Supporting community carers via videoconferencing

We provided support, practical advice and networking opportunities for carers in rural and remote areas of Western Australia through the use of videoconferencing. The first videoconference for carers occurred in June 2004. In the next 12 months there were 11 videoconferences with 11 rural towns. Some sessions were point-to-point and some were multipoint. Over 90 carers participated in the sessions. A facilitator with expertise on stress in carers delivered the sessions from Perth. The acceptance of videoconferencing as a support medium by the carers attending was positive and there were requests for the sessions to be continued. The skills of the facilitator to connect in a very personal way with each person were important to the success of the programme.

Evaluation of Driver Stress in a Motor-vehicle Driving Simulator Using a Biochemical Marker

The purpose of this study was to evaluate salivary amylase activity (sAMY) as an indicator of the acute psychological effects of driving. The influence of the operation of a device not directly associated with driving was also estimated using a car navigation system. The psychological effects of driving were examined using sAMY analysis, oculomotor angle and subjective evaluation with a questionnaire, and the methods were compared. The change in sAMY over time was analysed before and during driving. The results indicate that the psychological effect of driving-induced stress, a condition that cannot be easily detected or recognized by a subjective evaluation, is quickly quantified using sAMY. Moreover, the results suggest that the operation of a non-driving-related device may also reduce the driver's capacity to concentrate on driving.

Hair pulling: a review

Hair pulling has been reported in humans, six different non-human primate species, mice, guineapigs, rabbits, sheep and muskox, dogs and cats. This behaviour seems to occur only in subjects who are confined in an artificial environment. It has been classified as a mental disorder in humans, as a behavioural pathology in animals. The hair is not only pulled but also, in most species, ingested. Hair pulling can be both self-directed and partner-directed, contains elements of aggression, manifests more often in females than in males, is associated with psychogenic distress, and resists treatment. Research data collected from affected animals are probably not normative, hence scientifically unreliable. The preemptive correction of husbandry deficiencies causing long-term stress may prevent the development of this bizarre behaviour in healthy subjects.

Is Fixed-Term Employment a New Risk for Adverse Physical Working Conditions?

Relationships between employment type and the physical work environment were studied among blue-collar workers (n = 1,127). Based on survey data, we set out to compare the evaluations of environmental load and physical strain at work given by fixed-term (17% of all) and permanent workers. The type of employment was not related to environmental load. However, working on a fixed-term basis increased the risk of physical strain at work. Analyses revealed that this connection was evident only among fixed-term construction workers. The results did not support the much-cited view that the disintegration of standard employment has given rise to a new series of work environment problems. Such problems are concentrated in an area with a long tradition of work environment problems, that is, in the construction industry.

Genotype–Environment Interactions: Cognitive Aging and Social Factors

The possibility of genotype–environment interaction for memory performance and change was examined in 150 monozygotic (MZ) twin pairs from the Swedish Adoption Twin Study of Aging (SATSA). We used an MZ twin pair difference approach to examine the possibility that genotype was associated with intrapair variability and thus suggestive of genotype–nonshared environment interactions. Multiple ‘variability genes’ were found for longitudinal change in a semantic memory task including candidates coding for apolipoprotein E (APOE) and estrogen receptor alpha (ESR1) as well as serotonin candidates (HTR2Aand5HTT). One candidate also related to variability in change in episodic memory (5HTT). Of the significant associations observed, generally results indicated that MZ pairs who carry putative risk alleles were less variable than noncarriers, suggesting that noncarriers may be more sensitive to environmental contexts. We sought to ‘contextualize’ the possible nonshared environmental influences for found gene–environment (G × E) effects by considering intrapair differences in measured social and stress factors, including social support, life events and depressive symptoms. Results suggested that nonshared environmental influences associated with depressive symptoms may moderate the G × E relationship observed forESR1andAPOEand longitudinal semantic memory change whereby noncarriers of putative risk alleles may be relatively more sensitive to depressionevoking environmental contexts than carriers of the risk allele. Thus, the contexts that facilitate or reduce depressive symptoms may affect semantic memory resiliency dependent on genotype. Further work ought to consider larger sample sizes as well as consider additional social and contextual factors.

Circadian Variation in Cortisol Reactivity to an Acute Stressor

To investigate the role of the circadian pacemaker in cortisol reactivity to a cold pressor challenge, 26 diurnally subjects participated in a constant-routine protocol and were divided into two groups. Group 1 started immediately after a monitored sleep period at 09:00 h, while group 2 started 12 h later. After 2 h of adaptation, a cold pressor test was presented every 3 h. The cortisol response was assessed by means of saliva samples that were taken before and after the test. The pretest samples were considered to be base-rate measures and base-rate values as subtracted from post-test values were considered as reactivity measures. Both measures showed distinct Time-of-Day variations (respectively: F(7,168) = 16.92, p < 0.001, epsilon = 0.383; and F(7,175) = 8.01, p < 0.001, epsilon = 0.523). These findings are interpreted as evidence for the existence of an endogenous circadian periodicity underlying the sensitivity of the hypothalamus-pituitary-adrenal (HPA)-axis to acute stress.

EFFECTS OF HOSTILITY AND STRESS ON AFFECTIVE VERBAL LEARNING IN WOMEN

The current experiment investigated the effects of hostility on affective verbal learning and physiological regulation in high and low hostile women. The Auditory Affective Verbal Learning Test (AAVLT) was administered to women in either a cold pressor or no cold pressor condition. Systolic blood pressure, diastolic blood pressure, and heart rate were recorded before and after the cold pressor or no cold pressor manipulation. Results indicated that high hostile women learned fewer words across conditions. The cold pressor primarily influenced neutral learning in high and low hostile participants. Additionally, primacy and recency effects of the AAVLT were replicated.

A Multidimensional Model for Understanding Cancer Pain

The experience of pain pervades the physical and psychosocial domains of a patient's existence. It has a concrete underpinning in the form of an injury or disease process, yet subjective responses to pain sensations are psychosocial processes that influence the experience of pain and the capacity to cope with it. Anticipation of pain is one of the key fears associated with cancer, and uncontrolled pain strips away morale and quality of life. The interacting biopsychosocial dimensions are important areas for consideration in the comprehensive, skillful approach to assessment and treatment of cancer pain. This article addresses the interactive relationships between pain and mood using the biopsychosocial model as a heuristic for assessment.

Psychological distress across the course of care: a case study from implantable cardioverter defibrillator to cardiac transplantation evaluation

The psychological distress of cardiac patients can complicate treatment or the recovery process. This case study presents a 47-year-old male recipient of an implantable cardioverter defibrillator who experienced multiple, consecutive shocks and subsequently developed anxiety and depressive difficulties. Psychological treatment to diminish these symptoms was employed. Despite declining cardiac function, the patient made significant progress in managing this negative affect. Subsequently, he was evaluated for cardiac transplant, and this treatment progress became critical evidence of his psychosocial suitability for transplant.

Salivary cortisol concentrations, stress and quality of life in women with endometriosis and chronic pelvic pain

The objective of this study was to evaluate the perceived stress index, quality of life, and hypothalamus-pituitary-adrenal axis activity in women with endometriosis and chronic pelvic pain. For the study, 93 women with endometriosis and 82 healthy women volunteered. The visual analogue scale (VAS) (0=no pain; 10=severe pain) was used to determine pain intensity; the perceived stress questionnaire (PSQ) defined stress index, and the health-related quality-of-life (HRQOL)-SF-36 questionnaire was used to evaluate quality of life. Salivary cortisol was measured at 0800, 1600, and 2000 h and the awakening cortisol response was assessed to evaluate the hypothalamus-pituitary-adrenal axis activity. The results show that women with endometriosis and chronic pelvic pain of moderate intensity (4.1+/-0.58, mean+/-SEM) have higher levels of perceived stress (0.55+/-0.01 versus 0.42+/-0.01, p<0.05), a poorer quality of life expressed as lower scores for all items of the inventory and hypocortisolism. Lower levels of salivary cortisol were observed in all three samples collected, as well as in the awakening cortisol response, for women with endometriosis (0.19+/-0.09 microg/dl) when compared with controls (0.78+/-0.08 microg/dl, p<0.05 l), and it was independent of pain intensity and Mental health (MH) scores in SF-36. We concluded that women with endometriosis and chronic pelvic pain show low concentrations of salivary cortisol and a high level of perceived stress, associated with a poor quality of life. Whether the hypocortisolism was an adaptive response to the aversive symptoms of the disorder or a feature related to the etiology of endometriosis remains to be elucidated.

Epigenetic programming of stress responses through variations in maternal care

Early life experiences shape an individual's physical and mental health across the lifespan. Not surprisingly, an upbringing that is associated with adversity can produce detrimental effects on health. A central theme that arises from studies in human and nonhuman species is that the effects of adversity are mediated by the interactions between a mother and her young. In this review we describe some of the long-term effects of maternal care on the offspring and we focus on the impact of naturally occurring variations in the behavior of female rats. Of particular interest are mothers that engage in high or low amounts of licking/grooming (LG) and arched-back nursing (ABN) of their pups, but do so within the normal range for this species. Such variations in LG-ABN can alter the function of the hypothalamic-pituitary-adrenal (HPA) axis, and cognitive and emotional development by directly affecting the underlying neural mechanisms. At the heart of these mechanisms is gene expression. By studying the hippocampal glucocorticoid receptor gene, we have identified that maternal care regulates its expression by changing two processes: the acetylation of histones H3-K9, and the methylation of the NGFI-A consensus sequence on the exon 1(7) promoter. Sustained "maternal effects" appear elsewhere in biology, including plants, insects, and lizards, and may have evolved to program advantages in the environments that the offspring will likely face as adults. Given the importance of early life and parent-child interactions to later behavior, prevention and intervention programs should target this critical phase of development.

Stress reduction through consolation in chimpanzees

Consolation, i.e., postconflict affiliative interaction directed from a third party to the recipient of aggression, is assumed to have a stress-alleviating function. This function, however, has never been demonstrated. This study shows that consolation in chimpanzees reduces behavioral measures of stress in recipients of aggression. Furthermore, consolation was more likely to occur in the absence of reconciliation, i.e., postconflict affiliative interaction between former opponents. Consolation therefore may act as an alternative to reconciliation when the latter does not occur. In the debate about empathy in great apes, evidence for the stress-alleviating function of consolation in chimpanzees provides support for the argument that consolation could be critical behavior. Consistent with the argument that relationship quality affects their empathic responses, we found that consolation was more likely between individuals with more valuable relationships. Chimpanzees may thus respond to distressed valuable partners by consoling them, thereby reducing their stress levels, especially in the absence of reconciliation.

Pituitary--adrenal responsiveness of rat mothers to noxious stimuli and stimuli produced by pups

Studies on the response of female rats to various stresses during the course of lactation showed a marked reduction in pituitary-adrenal activity. Maximum suppression coincided with the period of maximum lactation, about 14 days after parturition. Both pituitary corticotropin and the release of corticosterone were significantly reduced. Females showing maternal behaviour but not lactating did not exhibit this buffering of the stress response. Another aspect of pituitary-adrenal activity has been studied in lactating female rats. Females, although they have a buffered stress response, responded differently, in terms of pituitary-adrenal activity, to stimuli emitted by the pups: pups which are exposed to noxious stimuli elicit a much greater pituitary-adrenal response in lactating females than do pups which are merely handled. Separation from the pups does not elicit a pituitary-adrenal response. This difference in response is modified if the infants are malnourished and is not observed in virgin animals that are not lactating.

Biology and health inequality

Intriguing parallels between civil servant and nonhuman primate hierarchies suggest that highly stratified societies foster health inequalities. Determining how social differences translate into chronic disease remains a challenge, but neuroendocrine pathways appear to play a role.

Sympathetic arousal to a vestibular stressor in high and low hostile men

The aim of the present experiment was to extend the literature on hostility and a cerebral systems based model of sympathetic arousal to a vestibular-based stress. Several authors have concluded that autonomic stress reactivity in high hostile individuals must be interpersonally based, whereas healthy vestibular system functioning does not depend on interpersonal features. Utilizing a vestibular activation paradigm, skin conductance levels of 15 high hostile and 15 low hostile men were recorded after brief passive rotation about the vertical neuroaxis. It was expected that hostile individuals would exhibit higher skin conductance levels after rotation compared with low hostile individuals. The results confirmed expectations of heightened sympathetic tone among high hostiles subsequent to vestibular stress. Overall, the findings are interpreted to support a cerebral model of frontal region capacity limitation for regulation of vestibular stress that is independent of psychosocial mechanisms.

Effect of lithium on swim stress-induced antinociception in naive mice and mice with subchronic administration of morphine or swim stress in formalin test

BACKGROUND

Lithium has been shown to relieve mania and induce antinociception. In the present study, swim stress at 8C induced antinociception in both phases of the formalin test. Intraperitoneal administration of lithium chloride (LiCl) (0.05, 0.25, and 0.5 mg/kg) also induced antinociception in both phases of the formalin test.

METHODS

Antinociception was assessed by the formalin test method. Swim stress was achieved in the 8C water in a container 5 cm in diameter and 20 cm tall filled with water do a depth of 11 cm.

RESULTS

The drug (0.5 and 5 mg/kg) potentiated swim stress-induced antinociception in the second phase of the test. Repeated exposure to water swimming stress with a period of 40 sec, once daily for three days, in combination with lithium chloride did not alter stress-induced antinociception in either phases of the formalin test, when swim stress-induced antinociception was tested on the fourth day. Subchronic treatment with morphine (25 mg/kg), once daily for three days, in the presence or absence of lithium chloride (5 mg/kg) did not alter swim stress-induced antinociception, either, when swim stress-induced antinociception was tested on the fourth day.

CONCLUSION

It may be concluded that lithium chloride potentiates swim stress-induced antinociception, but the drug has no influence on the response of subchronic administration swim stress or morphine.

Anticipatory stress response: a significant commonality in stress, relaxation, pleasure and love responses

With this work we examine common pathways and autoregulatory similarities between different physiological phenomena, particularly with regard to stress, relaxation and love responses, against the background of recent research findings. Various stress reducing practices that incorporate an initial and short-lived stress pathway activation, e.g., love, relaxation and placebo responses, exhibit anticipatory stress response (ASR) physiology. The initial activation of this stress component of the total response, i.e., love, relaxation, and mental or physical stress responses, is significant and, as we speculate, may represent a common protective mechanism, since activation (i.e., stress response) is started first and, if the situation appears to be 'safe', may be followed by relaxation, if appropriate. Also, the emergence of love became evolutionarily important in organisms exhibiting cognition, because it deployed the validation for emotionality-controlling logical behavior. Therefore, love and relaxation responses may be considered as intrinsic health promoting physiological capabilities.

Anxiety as an enhancing phenomenon in origin of stress, CAN and PTSD in disabled children. Contribution to the ICD-10 re-classification

This paper studies the contribution of anxiety in origin of functional behavioural disorders of children. The intense sensing of anxiety attributes to the shaping of one's personality. Adaptation and adjustment, accommodation and assimilation to stressful conditions producing anxiety are analyzed. There are diagnosed reactions of organism to the circumstances of the CAN syndrome and trauma. In these circumstances, a primary perception of reality is at stake that consequently leads to sociopathological features. This paper also provides the authors' opinions of psychoanalytical and behavioural schools on origin of personal decompensation and neurotic disorders. Causes of panic disorder and other diseases, in which a stress trauma plays a role, are considered. For these reasons the authors suggest classifying the CAN syndrome as a separate nosologic unit in the future ICD-11.

Stress and reproductive failure: past notions, present insights and future directions

PROBLEM

Maternal stress perception is frequently alleged as a cause of infertility, miscarriages, late pregnancy complications or impaired fetal development. The purpose of the present review is to critically assess the biological and epidemiological evidence that considers the plausibility of a stress link to human reproductive failure.

METHODS

All epidemiological studies published between 1980 and 2007 that tested the link between stress exposure and impaired reproductive success in humans were identified. Study outcomes were evaluated on the basis of how associations were predicted, tested and integrated with theories of etiology arising from recent scientific developments in the basic sciences. Further, published evidence arising from basic science research has been assessed in order to provide a mechanistic concept and biological evidence for the link between stress perception and reproductive success.

RESULTS

Biological evidence points to an immune-endocrine disequilibrium in response to stress and describes a hierarchy of biological mediators involved in a stress trigger to reproductive failure. Epidemiological evidence presents positive correlations between various pregnancy failure outcomes with pre-conception negative life events and elevated daily urinary cortisol. Strikingly, a relatively new conceptual approach integrating the two strands of evidence suggests the programming of stress susceptibility in mother and fetus via a so-called pregnancy stress syndrome.

CONCLUSIONS

An increasing specificity of knowledge is available about the types and impact of biological and social pathways involved in maternal stress responses. The present evidence is sufficient to warrant a reconsideration of conventional views on the etiology of reproductive failure. Physicians and patients will benefit from the adaptation of this integrated evidence to daily clinical practice.

Evidence that the COMT(Val158Met) polymorphism moderates sensitivity to stress in psychosis: an experience-sampling study

Gene-environment interactions involving the catechol-O-methyltransferase Val(158)Met polymorphism (COMT(Val158Met)) have been implicated in the causation of psychosis. Evidence from general population studies suggests that Met/Met subjects are sensitive to stress, a trait associated with psychosis. We hypothesized that the Met allele would moderate the effects of stress on negative affect (NA) in controls, and on NA and psychosis in patients with a psychotic disorder. Thirty-one patients with a psychotic disorder and comorbid cannabis misuse and 25 healthy cannabis users were studied with the experience sampling method (ESM), a structured diary technique assessing current context and emotional and psychotic experiences in daily life. A significant interaction between COMT(Val158Met) genotype and ESM stress in the model of NA was found for patients (interaction chi(2) = 7.4, P = 0.02), but not for controls (interaction chi(2) = 3.8, P = 0.15). In the model of ESM psychosis, a significant interaction between COMT(Val158Met) genotype and ESM stress was also apparent (interaction chi(2) = 11.6, P < 0.01), with Met/Met patients showing the largest increase in psychotic experiences as well as NA in reaction to ESM stress. The findings suggest that the COMT(Val158Met) polymorphism moderates affective and psychotic responses to stress in patients with psychosis, providing evidence for gene-environment interaction mechanisms in the formation of psychotic symptoms.

Cortisol and behavioral responses of working dogs to environmental challenges

This paper's primary objective is to analyse the physiological (cortisol) and behavioral responses of military working dogs (MWD). Dogs (N=27) were submitted twice to environmental challenges (challenge 1 and 2, 20 days in-between) composed of social (training), visual (mobile toy car) and auditory (air blast) stimuli. Cortisol levels decreased back to the baseline after the second challenge. The behavioral observations showed that these MWD were more active, and presented less stereotypic behaviors (pacing, manipulation of the environment) during both visual challenges, whereas half low posture was observed during the first but not during the second visual challenge. The present study shows that this group of MWD still has an adaptation capacity to an environmental challenge (return to baseline of the cortisol levels, a higher posture during the second than at the first challenge). These results are encouraging and indicate that the dogs might have a diminished welfare (i.e. stereotypic behaviors), but are not chronically stressed.

Glucocorticoid receptor mRNA expression in the hippocampal formation of male rats before and after pubertal development in response to acute or repeated stress

Numerous studies have established that adolescence is marked by substantial changes in stress reactivity and hippocampal function. Glucocorticoid receptors (GRs) in the hippocampus are imperative in corticosterone-dependent gene transcription when glucocorticoid levels are relatively high, such as during periods of stress. As reported previously, in reaction to acute stress, prepubertal animals show a significantly more protracted corticosterone response compared to adults. Chronic stress, however, results in a higher peak response, but a faster return to baseline in prepubertal compared to adult animals. Thus, depending on the developmental stage and experience of the animal, the hippocampus is exposed to different concentrations and durations of corticosterone. The present set of experiments assessed the effects of acute or repeated stress on GR mRNA expression in the dorsal and ventral hippocampal formation either before or after pubertal maturation in male rats. We found that acute stress results in a significant decrease in GR mRNA in the CA1 pyramidal cell layer and dentate gyrus in the dorsal and ventral hippocampal formation of both prepubertal and adult males. In response to repeated stress, we found no differences in GR expression in either the dorsal or ventral hippocampus. Thus, despite the dramatic differences in corticosterone concentration following stress at these two developmental stages, the stress-induced changes in GR expression in the hippocampus before and after pubertal maturation were more similar than different. These data point to a dissociation between differential stress-induced corticosterone responses and regulation of hippocampal GR levels in prepubertal and adult animals.

The glare hypothesis of macular pigment function

PURPOSE

Discomfort and reduced visual performance due to glaring light conditions are common complaints for most individuals. Past studies have shown that macular pigment (MP) reduces discomfort due to glare. In this study, we evaluated whether MP was related to visual performance under glare conditions.

METHODS

Thirty-six healthy subjects participated (age range, 18 to 41). Spatial profiles of MP optical density were measured using heterochromatic flicker photometry with a Newtonian-view macular densitometer. Photostress recovery and grating visibility under veiling conditions were assessed in a Maxwellian-view optical system. Both experiments used six monochromatic lights (from 440 to 620 nm) and a broadband xenon white. For the veiling glare experiment, subjects fixated a 1 degrees diameter disk containing a black and white 100% contrast grating stimulus. The intensity of an annulus (the glare source) with an 11 degrees inner and 12 degrees outer diameter was adjusted by the subject until the grating stimulus was no longer seen. For the photostress recovery experiment, the time required to detect a 1 degrees -diameter grating stimulus (detailed above) after a 5-s exposure to a 2.5 microW/cm2, 5 degrees -diameter disk was recorded. Both central and eccentric (10 degrees temporal retina) viewing conditions were assessed.

RESULTS

MP at 30' eccentricity ranged from 0.08 to 1.04 OD, and was found to dramatically reduce the deleterious effects of glare. Visual thresholds under glare conditions were strongly related to MP density (e.g., r = 0.76, p = 0.0001 when using white light). Photostress recovery time, after exposure to xenon-white light, was significantly shorter for subjects with higher MP levels (r = -0.79, p = 0.0001). Both photostress recovery and veiling glare functions were well-described by the photopic spectral sensitivity function (Vlambda).

CONCLUSIONS

MP is strongly related to improvements in glare disability and photostress recovery in a manner consistent with its spectral absorption and spatial profile.

The effects of stress on body weight: biological and psychological predictors of change in BMI

OBJECTIVE

To investigate individual differences in the effects of stress on BMI.

RESEARCH METHODS AND PROCEDURES

Participants were 71 healthy women volunteers enrolled in a university-based nurse practitioner program. Predictors of change in BMI were hypothesized to be cortisol secretion, dietary restraint, binging, mastery, mood, and eating attitudes. Measures were made at the beginning of the academic semester and 12 weeks later during the participants' examination period.

RESULTS

The women were of normal weight (BMI 25.2 +/- 4.3) for their age [43; standard deviation (SD), 7]. By the examination period, 40 had gained weight (mean, 5.5 pounds; SD, 2.2), 19 lost weight (mean, 2.5 pounds; SD, 1.5), and 12 had stable weight. BMI, salivary cortisol secretion, binging behavior, depression, and anxiety increased significantly, whereas scores on dietary restraint, weight, shape, and eating concerns, and mastery decreased significantly. Regression analysis showed that change in daily cortisol secretion significantly predicted change in BMI and that mastery significantly moderated this relationship. However, a reduction in dietary restraint was a perfect mediator of this relationship. Change in cortisol secretion also significantly predicted change in dietary restraint, and this was moderated by dietary restraint at the beginning of the academic semester. Reduction in dietary restraint was also predicted by a reduction in mastery and weight concern.

DISCUSSION

We identified individual differences that confer vulnerability to weight gain during stressful life events (dietary restraint and mastery). Given that women are exposed to daily stressors and use cognitive strategies to restrain their dietary intake, increasing awareness of the role of stress on eating behavior and weight is an important goal.

A study on stress, depression and NK cytotoxic potential in women with recurrent spontaneous abortion

It has been recognized that acute and chronic stress has an impact on the immune system. Acute stress may have a stimulating effect on the immune system, while in the case of chronic stress specially depression, the immune system could be down-regulated. However, an association between depression and a higher number of circulating white blood cells with increased activity has been reported. Elevation in immune cell numbers and alteration in cytokine profiles are documented for women suffering sporadic spontaneous abortion with a high stress score. In spite of these contradictory results and to make a new approach in immunological (NK activity) as well as psychological parameters (stress/depression) in women suffering from recurrent spontaneous abortion (RSA) the present study was planned. Forty-five women with a history of RSA and a matched control group were participated in this study. A questionnaire for life events known as life change units (LCU) and the Beck Depression Inventory (BDI) outlines were used and the socio-psychological events were recorded after visiting and interview. Fresh peripheral blood lymphocytes were taken as a source of NK activity and K562 cell line were used as NK sensitive target. The experiments were performed and the cells were analyzed with a flow-cytometer. The stress and the depression scores were determined 245+/-83.6 and 27.6+/-8.8 for women with RSA and 224+/-79.6 and 19.4+/-7.1 for non-RSA group respectively. There was an association between life stress scores and depression scores with r=0.65 and P=0.000 for RSA women. A correlation with r =-0.34 and P = 0.02 was found between depression scores and NK cytotoxicity. The Pearson correlation test showed a lack of relationship between high stress score and NK activity with the r=0.011 and P=0.95, but r=-0.30 and P=0.072 was obtained for high depression scores and NK cytotoxicity. Therefore, it could be suggested that in the case of women with a history of recurrent spontaneous abortion, modulation for immunological parameters (i.e immunotherapy) concurrently with managing psychological aspects (stress/depression) could be modified for the benefit of the patients.

Identifying early behavioral and molecular markers of future stress sensitivity

Puberty is a plastic period of neurological development when critical maturation of stress pathways occurs. Abnormal maturation may be predictive of future stress sensitivity and affective disorder risk. To identify potential early markers of stress-related disease predisposition, we examined physiological and behavioral stress responses in male pubertal mice compared with adults, using a genetic model of elevated stress sensitivity, CRF receptor-2 (CRFR2)-deficient mice. Juvenile mice of both genotypes exhibited greater basal and stress-induced corticosterone levels than adult mice, indicating that overall hypothalamic-pituitary-adrenal axis sensitivity diminishes in adulthood. However, juvenile CRFR2-deficient mice displayed a delayed stress recovery typical of adults of this genotype, suggesting an early marker of stress sensitivity. The adult phenotype of reduced hippocampal glucocorticoid receptor expression in these sensitive mice was also detected during puberty. This reduction may account for an impaired hypothalamic-pituitary-adrenal axis negative feedback and as such be an early indicator of a stress-sensitive phenotype. Examination of behavioral responses to stress revealed that CRFR2-deficient mice show exaggerated postpubertal maturation. Although wild-type mice did not alter their burying response to stress-provoking marbles after puberty, CRFR2-deficient mice showed a dramatic increase in burying behavior. We conclude that identification of abnormal pubertal stress pathway maturation may be predictive of adult heightened stress sensitivity and future susceptibility to stress-related affective disorders.

Medically unexplained symptoms and between-group differences in 24-h ambulatory recording of stress physiology

People with medically unexplained symptoms (MUS) often have a comorbid history of stress and negative affect. Although the verbal-cognitive and (peripheral) physiological stress systems have shown a great degree of independence, at the same time it is claimed that chronic stress and negative affect can result in a disregulated physiological stress system, which may lead to MUS. Previous studies could not demonstrate a straightforward between subject relationship between MUS and stress physiology, supporting the view of independence. The aim of the current study was to further explore this relationship using an improved methodology based on ecologically valid 24-h real-life ambulatory recordings. Seventy-four participants (19 male; 55 female) with heterogeneous MUS were compared with 71 healthy controls (26 male; 45 females). Momentary experienced somatic complaints and mood, heart rate, cardiac autonomic activity, respiration and saliva cortisol were monitored using electronic diary and ambulatory registration devices. Participants with MUS reported much more momentary complaints and negative affect as compared to controls. Although MUS seemed to be associated with elevated heart rate and reduced low and very-low frequency heart period variability, these effects disappeared after controlling for differences in sports behaviour. No group differences were found for cardiac autonomic activity, respiration, end-tidal CO(2) and saliva cortisol. Our 24-h real-life ambulatory study did not support the existence of a connection between MUS and disregulated peripheral stress physiology. Future studies may instead focus on central measures to reveal potential abnormalities such as deviant central processing of visceral signals in MUS patients.

The role of corticotropin-releasing factor in behavioural responses to stress

Corticotropin-releasing factor (CRF), when administered directly into the CNS, can have activating properties on behaviour and can enhance behavioural responses to stress. CRF injected intraventricularly produces a dose-dependent increase in locomotor activity and increased responsiveness to an acoustic startle stimulus. However, this profile of activation changes to enhanced suppression of behaviour in stressful situations and includes increased freezing, increased conditioned suppression, increased conflict, decreased feeding and decreased behaviour in a novel open field. These effects of CRF are independent of the pituitary-adrenal axis and can be reversed by the CRF antagonist alpha-helical CRF(9-41). More importantly, the CRF antagonist can also reverse many behavioural responses to stressors. alpha-Helical CRF(9-41) reverses stress-induced fighting behaviour, stress-induced freezing, stress-induced suppression of feeding, stress-induced decreases in exploration of an elevated plus maze, fear-potentiated startle and the development of conditioned suppression. Intracerebral microinjections suggest that the amygdala may be an important site for the anti-stress effects of alpha-helical CRF(9-41). These results suggest that endogenous CRF systems in the CNS may have a role in mediating behavioural responses to stress and further suggest that CRF in the brain may function as a fundamental behavioural activating system. This CRF system may be particularly important in situations where an organism must mobilize not only the pituitary-adrenal system but also the CNS in response to environmental challenge.

Psychiatric morbidity and quality of life in patients with chronic idiopathic urticaria

BACKGROUND

Chronic idiopathic urticaria (CIU) is a frequently occurring disease that has a great impact on the health-related quality of life (HRQL) of patients and seems to be associated with a number of psychological factors.

OBJECTIVES

To determine the prevalence of psychiatric morbidity in patients with CIU and to determine HRQL of CIU patients compared with controls.

METHODS

A semistructured interview form, a generic form of the HRQL questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]), and the Structured Clinical Interview for DSM-IV Axis Disorders (SCID-I) were administered to CIU patients who presented to the Allergy Department of the University of Istanbul (from January 1 to April 30, 2005). Healthy subjects matched sociodemographically with the study group were used as the control group.

RESULTS

Eighty-four CIU patients and 75 controls were included in the study. The mean +/- SD age of the study participants was 36.83 +/- 10.26 years, and 84% were women. The mean +/- SD duration of the disease was 6.34 +/- 7.2 years, and symptoms were intermittent in 51%. The SCID-I revealed a psychiatric diagnosis in 60% of the patients. In terms of the distribution of psychiatric diagnoses, the most frequently occurring diagnosis was depressive disorders (40%). Most patients (81%) believed that their illnesses were due to stress. The subdomains on the SF-36 measurements were significantly lower than those of the control subjects (P < or = .005). The physical function, vitality, and mental health subdomains of the SF-36 in the patients with a psychiatric diagnosis were significantly lower (P < .05).

CONCLUSION

These findings suggested that psychiatric morbidity is high among ICU patients and is detrimental to their quality of life.

Impaired cortisol response to acute stressors in patients with coronary disease. Implications for inflammatory activity

OBJECTIVES

Inflammation is assumed to play a major role in the progress of atherosclerotic disease. We hypothesized that an altered hypothalamic-pituitary adrenal (HPA) axis activity was linked to a disinhibited inflammatory activity in patients with coronary artery disease (CAD).

METHODS

Thirty CAD patients were assessed 12-14 weeks after a first-time acute coronary syndrome. Serum samples were assayed for C-reactive protein (CRP) and interleukin-6. Free cortisol was measured in a 24-h urine sample and in repeated saliva samples 30 min after awakening and at bedtime. The levels of inflammatory markers and cortisol were also determined before and after standardized physical and psychological stress tests.

RESULTS

The CAD patients had a higher 24-h cortisol secretion and a flattened diurnal slope, resulting from significantly higher cortisol levels at bedtime, compared to clinically healthy controls. The levels of evening cortisol were strongly related to inflammatory markers in serum. When exposed to acute physical and psychological stressors, the CAD patients showed a significantly blunted cortisol response compared to controls. In addition, a stress-induced increase in CRP was only observed in the patient group.

CONCLUSIONS

Patients with CAD exhibited a cortisol pattern that markedly differed from controls. The data indicate that a dysfunctional HPA axis response involves a failure to contain inflammatory activity in CAD patients, thus providing a possible link between stress and inflammation in disease.

Possible GABAergic Modulation in the Protective Effect of Zolpidem in Acute Hypoxic Stress-induced Behavior Alterations and Oxidative Damage

Hypoxia is an environmental stressor that is known to elicit alterations in both the autonomic nervous system and endocrine functions. The free radical or oxidative stress theory holds that oxidative reactions are mainly underlying neurodegenerative disorders. In fact among complex metabolic reactions occurring during hypoxia, many could be related to the formation of oxygen derived free radicals, causing a wide spectrum of cell damage. In present study, we investigated possible involvement of GABAergic mechanism in the protective effect of zolpidem against acute hypoxia-induced behavioral modification and biochemical alterations in mice. Mice were subjected to acute hypoxic stress for a period of 2 h. Acute hypoxic stress for 2 h caused significant impairment in locomotor activity, anxiety-like behavior, and antinocioceptive effect in mice. Biochemical analysis revealed a significant increased malondialdehyde, nitrite concentrations and depleted reduced glutathione and catalase levels. Pretreatment with zolpidem (5 and 10 mg/kg, i.p.) significantly improved locomotor activity, anti-anxiety effect, reduced tail flick latency and attenuated oxidative damage (reduced malondialdehyde, nitrite concentration, and restoration of reduced glutathione and catalase levels) as compared to stressed control (hypoxia) (P < 0.05). Besides, protective effect of zolpidem (5 mg/kg) was blocked significantly by picrotoxin (1.0 mg/kg) or flumazenil (2 mg/kg) and potentiated by muscimol (0.05 mg/kg) in hypoxic animals (P < 0.05). These effects were significant as compared to zolpidem (5 mg/kg) per se (P < 0.05). Present study suggest that the possible involvement of GABAergic modulation in the protective effect of zolpidem against hypoxic stress.

The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability

An increasing number of studies consider the specific processes by which distressing sensations, thoughts, and emotional experiences exert their influence on the daily functioning of those who suffer with chronic pain. Clinical methods of mindfulness and the processes that underlie them appear to have clear implications in this area, but have not been systematically investigated to this point in time. The purpose of the present study was to examine mindfulness in relation to the pain, emotional, physical, and social functioning of individuals with chronic pain. The present study included 105 consecutive patients attending a clinical assessment for treatment of chronic pain. Each completed a standardized battery of questionnaires, including a measure of mindfulness, the Mindful Attention Awareness Scale [Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol 2003;84:822-48]. Correlation analyses indicated that mindfulness was unrelated to age, gender, education, or chronicity of pain, but was significantly related to multiple measures of patient functioning. In multiple regression analyses, after controlling for patient background variables, pain intensity, and pain-related acceptance, mindfulness accounted for significant variance in measures of depression, pain-related anxiety; physical, psychosocial, and "other" disability. In each instance greater mindfulness was associated with better functioning. The combined increments of variance explained from acceptance of pain and mindfulness were at least moderate and, in some cases, appeared potentially meaningful. The behavioral processes of mindfulness and their accessibility to scientific study are considered.

[Critical factors for subjective burden of mothers of children with developmental language disorders]

BACKGROUND

In earlier studies, it was found that mothers of children with developmental language disorders had a higher incidence of anxiety and depression in comparison to the normal population. This study concentrated on the following questions: is the perceived stress, anxiety and depression of mothers with children with developmental language disorders higher than in the normal population, even for those mothers who are not exposed to any further stressors? and what environmental factors play an important role in the mental health of the mothers?

MATERIALS AND METHODS

A total of 90 mothers (aged 32.9+/-4.7 years) of preschoolers diagnosed with a developmental language disorder, but with otherwise normal development, participated in the study. The mental health of the mothers was assessed using the Perceived Stress Scale (PSS) and the German version of the Hospital Anxiety and Depression Scale (HASD-D). Environmental factors were captured by a structured anamnestic procedure. Predictors of mental health were determined using multivariate regression analysis.

RESULTS

The entire sample demonstrated significant levels of stress, anxiety and depression. In comparison to the standardized values, those mothers of children with developmental language disorders who were not exposed to any further stressors, were also shown to have significantly higher rates of stress and depression on the scales used, although not significantly higher levels of anxiety. A significant predictor of positive overall mental health of the mothers was the extent of adequate support in child rearing.

CONCLUSIONS

Health professionals dealing with children with developmental language disorders must reckon with a considerable number of mothers whose mental health is negatively affected. When treating a child with a developmental language disorder, measures to improve the mother's state of well-being should be considered, including counseling and self-help groups.

Maternal negative attitudes towards pregnancy as an independent risk factor for low birthweight

AIM

Recently, Japan has witnessed an increase in the number of low-birthweight (LBW) infants. LBW children face a variety of social and medical risk factors. Thus, besides reducing infant mortality, preventing LBW would have many other important health benefits. Emotional status during pregnancy is stated as one of the important risk factors for LBW. This study aims to clarify the relationship between maternal emotions and low birthweight (LBW) after adjusting the effects of other well-known factors that influence LBW.

METHODS

This community-based case-control study involved 145 newborns with LBW (cases) and 213 newborns with normal weight (controls). They were born in the municipalities that fall within the jurisdiction of the Yoshida public health center between 1st January 2003 and 30th September 2004. Participants' mothers were interviewed using a simple, structured questionnaire to collect general data on mother and infant, hazardous habits and maternal socioeconomic, occupational and psychological factors. The odds ratio with a 95% confidential interval of delivering LBW infants was calculated using logistic multivariable regression analysis based on maternal and infant factors.

RESULTS

In the multivariable regression model, the second-born or subsequent infant was unlikely to be LBW. On the contrary, maternal smoking habit during pregnancy, mothers who kept house by themselves and maternal negative attitudes towards pregnancy during the early stages promoted LBW incidence.

CONCLUSION

Maternal negative attitude towards pregnancy during the early stages was an independent LBW risk factor and our simple questionnaire can be used to estimate maternal psychological status in early pregnancy.

Effects of ning shen ling granule and dehydroepiandrosterone on cognitive function in mice undergoing chronic mild stress

OBJECTIVE

To investigate the changes of spontaneous and cognitive behavior, and cholinergic M receptors in the brain of mice subjected to chronic mild stress (CMS), and to determine the effect of Ning Shen Ling Granule (NSL) and dehydroepiandrosterone (DHEA) on them.

METHODS

CMS model mice were established by applying stress every day for 3 consecutive weeks with 7 kinds of unforeseeable stress sources, and they were medicated for 1 week beginning at the 3rd week of modeling. The changes in behavior were determined by Morris Water Maze and spontaneous movement test, and M-receptor binding activity in cerebral cortex, hippocampus and hypothalamus were measured by radioactive ligand assay with 3H-QNB.

RESULTS

(1) The spontaneous movement in CMS model mice was significantly reduced, with the latency for searching platform in Morris Water Maze obviously prolonged (P<0.01), and these abnormal changes in behavior were improved in those treated with NSL and DHEA. (2) The binding ability of M-receptor in cerebral cortex and hippocampus of CMS mice was significantly decreased as compared with those in the control group (P<0.05), but could be restored to the normal level after intervention with NSL or DHEA.

CONCLUSION

The decline of spontaneous movement and spatial learning and memory ability could be induced in animals by chronic mild stress, and that may be related to the low activity of central cholinergic M-receptors. Both NSL and DHEA could effectively alleviate the above-mentioned changes.

A bio-psycho-socio-molecular approach to pain and stress management

Stress and trauma are interconnected with the experience of pain. This connection is due to a physiological coupling of underlying molecular autoregulatory mechanisms, as well as phenomenological similarities. Nonpharmaceutical therapeutic approaches such as the relaxation response, a process that supports physiological stress reduction and decreases the negative mental and physical effects of stress, also facilitate pain relief, again demonstrating physiological commonalities. These behavioral approaches have a critical impact on molecular patterns of autoregulation, leading to the assumption of a bio-psycho-socio-molecular model of autoregulation, including stress and pain. Thus, molecules and behavior may be seen as two sides of the same problem in pain and stress relief.

Adaptation in the corticosterone and hyperthermic responses to stress following repeated stressor exposure

Previous studies have shown that repeated daily exposure to the same (homotypic) stressor results in habituation of the corticosterone (CORT) response. Others have found that the stress response to a more ethologically relevant stressor, social defeat, does not habituate and, in some cases, sensitisation has been observed. Similar observations have been noted when core temperature is examined. Although habituation and/or sensitisation have been reported during stressor exposure, little is known about the development of an anticipatory fever in response to daily stressor exposure. The aim of the present study was to compare systematically commonly used laboratory stressors (i.e. restraint, cage confinement and social defeat) using a common set of procedures and analyses. Specifically, we examined: (i) the development of an anticipatory fever to repeated (5 days) homotypic stressor exposure; (ii) the adaptation of the fever response during stressor exposure; and (iii) the resolution of the fever response to stressors presented at the same time each day. For comparison, adaptation of the CORT response was also examined to assess the degree to which habituation to repeated stressor exposure may represent a more general response observed across diverse physiological measures. Habituation was observed after restraint and cage confinement, but not observed in either the CORT or hyperthermic responses to repeated social defeat. Furthermore, no anticipatory fever response was observed with repeated exposure to restraint, cage confinement, or social defeat. These data suggest that habituation to repeated stressor exposure may not occur with all homotypic stressor paradigms. In addition, rats do not appear to entrain an anticipatory fever response to a stressor presented at the same time each day, at least not within 5-6 days of repeated exposure.

Possible links between behavioral and physiological indices of tiredness, fatigue, and exhaustion in advanced cancer

GOALS

In this theoretical paper, we present the Edmonton Fatigue Framework (EFF), a new framework for the study of tiredness, fatigue, and exhaustion in advanced cancer.

MATERIALS AND METHODS

The Fatigue Adaptation Model (FAM), the starting point for the EFF, was drawn from a literature review pertaining to fatigue in depression, chronic fatigue syndrome, cancer, shift workers, and athletes published in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed, PsychINFO, SPORTdiscus, and CancerLit between 1995 and 2004, and from seven qualitative studies conducted by our group. The EFF, an elaboration of the FAM, was constructed after an expansion of our literature review to 2006 and team discussion. The EFF provides new insights into possible links between behavioral and physiological indices of tiredness, fatigue, and exhaustion as they occur in both ill and non-ill states. In this paper, however, we consider only possible links in advanced cancer.

CONCLUSIONS

We propose that stressors associated with advanced cancer and its supportive treatment trigger declines in four systems -- cognitive function, sleep quality, nutrition, and muscle endurance -- and that these declines reduce one's ability to adapt. While these systems each likely has its own effect on adaptation, we propose that the most important and serious effects arise from interactions among declines in cognitive function, sleep quality, nutrition, and muscle endurance.

CONCLUSIONS

Interventions for fatigue have been limited by a lack of understanding about its etiology. Hypotheses arising from the EFF; suggest a new direction for further study that focuses on interactions among cognitive function, sleep quality, nutrition, and muscle endurance.

A Pilot Study to Test the Effects of Art-Making Classes for Family Caregivers of Patients With Cancer

PURPOSE/OBJECTIVES

To test the effects of an art-making class (AMC) on reducing anxiety and stress among family caregivers of patients with cancer.

DESIGN

A pretest and post-test quasi-experimental design.

SETTING

A residential care facility near tertiary treatment centers in the southeastern United States.

SAMPLE

The convenience sample of 69 family caregivers was aged 18-81 years (X = 48 years) and predominantly Catholic. Most had at least a high school education. Two-thirds were daughters, wives, or mothers of patients with cancer.

METHODS

Participants completed a demographic data survey and a Beck Anxiety Inventory (BAI). Researchers collected a saliva sample from each participant to measure salivary cortisol, which indicates stress levels. Following pretesting, a two-hour AMC was delivered. Post-tests included a repeat BAI and a second saliva sample.

MAIN RESEARCH VARIABLES

Anxiety and stress.

FINDINGS

Anxiety was significantly reduced after AMC. Stress was reduced.

CONCLUSIONS

The AMC appeared to reduce anxiety and stress. The addition of a control group and replication with larger numbers are suggested. The physiologic cortisol measure corroborated BAI findings but was difficult to obtain from some cultural groups and was expensive to analyze.

IMPLICATIONS FOR NURSING

Family caregivers may benefit from participation in art-making interventions. Nurses should continue to investigate the use of creative approaches to promote holistic care.

Neurophysiologic methods to measure stress during survival, evasion, resistance, and escape training

Training in Survival, Evasion, Resistance, and Escape (SERE) is required for U.S. military members at high risk of capture. This physically and psychologically demanding course is considered an analog to the stress imposed by war, captivity, and related events, thus offering a unique and unprecedented medium in which to systematically examine human stress and performance during a realistically intense operational context. Operational stress is multifaceted, manifesting cerebral, neuroendocrine, cardiac, and cognitive characteristics, and necessitating an integration of multiple methods of measurement to appropriately characterize its complexity. Herein we describe some of our present research methods and discuss their applicability to real-time monitoring and predicting of key aspects of human performance. A systems approach is taken, whereby some of the "key players" implicated in the stress response (e.g., cerebral, neuroendocrine, cardiac) are briefly discussed, to which we link corresponding investigative techniques (fMRI, acoustic startle eye-blink reflex, heart rate variability, and neuroendocrine sampling). Background and previous research with each investigative technique and its relationship to the SERE context is briefly reviewed. Ultimately, we discuss the operational applicability of each measure, that is, how each may be integrated with technologies that allow computational systems to adapt to the performer during operational stress.

Acute exposure to stress improves performance in trace eyeblink conditioning and spatial learning tasks in healthy men

The present study investigated the effects of acute stress exposure on learning performance in humans using analogs of two paradigms frequently used in animals. Healthy male participants were exposed to the cold pressor test (CPT) procedure, i.e., insertion of the dominant hand into ice water for 60 sec. Following the CPT or the control procedure, participants completed a trace eyeblink conditioning task followed by a virtual navigation Morris water task (VNMWT). Hypothalamic-pituitary-adrenocortical (HPA) axis and sympathetic autonomic system (SAS) activity were assessed by measuring salivary cortisol, heart rate, and skin conductance at selected timepoints. Results revealed positive effects of stress on performance in both tasks. The stress group showed significantly more conditioned blinks than the control group during acquisition of trace eyeblink conditioning. The stress group also performed significantly better in the VNMWT than the control group, with the former showing significantly fewer failures to locate the hidden platform in the allotted time and smaller heading errors than the latter. Regression analyses revealed positive relationships between HPA axis and SAS activity during stress and eyeblink conditioning performance. Our results directly extend findings from animal studies and suggest potential physiological mechanisms underlying stress and learning.