Heather Buchanan

A systematic review of psychosocial factors associated with emotional adjustment in in vitro fertilization patients

BACKGROUND IVF treatment is usually stressful for patients, but individual differences in emotional response do exist. Differences in the stress response may be related to reproductive outcomes as well as to the development of psychiatric problems. This review collates research exploring which psychosocial factors (e.g. personality traits and coping strategies) are associated with the emotional adjustment of IVF patients. The aim is to reveal what is currently known about risk and protective factors for coping with the stress of IVF treatment and where further enquiry would be most beneficial. METHODS The databases, MEDLINE/PUBMED (US National Library of Medicine), PsycINFO (American Psychological Association), Web of Science (Social Sciences Citation Index) and EMbase, were searched from 1978 to September 2012 using relevant key words. All published peer-reviewed studies exploring associations between psychosocial factors and emotional adjustment outcomes were considered for inclusion. RESULTS There were 23 studies identified for review. One-third of the psychosocial factors explored were found to be significantly related to emotional adjustment outcome measures. Neuroticism and the use of escapist coping strategies were positively associated with distress by multiple studies. Social support was negatively associated with distress by several studies. A number of other psychosocial variables appear to be associated with distress, including self-criticism, dependency, situation appraisals and attachment style, but these have only been explored by one or two studies at most. There is a paucity of research using positive emotional outcome measures (e.g. well-being, positive affect, happiness or life satisfaction) to quantify emotional adjustment. CONCLUSIONS Whilst some psychosocial variables appear to be consistently associated with distress for IVF patients, two-thirds of the variables tested to date do not appear to be associated with emotional adjustment. This review highlights key psychosocial factors to assist the identification of patients at high risk of psychological distress. These findings highlight at least two psychological factors that may be amenable to alteration with psychological or educational interventions. Future work should explore whether experimental manipulation of such psychosocial factors can provide effective stress reduction in this clinical context.

The Huntington’s Disease quality of life battery for carers: reliability and validity

Research into the experience of the Huntington Disease (HD) spousal carer has established that carers experience several unique obstacles within their care‐giving role. However, there is still a need to establish methodically the factors that impact on the HD spousal carers’ situation and ultimately their quality of life. The aim of this pilot study, which was a result of three previous exploratory studies, was to validate a HD‐specific quality‐of‐life (QoL) measure, the Huntington disease quality‐of‐life battery for carers (HDQoL‐C) for use (initially) with spousal carers of HD patients. Eighty‐seven HD spousal carers took part in the piloting of the HDQoL‐C to assess its reliability and validity as a tool for use within QoL research. Results established the HDQoL‐C as a multidimensional and psychometrically sound disease‐specific and subjective QoL assessment tool that incorporates the individual’s physical health, psychological state, level of independence, social relationships and personal beliefs. The HDQoL‐C demonstrates good internal consistency, test–re‐test reliability and congruent validity.

Self-efficacy and Oral Hygiene Beliefs about Toothbrushing in Dental Patients: A Model-guided Study

Building on previous research on psychosocial variables associated with oral hygiene behavior, this study examined the ability of Health Belief Model variables (perceived benefits, barriers, susceptibility, severity) and self-efficacy beliefs about toothbrushing to inform prevalence of dental caries and toothbrushing frequency. To accomplish this goal, a sample of 125 dental patients completed self-report questionnaires and provided data on demographic and behavioral factors. A path analysis model with manifest variables was tested. Oral hygiene beliefs emerged as a multidimensional construct. Results suggested that stronger self-efficacy beliefs (β = .81) and greater perceived severity of oral diseases (β = .18) were related to increased toothbrushing frequency, which in turn was associated with better oral health status, as indicated by the total number of decayed, missing, and filled teeth due to dental caries (β = –.39). Possible strategies for improving oral health are discussed.

Development of a computerised dental anxiety scale for children: validation and reliability.

Objective To provide reliability and validity data on a computerised dental anxiety scale (the Smiley Faces Program or SFP) for children using faces as a response set.Setting Five schools across Derby, Newcastle-upon-Tyne and Shropshire.Subjects and method The SFP was completed by 464 children (mean age 10.8 years). For validity purposes, 241 children also completed two other childrens dental anxiety measures (the Modified Child Dental Anxiety Scale and the Dental Fear Survey). For test-retest purposes 100 of the children completed the SFP two weeks later.Results The SFP demonstrated good internal consistency (α = 0.8), test-retest reliability was good and significant correlations were found between the SFP and the other measures. The children rated the local anaesthetic and drill as the most anxiety-provoking items.Conclusion This study suggests that the SFP is a valid and reliable measure for assessing childrens trait dental anxiety and may help encourage dentists to formally assess dental anxiety.

Preparatory information for third molar extraction: does preference for information and behavioral involvement matter?

OBJECTIVE The objectives of the present study were to: (1) evaluate the impact of high versus low information provision in terms of anxiety towards third molar extraction (TME) as well as satisfaction with information provision. (2) Investigate how preference for information and behavioral involvement, interacted with the provision of information in terms of satisfaction with information and anxiety related to TME. METHODS Psychology freshmen completed the Krantz Health Opinion Survey and questions concerning anxiety about TME (pretest). They were randomly allocated into 2 conditions and asked to read either high or low information concerning TME. A posttest questionnaire (anxiety items and evaluation of the information) was then completed. RESULTS Data for 320 subjects were analysed (mean age=20.3, S.D.=4.0, range 16-51 years). Individual differences in preference for information did not affect outcome variables. There was a clear effect for information condition. The high information text was rated as more informative, requiring less additional information, and led to higher satisfaction by all participants. CONCLUSION Results suggest that more information is preferred, even when taking into account differences in preference for information and behavioral involvement. PRACTICE IMPLICATIONS Although more work is needed within samples of actual TME patients, these preliminary findings may have important implications for information provision for this common procedure.

Assessing dental anxiety in children: the Revised Smiley Faces Program.

Despite advances in local anaesthetic and treatment techniques, child dental anxiety still poses a significant problem for the child, parent(s) and dentist. Furthermore, the effects of this anxiety can persist into adulthood, which can often lead to avoiding the dentist (Skaret et al. 2000) and the subsequent deterioration of oral health (Hakeberg et al. 1993). It is necessary therefore to identify and quantify this anxiety, in order to implement and monitor the effect of treatment interventions. Inevitably, assessing dental anxiety in children is more complex than assessing anxiety in adults. Therefore, the assessment measure should be child-centred, quick and easy to use as well as reliable and valid (Freeman 2005).

Developments in making patients’ orthodontic choices better

Context Orthodontics is an unusual speciality as out‐patient treatment requires patients to attend services regularly for two to three years. Contact with services is even longer for some patients referred as children, with their parent or carer, and ultimately finishing treatment as autonomous adults. Treatment success is highly dependent on patient co‐operation. It is vital for patients to have as good an understanding as possible of what treatment entails, and whether or not it aligns with their expectations, before and during treatment. Method This article reviews evidence of the effectiveness of orthodontic information to enable patient involvement in treatment regimens. It critiques the current provision of information with reference to research from the decision and behaviour sciences about how people make sense of information when making treatment decisions. Findings Orthodontists provide a lot of verbal and written information about the ‘facts’ of treatment. This type of information is unlikely to facilitate patients’ decisions about, or adherence with, treatments. There is a paucity of evidence describing how: (1) patients make sense of orthodontic problems and treatments, (2) parents manage decision making about their childs treatment, and (3) variation in information needs across the lifespan and treatment experience. Practice implications We identified a set of questions to help service providers think critically about the effectiveness of their information provision. Further empirical research is needed to provide evidence to ensure the information included within orthodontic leaflets is relevant to patients and can be assimilated into their existing representations of the problem and treatment.

How to screen for non-adherence to antihypertensive therapy

The quality of assessment of non-adherence to treatment in hypertensive is poor. Within this review, we discuss the different methods used to assess adherence to blood-pressure-lowering medications in hypertension patients. Subjective reports such as physicians’ perceptions are inaccurate, and questionnaires completed by patients tend to overreport adherence and show a low diagnostic specificity. Indirect objective methods such as pharmacy database records can be useful, but they are limited by the robustness of the recorded data. Electronic medication monitoring devices are accurate but usually track adherence to only a single medication and can be expensive. Overall, the fundamental issue with indirect objective measures is that they do not fully confirm ingestion of antihypertensive medications. Detection of antihypertensive medications in body fluids using liquid chromatography–tandem mass spectrometry is currently, in our view, the most robust and clinically useful method to assess non-adherence to blood-pressure-lowering treatment. It is particularly helpful in patients presenting with resistant, refractory or uncontrolled hypertension despite the optimal therapy. We recommend using this diagnostic strategy to detect non-adherence alongside a no-blame approach tailoring support to address the perceptions (e.g. beliefs about the illness and treatment) and practicalities (e.g. capability and resources) influencing motivation and ability to adhere.

Effects of social gaze on visual-spatial imagination

Previous research suggests that closing one’s eyes or averting one’s gaze from another person can benefit visual-spatial imagination by interrupting cognitive demands associated with face-to-face interaction (Markson and Paterson, 2009). The present study further investigated this influence of social gaze on adults’ visual-spatial imagination, using the matrix task (Kerr, 1987, 1993). Participants mentally kept track of a pathway through an imaginary 2-dimensional (2D) or 3-dimensional (3D) matrix. Concurrent with this task, participants either kept their eyes closed or maintained eye contact with another person, mutual gaze with a person whose eyes were obscured (by wearing dark glasses), or unreciprocated gaze toward the face of a person whose own gaze was averted or whose face was occluded (by placing a paper bag over her head). Performance on the 2D task was poorest in the eye contact condition, and did not differ between the other gaze conditions, which produced ceiling performance. However, the more difficult 3D task revealed clear effects of social gaze. Performance on the 3D task was poorest for eye contact, better for mutual gaze, and equally better still for the unreciprocated gaze and eye-closure conditions. The findings reveal the especially disruptive influence of eye contact on concurrent visual-spatial imagination and a benefit for cognitively demanding tasks of disengaging eye contact during face-to-face interaction.

An exploratory study investigating children's perceptions of dental behavioural management techniques.

BACKGROUND Behaviour management techniques (BMTs) are utilised by dentists to aid childrens dental anxiety (DA). Childrens perceptions of these have been underexplored, and their feedback could help inform paediatric dentistry. AIM To explore childrens acceptability and perceptions of dental communication and BMTs and to compare these by age, gender, and DA. DESIGN A total of sixty-two 9- to 11-year-old school children participated in the study. Childrens acceptability of BMTs was quantified using a newly developed Likert scale, alongside exploration of childrens experiences and perceptions through interviews. anova and t-tests explored BMT acceptability ratings by age, gender, and DA. Thematic analysis was used to analyse interviews. FINDINGS Statistical analyses showed no effect of age, gender, or DA upon BMT acceptability. Children generally perceived the BMTs as acceptable or neutral; stop signals were the most acceptable, and voice control the least acceptable BMT. Beneficial experiences of distraction and positive reinforcement were common. Children described the positive nature of their dentists communication and BMT utilisation. CONCLUSION Dental anxiety did not affect childrens perceptions of BMTs. Children were generally positive about dentists communication and established BMTs. Childrens coping styles may impact perceptions and effectiveness of BMTs and should be explored in future investigations.