Psychometric Analysis for fear of COVID-19 Scale (FCV-19S) and its association with depression in patients with diabetes: A cross sectional study from a Tertiary Care Centre in Karachi, Pakistan.

BACKGROUND AND AIMS: To assess the psychometric properties of the Fear of COVID-19 (FCV-19S) scale and to determine its associated factors among the Pakistani patients with diabetes. METHODS: This observational study was conducted in 24-h helpline service, a department of Baqai Institute of Diabetology and Endocrinology (BIDE). Study duration was from August to September 2020. The target population was registered adult patients with type 2 diabetes aged >16 years. Baseline demographic details were obtained from hospital management system of BIDE. Forward-backward translation method was used to translate the existing Fear scale (FCV-19S). Symptoms of depressive disorder were assessed through Patient Health Questionnaire (PHQ9). RESULTS: Total of 380 participants with mean age 51.93 ± 12.03 years contributed in the study. Three factors loading and item correlation of fear COVID-19 explained 96% of total variance having unidimensional Cronbach's alpha of 0.881. All demographic indicators that showed significance in univariate model were included in multivariate model. Females had more fear for COVID-19 compared to males (OR = 1.73, 95% CI (1.15-2.6)), whereas current smokers had also showed 4 times more fear than non-smokers (OR = 4.19, 95% CI (1.18-14.83). Depression assessed by PHQ9 showed maximum fear of COVID-19 in participants with moderate depression. CONCLUSION: FCV-19S had adequate psychometric properties for assessing effects of pandemic in people with diabetes attending tertiary care center.

Fear expressions of dogs during New Year fireworks: a video analysis.

A high proportion of pet dogs show fear-related behavioural problems, with noise fears being most prevalent. Nonetheless, few studies have objectively evaluated fear expression in this species. Using owner-provided video recordings, we coded behavioural expressions of pet dogs during a real-life firework situation at New Year's Eve and compared them to behaviour of the same dogs on a different evening without fireworks (control condition), using Wilcoxon signed ranks tests. A backwards-directed ear position, measured at the base of the ear, was most strongly associated with the fireworks condition (effect size: Cohen's d = 0.69). Durations of locomotion (d = 0.54) and panting (d = 0.45) were also higher during fireworks than during the control condition. Vocalisations (d = 0.40), blinking (d = 0.37), and hiding (d = 0.37) were increased during fireworks, but this was not significant after sequential Bonferroni correction. This could possibly be attributed to the high inter-individual variability in the frequency of blinking and the majority of subjects not vocalising or hiding at all. Thus, individual differences must be taken into account when aiming to assess an individual's level of fear, as relevant measures may not be the same for all individuals. Firework exposure was not associated with an elevated rate of other so-called 'stress signals', lip licking and yawning.

An Investigation of Various Machine and Deep Learning Techniques Applied in Automatic Fear Level Detection and Acrophobia Virtual Therapy.

In this paper, we investigate various machine learning classifiers used in our Virtual Reality (VR) system for treating acrophobia. The system automatically estimates fear level based on multimodal sensory data and a self-reported emotion assessment. There are two modalities of expressing fear ratings: the 2-choice scale, where 0 represents relaxation and 1 stands for fear; and the 4-choice scale, with the following correspondence: 0-relaxation, 1-low fear, 2-medium fear and 3-high fear. A set of features was extracted from the sensory signals using various metrics that quantify brain (electroencephalogram-EEG) and physiological linear and non-linear dynamics (Heart Rate-HR and Galvanic Skin Response-GSR). The novelty consists in the automatic adaptation of exposure scenario according to the subject's affective state. We acquired data from acrophobic subjects who had undergone an in vivo pre-therapy exposure session, followed by a Virtual Reality therapy and an in vivo evaluation procedure. Various machine and deep learning classifiers were implemented and tested, with and without feature selection, in both a user-dependent and user-independent fashion. The results showed a very high cross-validation accuracy on the training set and good test accuracies, ranging from 42.5% to 89.5%. The most important features of fear level classification were GSR, HR and the values of the EEG in the beta frequency range. For determining the next exposure scenario, a dominant role was played by the target fear level, a parameter computed by taking into account the patient's estimated fear level.

Development and Validation of a Scale to Measure Fear of Activity in Patients With Coronary Artery Disease (Fact-CAD).

OBJECTIVE: To develop and validate a scale to measure fear of activity in patients with coronary artery disease. DESIGN: Psychometric study. SETTING: Outpatient cardiology clinics. PARTICIPANTS: The scale was applied to patients who had myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention within the last 12 months (N=250). INTERVENTIONS: A scale for fear of activity in patients with coronary artery disease (Fact-CAD) was created through semistructured focus group interviews with patients. Face and content validity of Fact-CAD was verified. MAIN OUTCOME MEASURES: Psychometric analysis included model fit, unidimensionality, reliability, local dependency, differential item functioning, and external construct validity. Analyses were performed using the Rasch Analysis Model. RESULTS: Fact-CAD scale was a reliable (high Person Separation Index of 0.89) and valid (unidimensional, no misfit, local independency supported, no residual correlations) measure of fear of activity. Three items showed differential item functioning according to employment status, marital status, and angina pectoris, which were not assigned as real item bias by experts and remained in the model. CONCLUSION: Fact-CAD was supported by Rasch analysis as a psychometrically valid scale to evaluate fear of activity in patients with coronary artery disease.

Fear Level Classification Based on Emotional Dimensions and Machine Learning Techniques.

There has been steady progress in the field of affective computing over the last two decades that has integrated artificial intelligence techniques in the construction of computational models of emotion. Having, as a purpose, the development of a system for treating phobias that would automatically determine fear levels and adapt exposure intensity based on the user's current affective state, we propose a comparative study between various machine and deep learning techniques (four deep neural network models, a stochastic configuration network, Support Vector Machine, Linear Discriminant Analysis, Random Forest and k-Nearest Neighbors), with and without feature selection, for recognizing and classifying fear levels based on the electroencephalogram (EEG) and peripheral data from the DEAP (Database for Emotion Analysis using Physiological signals) database. Fear was considered an emotion eliciting low valence, high arousal and low dominance. By dividing the ratings of valence/arousal/dominance emotion dimensions, we propose two paradigms for fear level estimation-the two-level (0-no fear and 1-fear) and the four-level (0-no fear, 1-low fear, 2-medium fear, 3-high fear) paradigms. Although all the methods provide good classification accuracies, the highest F scores have been obtained using the Random Forest Classifier-89.96% and 85.33% for the two-level and four-level fear evaluation modality.

Fear of clowns in hospitalized children: prospective experience.

Medical clowns (MC) have become an integral part of the pediatric staff of hospital wards. While several studies have demonstrated the huge benefits of MC, there are almost no data regarding fear of clowns, a known phenomenon that means an irrational fear of clowns. In the current study, we sought to examine the prevalence of fear of clowns in pediatrics wards, and to characterize the affected children. The clinical work of three certified MCs was prospectively assessed. Every child with fear of clowns was noted, data were retrieved from the medical records, and the parents/child completed a specific questionnaire with a research assistant. Fear of clowns was defined as crying, anxiety response or effort to avoid contact with the MCs in small children, while in older children, it was determined if the child either reported fear of MCs or made actions to avoid clowns' intervention. A total of 1160 children participated in the study. All were hospitalized in the department of pediatrics or the pediatric emergency medicine department at Carmel Medical Center, and were exposed to a MC intervention session. Of the 1160 children, 14 children experienced fear of clowns (1.2%). The average age of children who experienced fear of clowns was 3.5 years (range 1-15). Interestingly, most of the children demonstrating fear of clowns were girls (12 out of 14, 85.7%). We found no association between fear of clowns and specific diagnosis, fever, clinical appearance, religion, or ethnicity. CONCLUSION: The prevalence of fear of clowns in the general pediatric hospitalized population was 1.2%, with a significant predominance of girls (85.7%). Children who experienced significant fear of clowns also experienced significant fear of encountering or thinking about a MC visit. Fear of clowns can affect children at any age (range 1-15), any ethnicity, religion, or degree of illness. Further large scale studies are required to better understand this unique phenomenon of fear of clowns. What is Known: • Fear of clowns is a phenomenon known for more than several decades and related to the increased use of clowns as negative characters in horror movies and TV shows. • The increased use of medical clowns in hospital wards and corridors increases the significance of defining and characterizing this phenomenon in hospital wards. What is New: • The study is novel by giving new data related to the extent of fear of clowns in pediatrics wards and giving demographic characteristic of children experiencing fear of clowns.

The Classification of Anxiety and Fear-Related Disorders in the ICD-11.

Anxiety disorders are highly prevalent worldwide and engender substantial economic costs and disability. The World Health Organization is currently developing the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), which represents the first opportunity to improve the validity, clinical utility, and global applicability of the classification in more than 25 years. This article describes changes in the organization and diagnostic guidelines for anxiety and fear-related disorders proposed by the ICD-11 Working Group on the Classification of Mood and Anxiety Disorders and the rationale and evidence base for the proposals. In ICD-11, anxiety and fear-related disorders that manifest across the lifespan are brought together under a new grouping, and are partly distinguished by their focus of apprehension. The focus of apprehension is the stimulus or situation that triggers the fear or anxiety and may be highly specific as in specific phobia or relate to a broader class of situations as in social anxiety disorder. The guidelines also clarify the relationship between panic disorder and agoraphobia and a qualifier is provided for panic attacks in the context of other disorders. A standardized format emphasizing essential features of anxiety disorders is intended to improve clinical utility. Guidelines will be further refined based on findings from two types of field studies: those using a case-controlled vignette methodology disseminated via the Internet to practitioners worldwide (http://gcp.network) and clinic-based field trials implemented globally at participating field study centers.

IMPAIRED FEAR EXTINCTION ASSOCIATED WITH PTSD INCREASES WITH HOURS-SINCE-WAKING.

BACKGROUND: Prior research has demonstrated that time-of-day may play an important role in the extinction of conditioned fear, with extinction better learned earlier in the day rather than later. Impaired fear extinction memory is widely considered a key mechanism of posttraumatic stress disorder (PTSD). The relationship between fear extinction and PTSD symptoms may be moderated by hours-since-waking. METHOD: In the present experiment, we examined whether hours-since-waking would moderate fear extinction learning ability in a clinical PTSD sample (n = 15), compared to trauma-exposed (n = 33) and nonexposed controls (n = 22). Participants completed a standardized differential fear conditioning and extinction paradigm, providing skin conductance response measures to quantify conditioned responding. RESULTS: Mixed-model analysis of variance revealed a PTSD-specific impairment in extinction learning ability in the late extinction phase. A moderation analysis showed that hours-since-waking was a significant moderator of the relationship between impaired late extinction and PTSD symptoms. Specifically, we found that participants with higher PTSD symptoms demonstrated poorer fear extinction learning ability as they were awake for longer. CONCLUSIONS: The results of the current study add to a growing literature indicating deficits in fear extinction learning in PTSD samples, compared to trauma-exposed and nonexposed controls. These results support previous findings that fear extinction is impaired later in the day, and extends this to a clinical sample, suggesting that exposure-therapy may be optimized by scheduling sessions in the morning.

Htr2a-Expressing Cells in the Central Amygdala Control the Hierarchy between Innate and Learned Fear.

Fear is induced by innate and learned mechanisms involving separate pathways. Here, we used an olfactory-mediated innate-fear versus learned-fear paradigm to investigate how these pathways are integrated. Notably, prior presentation of innate-fear stimuli inhibited learned-freezing response, but not vice versa. Whole-brain mapping and pharmacological screening indicated that serotonin-2A receptor (Htr2a)-expressing cells in the central amygdala (CeA) control both innate and learned freezing, but in opposing directions. In vivo fiber photometry analyses in freely moving mice indicated that innate but not learned-fear stimuli suppressed the activity of Htr2a-expressing CeA cells. Artificial inactivation of these cells upregulated innate-freezing response and downregulated learned-freezing response. Thus, Htr2a-expressing CeA cells serve as a hierarchy generator, prioritizing innate fear over learned fear.

How task shapes the use of information during facial expression categorizations.

Accurate classification of the emotional state of others is of vital importance to human social functioning and is a process that relies heavily upon the extraction and processing of specific visual cues from faces. Although the successful identification of a given facial expression has been shown to rely on the processing of specific visual features, it remains largely unknown how fixed the processing of these specific visual cues actually is. In a series of experiments we tested if observers make use of different visual information from expressive faces depending on the nature of the categorization task. To this end, we determined the facial features crucial for the categorization of three key facial expressions of emotion (fear, disgust, and anger) during "expressive or neutral" and "which expression" categorization tasks. For fearful categorizations we observed that the same high spatial-frequency features were consistently used irrespective of task, but that low spatial-frequency features were important only in limited comparison tasks with one or two alternative comparison categories. Moreover, information use from the low spatial frequency bands was not fixed and varied depending on the comparison categories used in the task as participants made use of the most salient visual information available to perform the task at hand. These results provide novel evidence of flexible information use in categorizing expressive faces and highlight the crucial importance of the nature of categorization task in determining the spatial-frequency features that are attended to and encoded during the categorization of facial expressions of emotion.

Fearful, but not angry, expressions diffuse attention to peripheral targets in an attentional blink paradigm.

We previously demonstrated that fearful facial expressions implicitly facilitate memory for contextual events whereas angry facial expressions do not. The current study sought to more directly address the implicit effect of fearful expressions on attention for contextual events within a classic attentional paradigm (i.e., the attentional blink) in which memory is tested on a trial-by-trial basis, thereby providing subjects with a clear, explicit attentional strategy. Neutral faces of a single gender were presented via rapid serial visual presentation (RSVP) while bordered by four gray pound signs. Participants were told to watch for a gender change within the sequence (T1). It is critical to note that the T1 face displayed a neutral, fearful, or angry expression. Subjects were then told to detect a color change (i.e., gray to green; T2) at one of the four peripheral pound sign locations appearing after T1. This T2 color change could appear at one of six temporal positions. Complementing previous attentional blink paradigms, participants were told to respond via button press immediately when a T2 target was detected. We found that, compared with the neutral T1 faces, fearful faces significantly increased target detection ability at four of the six temporal locations (all ps < .05) whereas angry expressions did not. The results of this study demonstrate that fearful facial expressions can uniquely and implicitly enhance environmental monitoring above and beyond explicit attentional effects related to task instructions.

The impact of chronic obstructive pulmonary disease-related fears on disease-specific disability.

Anxiety is frequently observed in persons with chronic obstructive pulmonary disease (COPD). Although anxiety in persons with COPD is multifaceted, it is mostly assessed as a general psychopathological condition. Consequently, the objectives of this study were to revise an existing questionnaire assessing relevant anxieties for use in clinical practice and research, to examine the association between COPD-related fears and disability, and finally to develop norms for COPD-related fears. Disease severity (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, use of long-term oxygen), sociodemographic characteristics, COPD-specific disability (COPD assessment test), and psychopathology (depression, general anxiety, somatoform symptoms, and disease-related fears) were obtained from a sample of 1025 individuals with COPD via the Internet. We used the COPD Anxiety Questionnaire (German: CAF) for the assessment of different fears that have been found to be relevant in COPD: fear of dyspnea, fear of physical activity, fear of progression, fear of social exclusion, and sleep-related worries. Mean COPD-specific disability was high (22.87). After explanatory and confirmatory factor analyses, a revised version of the CAF was constructed. The economical and user-friendly CAF-R showed adequate reliability and expected correlations with convergent and discriminant constructs. Gender-specific norms are provided for use in clinical practice and research. Even after controlling for GOLD stage, sociodemographic variables, and psychopathology, COPD-related fears contributed incrementally to disease-specific disability. The CAF-R is an economical and reliable tool to assess different specific fears in COPD. Results indicate that disease-specific fears have an impact on disability, supporting the assumption that detailed assessment of anxiety in COPD should be included in clinical practice.

Describing temperament in an ungulate: a multidimensional approach.

Studies on animal temperament have often described temperament using a one-dimensional scale, whereas theoretical framework has recently suggested two or more dimensions using terms like "valence" or "arousal" to describe these dimensions. Yet, the valence or assessment of a situation is highly individual. The aim of this study was to provide support for the multidimensional framework with experimental data originating from an economically important species (Bos taurus). We tested 361 calves at 90 days post natum (dpn) in a novel-object test. Using a principal component analysis (PCA), we condensed numerous behaviours into fewer variables to describe temperament and correlated these variables with simultaneously measured heart rate variability (HRV) data. The PCA resulted in two behavioural dimensions (principal components, PC): novel-object-related (PC 1) and exploration-activity-related (PC 2). These PCs explained 58% of the variability in our data. The animals were distributed evenly within the two behavioural dimensions independent of their sex. Calves with different scores in these PCs differed significantly in HRV, and thus in the autonomous nervous system's activity. Based on these combined behavioural and physiological data we described four distinct temperament types resulting from two behavioural dimensions: "neophobic/fearful--alert", "interested--stressed", "subdued/uninterested--calm", and "neoophilic/outgoing--alert". Additionally, 38 calves were tested at 90 and 197 dpn. Using the same PCA-model, they correlated significantly in PC 1 and tended to correlate in PC 2 between the two test ages. Of these calves, 42% expressed a similar behaviour pattern in both dimensions and 47% in one. No differences in temperament scores were found between sexes or breeds. In conclusion, we described distinct temperament types in calves based on behavioural and physiological measures emphasising the benefits of a multidimensional approach.

Identifying a subset of fear-evoking pictures from the IAPS on the basis of dimensional and categorical ratings for a German sample.

BACKGROUND AND OBJECTIVES: The International Affective Picture System (IAPS) is a set of colour photographs depicting a wide range of subject matters. The pictures, which are widely used in research on emotions, are commonly described in terms of the dimensions of valence, arousal and dominance. Little is known, however, about discrete emotions that the pictures evoke. Our aim was to collect dimensional and categorical ratings from a German sample for a subset of IAPS pictures and to identify a set of fear-evoking pictures. METHODS: 191 participants (95 female, 96 male, mean age 23.6 years) rated 298 IAPS pictures regarding valence, arousal and the evoked emotion. RESULTS: 64 fear-evoking pictures were identified. Sex differences for categorical and dimensional ratings were found for a considerable number of pictures, as well as differences from the US norms. CONCLUSIONS: These differences underscore the necessity of using country-specific and sex-specific norms when selecting stimuli. A detailed table with categorical and dimensional ratings for each picture is provided.

Can drawing be considered a projective measure for children's distress in paediatric dentistry?

BACKGROUND: Several tools have been developed for the measurement of emotional status of the child in paediatric dental clinics including nonverbal self-report techniques. Subjective methods like drawing and Child Drawing: Hospital (CD:H) score have recently been applied in hospitalized children. Studies, however, have not attempted to analyse children's drawings as an aid to investigate the subjective feelings of children in paediatric dental settings. AIM: To assess drawing as a measure for child's distress in paediatric dental settings. DESIGN: Fifty-four children, aged 4-11 years, participated in this study. After finishing the first therapeutic session, the child was instructed to draw a picture of a person in a dental clinic. The pictures were scored using CD:H score sheet and the findings were compared with SEM and Frankl scores. RESULTS: CD:H was correlated with both Frankl (correlation coefficient = -0.550) and SEM (correlation coefficient = +0.483) scales (P < 0.001). CONCLUSION: Drawing is a useful measure of children's emotional status in dental settings in a way that is easier, familiar and more enjoyable for the child patient.

Trait anxiety, disgust sensitivity, and the hierarchic structure of fears.

This paper describes an evaluation of Taylor's (1998) hierarchic model of fears and its relationship to trait anxiety and disgust sensitivity (DS). In Study 1 (N=420), a confirmatory factor analysis supported a hierarchic structure of fears. Next, an analysis using structural equation modeling indicated that trait anxiety is associated with claustrophobic and social fears, whereas DS is associated with all four fear subtypes examined (claustrophobic, social, blood-injection-injury and animal). However, trait anxiety and DS did not account for all variance shared by fear subtypes. The addition of a generalized "fear factor" accounted for significant residual shared variance between the four fear subtypes, beyond that accounted for by trait anxiety and DS. Study 2 (N=213) generally replicated these results. Findings suggest that the hierarchic structural model of fears would benefit from inclusion of trait anxiety and DS as higher-order contributors to fearfulness.

A taxometric study of the latent structure of disgust sensitivity: converging evidence for dimensionality.

Disgust sensitivity has recently been implicated as a specific vulnerability factor for several anxiety-related disorders. However, it is not clear whether disgust sensitivity is a dimensional or categorical phenomenon. The present study examined the latent structure of disgust by applying three taxometric procedures (maximum eigenvalue, mean above minus below a cut, and latent-mode factor analysis) to data collected from 2 large nonclinical samples on 2 different measures of disgust sensitivity. Disgust sensitivity in the first sample (n=1,153) was operationalized by disgust reactions to food, animals, body products, sex, body envelope violations, death, hygiene, and sympathetic magic, as assessed by the Disgust Sensitivity Scale (J. Haidt, C. McCauley, & P. Rozin, 1994). Disgust Sensitivity Scale indicators of core, animal reminder, and contamination disgust were also examined in the 1st sample. Disgust sensitivity in the 2nd independent sample (n=1,318) was operationalized by disgust reactions to animals, injections and blood draws, mutilation and death, rotting foods, and odors, as assessed by the Disgust Emotion Scale (R. A. Kleinknecht, E. E. Kleinknecht, & R. M. Thorndike, 1997). Results across both samples provide converging evidence that disgust sensitivity is best conceptualized as a dimensional construct, present to a greater or lesser extent in all individuals. These findings are discussed in relation to the conceptualization and assessment of disgust sensitivity as a specific dimensional vulnerability for certain anxiety and related disorders.

Sixteen-item Anxiety Sensitivity Index: confirmatory factor analytic evidence, internal consistency, and construct validity in a young adult sample from the Netherlands.

The present investigation examined the factor structure, internal consistency, and construct validity of the 16-item Anxiety Sensitivity Index (ASI; Reiss Peterson, Gursky, & McNally 1986) in a young adult sample (n = 420) from the Netherlands. Confirmatory factor analysis was used to comparatively evaluate two-factor, three-factor, and four-factor models of the anxiety sensitivity construct. Support was found for a hierarchical structure of anxiety sensitivity, with one global higher-order factor and four lower-order factors. Internal consistency for the global and lower-order factors of the 16-item ASI was adequate. Convergent and discriminant associations between the 16-item ASI and general mood and panic-specific variables were consistent with anxiety sensitivity theory. In addition, incremental validity of the anxiety sensitivity construct was established, relative to negative affectivity, for unexpected panic attacks and agoraphobic avoidance.

Tratamiento psicológico del miedo a las caídas: un estudio de caso / Psycological treatment of the fear of falling: A case study

Objetivo: el miedo a las caídas es la complicación más común entre las personas mayores que han presentado una caída de la que no se ha derivado lesión física importante. Material y método: se presentan los resultados de una intervención conductual llevada a cabo con una mujer de 69 años que, durante un período de 1 año, había presentado diversas caídas sin causa física que, según informe médico, las justificara. Esta persona había reducido drásticamente su actividad, y se desplazaba tan sólo apoyada en muebles o en otra persona. La intervención consistió en una fase educativa acerca del problema y la explicación de éste en términos conductuales; el aprendizaje de estrategias para minimizar la ansiedad ante la realización de actividades y reanudar de forma gradual las actividades temidas (exposición en vivo, respiración profunda, autoinstrucciones, parada de pensamiento y aserción encubierta), así como correciones ambientales y eliminación de factores de riesgo. Resultados y discusión: los resultados del programa, tras 8 sesiones de intervención, evaluados con distintas técnicas de autoinforme y tests situacionales, indican que se ha reducido de una forma notable la ansiedad global para andar y mantenerse de pie, así como que ha aumentado significativamente el número de conductas de movilidad en solitario —especialmente, en el ámbito del hogar— y de actividades de la vida diaria realizadas de forma independiente, cuya realización se había suprimido desde la primera caída (AU)

Objective: fear of falling is the most common complication in elderly people who have suffered a fall without sustaining serious physical injury. Material and methods: we present the results of a behavioural intervention carried out in a 69-year-old woman who had had various falls over a period of 1 year, with no cause, according to her medical report, that would explain these falls. The patient had drastically reduced her activity and moved about only by supporting herself on items of furniture or on other people. The intervention consisted of an education phase about the problem and its explanation in behavioural terms. The patient learned behavioural strategies to minimise anxiety in the face of activities, and gradual recommencement of the feared activities (exposure in vivo, deep breathing, self-instructions, thought stopping and covert assertion), in addition to environmental changes and elimination of risk factors. Results and discussion: the results of the intervention programme after eight sessions, assessed with various self-report techniques and situational tests, indicate a notable reduction in the patient’s overall anxiety about walking and remaining on her feet, and a significant increase in the number of unaided mobility behaviours -especially in the home environment- and of independently carried out everyday activities, which had been ceased since the first fall (AU)

Fear of death and good death among the young and elderly with terminal cancers in Taiwan.

Fear of death is a common characteristic among palliative care patients. We might think that the elderly display a higher degree of acceptance of the inevitability and less fear in the face of death. This study was aimed at investigating the relationship between the death fear level and the good-death scale in two age groups. The study was conducted in 224 patients with terminal cancers admitted to the Palliative Care Unit in National Taiwan University Hospital during the period of January 1 through October 31, 2001. The mean age was 62.13 +/- 15.47 years. The duration of admission in the elderly group was shorter than that of the younger group (P < 0.05). The severity of death fear decreased gradually in both groups after being admitted to the hospice (P < 0.05). However, the elderly (> or = 65 years of age) displayed higher levels of death fear than the younger group at two days before death (P < 0.05). A significant negative correlation was observed between the degree of death fear and the total good death score in both groups at two days before death (P < 0.05). The comprehensive care in the palliative care unit might relate to the relief of the death fear of terminal cancer patients. There is a need for psychological and spiritual care in elderly patients.