The Blood Donation Ambivalence Survey: measuring conflicting attitudes about giving blood.

OBJECTIVES: This study was designed to develop and conduct initial validation testing for a novel measure of ambivalence about donating blood. BACKGROUND: Previous studies of living organ, bone marrow and stem cell donors have identified donation-related ambivalence as a predictor of decisions about donation and post-donation outcomes. Ambivalence about blood donation has not received the same attention. METHODS: In Study 1, a sample of young adults (N = 396) were administered test items of ambivalence, and exploratory (EFA) and confirmatory factor analyses (CFA) were performed to identify the Blood Donation Ambivalence Survey. In Study 2, a separate sample of young adults (N = 241) completed the Blood Donation Ambivalence Survey in addition to questionnaires assessing known predictors of blood donation. RESULTS: Exploratory and confirmatory factor analyses indicated a two-factor structure reflecting commitment to donating blood and indecision about giving blood. The commitment subscale was positively related to known predictors of increased donation behaviour (e.g. donation intention, self-efficacy), whereas the indecision subscale was positively related to known predictors of decreased donation behaviour (e.g. donation anxiety, negative affect). Furthermore, a history of blood donation was associated with greater commitment and less indecision. CONCLUSIONS: The present findings provide strong initial support for the reliability and validity of a novel measure of blood donor ambivalence.

Initial validation of a virtual blood draw exposure paradigm for fear of blood and needles.

Fear of blood, injections, and needles commonly prevents or delays individuals' receipt of health care, such as vaccines or blood draws. Innovative methods are needed to overcome these fears and reduce anxiety related to activities of this nature. The present study describes initial testing of an arm illusion paradigm that may prove useful during early phases of graded exposure for people with blood and needle fear. Seventy-four undergraduate students aged 18-29 years were tested. In line with study aims, results indicated that the virtual blood draw paradigm promoted strong perceptions of arm ownership and elicited significant changes in physiological indices (blood pressure, heart rate, electrodermal activity, respiratory rate) in response to key procedure elements (e.g., needle insertion). Further, bivariate correlations indicated that individual differences in self-reported blood and needle fear collected prior to the illusion paradigm were significantly associated with presyncopal symptoms reported following the procedure. In regression analyses, self-reported measures of blood and needle fear explained unique variance in presyncopal symptoms even after controlling for general state anxiety. These findings provide initial support for the virtual blood draw paradigm as a promising tool to help provide graded exposure to medical procedures involving needles and blood draw.

The effects of leg crossing and applied tension on blood donor return.

BACKGROUND AND OBJECTIVES: Repeated isometric muscle tension (applied tension) during blood donation reduces vasovagal symptoms in many donors. Experiencing vasovagal symptoms has been found to reduce blood donor return. However, does practicing applied tension improve blood donor return? Follow-up results from a randomized controlled trial are presented. METHODS: Data were collected in mobile clinics held in several colleges and universities. During the baseline donation, participants either (1) practiced 'standard' applied tension consisting of repeated 5 s cycles of whole-body isometric muscle tension in the donation chair (N = 133), (2) practiced tension with legs crossed (N = 131), or (3) gave blood as usual (N = 140). Subsequent blood donations in the following 2 years were determined. RESULTS: Applied tension had no effect on immediate (at the end of the baseline blood donation) rating of intention to give blood or the dichotomous measure of whether or not the participant gave blood again in the following 2 years. However, men asked to practice applied tension with legs crossed gave approximately one unit more during the follow-up period compared with men in the control group (F1,106  = 5·32, P = 0·023). This was associated significantly with adherence - men assigned to the applied tension with legs crossed condition who did not practice as instructed were no more likely to return than controls. CONCLUSION: The results provide modest support for the idea that applied tension may increase subsequent blood donation though the results were limited to men who practiced the technique as instructed.

Applied tension may help retain donors who are ambivalent about needles.

BACKGROUND: Vasovagal symptoms can discourage people who might otherwise give blood on many occasions. However, the effects of symptoms on donor retention as well as the effects of treatments to reduce vasovagal symptoms on donor retention are probably moderated by a person's confidence that they can tolerate the procedure. METHODS: Data from a study on the effects of the muscle tensing technique applied tension (AT) on donor retention were examined to determine if (1) the degree of donor ambivalence about needles influenced the impact of vasovagal symptoms on subsequent return and (2) ambivalence about needles moderated the effect of learning AT on donor return. One-year follow-up data on 614 people who had previously given blood and were randomly assigned to either a no treatment, donation-as-usual condition or one of two conditions involving AT were obtained. Self-reported degree of needle ambivalence and vasovagal symptoms were assessed during the initial blood donation. RESULTS: Among participants in the no treatment group, increases in vasovagal symptoms were associated with decreases in donor return but only among people who expressed some fear of blood draws. Similarly, among people who expressed no fear of needles, learning AT had no effect on post-donation estimate of the likelihood they would give blood again or return rate. However, among people with some fear of blood draws learning AT led to both a higher estimate that they would give blood again as well as actual return rate. CONCLUSIONS: The experience of vasovagal symptoms may not deter people who are generally confident in their ability to tolerate blood donation. However, among people who are ambivalent about needles, symptoms may 'confirm' pre-existing doubts about their suitability for blood donation and lead to drop-out. Targeted interventions that give the uncertain volunteer a sense of confidence that they might be able to realize their goal and become a regular blood donor may be useful.

Blood pressure and cerebral oxygenation responses to skeletal muscle tension: a comparison of two physical maneuvers to prevent vasovagal reactions.

AIM: The present study compared blood pressure, heart rate, and cerebral oxygenation responses to two manipulations used to prevent vasovagal reaction -- skeletal muscle tensing alone and skeletal muscle tensing with leg crossing. METHODS AND RESULTS: Using a repeated measures within-subjects design, healthy young adults engaged in a brief laboratory protocol that included an initial 3 min resting baseline, 3 min of muscle tensing (or no-tensing control), and a 1 min orthostatic challenge. This sequence was repeated three times for each participant to allow for a direct comparison of physiological responses to two different muscle-tensing manipulations as compared to the no-tensing control condition. Results indicated that, relative to the no-tensing, both muscle tensing manipulations elicited significant increases in systolic blood pressure (8.7 +/- 1.1 mmHg), diastolic blood pressure (4.9 +/- 0.6 mmHg), and heart rate (10.9 +/- 0.9 bpm), while a significant increase in cerebral oxygenation was only observed in response to muscle tensing with legs crossed (0.8 +/- 0.2%). Blood pressure and heart rate responses to orthostatic challenge did not differ between the two tensing manipulations, although muscle tensing with legs crossed was followed by a more rapid recovery of cerebral oxygenation levels. CONCLUSION: These findings suggest that muscle tensing elicits physiological adaptations that may help reduce the risk of vasovagal reactions; however, the combination of lower body tension with the legs crossed is likely to be most effective as it was uniquely associated with significant increases in the flow of oxygenated blood to the brain.

Cardiovascular recovery from stress predicts longitudinal changes in blood pressure.

Cardiovascular reactivity and recovery were examined as predictors of blood pressure changes over 3 years. Blood pressure and heart rate readings were obtained from 73 men and women aged 18-20 years during cold pressor, mental arithmetic, tourniquet ischemia, cycle exercise and step exercise tasks. Regression analyses indicated that after adjustment for initial blood pressure, initial age, initial body-mass index, sex, parental history of hypertension, and length of follow-up, heightened heart rate reactivity to mental arithmetic was associated with increased follow-up systolic blood pressure (DeltaR(2)=0.04, P<0.05). Systolic blood pressure recovery from cold pressor and tourniquet ischemia were also positively related to follow-up systolic blood pressure (DeltaR(2)=0.04 and 0.04, respectively, P<0.05) and remained so even after adjustment for the corresponding cardiovascular reactivity measures. These findings suggest that cardiovascular reactivity and recovery measures are modest predictors of longitudinal changes in blood pressure.

Distraction reduces self-reported physiological reactions to blood donation in novice donors with a blunting coping style.

OBJECTIVE: Vasovagal reactions experienced by some blood donors (eg, faintness, lightheadedness, and dizziness) have been shown to be related to a decreased likelihood of future blood donations. This study evaluated the efficacy of audiovisual distraction as a means of reducing self-reported physiological reactions in first-time blood donors. Because interventions that are consistent with an individual's preferred coping style have been shown to be more effective at reducing physiological and psychological responses to stressful medical procedures, coping style (monitoring vs. blunting) was assessed as a possible moderating variable. METHODS: First-time blood donors were randomly assigned to one of two conditions: audiovisual distraction or no-treatment control. Participants in the distraction group donated blood at an American Red Cross blood drive while watching a three-dimensional video presentation on a personal visor and headset. The control group donated blood according to standard American Red Cross procedures. Score on a self-reported measure of physiological reactions completed immediately after donation served as the dependent variable. RESULTS: Individuals who typically use blunting coping strategies to cope with stress reported an attenuation of vasovagal reactions to blood donation in the distraction vs. the control condition (t(49) = 2.29, p < .05), whereas donors who prefer a monitoring coping style did not benefit from distraction. CONCLUSIONS: Among first-time blood donors, audiovisual distraction may be an effective means of reducing vasovagal reactions in donors who prefer to cope with stress using such strategies as distraction, denial, and reinterpretation.

Assessing supraspinal modulation of pain perception in individuals at risk for hypertension.

In this study we tested the hypothesis that hypoalgesia in individuals at risk for hypertension is related to enhanced activation of supraspinal pain modulation systems. Supraspinal inhibition of pain signals was assessed using a diffuse noxious inhibitory control paradigm, in which a noxious conditioning stimulus was used to suppress pain in response to a noxious test stimulus applied to a remote area of the body. Specifically, the nociceptive flexion reflex (NFR) was assessed in 113 healthy young adults before, during, and after exposure to forearm tourniquet ischemia. Consistent with previous evidence of hypoalgesia in individuals at risk for hypertension, offspring of hypertensive individuals exhibited significantly higher NFR thresholds than offspring of normotensive persons. Although NFR activity was significantly decreased in all participants during concomitant application of forearm ischemia, the degree of attenuation of NFR activity was not significantly different as a function of risk for hypertension.

Identifying hypertension using the Ohio Blood Pressure History Survey.

Although medical survey studies often rely on self-reported symptoms to establish the presence or absence of clinical conditions in respondents, recent findings suggest that surveys that assess a broad range of symptoms may have limited sensitivity in detecting specific clinical conditions such as hypertension. The present study evaluated the accuracy of a blood pressure history survey mailed to 800 men and women who had received treatment at a military medical facility in the previous year. Compared with their medical records, patient reports of a previous diagnosis of hypertension exhibited an overall accuracy of 94.2%. This high level of overall accuracy was associated with equally high proportions of correct identifications of high blood pressure histories (sensitivity = 95.4%) and normal blood pressure histories (specificity = 92.4%). Our findings indicate that the Ohio Blood Pressure History Survey is a highly accurate measure of hypertension history among active and retired military personnel.

Decreased pain perception and risk for hypertension: considering a common physiological mechanism.

For almost two decades, researchers have demonstrated that hypertension is reliably associated with decreased perception of pain. More recently, a growing body of evidence has begun to suggest that hypoalgesia is not a consequence of high blood pressure, as the phenomenon precedes the onset of hypertension in individuals at risk for the disorder. This article provides a review of empirical evidence of decreased pain perception in normotensive persons with a family history of hypertension, elevated resting blood pressure, or exaggerated cardiovascular reactivity to stress. Based on the existing evidence, hypoalgesia is argued to be a correlate of dysregulation of central nervous system structures involved in both pain control and cardiovascular regulation in individuals who are genetically predisposed to develop high blood pressure. As such, hypoalgesia may serve as a valuable method of identifying individuals at greatest risk for hypertension.

Caffeine attenuates vasovagal reactions in female first-time blood donors.

The experience of vasovagal reactions during blood donation (e.g., faintness, dizziness, lightheadedness) can be a deterrent to repeat donation. Because these reactions are associated with decreases in blood pressure, caffeine was examined as a potential modulator of vasovagal reactions by virtue of its pressor effects. Using a randomized, double-blind design, 62 female undergraduate 1st-time blood donors received either 0, 125, or 250 mg of caffeine prior to blood donation. Participants who received 250 mg of caffeine had lower scores on the Blood Donation Reactions Inventory, required fewer interventions by phlebotomists for negative reactions, and reported a greater likelihood of repeat donation than participants who received placebo. These findings suggest that a moderate dose of caffeine attenuates negative reactions in novice female blood donors and may increase the likelihood of repeat donations.

A comparison of diffuse noxious inhibitory controls in men and women.

Results from clinical and experimental pain studies provide consistent evidence of sex differences in pain perception, with women reporting more clinical pain and demonstrating lower pain threshold and tolerance levels than men. The present study was designed to assess the notion that sex differences in pain perception may be related to differential activation of supraspinal pain modulation systems. Specifically, the phenomenon of diffuse noxious inhibitory controls (DNIC) was examined in healthy young adult men (n = 39) and women (n = 44) using repeated assessment of nociceptive flexion reflex activity before, during and after exposure to forearm ischemia. Consistent with previous research, women exhibited significantly lower nociceptive flexion reflex thresholds than men, and reported significantly greater pain in response to both forearm ischemia and repeated electrocutaneous stimulation required to elicit the nociceptive flexion reflex. Application of forearm ischemia was associated with a significant decrease in nociceptive flexion reflex activity in both men and women, however, the degree of attenuation of nociceptive flexion reflex activity was not significantly different between the sexes. These findings suggest that men and women exhibit similar activation of diffuse noxious inhibitory controls, but they do not exclude the possibility of sex differences in other forms of central pain modulation.

Assessing parental history of hypertension: father (and mother) knows best!

In hypertensive risk studies, offspring reports are often used to establish parental history of hypertension. This method is simple and less costly than contacting parents and has been reported to be > or = 84% accurate when compared with parental confirmation. The present study examined two components that contribute to overall accuracy: sensitivity (correct identification of high blood pressure) and specificity (correct identification of normal blood pressure). Undergraduate volunteers (282 women, 211 men) provided parental blood pressure information, and then blood pressure history questionnaires were mailed to their biological parents. Comparison of offspring and parent reports revealed a combination of high specificity (92.9%) and low sensitivity (68.2%), suggesting that offspring reports may be misleading when attempting to identify hypertensive parents.

Computerized depression screening and awareness.

The DEPRESSION Awareness, Recognition and Treatment (D/ART) program under the sponsorship of the National Institutes of Health has made consistent efforts to help educate many communities around the nation about depression. One important aspect of this effort includes offering free screening for depression to the general public. Since new technology often promotes curiosity and interest, a computerized depression screening and awareness program was created to use at fairs and other local events. Individuals who participated completed a computerized version of the Center for Epidemiological Studies Depressed Mood Scale (CES-D) and then received a one page printout that described the common symptoms of depression, a score indicative of their level of depressed mood, a brief explanation of the score, and a telephone number where additional information could be obtained. This paper details the construction of the computerized version of the CES-D including an evaluation of psychometric properties and consumer satisfaction with the program.

Change mechanisms associated with combined relaxation/EMG biofeedback training for chronic tension headache.

Therapeutic mechanisms hypothesized to underlie improvements in tension headache activity achieved with combined relaxation and electromyographic (EMG) biofeedback therapy were examined. These therapeutic mechanisms included (1) changes in EMG activity in frontal and trapezii muscles, (2) changes in central pain modulation as indexed by the duration of the second exteroceptive silent period (ES2), and (3) changes in headache locus of control and self-efficacy. Forty-four young adults with chronic tension-type headaches were assigned either to six sessions of relaxation and EMG biofeedback training (N = 30) or to an assessment only control group (N = 14) that required three assessment sessions. Measures of self-efficacy and locus of control were collected at pre- and posttreatment, and ES2 was evaluated at the beginning and end of the first, third, and last session. EMG was monitored before, during, and following training trials. Relaxation/EMG biofeedback training effectively reduced headache activity: 51.7% of subjects who received relaxation/biofeedback therapy recorded at least a 50% reduction in headache activity following treatment, while controls failed to improve on any measure. Improvements in headache activity in treated subjects were correlated with increases in self-efficacy induced by biofeedback training but not with changes in EMG activity or in ES2 durations. These results provide additional support for the hypothesis that cognitive changes underlie the effectiveness of relaxation and biofeedback therapies, at least in young adult tension-type headache sufferers.

Risk for hypertension and pain sensitivity in women.

To evaluate the possible negative association between risk for hypertension and pain sensitivity by in women 24 healthy young adult women with a parental history of hypertension and 24 without a parental history of hypertension participated in 2 laboratory sessions in which electric shock and the cold-pressor test were administered To assess the possible role of stress-induced analgesia in blood pressure-related hypoalgesia, the sessions were identical with the exception of the fact that participants were exposed to a stressful 20-min videogame before the pain stimuli on one occasion and a nonstressful control task on the other. Women with a parental history of hypertension and high blood pressure reactivity to the videogame displayed a reduced sensitivity to electric shock on both days, suggesting that risk for hypertension is associated with reduced sensitivity to at least some pain stimuli in women. Blood pressure reactivity to stress-associated baroreceptor stimulation was not implicated as a mediator of decreased pain perception. However, other analyses revealed an effect of family history on shock pain only among women who report relatively high anxiety, suggesting that other aspects of the stress response may be involved in this phenomenon.

Resting systolic blood pressure, parental history of hypertension, and sensitivity to noxious stimuli.

Increased nociceptive thresholds have been reported in hypertensive rats and humans, and also in normotensive humans at risk for developing hypertension by virtue of elevated resting blood pressure levels or a family history of hypertension. Because risk for hypertension may be more accurately predicted by a combination of risk factors, the present study examined the pain sensitivity of young adult males as a function of resting systolic blood pressure and family history of hypertension. Cold pressor and forearm ischemia tasks were administered in a counterbalanced order. Pain was assessed using numerical rating scales of intensity and unpleasantness during the tasks and the McGill Pain Questionnaire immediately following the tasks. Individuals with a parental history of hypertension obtained significantly lower Pain Rating Index scores on the McGill Pain Questionnaire for both tasks, and also reported significantly lower pain on both numerical rating scales during the ischemic task. No significant relationship was observed between resting systolic blood pressure and measures of pain sensitivity.

Exteroceptive suppression of temporalis and masseter muscle activity is enhanced in offspring of hypertensives.

Exteroceptive suppression of temporalis and masseter muscle activity was examined in young men with and without a parental history of hypertension. Recent clinical studies suggest that the second exteroceptive suppression period is attenuated in several chronic pain disorders and that this brainstem reflex may serve as a noninvasive index of endogenous pain control. In the present study, offspring of hypertensives exhibited a significant protraction of the late exteroceptive suppression period for both muscle sites, suggesting that the decreased pain sensitivity previously observed in individuals at risk for hypertension may be related to enhanced central pain modulation.

Predicting vasovagal reactions in volunteer blood donors.

Measures of blood and injury sensitivity, pain sensitivity, and anxiety were examined as potential predictors of syncope and related reactions in 215 volunteer blood donors. The Blood and Injury Fears subscale of the Fear Survey Schedule was the best predictor for first-time donors (r[84] = 0.43, p < 0.001), whereas the Mutilation Questionnaire was the best predictor for experienced donors (r[127] = 0.31, p < 0.01). In contrast with previous studies, few significant predictions were observed for demographic variables (e.g., age, body mass index, or number of previous donations), suggesting that psychological measures may be better suited to the task of identifying high risk donors.

Parental history of hypertension and enhanced cardiovascular reactivity are associated with decreased pain ratings.

Ischemic pain was examined in adult males with and without a parental history of hypertension. Blood pressure and heart rate were recorded during baseline, cold pressor, and ischemia. Repeated pain ratings were obtained during cold pressor and ischemia, and the McGill Pain Questionnaire was completed after each stressor. A median split was used to identify high and low mean arterial pressure and heart rate reactors to cold pressor. Parental history of hypertension, high heart rate reactivity, and high mean arterial pressure reactivity were each associated with significantly lower ischemic pain ratings on the McGill Pain Questionnaire, suggesting that risk for hypertension is associated with hypoalgesia in normotensives.