Coping and immunosuppression: inescapable but not escapable shock suppresses lymphocyte proliferation

Fifty Years of Handedness Research: A Neurological and Methodological Update

Handedness, a complex human aspect that reflects the functional lateralization of the hemispheres, also interacts with the immune system. This study aimed to expand the knowledge of the lateralization of hand, foot, and eye activities in patients with immune-mediated (IM) or other (noIM) neurological diseases and to clarify the properties of the Edinburgh Handedness Inventory (EHI) in an Italian population. Three hundred thirty-four patients with IM or noIM diseases affecting the brain or spine and peripheral nervous system were interviewed about stressful events preceding the disease, subjective handedness, and familiarity for left-handedness or ambidexterity. The patients and 40 healthy subjects underwent EHI examination. In the whole group of participants, 24 items of the EHI were classified into five factors (Hand Transitive, Hand Refined, Hand Median, Foot, Eye), demonstrating good reliability and validity. Chronological age had a significant influence on hand and foot EHI factors and the laterality quotient (LQ), particularly on writing and painting. In the patient groups, EHI factors and the LQ were also predicted by age of disease onset, duration of disease, and family history of left-handedness or ambidexterity. No differences were found between patients and healthy subjects, but pencil use scored significantly lower in patients with IM diseases than in those with noIM brain diseases. These results demonstrate that the lateralization of hand and foot activities is not a fixed human aspect, but that it can change throughout life, especially for abstract and symbolic activities. Chronic neurological diseases can cause changes in handedness. This may explain why, unlike systemic immunological diseases, IM neurological diseases are not closely associated with left-handedness. In these patients, the long version of the EHI is appropriate for determining the lateralization of body activities to contextualize the neurological picture; therefore, these findings extend the Italian normative data sets.

Animal Behavior and Learning: Support from Applied Behavior Analysis

Applied behavior analysis (ABA) is a relevant field for veterinarians helping clients whose animals engage in problem behaviors. In ABA, learning is defined as behavior change due to changes in the environment. Changing behavior then requires changes in conditions. Understanding the importance of control and the difference between emotional behavior and emotional feelings also is informed by ABA. Every behavior intervention should start with a systematic, analytical process called a functional assessment. Behavior change strategies are described, including an ethical procedural hierarchy based on the least intrusive, effective behavior change solution.

Effects of experimental chronic traffic noise exposure on adult and nestling corticosterone levels, and nestling body condition in a free-living bird

Transportation noise affects urbanized, rural, and otherwise unaltered habitats. Given expanding transportation networks, alterations in the acoustic landscapes experienced by animals are likely to be pervasive and persistent (i.e. chronic). It is important to understand if chronic noise exposure alters behavior and physiology in free-living animals, as it may result in long-lasting impacts, such as reduced reproductive success. Here, we experimentally tested the effects of chronic traffic noise on baseline and stress-induced corticosterone (the primary avian glucocorticoid), parental feeding behavior, and fitness proxies in breeding tree swallows (Tachycineta bicolor). Our results show that chronic traffic noise is related to altered corticosterone in both adult female and nestling tree swallows, suggesting that noise may be a stressor in both groups. In adult females, our results suggest that traffic noise is related to a limited ability to respond to subsequent acute stressors (i.e. reduced stress-induced corticosterone levels after handling). Further, our results show no evidence of habituation to noise during the breeding season, as the negative relationship between traffic noise and adult female stress-induced corticosterone became stronger over time. In nestlings, we found a positive relationship between traffic noise exposure and baseline corticosterone. Finally, we found a negative relationship between traffic noise and nestling body condition, despite no detectable effects of noise on nestling provisioning (e.g. parental feeding rate, or insect bolus size/composition). These results highlight the potential long-term consequences of chronic noise exposure, as increased baseline corticosterone and reduced nestling body condition in noise-exposed areas may have negative, population-level consequences.

Effects of Nesting Material on the Toxicologic Assessment of Cyclophosphamide in Crl:CD1(ICR) Mice

The provision of nesting material benefits mice by reducing cold stress, improving feed conversion, increasing litter size, and improving adaptive immunity. The effects of toxins are sensitive to environmental changes, and the introduction of novel items can alter results in some toxicologic studies. We hypothesized that nesting material would reduce stress and positively alter immunologic parameters in Crl:CD1(ICR) mice, thus changing typical results from a well-studied immunomodulating drug, cyclophosphamide. A 13-wk study assessed the following treatments in a factorial design (n = 4; 32 cages total): nesting (0 or 10 g) and drug (50 mg/kg cyclophosphamide or 10 mL/kg saline; IP weekly). Detailed examinations and body weights were recorded weekly, and nests were scored twice weekly. Fecal pellets were collected at 0, 4, 6, and 12 wk for analysis of corticosterone metabolites. At study termination, clinical pathology and immune parameters were collected, a necropsy performed, and lymphoid organs and adrenal glands were submitted for histopathology. All expected results due to cyclophosphamide were observed. Nesting reduced the proportion of mice with piloerection, and body weights were highest in saline-nested male mice. No differences in hematology, clinical chemistry, or absolute lymphocyte counts were observed. Corticosterone metabolites in all nested groups were not different from baseline levels but all nonnested groups had higher levels than baseline. Nested cyclophosphamide-treated groups had significantly lower corticosterone levels than nonnested cyclophosphamide-treated groups. This study illustrates that nesting material does not alter the results of a standard toxicology study of cyclophosphamide but alleviates study-related stress and improves mouse welfare.

Stressed out: providing laboratory animals with behavioral control to reduce the physiological effects of stress

Laboratory animals experience a large amount of environmental stress. An animal's environment can include both physiological and social stressors that may require an animal to adapt to maintain allostatic balance. For example, thermal stress can lead to changes in behavior, reproduction and immune function, which has been detrimental to cancer modeling in mice. Chronic uncontrollable stress is widely acknowledged for its negative alterations to physiology. However, there is a lack in the understanding of how the laboratory environment affects animal physiology and behavior, particularly as it relates to characteristics of the human disease being modeled. Given the evidence on how stressors affect physiology, it is clear that efforts to model human physiology in animal models must consider animal stress as a confounding factor. We present evidence illustrating that providing captive animals with control or predictability is the best way to reduce the negative physiological effects of these difficult-to-manage stressors.

Search Activity Concept: Relationship between Behavior, Health and Brain Functions

Search activity concept provides a new classification of the behavior which distinguishes search activity (activity in the uncertain situation with the constant feedback between behavior and its outcome), stereotyped behavior with a definite probability forecast, panic (activity without feedback between activity and its outcome) and renunciation of search. Only search activity which includes fight, flight, orienting behavior and creativity raises the body’s resistance to stress, to natural and experimentally induced pathology whereas renunciation of search which display itself in freezing, helplessness and depression forms a nonspecific predisposition to somatic disturbances (e.g. psychosomatic diseases). Dreams in REM sleep are regarded as a specific form of search activity aimed at compensating for the lack of search in waking. REM sleep deprivation on a small as well as on rotating platform raises the requirement in REM sleep by frustrating search activity. It is suggested that in wakefulness characterized by the prominent search activity the inhibitory alpha-2- adrenoreceptors became less sensitive to stimulation and consequently in this state the activity of the brain monoamine neurons is less limited by the level of brain monoamines. During renunciation of search brain monoamine synthesis is not stimulated by monoamine exhaustion. In REM sleep the critical level of brain monoamines for search activity to start is lower than in wakefulness and alpha-2-adrenoreceptors are less sensitive than in the state of renunciation of search although more sensitive than during search behavior in waking. REM sleep indirectly contributes to memory consolidation by carrying out its main function — restoration of search activity. A functionally sufficient REM sleep contains search activity in dreams (subject is active in his/her own dream scenario) while in functionally insufficient REM sleep dreams are characterized by subject’s passive position and feeling of helplessness. REM sleep insufficiency is an obligate condition for mental and somatic disorders to appear. The difference between normal (adaptive) and pathological (maladaptive) emotional tension is determined by the presence or absence of search activity in the structure of emotional tension. Repression of the unacceptable motive causing neurotic anxiety is a human variant of renunciation of search. Hypochondriac symptoms are in negative relationships with psychosomatic disorders and they, as well as positive symptoms in schizophrenia and anorectic behavior in anorexia nervosa, represent a pathological misdirected search activity.

Sex-Related Differences in Health and Illness

Mortality and morbidity statistics which reflect the major health disorders in the nation have changed dramatically in this century. Infectious diseases have been largely controlled, and this country's citizens are now burdened with the chronic and disabling disorders of an aging population that are increasingly linked to environmental and behavioral factors. This article documents gender and sex differences among the major life-threatening disorders and chronic health problems and suggests implications for psychology as a health science and profession.

Psychoneuroimmunology: Then and Now

Psychoneuroimmunology (PNI) emerged in the neurosciences in the late 1970s to early 1980s and has extended to influence the fields of psychology, psychiatry, endocrinology, physiology, and the biomedical research community. This review documents the journey of PNI from the early 1980s to the present. Today, we recognize that the highly complex immune system interacts with an equally complex nervous system in a bidirectional manner. Evolutionarily old signals continue to play a role in these communications, as do mechanisms for protection of the host. The disparity between physical and psychological stressors is only an illusion. Host defense mechanisms respond in adaptive and meaningful ways to both. The present review will describe a new way of thinking about evolutionarily old molecules, heat shock proteins, adding to a body of evidence suggesting that activation of the acute stress response is a double-edged sword that can both benefit and derail optimal immunity.

The translational aspect of complementary and alternative medicine for cancer with particular emphasis on Kampo

Complementary and alternative medicine (CAM) including Japanese Kampo is known to have anticancer potential. An increasing number of cancer survivors are using CAM for disease prevention, immune system enhancement, and symptom control. Although there have been abundant previous clinical reports regarding CAM, scientific investigations aimed at acquiring quantifiable results in clinical trials, as well as basic research regarding CAM, have only recently been undertaken. Recent studies suggest that CAM enhancement of immune function is related to cytokines. This review provides a translational aspect of CAM, particularly Hozai in Kampo from both scientific and clinical points of view for further development of CAM for cancer treatment.

"Anatomy of an Illness": control from a caregiver's perspective

Caregivers of loved ones with chronic illnesses experience an uncontrollable challenge with potentially negative behavioral and medical consequences. Extensive research has demonstrated immune and endocrine regulation can be significantly disrupted by negative behavioral factors based on both animal models and human studies. However, fewer studies have focused on how psychosocial interventions might reverse the negative consequences of stressors such as caregiving. The distress of caring for individuals with cancer has only recently begun to receive attention. These interventions addressing caregiver distress are rare overall and caregivers of patients receiving hematopoietic stem cell transplants (HSCT) have received even less attention. HSCT caregivers report feelings of loss of control. Animal studies suggest that control over aversive events can mitigate the negative consequences of stressors. Caregivers of allogeneic HSCT patients for blood cancers must be available 24/7 for three months or longer following stem cell infusion to closely monitor the recipients' health and well-being. Does establishing a greater sense of control have positive impacts on caregivers? A randomized control trial of a cognitive behavioral stress management intervention for allogeneic HSCT caregivers is briefly described. A model of caregiver mental health which may potentially impact the patient's quality of life is proposed. These relationships exist in a complex system that includes genetic influences, sex, social environment, and prior experience. This system fits well within recent formulations of a "complexity science" approach to health and well-being.

The release of immunosuppressive factor(s) in young males following exercise

It has been shown that a suppressive protein, acting as an immune suppressor, is generated in animals and humans under particular stresses. However, studies related to immunosuppressive factors in response to the stress resulting from acute exercise are limited. This study compares the effects of pre- and post-exercise human serum on concanavalin A stimulated lymphocyte proliferation of mice. In the present study, blood samples in eight male undergraduates (age 21 ± 0.7 years) were taken before and immediately after ten sets of exercise consisting of 15 free and 30 10-kg loaded squat jumps in each set. The suppression of lymphocyte proliferation was analysed with high pressure liquid chromatography. It was noted from the result of gel chromatography columns that the post-exercise values of the suppression of lymphocyte proliferation, in comparison to corresponding pre-exercise values, were generally greater with significant differences observed in 7.5th-9th min post-exercise eluates (P < 0.05). Such findings suggest that intense eccentric type exercise may lead to generation of immunosuppressive factor(s) in young males.

Self-administered and yoked nicotine produce robust increases in blood pressure and changes in heart rate with modest effects of behavioral contingency in rats

Experimenter-administered nicotine produces reliable increases in blood pressure and changes in heart rate. However, an extensive literature demonstrates that the effects of psychoactive drugs are dependent on whether administration is contingent on behavior. The present study assessed the cardiovascular effects of nicotine and whether those effects vary as a function of whether nicotine was self-administered or response-independent. Rats were divided into three groups according to a yoked design. The pattern of infusions for each triad was determined by the animal self-administering nicotine; the other two animals received either yoked nicotine or saline. Heart rate and blood pressure were measured during eighteen daily, 1h drug sessions by radiotelemetry. Each session was preceded and followed by a 20 minute period during which cardiovascular function was monitored in the operant chambers, but drug was not available. Acute exposure to yoked nicotine produced a rapid rise in blood pressure that was larger than the increase observed with self-administered nicotine. Additional infusions during the first session resulted in a similar sustained elevation in blood pressure in the nicotine groups. Over subsequent sessions, self-administered nicotine produced a larger effect on systolic blood pressure particularly early in each session, although for both self-administered and yoked nicotine the hypertensive effects waned partially with repeated test sessions. This decrease was fully accounted for by a pre-session decrease in pressure; relative to pre-session levels the strong hypertensive effects of nicotine persisted. Initial exposure to nicotine produced a short-lived bradycardia that in subsequent sessions was replaced with a longer-lasting nicotine-induced tachycardia; neither effect was related to the behavioral contingency of nicotine delivery. Together, these data provide a rich picture of the cardiovascular effects of nicotine. Effects of behavioral contingency were observed, but differences were limited. Other non-pharmacological factors such as baseline shifts potentially related to nicotine-associated cues deserve further attention.

CNS–immune system interactions: Conditioning phenomena

Converging data from different disciplines indicate that central nervous system processes are capable of influencing immune responses. This paper concentrates on recent studies documenting behaviorally conditioned suppression and enhancement of immunity. Exposing rats or mice to a conditioned stimulus previously paired with an immunomodulating agent results in alterations in humoral and cell-mediated immune responses to antigenic stimuli, and unreinforced reexposures to the conditioned stimuli result in extinction of the conditioned response. Although the magnitude of such conditioning effects has not been large, the phenomenon has been independently verified under a variety of experimental conditions. The biological impact of conditioned alterations in immune function is illustrated by studies in which conditioning operations were applied in the pharmacotherapy of autoimmune disease in New Zealand mice. In conditioned animals, substituting conditioned stimuli for active drugs delays the onset of autoimmune disease relative to nonconditioned animals using a dose of immunosuppressive drug that, by itself, is ineffective in modifying the progression of disease. The hypothesis that such conditioning effects are mediated by elevations in adrenocortical steroid levels receives no support from available data. Despite its capacity for self-regulation, it appears that the immune system is integrated with other psychophysiological processes and subject to modulation by the brain.

ERK2 and CREB activation in the amygdala when an event is remembered as "Fearful" and not when it is remembered as "Instructive"

A training protocol was developed based on durable exposure to the two-way shuttle avoidance task, in which the conditioned stimulus (CS), which was fear evoking for both training conditions on the first day of training, becomes instructive at the end of training under controllable conditions but remains fear evoking under the uncontrollable conditions. The protocol was utilized to examine whether, depending on the training regime, the memory formed will result in a different level of involvement of the amygdala. Three groups of rats were tested: controllable, subjected to durable avoidance learning; uncontrollable, subjected to the same training schedule but with no control over the stressor; and naive. Two weeks later, after the introduction of a reminder cue, freezing response, defecation, and blood corticosterone (CORT) of the uncontrollable group were higher than in the controllable and naive groups, indicating that indeed, for this group, the CS remained fear evoking. Significantly higher than chance shuttling responses of the controllable group indicated that, for them, the CS became "instructive." Activation of ERK2 and CREB in the basolateral amygdala (BLA) was highest in the uncontrollable group compared with the controllable and naive groups. Overall, the results indicate that the training procedure succeeded in dissociating between the physical (electric shock) and the psychological (control) attributes of the experience. Also, our findings support the view that an emotionally charged reminder cue activates the amygdala but that, as a previously fear-evoking memory cue becomes instructive, the involvement of the amygdale lessens.

Pessimistic, anxious, and depressive personality traits predict all-cause mortality: the Mayo Clinic cohort study of personality and aging

OBJECTIVE

To study the association between several personality traits and all-cause mortality.

METHODS

We established a historical cohort of 7216 subjects who completed the Minnesota Multiphasic Personality Inventory (MMPI) for research at the Mayo Clinic from 1962 to 1965, and who resided within a 120-mile radius centered in Rochester, MN. A total of 7080 subjects (98.1%) were followed over four decades either actively (via a direct or proxy telephone interview) or passively (via review of medical records or by obtaining their death certificates). We examined the association of pessimistic, anxious, and depressive personality traits (as measured using MMPI scales) with all-cause mortality.

RESULTS

A total of 4634 subjects (65.5%) died during follow-up. Pessimistic, anxious, and depressive personality traits were associated with increased all-cause mortality in both men and women. In addition, we observed a linear trend of increasing risk from the first to the fourth quartile for all three scales. Results were similar in additional analyses considering the personality scores as continuous variables, in analyses combining the three personality traits into a composite neuroticism score, and in several sets of sensitivity analyses. These associations remained significant even when personality was measured early in life (ages 20-39 years).

CONCLUSIONS

Our findings suggest that personality traits related to neuroticism are associated with an increased risk of all-cause mortality even when they are measured early in life.

Mind-body medicine and cancer

Mind-body medicine, grounded in a respectful, therapeutic partnership, should be a central element in the care of every person diagnosed with cancer. This article reviews some of the physiologic foundations of mind-body medicine, the introduction of mind-body approaches to cancer care in the 1970s, the specific mind-body approaches that have been used, and the evidence that supports their use. The importance of group support for enhancing the effectiveness of these approaches is discussed. Guidelines are offered for integrating mind-body approaches and perspectives in the care of people who have cancer.

Psychoneuroimmunology

Psychoneuroimmunology (PNI) is a discipline that has evolved in the last 40 years to study the relationship between immunity, the endocrine system, and the central and peripheral nervous systems. In this manner, neurotransmitters, hormones, and neuropeptides have been found to regulate immune cells, and these in turn are capable of communicating with nervous tissue through the secretion of a wide variety of cytokines. Of critical importance is the effect of products of the CNS and nerves on the maintenance of the delicate balance between cell-mediated (Th1) and humoral (Th2) immune responses. A good example of how this concept operates in vivo becomes evident when analyzing the effects of stressors. Chronic stress affects significantly the function of the immune system as well as modifies the evolution of a variety of skin diseases, as psychosocial interventions have proved to be effective in their therapy.

Stressful life events and psychological dysfunctions before the onset of type 1 diabetes mellitus

AIM

To test the hypothesis that stressful life events and psychological dysfunction increase the risk for development of type 1 diabetes mellitus (DM1).

METHOD

A case-control study comprising 105 children with DM1 and 210 controls matched by age +/- 1 year), sex and place of residence. Conditional univariate and multivariate logistic regressions were used to analyze the data.

RESULTS

After adjustment for possible confounders, the following factors were positively related to DM1: parents' job-related issues changed or lost job (odds ratio [OR] 11.5, 95% confidence interval [CI] 1.6-81.8); other severe life events--severe accident, hospitalization or death of close friend, quarrels between parents, war in republics of former Yugoslavia, near-drowning in a pool, falling down, unhurt participant of an accident (OR 68.5, 95% CI 13.5-349.0); other minor life events--conflicts with parents/teacher/neighbors, lost in town, physical attack, failure in competition, penalty, examination, death of pet, presence at lightning strike, thrown out of dwelling (OR 32.7, 95% CI 6.3-169.6); and learning problems (OR 17.5, 95% CI 4.3-71.6).

CONCLUSION

These results support the hypothesis that stressful life events and psychological dysfunctions are associated with DM1.

Appraisal and Consequences of Cadaver Dissection

First exposure to human cadaver dissection has the potential to be an actual stressor which can cause psychological trauma. This study examines the relationship between anatomy students' experience of this potential stressor and various psychological and personal factors. Questionnaires measuring emotional reactions to cadaver dissection, coping strategies, personality and attitudes to death were administered to anatomy students at two medical schools immediately after their first exposure to human cadaver dissection. Emotional reactions to recalling this experience were assessed 4 months later. Data on these variables were obtained from 141 students. Students found the experience mostly challenging and, on average, did not report serious emotional difficulties. However, a minority of students (10/141) experienced serious adverse consequences. It is possible that the typical student who undertakes an anatomy course is already psychologically prepared for such transactions. However, low cost desensitization programs could be made available for the minority of individuals who may experience adverse reactions in this situation.

Perceived control and immune and pulmonary outcomes in children with asthma

OBJECTIVE

This study tested the relationships between perceived control and biological processes relevant to asthma in children.

METHODS

Forty children diagnosed with asthma completed the Children's Health Locus of Control (CHLC) scale. Participants also completed pulmonary function testing, measuring forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1). Blood was drawn to assess immune markers associated with asthma. Specifically, stimulated production of the cytokines interleukin 4 (IL-4), interleukin-5 (IL-5), interleukin-13 (IL-13), interferon-gamma (IFN-gamma), as well as eosinophil count, was measured. At home, participants completed peak expiratory flow rate (PEFR) measures to monitor their daily pulmonary function.

RESULTS

Higher levels of perceived control were associated with significantly better FVC, FEV1, and PEFR variability. Higher levels of perceived control were also associated with decreased production of asthma-related cytokines, including IL-4, IL-5, and IL-13.

CONCLUSION

These results suggest that psychological processes such as perceived control may play an important role in asthma-related biological processes among children with asthma.

The Belgrade childhood diabetes study - comparison of children with type 1 diabetes with their siblings

A case-control study was conducted in Belgrade (about 320,000 inhabitants 0-16 years old) during the period 1994-97, comprising 68 diabetic children (cases) and 68 controls chosen from the siblings of the cases. Analysis using multivariable logistic regression analysis indicated the following independent risk factors for Type 1 diabetes: higher birth order, infections during the 6 months preceding the onset of the disease and stressful events. Out of individual stressful and psychological factors, 'other' stressful events (severe accident or hospitalisation or death of a close friend, conflict with a teacher, death of a pet, failure in competition, quarrel between parents, punishment, physical attack, war in republics of former Yugoslavia and near drowning in the pool) and learning problems were independent risk factor for Type 1 diabetes. The results obtained in this study of siblings supports the hypothesis that environmental factors play a role in the development of Type 1 diabetes.

Immune, endocrine and cardiovascular responses to controllable and uncontrollable acute stress

This study, using a triadic-yoked design, clarified the effects of controllability of acute stress on responses of immune, cardiovascular (heart rate and blood pressure), and cortisol activities. Forty-three women in their follicular phase completed a mental arithmetic task as a stressor in which controllability was manipulated by correct or yoked-bogus feedback. The task decreased proportions of CD3+ T cells, CD4+ T cells, and CD19+ B cells, whereas it increased the numbers of white blood cells, lymphocytes, natural killer (NK) cells, and NK cell activity (NKCA). Our main hypothesis that greater immune and cardiovascular responses to the task would be obtained under the uncontrollable condition than under the controllable condition was not supported. However, the uncontrollable stress condition, but not the controllable situation, led to higher correlations between heart rate or blood pressure, and various immune parameters. On the other hand, parameters of heart rate variability reflecting sympathetic and parasympathetic activities showed significant correlations only with NKCA. These results suggest that immune responses were most directly associated with cardiovascular activities under the uncontrollable condition.

O desamparo aprendido revisitado: estudos com animais

O desamparo aprendido tem sido definido como a dificuldade de aprendizagem apresentada por indivíduos que tiveram experiência prévia com estímulos aversivos incontroláveis. O objetivo deste trabalho é fazer uma revisão crítica dos estudos sobre o desamparo aprendido, com animais. Nessa análise, são considerados aspectos conceituais e metodológicos dos estudos em questão e as interpretações teóricas sobre esse efeito comportamental. Aborda-se a evolução histórica desses estudos, bem como alguns aspectos controversos das publicações que se acumularam ao longo de quatro décadas de pesquisa. A associação do desamparo aprendido com a depressão clínica é analisada criticamente, destacando-se a necessidade de maior rigor metodológico e conceitual nos estudos da área.

Volunteer support, marital status, and the survival times of terminally ill patients

This study examines the possibility that volunteer support can influence how long terminally ill patients survive. Hospice patient files (N = 290) were coded for marital status and volunteer support condition, respectively, the latter on the basis of whether visits from volunteers were requested and received (n = 94), requested but not received (n = 28), or neither requested nor received (n = 168). Baseline health, disease type, and demographic dimensions were comparable across support conditions. Results indicated that when a baseline health status effect was controlled for (p<.0002), patients in the volunteer support condition survived significantly longer than did patients in either unvisited condition (p<.0001). Neither marital status nor gender independently predicted survival time.

The Belgrade childhood diabetes study: a multivariate analysis of risk determinants for diabetes

BACKGROUND

The aim of this study was to evaluate some hypotheses about factors related to the development of type 1 diabetes mellitus.

METHODS

A case-control study was conducted in Belgrade during the period 1994-1997. A total of 105 recently onset diabetic and 210 control children, individually matched by age (+/-1 year), sex and place of residence, were included in the study.

RESULTS

According to multivariate regression analysis, the following factors were related to type 1 diabetes: stressful events and symptoms of psychological dysfunction during the 12 months preceding the onset of the disease [odds ratio (OR) 3.48, 95% confidence interval (CI) 2.15-5.65; and OR 2.15, 95% CI 1.33-3.48], irregular vaccination (OR 16.98, 95% CI 1.38-208.92), infection during 6 months preceding the onset of the disease (OR 4.23, 95% CI 1.95-9.17), higher education of father (OR 1.50, 95% CI 1.05-2.14), mother's consumption of nitrosoamines-rich food during pregnancy (OR 4.33, 95% CI 1.95-9.61), alcohol consumption by father (OR 3.80, 95% CI 1.64-8.78), insulin-dependent and non-insulin-dependent diabetes mellitus in three generations of children's relatives (OR 20.04, 95% CI 4.73-84.81; and OR 5.52, 95% CI 2.45-12.46), and use of ultrasound diagnostic techniques during pregnancy (OR 0.42, 95% CI 0.17-1.00).

CONCLUSIONS

Among non-genetic factors, those affecting the child during pregnancy are especially important because of their preventability.

Neural Substrates of Coping Behavior in the Rat: Possible Importance of Mesocorticolimbic Dopamine System

This study measured expression of Fos protein, an indicator of neural activation, in 116 brain regions of rats that were able to control a stressor (i.e., avoid and/or escape an electric shock), and compared the changes with those observed in yoked rats that received the same shocks but without having control over them. The authors' interest was to find brain regions where elevated activity occurs in conjunction with control. Activity in these brain regions might be responsible for the consequences of having control, such as reduction of stress responses. Eleven brain regions were found in which rats with control showed significantly more Fos expression than was seen in yoked rats that did not have control. Six of these brain regions were part of the mesocorticolimbic dopamine system. These results point to the mesocorticolimbic dopamine system as being importantly involved in the mediation and/or the consequences of coping behavior.

Activity and plasticity in the CA1, the dentate gyrus, and the amygdala following controllable vs. uncontrollable water stress

The level of controllability has been shown to modulate the effects of stress on physiology and behavior. In the present study, we investigated the effects of controllable vs. uncontrollable stressors on plasticity in hippocampal CA1, the dentate gyrus (DG), and basal amygdala nucleus (B) in the rat, using the electrophysiological procedure of long-term potentiation (LTP). A naive group was left undisturbed until the electrophysiological recording commenced. Rats of the two controllable stress groups were trained in the Morris water maze to locate an invisible underwater platform (the first group), or visible platform (the second group), thus escaping from the water, before the recording. The uncontrollable stress group underwent the same procedure (exposure time to water was adjusted to the averaged exposure time of the first controllable group) without the escape platform. We first assessed the effects of stress and controllability on LTP in CA1. Both controllable stressors and the uncontrollable stress impaired CA1 LTP, with a more robust effect induced by the uncontrollable stress. We further assessed the effects of the same procedures on LTP in DG and B. The uncontrollable stress enhanced LTP in DG and increased baseline responses (suggesting uncontrollable stress-induced plasticity) in the amygdala. All the stressors decreased amygdalar LTP. An assessment of plasma levels of corticosterone (CORT), following the behavioral procedures, revealed an enhancement in CORT release following the uncontrollable, but not controllable stress, indicating the uncontrollable condition as the most stressful. These findings provide insight into the differential effects of stress and stress controllability on different hippocampal subregions and the amygdala.

Stress, depression, the immune system, and cancer

The links between the psychological and physiological features of cancer risk and progression have been studied through psychoneuroimmunology. The persistent activation of the hypothalamic-pituitary-adrenal (HPA) axis in the chronic stress response and in depression probably impairs the immune response and contributes to the development and progression of some types of cancer. Here, we overview the evidence that various cellular and molecular immunological factors are compromised in chronic stress and depression and discuss the clinical implications of these factors in the initiation and progression of cancer. The consecutive stages of the multistep immune reactions are either inhibited or enhanced as a result of previous or parallel stress experiences, depending on the type and intensity of the stressor and on the animal species, strain, sex, or age. In general, both stressors and depression are associated with the decreased cytotoxic T-cell and natural-killer-cell activities that affect processes such as immune surveillance of tumours, and with the events that modulate development and accumulation of somatic mutations and genomic instability. A better understanding of the bidirectional communication between the neuroendocrine and immune systems could contribute to new clinical and treatment strategies.

Odor from Industrial Hog Farming Operations and Mucosal Immune Function in Neighbors

The authors evaluated whether exposure to malodor from industrial hog farming operations has a psychophysiologically mediated immunosuppressive effect on secretory immunoglobulin A (sIgA) in neighbors. Fifteen adults living within 2.4 km (1.5 mi) of at least one hog farming operation rated odor intensity on a 9-point scale and provided saliva samples twice daily for two weeks. The authors used hierarchical regression to model the association between reported odor and sIgA; study participants were their own controls. The natural log of slgA concentration and secretion rate declined, on average, 0.058 (0.032) and 0.116 (0.103), respectively, for each incremental 1-unit increase in reported odor from 4 to 9, adjusted for time of day, suggesting reduced levels of sIgA in response to moderate or high odor. Findings support the hypothesized immunosuppressive effect of malodor on mucosal immunity and provide preliminary data useful in understanding health effects related to malodor from industrial hog farming operations.

Voluntary freewheel running selectively modulates catecholamine content in peripheral tissue and c-Fos expression in the central sympathetic circuit following exposure to uncontrollable stress in rats

Modulation of sympathetic drive to the spleen is one potential mechanism whereby physical activity prevents stress-induced splenic immune suppression in rats. The current study tested the hypothesis that voluntary freewheel running reduces peripheral sympathetic drive by modulating stress-induced activity of brain regions synaptically linked to sympathetically innervated peripheral organs, including the adrenals and spleen. To this end, adrenal and splenic catecholamine content and activity of the central sympathetic circuit indexed by c-Fos protein induction, elicited by acute exposure to inescapable tail shock, were measured. Stressor exposure depleted adrenal and splenic norepinephrine content and elicited a robust increase in c-Fos in the brains of sedentary rats. Physical activity status had no effect on adrenal norepinephrine content. Indicative of attenuated sympathetic drive to the spleen, however, 6 weeks of voluntary freewheel running diminished stress-induced splenic norepinephrine depletion, and significantly attenuated stress-induced c-Fos in specific brain regions responsible for sympathetic regulation, including tyrosine hydroxylase-immunoreactive neurons of the locus coeruleus, A5 cell group and rostral ventrolateral medulla. Results suggest that voluntary activity attenuates sympathetic drive to the spleen during stressor exposure by selectively modulating stress-induced activity of the central sympathetic circuit. The attenuation of sympathetic responses observed in this study may be one important mechanism for the protective effect of physical activity against stress-related illness and immunosuppression.

Person-centered approach to care, teaching, and research in fibromyalgia syndrome: justification from biopsychosocial perspectives in populations

OBJECTIVES

To describe complex interactions of multiple factors believed to contribute to fibromyalgia syndrome (FMS) at a person-centered level to enhance approaches to care, teaching, and research. The main factors addressed were central nervous system sensory sensitization, autonomic nervous system (ANS) activation, neurohumoral perturbations, and psychosocial and environmental stressors. A person-centered approach is defined as attention to major biopsychosocial issues of affected individuals.

METHODS

Literature on classification, mechanistic pathways, course and outcomes, and management of FMS was reviewed to assess applications of person-centered approaches to care, teaching, and research. Various biopsychosocial influences were considered in relation to the heterogeneous subjective manifestations of this illness, including central hyperalgesia, ANS and other neurohumoral perturbations, functional hyperexcitability, nonrestorative sleep, and psychologic distress.

RESULTS

A person-centered approach to FMS can expand on and strengthen traditional biomedical concepts. Adding such a focus can help to untangle current controversies in the course, outcomes, and treatment of FMS. A person-centered approach can also help in the subgrouping of affected patients for greater specificity in care programs and in improved clinical investigations. In the biomedical model, diverse symptoms of FMS are often addressed separately and apart from their interconnectedness and linkages to the patient's individualized biopsychosocial factors. However, the causes of FMS symptomatology are not likely to be caused by uniform biologic abnormalities across populations. Rather, the syndrome likely results from personal reactivities to varied multifactorial biopsychosocial influences. Common denominators among individuals may include varying degrees of ANS activation (or personal susceptibility to ANS activation), nonrestorative sleep, negative affectivity, and other central pain sensitization mechanisms, among the pathways reviewed.

CONCLUSIONS

Innovative analytical methodologies will need to be developed to more effectively investigate complex interacting biopsychosocial dynamics at a person-centered level, including qualitative research, and multifactorial and multilevel techniques. Adding person-centered approaches to biopsychosocial concepts of FMS promises to show new physiopathogenetic insights and more effective treatment than current biomedical models alone. Person-centered approaches enhance patient-physician relationships and help prioritize patients' goals in mutually derived treatment plans.

Quantifying the stress induced by distress in patients with lumbar disc herniation in terms of natural killer cell activity measurements: chromium release assay versus multiparameter flow cytometric assay

STUDY DESIGN

A comparative study was conducted.

OBJECTIVES

To attempt quantification of the stress in patients with lumbar disc herniation by measuring natural killer cell activity, and to evaluate the assay methodology.

SUMMARY OF BACKGROUND DATA

Stressful events may have adverse effects on health. Distress in the patient with lumbar disc herniation also may be a stressful event. Previous findings have shown the activity of natural killer cells to be impaired in medical student volunteers and after bereavement or other stressful life events. However, the stress in patients with spinal disorders has not been evaluated. The standard assay for natural killer cell activity has been the chromium release assay. However, this assay requires the use of radioactive chromium. Flow cytometric assay is a nonradioactive method that analyzes the activated natural killer lymphocyte subsets: CD45+, CD56+, CD69+.

METHODS

Peripheral blood lymphocytes were obtained from 20 patients with lumbar disc herniation (mean age, 30.8 years) and 20 healthy individuals (mean age, 38.9 years). Both chromium release assay and flow cytometric assay were performed for each patient.

RESULTS

The mean natural killer cell activity in the patients (8.0% +/- 4.3%) was significantly lower than in the 20 healthy adult volunteers (12.6% +/- 4.5%). The mean natural killer cell activity in the healthy volunteers was 12.6% +/- 4.5% for the chromium release assay and 11.0% +/- 4.1% for the flow cytometric assay. The correlation (r = 0.77) of natural killer cell activity between the two methods was high.

CONCLUSIONS

Natural killer cell activity in the patients with lumbar disc herniation was significantly lower than in healthy individuals, and the stress induced by pain and other distress may be present in patients with lumbar disc herniation. For measuring natural killer cell activity, flow cytometric assay is a reproducible assay, and it may be a viable alternative to the standard chromium release assay.

Human response to environmental noise: the role of perceived control

Negative impacts of noise exposure on health and performance may result in part from "learned helplessness," the syndrome of deficits typically produced by exposure to uncontrollable events. People may perceive environmental noise to be uncontrollable, and several effects of noise exposure appear to parallel "learned helplessness" deficits. In the present socioacoustic survey (N = 1,015), perceived control over aircraft noise correlated negatively with some effects of noise (though not others). Furthermore, these effects were better predicted by perceived control than by noise level. These observational data support the claim that "learned helplessness" contributes to the effects of noise exposure.