A parent-led intervention to reduce anxiety in autistic children with a severe to profound intellectual disability: protocol for the LADDERS pilot feasibility trial

Background There is a need for evidence-based approaches to reduce anxiety experienced by autistic children with severe to profound intellectual disability (ID). Avoidance of anxiety triggers, as a response to pronounced anxiety, occurs irrespective of age, background and neurodiversity. When avoidance is unhelpful, evidence-based anxiety reduction approaches aim to reduce it gradually (graded exposure), subsequently reducing anxiety. Combining graded exposure with emotional regulation techniques may be effective and acceptable for autistic children with severe to profound ID, if sensitive to needs and characteristics of autistic children. We have developed a 16-week, parent-led intervention (LADDERS) to reduce anxiety in this population of autistic children. LADDERS consists of psychoeducation, graded exposure-based tasks, and skills building, delivered utilising a person-centred approach. This study aims to assess whether LADDERS 1) reduces anxiety and 2) whether autistic children and parents find it acceptable and feasible. Method A single-site, multiple baseline, single case experimental study will be conducted. Participants will be parents of autistic children aged between 4-15 years. A minimum of 8 participants will be recruited through a research participant database, the Autistica Discover Network and social media. Once eligibility is confirmed, participants will be assessed at baseline, during the intervention and at a 2-month follow-up (week 24). The primary outcome measure will be a daily diary that assesses child anxiety. Discussion The study will provide preliminary evidence of whether LADDERS reduces anxiety in autistic children with severe to profound ID. Qualitative data from parents and child engagement will provide data on acceptability and feasibility.

Functional Changes in Brain Activity Using Hypnosis: A Systematic Review

Hypnosis has proven a powerful method in indications such as pain control and anxiety reduction. As recently discussed, it has been yielding increased attention from medical/dental perspectives. This systematic review (PROSPERO-registration-ID-CRD42021259187) aimed to critically evaluate and discuss functional changes in brain activity using hypnosis by means of different imaging techniques. Randomized controlled trials, cohort, comparative, cross-sectional, evaluation and validation studies from three databases—Cochrane, Embase and Medline via PubMed from January 1979 to August 2021—were reviewed using an ad hoc prepared search string and following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. A total of 10404 articles were identified, 1194 duplicates were removed and 9190 papers were discarded after consulting article titles/abstracts. Ultimately, 20 papers were assessed for eligibility, and 20 papers were included after a hand search (ntotal = 40). Despite a broad heterogenicity of included studies, evidence of functional changes in brain activity using hypnosis was identified. Electromyography (EMG) startle amplitudes result in greater activity in the frontal brain area; amplitudes using Somatosensory Event-Related Potentials (SERPs) showed similar results. Electroencephalography (EEG) oscillations of θ activity are positively associated with response to hypnosis. EEG results showed greater amplitudes for highly hypnotizable subjects over the left hemisphere. Less activity during hypnosis was observed in the insula and anterior cingulate cortex (ACC).

Is music listening an effective intervention for reducing anxiety? A systematic review and meta-analysis of controlled studies

Anxiety is the most commonly diagnosed mental health disorder in the EU and 18% of the US population experiences an anxiety disorder at any one time. However, only 20% of individuals experiencing anxiety receive a formally administered intervention, highlighting a need for evidence-based interventions that can be self-administered. Music listening can be flexibly self-administered and may be useful for anxiety reduction, but further evidence is needed. The current paper addressed this by conducting the first systematic review and meta-analysis of controlled studies testing music listening interventions for naturally occurring state anxiety. A protocol was registered on PROSPERO ID: CRD42018104308. Searches were carried out of the Cochrane Library, Ovid MEDLINE, PsycINFO, Embase, Web of Science and CINAHL databases, yielding 6208 records. After screening for eligibility, 24 controlled studies were included in the review and 21 were included in the meta-analysis. Results of the meta-analyses showed that music listening had an overall significant large effect on alleviating anxiety ( d = −0.77 [95% CI = −1.26, −0.28], k = 21). It was concluded that music listening is effective for reducing anxiety in a range of groups. Further research should focus on clinical groups with diagnosed mental health problems.

Effects of exercise-based prehabilitation in children undergoing elective surgeries: a systematic review

Background: Prehabilitation is a therapeutic strategy involving preoperative physical exercises, nutritional support, and stress and anxiety reduction. This approach has been gaining popularity and has been seeing effective results in adults in terms of improving pre and postoperative outcomes. The purpose of this review was to summarise the evidence about the effects of exercise-based prehabilitation programs on various outcome measures in children post elective surgeries.­­ Methods: PubMed, Scopus, Web of Science, PEDro, CINAHL/EBSCO and EMBASE electronic databases were searched from inception to June 2021. Based on the inclusion criteria, titles and abstracts were independently screened by the authors. After that, a data extraction table of the selected studies which included the participants, type, and details of exercise intervention, outcome measures and results were analysed after which the quality assessment of the studies was done. Results: The search yielded 2219 articles of which three articles fulfilled the inclusion criteria with two studies being randomized controlled trials and one being a quasi-experimental pre-post type of study. One randomized controlled trial was on the effects of exercise-based prehabilitation in reducing pulmonary complications post cardiac surgeries in children and the other two studies were on the effects of prehabilitation on functional capacity & pulmonary function. All the three articles found that exercise-based prehabilitation had a positive effect on children’s post-surgery. Conclusion: Although there is a paucity of evidence-based literature, we conclude based on the existing literature retrieved by our review that exercise-based prehabilitation improves postoperative outcomes and helps in reducing postoperative complications in children undergoing various surgeries.

Do Games Reduce Math Anxiety? A meta-analysis.

In this paper, we meta-analyse the empirical evidence about the effectiveness of game-based interventions to reduce students' level of math anxiety. After performing a search for randomised controlled studies relevant to game-based intervention for math anxiety, 16 experimental studies with a total of 686 participants described in 11 peer-review articles met the selection criteria.A random-effects meta-analysis indicated a small and non-significant reduction of math anxiety (mean effect size ES=-0.32, CI=[-0.64,0.01]). The results were moderated by several factors: non-digital games were more effective, while digital games had a negligible mean effect size of $ES=-0.13$, $CI=[-0.33,0.08]$. The effect size was moderated also by the total duration of the intervention, to the advantage of longer interventions, and by the type of gameplay: games had a greater effect on math anxiety reduction when they promoted collaborative and social interactions. Such features were only present in non-digital games, while all the digital games analysed were single-player. In the final section of the paper, we discuss future possible research directions. The weak results obtained indicated the need to develop and test games explicitly designed for math anxious students. This will require the investigation of the relationship between game features and math anxiety through the analysis of the behaviour of anxious and non-anxious students at play. Among the features that an anxiety-aware game could employ, we suggest collaborative gameplay, social interactions, adaptability, features promoting intrinsic motivation and real-time measurements of math anxiety.

Psychometric Properties of Scared-C Scale in a Romanian Community Sample and Its Future Utility for Dental Practice

The psychological management of children and adolescents in need of pedodontics or orthodontic treatments continues to be an essential objective in dental activity because along with the accuracy of the techniques that are used, anxiety reduction, and knowledge of how to approach the patient are necessary for the treatment to be successful. Therefore, our study aimed to validate the Screen for Child Anxiety Related Emotional Disorders questionnaire, the child version of 41 items (SCARED-C) in the Romanian population for later use in pediatric dentistry. The instrument showed moderate to good internal consistency (α Cronbach from 0.63 to 0.91 for the total scale) and good test–retest reliability (0.70) on a subset of a sample comprising 85 children. A confirmatory factorial analysis (CFA) was conducted to test the factor structure of the Romanian version of the SCARED-C; the results showed that SCARED-C has good psychometric properties that can be used for screening anxiety in Romanian children and adolescents. The implications of using the SCARED-C in dental practice are discussed. Future studies need to be conducted to explore the convergent and discriminative validity of the instrument and its sensitivity to current DSM-V criteria. Application on a pediatric dental sample is also required.

Skilful Surfing Online for Anxiety Reduction (SO-FAR) in Pregnancy

The development of the Skilful surfing Online For Anxiety Reduction (SO-FAR) in pregnancy (SO-FAR) mental health (mHealth) application (app) was supported by previous research which modelled the theory of Skilful Surfing. The model informed the app development, with each facet of the model corresponding to a different intervention included in the app. The aim of this chapter was to report the development of an mHealth app to relieve pregnancy-specific health anxiety. App content inclusion was based on previous literature and recommendations for mHealth app inclusions. Overall, the chapter provides the reader with a comprehensive account of the development of the SO-FAR app which may reduce levels of pregnancy-specific HA by encouraging women to become more adept when navigating through online health information, self-aware, and educated and promoting the ability to identify triggers and understand when and why they are experiencing maladaptive cognition and rumination in a self-guided manner.

Intervensi Keperawatan pada Pasien Terkonfirmasi COVID-19 dengan Komorbid DM Tipe 2 dan Hipertensi: Studi Kasus

Comorbidities in COVID-19 patients with the highest percentage are hypertension and diabetes mellitus. Patients with comorbid hypertension and DM have high morbidity and mortality. This study aims to determine the interventions in COVID-19 patients with comorbid DM and hypertension. The method used is a case study with data collection through patient and family interviews, medical record studies and direct observation or through CCTV. The studies showed that the patient was diagnosed with severe COVID-19 by oxygen therapy (NRM 15 L/min), treating COVID-19 and managing comorbid hypertension and DM with medication and monitoring and reducing anxiety. During treatment, the patient was desaturated, blood pressure and blood sugar level had not been controlled, and the anxiety was quite high. It can be said that interventions that can be given to COVID-19 patients with comorbid hypertension and DM are oxygen therapy, medication, anxiety reduction, and comorbid management. Comorbid hypertension and DM were controlled with medication and regular monitoring. the patient's blood pressure and blood sugar level had not been controlled, it is possible that the patient's anxiety is still experienced. So that as health workers in providing care are expected to pay attention to the biopsychosociospiritual aspects so that the patient's problems are resolved.

SMART: Stress Management and Resilience Training for emergency physicians. Protocol for a pilot study with intervention. (Preprint)

UNSTRUCTURED Background In recent years, the factors of stress, anxiety and work-life balance received more attention. More specifically, the determinants of professional well-being, impact of occupational risks and traumatic events, stress and type D personality, and work stress related problems in physicians in COVID-19 Times were addressed in physicians and more specifically in emergency physicians. The primary aim of this study is to evaluate the effectiveness of a Stress Management and Resiliency Training (SMART) program on stress, anxiety and resilience as well as the professional quality of life of hospital physicians and in particular emergency physicians. Methods This is a pre-post intervention study, pilot study with intervention. Setup / Participants: The participants (hospital physicians/emergency physicians) are recruited through internal and external networks such as the specialist medicine trainees and social media of the own professional group of physicians and physician specialists in training. A combination of several validated interventional and coping strategies will be used to achieve an improvement of personal factors such as stress reduction, anxiety reduction, resilience, quality of professional life of the hospital physicians/emergency physicians. This study also measures additional data such as heart rate variability and physical activity based on the number of daily steps. Discussion Some aspects of this intervention study have already been initiated in previous studies, whereby we aim to achieve even more efficient and structural improvement with a combination of various validated methodologies and coping strategies to address these factors (stress reduction, anxiety reduction, resilience increase, quality of life increase) of hospital/emergency physicians. The abovementioned study will also include process measures such as heart rate variability and physical activity based on the number of daily steps. With this she responds to new trends in chronic stress research. Further studies should be undertaken to confirm the results of this study to identify determinants that can be the object of adequate interventions to improve professional well-being in these physicians.

Effects of exercise-based prehabilitation in children undergoing elective surgeries: a systematic review

Background: Prehabilitation is a therapeutic strategy involving preoperative physical exercises, nutritional support, and stress and anxiety reduction. This approach has been gaining popularity and has been seeing effective results in adults in terms of improving pre and postoperative outcomes. The purpose of this review was to summarise the evidence about the effects of exercise-based prehabilitation programs on various outcome measures in children post elective surgeries.­­ Methods: PubMed, Scopus, Web of Science, PEDro, CINAHL/EBSCO and EMBASE electronic databases were searched from inception to June 2021. Based on the inclusion criteria, titles and abstracts were independently screened by the authors. After that, a data extraction table of the selected studies which included the participants, type, and details of exercise intervention, outcome measures and results were analysed after which the quality assessment of the studies was done. Results: The search yielded 2219 articles of which three articles fulfilled the inclusion criteria with two studies being randomized controlled trials and one being a quasi-experimental pre-post type of study. One randomized controlled trial was on the effects of exercise-based prehabilitation in reducing pulmonary complications post cardiac surgeries in children and the other two studies were on the effects of prehabilitation on functional capacity & pulmonary function. All the three articles found that exercise-based prehabilitation had a positive effect on children’s post-surgery. Conclusion: Although there is a paucity of evidence-based literature, we conclude based on the existing literature retrieved by our review that exercise-based prehabilitation improves postoperative outcomes and helps in reducing postoperative complications in children undergoing various surgeries.