well in U.S. (n = 283) and Dutch (n = 258) samples. The short form also had comparable convergent and discriminant validity with the original MFS in relation to domains of disgust in both samples. Receiver operating characteristic (ROC) analysis in Study 3 demonstrated that the subscales of the short version were comparable with the original MFS in classifying participants high (n = 40) and low (n = 40) in blood/injection phobia. Last, structural equation modeling in Study 4 (n = 113) revealed that the MFS-short form demonstrated excellent convergent/discriminant validity with strong associations with injection fear and no association with spider fear. These findings suggest that the MFS-short form has considerable strengths, including decreased assessment time, while retaining sound psychometric properties.

I am going to gag: Disgust cognitions in spider and blood–injury–injection fears

There is mounting evidence that disgust plays an important role in certain anxiety disorders, yet little is known about disgust's cognitive component. The current study introduces a measure of cognitions associated with disgust and contamination to assess the role of disgust-specific primary and secondary appraisals in phobic responding. A multi-modal assessment of blood–injury–injection (BII) and spider phobia was conducted using BII (N=29) and spider (N=30) fearful groups, and a non-fearful control group (N=30). The Disgust Cognitions scale showed good reliability and validity, and distinguished among the groups. For example, relative to the other groups, the spider fear group reported higher disgust cognitions following presentation of a live spider, whereas the BII Fear group reported higher disgust cognitions following a surgery video. Moreover, the scale was associated with multiple phobic indicators (behavioural avoidance, subjective distress, symptom endorsement), suggesting cognitions may be critical to understanding how disgust contributes to anxiety disorders.

A Preliminary Investigation of the Efficacy of Disgust Exposure Techniques in a Subclinical Population With Blood and Injection Fears

AbstractThe current study examined whether a traditional exposure-based treatment for blood-injection-injury (BII) phobia would be effective at reducing disgust responses to BII stimuli and whether the addition of modules targeting disgust would provide incremental efficacy. Participants, many of whom reported subclinical BII phobia symptoms, underwent one of two single-session exposure protocols, one targeting fear alone, and the other targeting both fear and disgust. Both treatments consisted of education components (fear-only or fear-disgust) and in vivo exposure (fear-only or fear-disgust). Both the fear-only and the fear-disgust treatment groups significantly decreased fear and avoidance behaviour toward BII stimuli over time. The two groups also experienced similar reductions in disgust responses to BII-related stimuli and global as well as domain-specific disgust sensitivity. The effect sizes indicated that the fear-disgust group evidenced greater reduction in symptoms than did the fear-only group. The implications of the results for models of phobia maintenance and treatment are discussed.

Maximizing the value of validation findings to better understand treatment satisfaction issues for diabetes

Variables associated with treatment satisfaction (TS) can be broadly categorized as precursors, ongoing treatment issues, and treatment outcomes. This study continues the validation process for the Insulin Treatment Satisfaction Questionnaire (ITSQ) while examining relationships between TS and these broader influences. Data (N = 299) were collected in a RCT comparing safety and efficacy of inhaled vs. injectable insulin. Validation examined item and factor characteristics, reliability and validity. Regression analyses examined relationships between overall and domain specific TS and the broader influences. Patients with less previous or current treatment burden had greater TS (p < 0.001). Gender, injection fear, functioning, age, compliance and glycemic control were differentially related to TS at the beginning and end of study. Baseline satisfaction was predictive of future TS (p < 0.001). When all significant factors were examined together, lower burden with the current treatment and higher satisfaction with previous treatment continued to be key (p < 0.001) while other factors were no longer significant. Validation findings confirmed the ITSQ was psychometrically sound. Over the course of treatment, some factors are associated with TS at treatment start while others are key drivers at treatment end. This suggests that TS is not a static concept.

The Disgust Propensity and Sensitivity Scale-Revised: Psychometric properties and specificity in relation to anxiety disorder symptoms

The present study examined the factor structure and psychometric properties of the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R) in a nonclinical sample ( N = 340). Principal components analysis of the DPSS-R revealed a two-factor structure consisting of Disgust Propensity and Disgust Sensitivity. Although the two-factor structure converged well with prior research, four of the 16 DPSS-R items did not load onto the predicted factor. The DPSS-R demonstrated good reliability and validity. The DPSS-R and its two factors were moderately correlated with spider fear and contamination fear and mildly correlated with injection fear. The relation between the DPSS-R and these anxiety disorder symptoms remained largely intact after controlling for negative affect. Regression analyses also revealed that the two DPSS-R factors demonstrate specificity in the prediction of anxiety disorder symptoms. These findings are discussed in terms of promoting a more valid and reliable assessment of disgust in anxiety disorders.

Injection Phobia: A Systematic Review of Psychological Treatments

Injectable medications are commonplace but injection phobia can have a detri-mental impact on the utilization of health care by patients with subsequent adverse clinical outcomes. This systematic review aimed to identify the various psychological treatments for injection phobia and to assess their effectiveness. A systematic literature search was conducted using Cochrane, PsycINFO, EMBASE, MEDLINE, and AMED databases. Studies with five or more cases that investigated psychological treatment outcomes were selected and assessed in terms of methodological quality, type of intervention and outcomes. Eighty-four publications were identified by the search. Only three studies fulfilled the selection criteria and all used cognitive-behavioural techniques, including exposure to the feared object through a traditional graded hierarchy. Methodology differed but all had optimistic outcomes. Psychological treatments for injection fear or phobia exist, but the overall quality of evidence for treatment effectiveness is poor and outcome measures need consensus and further development.

Psychiatric Diagnoses Among Self-Referred Dental Injection Phobics

In order to determine the psychiatric characteristics of people with dental injection phobia, 118 dental injection phobics were systematically assessed using a structured clinical interview and a written questionnaire. Fifty-four percent of subjects had a current Axis I diagnosis other than dental injection phobia, mainly anxiety, mood or adjustment disorder, and 68.6% of subjects had an additional lifetime Axis I diagnosis. Subjects with additional current Axis I diagnoses reported higher dental anxiety, greater severity of injection fear cognitions, and poorer relationships with dental professionals, than did subjects without any or with past Axis I diagnoses. Further investigation is needed to explore the treatment possibilities for patients with and without additional current diagnoses.

Dental fear with and without blood-injection fear: implications for dental health and clinical practice

The relation between dental, blood and injection fear and oral health was examined in 936 New Zealand 18-year-olds. Of the approximately ten percent ( n=96) of the sample who reported a dental fear, 1 in 10 also reported a fear of blood and 53% a co-morbid fear of injections. Study members with dental fear alone or co-morbid dental and blood or injection fear had significantly worse oral health (i.e. greater caries experience) than a no-fear comparison group or individuals with blood-injection fear only. Further, individuals with dental and blood or injection fear had a significantly higher level of recent tooth decay than individuals with dental fear alone. Time since last dental treatment also tended to be highest in this group. Implications for dental health and practice were discussed.

CARL: A LabVIEW 3 computer program for conducting exposure therapy for the treatment of dental injection fear

This paper describes CARL (Computer Assisted Relaxation Learning), a computerized, exposure-based therapy program for the treatment of dental injection fear. The CARL program operates primarily in two different modes; in vitro, which presents a video-taped exposure hierarchy, and in vivo, which presents scripts for a dentist or hygienist to use while working with a subject. Two additional modes are used to train subjects to use the program and to administer behavioral assessment tests. The program contains five different modules, which function to register a subject, train subjects to use physical and cognitive relaxation techniques, deliver an exposure hierarchy, question subjects about the helpfulness of each of the therapy components, and test for memory effects of anxiolytic medication. Nine subjects have completed the CARL therapy program and 1-yr follow-up as participants in a placebo-controlled clinical trial examining the effects of alprazolam on exposure therapy for dental injection phobia. All nine subjects were able to receive two dental injections, and all reduced their general fear of dental injections. Initial results therefore indicate that the CARL program successfully reduces dental injection fear.

The role of disgust and fear in blood and injection—related fainting symptoms: A structural equation model

Structural equation models were used to examine the relationship of blood, injection, and injury (BII) fears, disgust sensitivity, and trait anxiety to having experienced fainting-related symptoms in 722 university students. The latent variable representing BII fears was highly positively related to faint symptoms whereas that relating to disgust experiences was inversely related to fainting. A second disgust sensitivity variable was not directly related to fainting. Trait anxiety added nothing directly to the model, although it was related to BII latent variable. Additional analyses included a gender-related cross-validation which showed that models developed on one gender group did not fit well when applied to the other gender group. Blood drawings were the most common faint eliciting situations and were found to be reportedly more likely to elicit faint symptoms than were injections.

FOUR DIMENSIONS OF FEAR OF DENTAL INJECTIONS

In 1995, students and staff at the University of Washington were surveyed regarding avoidance of dental care and fear of dental injections. More than 25 percent of adults surveyed expressed at least one clinically significant fear of injections. Almost one in 20 respondents indicated avoiding, cancelling or not appearing for dental appointments because of fear of dental injections. Fear of dental injections consists of four dimensions. General fear of dental injections including pain of injection and of bodily injury from injection are the two most common dimensions of dental injection fear. Many people also express fears of acquired disease. Fear related to local anesthetic (such as side effects, inadequate anesthesia) is less frequent. Some respondents have fears that must be categorized using more than one of these dimensions. Understanding the nature of a patient's fear of injection may suggest strategies to address his or her concerns.

Factorial dimensions and correlates of blood, injury, injection and related medical fears: Cross validation of the Medical Fear Survey

The Medical Fear Survey (MFS) and its companion scale, the Medical Avoidance Survey (MAS) were factor analyzed and the factor analysis was cross validated in sample of 934 participants. Seven reliable factors were derived from the MFS which cover the domain of blood, injury, and injection fears and phobias. These factors were entered into a discriminate analysis to predict blood injury-related fainting. The single factor, “fear of injections and blood draws” accounted for the majority of the MFS prediction of fainting, correctly classifying 72% of the fainters and 47% of non-fainters. The factors were examined in composite and individually in relation to gender and fainting. Overall, females and fainters scored significantly higher on the MFS although there was some variability. Implications for assessment and conceptualization of blood, injury, injection fears and phobias are discussed.