Margrethe Vika

Fear of blood, injury, and injections, and its relationship to dental anxiety and probability of avoiding dental treatment among 18‐year‐olds in Norway

BACKGROUND More knowledge about the relationship between blood-injury-injection phobia (BIIP) and dental anxiety (DA) may give new clinically relevant information in the assessment and management of children with DA. OBJECTIVE The aims of this study were to explore the relationships between BIIP and DA, and to explore to what extent the two subtypes of BIIP in combination with DA are related to self-reported probability of avoiding dental treatment if a dental injection is needed. METHODS The subjects were a random sample of 1385 18-year-olds attending high schools in a county of Norway, and the data were collected by use of questionnaires completed in classrooms. The survey instruments applied were Dental Fear Survey, Injection Phobia Scale-Anxiety, and Mutilation Questionnaire. RESULTS About 11% of the subjects with DA and subtypes of BIIP, respectively, reported high probability of avoiding dental treatment in a situation where a dental injection was possibly needed. In multiple regression analysis, only DA contributed to self-reports of high probability of avoiding dental treatment. CONCLUSION The results indicate that among adolescents, BIIP is relatively often connected with DA. Clinical implications are discussed.

One‐ vs. five‐session treatment of intra‐oral injection phobia: a randomized clinical study

The present study aimed to evaluate the effect of one and five sessions of treatment for intra-oral injection phobia in 55 subjects fulfilling the DSM-IV criteria for specific phobia. The subjects were randomly assigned to one or five sessions of cognitive behavioural therapy (CBT) performed by dentists. Assessments included behavioural tests and self-report instruments used pretreatment, post-treatment, and at 1 yr of follow-up. The dental anxiety scale (DAS), the injection phobia scale-anxiety, and the mutilation questionnaires were applied. Mean avoidance duration of intra-oral injections before treatment was 7.0 yr. The results showed that 89% of the subjects had received intra-oral injections from a regular dentist during the 1-yr follow-up. The only significant difference between the one- and the five-session groups was that the five-session group reported less anxiety (as measured using the DAS) at 1 yr of follow-up. It was concluded that both treatments performed by dentists specially trained in CBT have a significant treatment effect on the intra-oral injection phobia.

Fatigue and quality of life in women treated for various types of gynaecological cancers: a cross-sectional study

Aims and objectives To examine the prevalence of cancer-related fatigue in women treated for various types of gynaecological cancers and, for these cancers, to assess fatigue in relation to distress, health-related quality of life, demography and treatment characteristics. Background Advances in treatment of cancer have improved the likelihood of survival. Consequently, there are a growing number of patients who become survivors after cancer and who face side effects even years after treatment. One of the most frequently reported side effects across all types and stages of the disease is cancer-related fatigue. Design A descriptive cross-sectional study. Methods One hundred and twenty women treated for gynaecological cancers who were participants in an intervention study were included. Fatigue, psychological distress, health-related QoL and demographics were assessed by questionnaires. Disease and treatment characteristics were extracted from medical records. Results Cancer-related fatigue was reported in 53% of the women treated for gynaecological cancers, with a higher proportion in the group of cervical cancer, followed by ovarian cancer. Younger participants reported fatigue more frequently than older participants. When adjusting for age, the type of cancer a woman experiences was shown to have little impact on her risk of experiencing fatigue. The participants with fatigue reported higher levels of anxiety and depression than participants without fatigue. There was a relationship between fatigue and quality of life as measured by SF-36 domains. Conclusion The findings underscore the importance of screening for fatigue, patient education and symptom management. This should be included in a standard procedure during treatment and follow-up. Both somatic and psychological aspects of fatigue should be emphasised. Relevance to clinical practice The findings imply the need for health personnel to have focus on fatigue during the entire cancer trajectory of women after gynaecological cancers, as well as the need for screening, information, guidance and symptom management.

Sexual activity and functioning in women treated for gynaecological cancers

AIMS AND OBJECTIVES A description and comparison of sexual activity and function in relation to various gynaecological cancer diagnoses, treatment modalities, age groups, psychological distress and health-related quality of life. BACKGROUND Various forms of gynaecological cancer have the potential to negatively influence sexual functioning, but there are few studies that describe and compare sexual activity and functioning according to diagnosis. DESIGN A descriptive cross-sectional study. METHODS The study includes 129 women from an intervention study. The questionnaires addressed sexuality, psychological distress, health-related quality of life and demographics. Disease and treatment characteristics were extracted from medical records. RESULTS Close to two-thirds of the women were sexually active. However, 54% of the sexually active women reported that they were not satisfied or little satisfied with their sexual activity. About half of the women reported dryness in the vagina, and 41% reported pain and discomfort during penetration. There were no significant differences concerning pleasure and discomfort related to treatment modality, diagnoses or FIGO stage. CONCLUSION Health personnel should make a priority of sexuality throughout a patients cancer treatment and in the follow-up, as sexuality is a vital part of a good life. RELEVANCE TO CLINICAL PRACTICE Since the patients experience relatively low satisfaction with their sexual activity and many report pain during penetration, health personnel need to be sensitive to the woman, her questions, and her needs. Of importance are also the personnels ability to communicate and their expertise in diagnosing and treating difficulties relating to sexuality.

Treatment of intra-oral injection phobia: a randomized delayed intervention controlled trial among Norwegian 10- to 16-year-olds

Abstract Objective: To evaluate the effect of five sessions of cognitive behavioural therapy (CBT) for 10- to 16-year-olds with intra-oral injection phobia. Material and methods: This was a randomized delayed intervention controlled trial in 67 patients, fulfilling the DSM-5 criteria for specific phobia. All patients received the same CBT performed by dentists specially trained in CBT. The patients were randomly assigned to either an immediate treatment group (ITG) (34 patients) or a waitlist-control group (WCG) (33 patients). The WCG was put on a waitlist for 5 weeks. After treatment, all patients were combined for post-treatment analyses. Assessments including the psychometric self-report scales Intra-oral injection fear scale (IOIF-s), Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS), Injection Phobia Scale for children (IS-c) and Mutilation Questionnaire for children (MQ-c) and a behavioural avoidance test (BAT) followed by a questionnaire on cognitions during the BAT, occurred pre-, post-treatment/waitlist and at a 1-year follow-up. Results: CBT had a significant effect compared to no treatment (WCG). After treatment, the scores on the psychometric self-report scales were significantly reduced and higher levels in the BAT were achieved. The results were maintained at 1-year follow-up. Of the 67 patients, 70.1% received intra-oral injections during CBT treatment, whereas 69.4% of those completing the CBT, in need for further dental treatment, managed to receive the necessary intra-oral injections at their regular dentist. Conclusions: The 10- to 16-year-olds diagnosed with intra-oral injection phobia benefitted positively on CBT performed by specially trained dentists.

High fear of intra‐oral injections: prevalence and relationship to dental fear and dental avoidance among 10‐ to 16‐yr‐old children

The present study aimed to: (i) estimate the prevalence of self-reported high fear of intra-oral injections, high blood-injury fear, and injection fear; (ii) explore the overlap between high fear of intra-oral injections and high fear of dental treatment; and (iii) evaluate the possible consequence of high fear of intra-oral injections in terms of avoidance of dental care. The sample included 1,441 subjects, 10- to 16-yr of age, attending elementary schools in a county of Norway. Data were collected using questionnaires that were completed in classrooms. The survey instruments used were the Intra-Oral Injection Fear-scale, the Childrens Fear Survey Schedule-Dental Subscale, the Injection Phobia scale for children, and the Mutilation Questionnaire for children. In total, 13.9% of the children reported high intra-oral injection fear. A strong association was found between fear of intra-oral injections and dental fear. When an intra-oral injection was needed, 10.6% would avoid dental treatment. In multiple regression analysis, high intra-oral injection fear was found to be associated with avoidance of dental treatment (OR = 6.52; 95% CI: 3.99-10.67). It was concluded that high fear of intra-oral injections was prevalent and might lead to avoidance of necessary dental treatment. Hence, intra-oral injection fear should be addressed before treatment of dental fear.

Undervisning og veiledning i gruppe for kvinner behandlet for underlivskreft. En hjelp i rehabiliteringen

Aim: The aim of the article is to describe a nurse-led intervention and to evaluate to what extent it is helpful for the participants in their follow-up after treatment for gynecological cancer. Background: Women beyond gynecological cancer have several needs that the routine follow-ups do not adequately fulfill. Studies show that follow-ups with a more holistic approach are most advantageous. Methods: The standardized intervention, with theoretical basis in Antonovskys salutogenetic thinking and Rogers client centered therapy, is described. A self-reported process evaluation form was answered by 34 (out of 45) women who participated in the group intervention. Findings: Women were satisfied with the group intervention, which seemed to meet the need for knowledge and information on various current topics related to life after cancer. Sharing experiences with one another and being in dialogue with experts and mentors who recognized the women, addressed their uncertainty and gave answers to their questions, was important for the outcome of the intervention. Conclusion: The nurse-led intervention seems to be useful for women treated for gynecological cancer. The intervention can be one important contribution to improve follow-up after cancer treatment, and thus to the womens coping resources and rehabilitation process.