Perceived Levels Of Anxiety Research Articles

Scaling of ventral hippocampal activity during anxiety.

The hippocampus supports a multiplicity of functions, with the dorsal region contributing to spatial representations and memory, and the ventral hippocampus (vH) being primarily involved in emotional processing. While spatial encoding has been extensively investigated, how the vH activity is tuned to emotional states, e.g. to different anxiety levels, is not well understood. We developed an adjustable linear track maze (aLTM) for male mice with which we could induce a scaling of behavioral anxiety levels within the same spatial environment. Using in vivo single-unit recordings, optogenetic manipulations and population-level analysis, we examined the changes and causal effects of vH activity at different anxiety levels. We found that anxiogenic experiences activated the vH and that this activity scaled with increasing anxiety levels. We identified two processes that contributed to this scaling of anxiety-related activity: increased tuning and successive remapping of neurons to the anxiogenic compartment. Moreover, optogenetic inhibition of the vH reduced anxiety across different levels, while anxiety-related activity scaling could be decoded using a linear classifier. Collectively, our findings position the vH as a critical limbic region that functions as an 'anxiometer' by scaling its activity based on perceived anxiety levels. Our discoveries go beyond the traditional theory of cognitive maps in the hippocampus underlying spatial navigation and memory, by identifying hippocampal mechanisms selectively regulating anxiety.Significant statement This study reveals how the ventral hippocampus (vH) functions as an "anxiometer", tuning its activity to different anxiety levels. Using an adjustable linear track maze (aLTM) for mice, we demonstrated that vH activity scales with increased anxiety. By recording single-neuron activity and performing optogenetic manipulation of vH during the aLTM task, we identified key neuronal mechanisms for neuronal scaling during anxiety. Additionally, a linear classifier was used to highlight anxiety-related activity scaling. Our findings advance the understanding of hippocampal function beyond spatial navigation and memory, offering new insights into how the brain regulates anxiety at the neuronal level.

Translated article] AVIP project (Prosthetic Virtual Friend): Study of clinical-functional outcomes and satisfaction with a mobile application in the perioperative management and follow-up of hip arthroplasty.

To analyse the clinical, quality of life, and healthcare quality outcomes obtained in a series of patients undergoing total hip arthroplasty (THA), who were empowered and monitored using the AVIP application. These results will be compared with a control group followed through a standard protocol. Randomised clinical trial with parallel groups involving patients with an indication for THA. Clinical variables were measured and compared using the WOMAC and mHHS, pain assessed by the VAS, quality of life with the SF-12 test. Walking capabilities were analysed using the Functional Gait Assessment Scale, along with satisfaction levels assessed through the SUCE questionnaire, and perceived anxiety levels related to the process. A total of 68 patients were evaluated, with 31 patients in the AVIP group and 33 in the Control group completing the follow-up. Both groups demonstrated improvement in clinical outcomes based on the WOMAC and mHHS hip tests, a reduction in perceived pain, and an enhancement in quality of life according to the SF-12 test. Patients in the AVIP study group exhibited non-inferiority in clinical outcomes and satisfaction compared to the control group, as well as lower anxiety levels and improved walking capabilities after the first month of follow-up. Notably, 82.25% of the follow-up visits for this group were conducted remotely. The implementation of a mHealth application like AVIP can be safely offered to selected patients undergoing hip arthroplasty, enabling effective monitoring and providing continuous information and training.

The Presence of a Pet Dog Is Associated with a More Balanced Response to a Social Stressor

Acute and chronic stress each have physical manifestations in the human body that can lead to many negative health impacts. Today, reported stress levels worldwide are at an all-time high, spurring the search for non-pharmaceutical interventions to maintain healthy stress levels. In this study, we examined whether a pet dog’s presence influences healthy adults’ acute stress responses as assessed through self-reports, heart rate, plasma cortisol, and salivary alpha-amylase. Participating pet dog owners were randomly assigned to undergo the Trier Social Stress Test either with their pet dog or alone. While there was no group difference in perceived anxiety levels, participants undergoing the acute psychological stressor with their pet dogs present had significantly lower heart rates, lower plasma cortisol responses, and higher salivary alpha-amylase responses than people without their dogs. Those who participated without their dogs had a statistically flat alpha-amylase response, which is typically associated with extreme or pathological stress. These findings extend the potential effects of pet dogs beyond merely lowering their owner’s stress levels to maintaining a healthier, balanced response across the sympathoadrenal medullary axis and hypothalamic–pituitary-adrenal axis.

Electrophysiological detection of exam stress inhealth schools' students.

Anxiety is a common issue among university students, many of them experience anxiety, depression, and stress during their school life. This study aimed to compare the acute physiological stress responses of students divided into two groups according to their perceived anxiety levels (positive test anxiety, PTA+, and negative test anxiety, PTA-). Heart rate variability (HRV) and electrodermal activity (EDA) were used to assess stress.Thirty-one healthy volunteers participated in the study. Participants completed anxiety assessments, including the Westside Test Anxiety Scale (WTAS), the State-Trait Anxiety Inventory (STAI), and the Test State Anxiety Inventory (TSAI). Based on their scores, participants were categorized into PTA+ and PTA- groups. All participants underwent 24-h continuous recordings of pulse and electrodermal activity (EDA) on two separate occasions: one day prior to a written exam and during a designated exam-free day serving as a baseline control.We compared the HRV and EDA data obtained on a regular day and on an exam day between the two groups. Results showed that the PTA+ group had significantly higher heart rate, stress index, low frequency, and short-term detrended fluctuation analysis (DFAα1) on the exam day. The tonic EDA component was also higher in the PTA+ group. Stress-related HRV and EDA parameters were negatively correlated with exam scores.In conclusion, the study found that physiological stress indicators obtained from HRV and EDA are associated with perceived exam anxiety in students.

Proyecto AVIP (Amigo VIrtual Protésico): estudio de resultados clínico-funcionales y de satisfacción con una aplicación móvil en el manejo perioperatorio y seguimiento de implantes protésicos de cadera

To analyze the clinical, quality of life, and healthcare quality outcomes obtained in a series of patients undergoing total hip arthroplasty (THA), who were empowered and monitored using the AVIP application. These results will be compared with a control group followed through a standard protocol. Randomized clinical trial with parallel groups involving patients with an indication for THA. Clinical variables were measured and compared using the WOMAC and mHHS, pain assessed by the VAS, quality of life with the SF-12 test. Walking capabilities were analyzed using the Functional Gait Assessment Scale, along with satisfaction levels assessed through the SUCE questionnaire, and perceived anxiety levels related to the process. A total of 68 patients were evaluated, with 31 patients in the AVIP group and 33 in the Control group completing the follow-up. Both groups demonstrated improvement in clinical outcomes based on the WOMAC and mHHS hip tests, a reduction in perceived pain, and an enhancement in quality of life according to the SF-12 test. Patients in the AVIP study group exhibited non-inferiority in clinical outcomes and satisfaction compared to the control group, as well as lower anxiety levels and improved walking capabilities after the first month of follow-up. Notably, 82.25% of the follow-up visits for this group were conducted remotely. The implementation of a mHealth application like AVIP can be safely offered to selected patients undergoing hip arthroplasty, enabling effective monitoring and providing continuous information and training.

Does COVID-19 anxiety in pregnant women affect marital adjustment?

In this study, it was tried to determine the relationship between anxiety and marital adjustment in pregnant women during the epidemic, and to explain the variables affecting anxiety and marital adjustment. During the epidemic, many factors cause changes in the perceived anxiety level and marital adjustment in pregnant women. As the level of COVID-19 anxiety increases in pregnant women, marital adjustment scores decrease. It was determined that the anxiety levels were lower and marital adjustment was higher in pregnant women who had a planned pregnancy, did not have fears about childbirth, thought that their physical, mental health were not affected.

Nursing students' perceived anxiety and heart rate variability in mock skill competency assessment.

Skill competency assessments induce stress and anxiety and may affect nursing student performance. Little is known about stress and perceived anxiety levels and their relationship in the mock skill competency assessment. A cross-sectional study was conducted to examine the stress levels (as assessed by heart rate variability, HRV) and perceived anxiety before, during and after the mock skill competency assessment, and to explore their relationships to performance in a total of ninety first-year undergraduate nursing students. The HRV decreased significantly during the assessment and increased significantly 10 min after the assessment (p < 0.01). Higher performers showed significantly lower HRV during and after the assessment (p < 0.01). The assessment score was negatively correlated with HRV during and after the assessment (p < 0.05). Considering assessment-related stress and anxiety through a mock assessment prior to the actual skill assessment provides implications for future nursing education.

The Effects of Low-Fidelity Simulation on Students' Perceived Abilities to Build Therapeutic Relationships.

The combination of nursing student anxiety toward patients with mental health conditions, along with their unpreparedness for exercising active listening, empathy, and self-awareness in clinical situations, creates a barrier to achieving therapeutic nurse- patient relationships. A quantitative quasiexperimental study with a one-group pretest-posttest design was used to determine whether a low-fidelity communication simulation laboratory would decrease nursing students' perceived anxiety levels toward mental health patients and increase students' perceived empathy, self-awareness, and active listening levels. After completing the communication simulation laboratory, students' anxiety decreased significantly (p < .001) and active listening increased significantly (p < .001); empathy and self-awareness levels were relatively unchanged. Using a communication simulation laboratory effectively decreased nursing students' perceived anxiety levels toward patients and improved their perceived active listening skills. The findings of the study support the use of low-fidelity simulations to prepare students for psychiatric nursing clinical practice. [J Nurs Educ. 2023;62(10):575-579.].

175 Does short-term equine interaction within a collegiate environment provide students with perceived coping skills for test anxiety during examination periods?

An epidemic of mental health concerns is apparent within the collegiate environment. These concerns are more prevalent during examination periods where stress and anxiety may be heightened. Many students struggle to find ways to cope with this additional anxiety. Data have shown a rise in on-campus substance abuse, emphasizing the urgent need for campuses to offer alternative approaches to cope with the stresses associated with academia. Studies have demonstrated equine interaction in an academic setting can improve life skills important for coping with the rigors of academics. While the benefits of consistent equine interaction have been reported, the impact of equine interaction on coping skills valuable for managing test anxiety for college students have yet to be studied. Therefore, the purpose of this study was to evaluate the impact of short-term equine interaction on perceived stress and coping skills development during the college examination period. Full-time college students (n = 27; Males = 3, Females = 24) engaged in a 1-h equine interaction session held on campus at the onset of final exam week (Fall 2022). College equine facilities staff and faculty conducted the sessions which consisted of grooming, leading, and grazing. Participants were given at the equine facility a 14-question survey instrument within 5 minpre- and post- equine interaction. Survey was developed working with mental health professionals associated with campus counseling services with questions formatted to follow standard mental health questionnaires targeting personal perception of stress levels and life skills associated with coping with test anxiety. Data were analyzed using a 2-tailed t-test to determine the significance of self-reported measures pre- and post- equine interaction with significance set at P ≤ 0.05. Participants (67%) reported moderate to high levels of anxiety surrounding grades and upcoming examinations, and yet, perceived anxiety levels following equine interaction were significantly reduced (93% reporting none to very low stress levels; P < 0.001). Perceived improvements were reported by participants in the following coping skills after equine interaction: focus (P = 0.008), self-efficacy in goal pursuit (P = 0.006), patience (P = 0.017), and calmness (P < 0.001). These perceived acquired coping skills lend themselves well to academic success. These skills coupled with decreased perceived test anxiety suggest the potential of collegiate equine interaction programs may be of benefit to students during high stress periods within the academic year.

Social impact of environmental disasters: Evidence from Canary Islands volcanic eruption

Social commitment to the environment, ecological attitudes and sense of place are essential indicators for the development of public policies aimed at environmental sustainability. Natural disasters are major events that affect people's well-being and perception of their environment. The objective of this research was to test the effects and consequences of the eruption of the volcano on the Spanish island of La Palma on 502 participants during a 10-month follow up. Of the total sample, 281 were direct victims of the volcanic eruptions and 221 participants formed the control group. Multiple analyses of variance were applied with repeated measures and by distinguishing the victim group and the control group participants. Three quadratic functions were also fitted relating the time variable to the following indicators: ecological attitudes, sense of place and perceived anxiety levels. In addition, the degree of commitment to nature was measured. The results found that this natural disaster predicted reductions in pro-ecological attitudes with an overall weight of 30.8% (43.9% for the victim group only) and 26.3% (36.8% for the victim group only) in sense of place. On the other hand, when analyzing stress levels, the natural disaster was able to explain 21.2% overall (92.8% for the victim group only) of the increases. The quadratic functions indicated that reductions and increases tended to stabilize two months after the natural disaster. We discuss the theorizing implicit in these effects and the implications they have for the development of public policies for environmental sustainability.

Outcomes and experiences of an online Balance-Space music therapy intervention for cancer patients: A mixed methods study

Coping with cancer requires both physical and emotional fortitude, and various intervention programs attempt to address these needs. Since the outbreak of the COVID-19 pandemic, many interventions have transitioned from live to online settings. Balance-Space is a music therapy intervention, which includes listening to original composed music, followed by an open discussion. Participants with a cancer diagnosis were randomized to either an online group music listening intervention or an online group meditation intervention. Both activities were followed by a group discussion led by two music therapists. A mixed methods study was employed and included both quantitative measurements of distress, anxiety, and pain and a qualitative analysis of the group discussion in the music intervention group. We found a significant reduction in participants' perceived pain levels following the music intervention when compared to the meditation intervention. This result was supported by qualitative content analysis, which revealed how music evoked physical reactions and affected the participants' experience of pain. There were no significant differences in participants' perceived distress levels and perceived anxiety levels between the two groups. These preliminary results are encouraging and support the need for further exploration of online music therapy interventions as a non-pharmacological treatment for cancer patients.

Hair cortisol level as a molecular biomarker in retinitis pigmentosa patients

Retinitis pigmentosa (RP) patients commonly experience negative psychological states due to their progressive and unpredictable loss of vision and visual variations related to stress. The aim of this study was to examine hair cortisol concentrations (HCCs), which is usually associated with chronic stress, pretending to unveil possible associations between underlying psychological factors and disease severity in RP patients. Seventy-eight RP patients and 148 healthy controls were included in this study. A complete ophthalmological exam was performed in all patients to grade into severity disease groups. Perceived stress and trait-anxiety were measured by the State-Trait Anxiety Inventory (STAI) questionnaire. Fifty-two (67%) patients had severe RP and 26 (33%) mild-moderate RP. Fifty-eight (58,9%) patients reported severely levels of stress and 18 (23.,1%) highly levels assessed by STAI questionnaire. RP patients exhibited higher HCCs (500.04±120.99pg/mg) than in controls (136.17±60.51pg/mg; p<0.001). Severe RP patients had significant higher HCCs than mild-moderate patients differing in 274.27pg/mg (p<0.001). RP severity grade and perceived anxiety levels in the questionaries were not associated. Group differences were not affected by relevant covariates (age, grade of severity, stress status, and gender). HCC seems an effective biomarker associated with chronic stress in RP patients. This study shows that HCC in patients with RP are elevated compared to population-based controls, and association between HCC and RP severity was found. Future research is needed to characterize the effect of untreated negative psychological states on progression of the disease if any.

The Effectiveness of Virtual Reality on Anxiety and Performance in Female Soccer Players.

With the increased use of technology, relaxation interventions are finding their way into technology devices like virtual reality head-mounted displays (VR HMDs). However, there is a lack of evidence on the efficacy of VR relaxation interventions to reduce anxiety in athletes and how that is portrayed in their movement patterns. The purpose of the current study was to examine how a VR relaxation intervention affected perceived anxiety levels and penalty kick performance of female soccer players. Thirteen female soccer players took five penalty kicks in baseline, stress-induced, and VR relaxation conditions. Perceived levels of anxiety, self-confidence, mental effort, heart rate (HR), accelerometry of the lumbar spine and thigh, and performance in each condition was obtained. Results indicated that the VR intervention significantly reduced cognitive anxiety and somatic anxiety from baseline (p = 0.002; p = 0.001) and stress (p < 0.001; p < 0.001) with large effect sizes (Kendall’s W = 0.72; 0.83). VR significantly increased self-confidence from baseline (p = 0.002) and stress (p = 0.001) with a large effect size (Kendall’s W = 0.71). Additionally, all participants felt that VR helped them relax. Mental effort was significantly higher in the stress condition compared to that in baseline (p = 0.007) with moderate effect size (Kendall’s W = 0.39). Peak acceleration and performance were not significantly influenced by stress or VR. This study serves as an initial step to evaluate VR relaxation interventions on performance in female soccer players.

DIFFERENCES IN ANXIETY CONCERNING THE COVID-19 VIRUS AND COVID-19 VACCINE BETWEEN WOMEN UNDERGOING INFERTILITY TREATMENT AND THOSE NOT PURSUING TREATMENT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people. With the development and administration of the SARS-CoV-2 vaccines, there is growing evidence to suggest that there has been reduced transmission of the virus. However, the novelty of the vaccine has raised many questions for infertility patients due to the lack of research. This study examines the perceived anxiety level of patients at a fertility clinic in Manhattan who are undergoing infertility treatments, such as Timed Intercourse (TIC), Intrauterine Insemination (IUI), and In-Vitro Fertilization (IVF).

Effect of a behavioral intervention on anxiety and perceived performance of non-technical skills during surgical simulations

Surgical trainees experience intrinsic stress and anxiety during high-acuity clinical situations which can negatively impact performance. Emerging data suggests that education in mindfulness-based coping techniques may improve performance. We evaluated the effects of a stress recovery intervention on novice trainees' perceived level of anxiety during an intentionally stressful simulation. Participants were recruited from surgical intern classes over three consecutive years. All participants completed a simulation intentionally designed to evoke a stress response. Participants then completed a stress recovery intervention or received no additional training. All participants then completed a second novel simulation. Intervention participants had significantly higher self-reported ability to manage stress (intervention 2.4 to 3.6, p<0.01; control 2.8 to 3.3, p=0.06), and stop, think, and observe (intervention 2.5 to 3.7, p<0.01; control 2.6 to 3.3, p=0.08) during the second simulation. Both groups also had significantly lower levels of state anxiety during the second simulation as compared to the first (intervention 45.1 vs 59.3, p<0.01; control 49.3 vs 57.4, p<0.05). During the second simulation, trainees in both groups reported improvements in perceived abilities to: recognize stress (intervention 2.7 to 4.1, p<0.01; control 2.9 to 3.6, p<0.05), communicate with and lead their team (intervention 2.4 to 3.3, p<0.05; control 2.3 to 3.3, p<0.01), and to prioritize, plan, and prepare (intervention 2.1 to 3.1, p<0.05; control 2.1 to 3.0, p<0.01). Our research shows that a brief intervention was associated with a significant increase in trainee ability to both recognize internal stress and engage in proactive coping mechanisms. This research also shows that while repeated stress-inducing simulations may themselves decrease perceived anxiety levels in novice surgical trainees, training in coping strategies may potentiate this effect.

Changes in Pain Medicine Training Programs Associated With COVID-19: Survey Results.

The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis of unprecedented proportions that has altered the practice of medicine. The pandemic has required pain clinics to transition from in-person visits to telemedicine, postpone procedures, and cancel face-to-face educational sessions. There are no data on how fellowship programs have adapted. A 17-question survey was developed covering topics including changes in education, clinical care, and psychological stress due to the COVID pandemic. The initial survey was hosted by Qualtrics Inc and disseminated by the Association of Pain Program Directors on April 10, 2020, to program directors at Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowships. Results are reported descriptively and stratified by COVID infection rate, which was calculated from Centers for Disease Control and Prevention data on state infections, and census data. Among 107 surveys distributed, 70 (65%) programs responded. Twenty-nine programs were located in states in the upper tertile for per capita infection rates, 17 in the middle third, and 23 in the lowest tertile. Nearly all programs (93%) reported a decreased workload, with 11 (16%) reporting a dramatic decrease (only urgent or emergent cases). Just more than half of programs had either already deployed (14%) or credentialed (39%) fellows to provide nonpain care. Higher state infection rates were significantly associated with reduced clinical demand (Rs = 0.31, 95% confidence interval [CI], 0.08-0.51; P = .011) and redeployment of fellows to nonpain areas (Rs = 0.30, 95% CI, 0.07-0.50; P = .013). Larger program size but not infection rate was associated with increased perceived anxiety level of trainees. We found a shift to online alternatives for clinical care and education, with correlations between per capita infection rates, and clinical care demands and redeployment, but not with overall trainee anxiety levels. It is likely that medicine in general, and pain medicine in particular, will change after COVID-19, with greater emphasis on telemedicine, virtual education, and greater national and international cooperation. Physicians should be prepared for these changes.

Comparative Study of the Restorative Effects of Forest and Urban Videos during COVID-19 Lockdown: Intrinsic and Benchmark Values.

The prolonged lockdown imposed to contain the COrona VIrus Disease 19 COVID-19 pandemic prevented many people from direct contact with nature and greenspaces, raising alarms for a possible worsening of mental health. This study investigated the effectiveness of a simple and affordable remedy for improving psychological well-being, based on audio-visual stimuli brought by a short computer video showing forest environments, with an urban video as a control. Randomly selected participants were assigned the forest or urban video, to look at and listen to early in the morning, and questionnaires to fill out. In particular, the State-Trait Anxiety Inventory (STAI) Form Y collected in baseline condition and at the end of the study and the Part II of the Sheehan Patient Rated Anxiety Scale (SPRAS) collected every day immediately before and after watching the video. The virtual exposure to forest environments showed effective to reduce perceived anxiety levels in people forced by lockdown in limited spaces and environmental deprivation. Although significant, the effects were observed only in the short term, highlighting the limitation of the virtual experiences. The reported effects might also represent a benchmark to disentangle the determinants of health effects due to real forest experiences, for example, the inhalation of biogenic volatile organic compounds (BVOC).

Pure purr virtual reality technology: measuring heart rate variability and anxiety levels in healthy volunteers affected by moderate stress.

IntroductionTraditional approaches to stress management are difficult to learn and to implicate in daily life. Emerging technologies like virtual reality (VR) have become a target of extensive study for recreational and medical purposes. The autonomic nervous system (ANS) plays a crucial role in stress response, post-stress relaxation, and recovery. This study aimed to assess the effect of modified VR intervention on short-term heart rate variability (HRV) and perceived anxiety levels in healthy volunteers affected by moderate stress. The stressors included mental arithmetic tasks.Material and methodsThe study involved healthy adults, of both sexes, aged 20 to 60 years, without history of cardiovascular diseases, essential abnormalities on ECG, and with normal or moderate level of situational anxiety. The VR gadgets used in the study were commercially available Bobo-VR X1 headsets, one with modification for medical applications (Pure Purr technology) and one with none (sham technology). The investigational (Pure Purr) headset with an audio-visual sequence was modified by adding a binaural effect and was synchronised with the tract of respiratory movements and the frequency of heart rate. To track changes in the ANS, participants underwent both electrocardiography (ECG) and measurement of HRV.ResultsThe findings showed a significant increase in parasympathetic activity after 5-minute exposure to the investigational device compared to stress, as shown by high-frequency HRV (499.8 ms2 and 340.5 ms2, p < 0.001). RMSSD for a modified headset was higher (p = 0.02) compared to a sham headset with no modifications (RMSSD difference of 12.3% (2.6% to 23.1%)). The LF/HF ratio, however, was lower (difference of 14.5% (2.6% to 23.1%), p = 0.04).ConclusionsThese findings suggest that a medical device with pre-installed Pure Purr software had a significant effect on the recovery of the ANS in healthy volunteers affected by moderate stress.

Studying the effect of structured ostomy care training on quality of life and anxiety of patients with permanent ostomy.

Patients with ostomy are faced with several physical, psychological, and social challenges and need to be prepared to overcome these challenges. Studies have shown that training plays an important role in helping patients to adapt with ostomy, live with it, and improve their psychological well-being and quality of life (QOL). Therefore, the present study aimed to determine the effect of structured ostomy care training on QOL and anxiety of the patients with permanent ostomy. In this randomised clinical trial study, 60 eligible participants were recruited from the only ostomy clinic in Kerman, Iran. They were selected using a purposive sampling method and randomly assigned to either a control group that received routine ostomy care or an intervention group that attended oral and practical training and a question and answer session by a trained ostomy nurse and received an ostomy information booklet besides their routine care. Outcome variables were anxiety and QOL in general and its physical, mental, social, and spiritual dimensions in detail. By using the anxiety subscale of Hospital Anxiety and Depression Scale (HADS) and City of Hope-quality of life [COH-QOL], data were collected before and 2 months after intervention in both groups. Data were analysed by SPSS version 19 using χ², analysis of variance (ANOVA), independent t, and paired t test and multiple regression analysis. The results showed that the intervention group had significantly lower mean scores in anxiety (P = .001) and a higher mean score in overall QOL (P = .009) compared with the control group. The most significant increase was observed for psychological, social, and physical aspects, and the least was in the spiritual aspect, all of which improved after intervention. After controlling the effects of confounding variables such as age, ostomy period, and number of children, the structured training programme still had a positive effect on QOL. Structured ostomy care training, including face-to-face education and personal practice of using ostomy equipment, along with written material provided by the ostomy nurse specialist, may lead to an increase in the overall QOL and a decrease in the perceived anxiety level in patients. This type of training is not routinely delivered to ostomy patients in our health care setting, so it is feasible to prepare surgical wards and to educate nurses to work with their patients before and after ostomy creation. Furthermore, to ease patients' religious concerns, we recommend counselling, and the support of religious leaders in the Muslim community may play a key role to adaptation regarding religious matters after ostomy surgeries and alleviate patients' concerns.

Delivery in patients with dyspareunia—A prospective study

Despite the high prevalence of dyspareunia, published data focused on childbirth is scarce. This study aimed to evaluate the prevalence of dyspareunia in a random primiparae parturient population, characterize their features, and describe associated perinatal outcomes. In this prospective observational study we approached primiparous women admitted to our labor ward. Women were asked to complete an interview, based on self-report of dyspareunia symptoms. Obstetrical outcomes were obtained and compared between women with (exposed) and without (controls) dyspareunia. Midwives completed a questionnaire regarding patients' cooperation, pain level, pelvic floor hypertonicity, difficulty with vaginal examinations and perceived anxiety level. One hundred seventy-three women completed a detailed questionnaire querying dyspareunia symptoms. Of them, 41.6% (n = 72) reported a certain degree of dyspareunia. Exposed women did not differ in demographic or clinical characteristics as compared to controls. Of the exposed group, 40.3% reported primary dyspareunia, 25.4% secondary dyspareunia, and 34.3% could not recall its beginning. Only 34.3% had consulted a practitioner regarding this problem. Rates of vaginal deliveries, vacuum deliveries, and cesarean deliveries were comparable (p = 0.845). There were no differences between the two groups in rates of analgesia usage, epidural anesthesia, episiotomy, and second stage duration. However, the severity of dyspareunia correlated with the incidence of perineal tears (66.7% in patients with severe dyspareunia, and 41.1% in controls, p = 0.011). Logistic regression analysis revealed that dyspareunia was independently associated with perineal tears (p = 0.029). Higher rates of anxiety and pelvic floor hypertonicity were reported in patients reporting severe dyspareunia (≥3/10 times). Dyspareunia is common among primiparous women, and these patients are more likely to suffer perineal tears and anxiety during delivery.