Perceived stress, workload and psychosomatic complaints in inpatient and outpatient care nurses.

Background: Occupational stress, dissatisfaction, higher risk for chronical and psychological disorders impairs the well-being of care nurses staff and maintaining the quality of elderly and disabled care. However, few studies have compared the psychological and physical stress in nurses working in inpatient and outpatient care settings. Aim: The aim of the present study was to compare perceived stress, workload and psychosomatic complaints in nurses working in inpatient and outpatient care settings. Methods: 158 care nurses working in geriatric and disabled care participated in the quantitative cross-sectional survey study. Comparisons of stress, workload and psychosomatic complaints were made between the inpatient and outpatient care group. Results: Nurses working in the outpatient care reported more subjective experience of stress and more workload compared to nurses working in inpatient care. Additionally, nurses working in outpatient care reported more psychosomatic complaints compared to nurses in inpatient care. Conclusions: Our results suggest that inpatient and outpatient nurses experience their nursing activities differently stressful. In future research the differential stress factors need to be explored to provide adequate job training and develop stress prevention programs.

[Prevalence of sleep disturbance in intensive care nurses: a post hoc analysis of a cross-sectional study]. / Häufigkeit von Schlafproblemen bei Intensivpflegenden: Eine Post-hoc-Analyse einer Querschnittstudie.

Background: Intensive care nurses have irregular and unusual working hours due to shift work, which can disrupt the natural light-dark rhythm and thus increase the risk for sleep disorders. Aim of the work: The aim of this post hoc analysis was to investigate the prevalence of self-reported sleep problems and associated factors among intensive care nurses working in Germany. Methods: This analysis was a post hoc analysis of a cross-sectional study, which was performed as an online survey. Collected data were sociodemographic, work-related and health-related data. These data were used to calculate the prevalence and respective 95% confidence intervals (95% CI) of sleep problems. Factors associated with sleep problems were identified using the χ2-test, Fisher's exact test, and logistic regression analysis. Results: The link to the online survey was accessed 1163 times and 490 intensive care nurses participated in the survey. A total of 432 intensive care nurses were included in this analysis, of whom 82.87% were women. A total of 57.64% (95% CI: 52.83-62.35%) reported sleep problems. Significantly associated with sleep problems were age (50-59 years odds ratio [OR]: 2.05, 95% CI: 1.00-4.21, p = 0.047 vs. 20-29 years) and living in a family (OR: 0.50, 95% CI: 0.27-0.93, p = 0.029 vs. single/living alone). In addition, depression (OR: 1.09, 95% CI: 1.06-1.12, p ≤ 0.001), anxiety (OR: 1.10, 95% CI: 1.06-1.14, p ≤ 0.001) and stress (OR: 1.09, 95% CI: 1.06-1.12, p ≤ 0.001) levels were significantly associated with sleep problems. Conclusion: Sleep problems were present in one out of every two participating intensive care nurses and in particular mental health was associated with sleep problems.

Resting-state networks in healthy adult subjects: a comparison between a 32-element and an 8-element phased array head coil at 3.0 Tesla.

BACKGROUND: Little research exists on the influence of a magnetic resonance imaging (MRI) head coil's channel count on measured resting-state functional connectivity. PURPOSE: To compare a 32-element (32ch) and an 8-element (8ch) phased array head coil with respect to their potential to detect functional connectivity within resting-state networks. MATERIAL AND METHODS: Twenty-six healthy adults (mean age, 21.7 years; SD, 2.1 years) underwent resting-state functional MRI at 3.0 Tesla with both coils using equal standard imaging parameters and a counterbalanced design. Independent component analysis (ICA) at different model orders and a dual regression approach were performed. Voxel-wise non-parametric statistical between-group contrasts were determined using permutation-based non-parametric inference. RESULTS: Phantom measurements demonstrated a generally higher image signal-to-noise ratio using the 32ch head coil. However, the results showed no significant differences between corresponding resting-state networks derived from both coils (p < 0.05, FWE-corrected). CONCLUSION: Using the identical standard acquisition parameters, the 32ch head coil does not offer any significant advantages in detecting ICA-based functional connectivity within RSNs.

Attentional bias toward negative information in patients with fibromyalgia syndrome.

OBJECTIVE: In addition to central nervous sensitization, affect dysregulation constitutes an important factor in the pathogenesis of fibromyalgia syndrome (FMS). The present study is concerned with emotional influences on information processing in FMS. The hypothesis of attentional bias, i.e., selective processing of negatively connoted stimuli, was tested. METHODS: Twenty-seven female FMS patients and 34 healthy women undertook an emotional modification of the Stroop task. Subjects had to decide whether the colors of positive, negative, and neutral adjectives accorded with color words presented in black. Attentional bias was defined as delay in color naming of emotional words relative to neutral words. Affective and anxiety disorders, pain severity, as well as medication were considered as possible factors mediating the expected interference. RESULTS: Patients showed marked attentional bias, manifested in a greater response delay due to negative words compared with the control group. Among the clinical features, pain severity was most closely associated with the extent of the interference. While depression played only a subordinate role, anxiety and medication were without effect. CONCLUSIONS: The study provides evidence of emotionally driven selective attention in FMS. Attentional bias to negative information may play an important role in the vicious circle between negative affective state and pain augmentation. In the management of FMS pain, strategies aiming at conscious direction of attention may be helpful, e.g., imagery techniques or mindfulness training.

The impact of cardiac perception on emotion experience and cognitive performance under mental stress.

Mental stress evokes several physiological responses such as the acceleration of heart rate, increase of electrodermal activity and the release of adrenaline. Moreover, physiological stress responses interact with emotional and behavioral stress responses. In the present study we provide evidence that viscero-sensory feedback from the heart (cardiac perception) is an important factor modulating emotional and cognitive stress responses. In our study, we compared participants with high versus low cardiac perception using a computerized mental stress task, in which they had to respond to rapidly presented visual and acoustic stimuli. Additionally, we assessed physiological responses (heart rate, skin conductance). Participants high in cardiac perception reported more negative emotions and showed worse task performance under the stressor than participants low in cardiac perception. These results were not moderated by physiological responses. We conclude that cardiac perception modulates stress responses by intensifying negative emotions and by impairing cognitive performance.

Implicit memory function in fibromyalgia syndrome.

The study investigated implicit memory function in fibromyalgia syndrome (FMS) and its association with clinical parameters. Implicit memory refers to the influence of past experience on current behavior without conscious awareness of these experiences. Eighteen FMS patients and 25 healthy individuals accomplished a word-stem completion task. As possible factors mediating the expected impairment, pain severity, emotional disorders, and medication were taken into account. The patients displayed markedly reduced task performance and higher levels of depression and anxiety. Among the clinical features, pain severity was most closely associated with performance, whereas depression, anxiety, and medication showed only a minor impact. The study documented reduced implicit memory function in FMS. In contrast to former findings on impaired performance of FMS patients on classical memory tests, lower implicit memory function cannot be ascribed to motivational deficits. Instead, the aberrances may relate to functional inference between central nervous nociceptive activity and cognitive processing.

Cerebral blood flow dynamics during pain processing in patients with fibromyalgia syndrome.

OBJECTIVES: Increased cerebral blood flow during processing of acute pain has repeatedly been observed in fibromyalgia syndrome. The study investigated the time dynamics of the pain-related hemodynamic response in fibromyalgia using transcranial Doppler sonography. METHODS: In 25 women with fibromyalgia and 25 healthy participants, blood flow velocities in the anterior and middle cerebral arteries of both hemispheres were recorded, while heat stimuli of 45°C were applied to their forearms. Thermal pain threshold and subjective pain experience during stimulation were assessed, and the participants completed the McGill Pain Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS: The early component of the blood flow response in both anterior cerebral arteries, that is, the steep flow increase during the initial stimulation period, was more pronounced in the patients than in the controls (mean [standard deviation] = 1.28% [1.85%] versus 0.24% [1.58%], p = .04). The patients showed lower pain threshold (p = .018), stronger sensory and affective pain experience (p < .001), and increased values on all questionnaire scales (all p values < .001). Although higher scores on each of the scales were associated with a stronger early blood flow response (r values ranging from 0.17 to 0.36), clinical pain severity proved to be the best predictor (ß = .33, p = .02). CONCLUSIONS: The increased blood flow response in the anterior cerebral arteries reflects hyperactivity of medial structures of the neuromatrix of nociception, structures involved in the processing of affective and cognitive aspects of pain. Aberrances in cerebral blood flow related to fibromyalgia and its clinical characteristics become particularly apparent in the enhancement of the initial component of the hemodynamic response.

Cerebral blood flow dynamics during pain processing investigated by functional transcranial Doppler sonography.

OBJECTIVE: Functional transcranial Doppler sonography (fTCD) enables reliable quantification of cerebral blood flow modulation during neural activation processes. Its high-time resolution, relatively simple technical arrangement, and low costs could make fTCD a useful tool in the investigation of brain activity underlying pain experience in fundamental and clinical research. The present pilot study explored the suitability of this technique to investigate cerebral hemodynamics during the processing of experimental heat pain. DESIGN: In 46 healthy subjects, blood flow velocities in the anterior cerebral arteries (ACA) and middle cerebral arteries (MCA) of both hemispheres were recorded, while heat stimuli of 45 and 47°C were applied to their left forearms (stimulus duration 20 seconds). Subjective sensory and affective pain intensities were assessed using visual analog scales. RESULTS: A biphasic right dominant blood flow increase arose in the ACA and MCA with maxima around 5 and 15 seconds after stimulus onset. The response was stronger under stimulation with 47°C with respect to 45°C, and the magnitude of the late response component correlated positively with sensory and affective pain intensity under the 45°C condition. CONCLUSIONS: The findings suggest that fTCD measurements prove sensitive both to different levels of physical intensity of painful stimuli and to interindividual differences in nociceptive responding. fTCD may be a valuable tool in clinical pain research, for instance, when it comes to quantifying the temporal dynamics of exaggerated nociceptive responses in chronic pain, or evaluating treatment effects on nociceptive processing.

Self-regulation of cerebral blood flow by means of transcranial Doppler sonography biofeedback.

BACKGROUND: Transcranial Doppler sonography (TCD) allows the continuous non-invasive assessment of intracranial blood flow velocities with high temporal resolution. It may therefore prove suitable for biofeedback of cerebral perfusion. PURPOSE: The study explored whether healthy individuals can successfully be trained in self-regulation of cerebral blood flow using TCD biofeedback. METHODS: Twenty-two subjects received visual feedback of flow velocities in the middle cerebral arteries of both hemispheres. They were randomly assigned to two groups, one of which attempted to increase, the other to decrease the signal within eight training sessions. Heart rate and respiratory frequency were also monitored. RESULTS: Both groups achieved significant changes in flow velocities in the expected directions. Modulations in heart rate and respiratory frequency during biofeedback did not account for these effects. CONCLUSIONS: TCD biofeedback enables efficient self-regulation of cerebral blood flow. It is promising in applications such as the treatment of migraine and post-stroke rehabilitation.

Hippocampal function during associative learning in patients with posttraumatic stress disorder.

In the last decade several studies have shown memory deficits in patients with posttraumatic stress disorder (PTSD) which have been associated with a reduced hippocampus volume. However, until now we do not know how or whether these structural abnormalities turn into functional abnormalities. Thus, the primary purpose of the present study was the investigation of the hippocampal function using functional magnet resonance imaging (fMRI). We compared PTSD patients and healthy control participants using an associative learning paradigm consisting of two encoding and one retrieval condition. During fMRI scanning participants had to learn face-profession pairs. Afterwards only faces were presented as cue stimuli for associating the category of the prior learned target profession and the participants had to decide whether this face belonged to a scientific or an artistic profession. Additionally, cognitive functioning, i.e. memory and attention, was examined using neuropsychological standard tests. During encoding PTSD patients showed stronger hippocampal and weaker prefrontal activation compared to healthy control participants. During retrieval the two groups did not differ neither in hippocampus activation nor in accuracy of retrieval. PTSD patients however showed a reduced activation in the left parahippocampal gyrus and other memory-related brain regions. We did not find any significant memory differences between PTSD patients and healthy control participants. The results suggest that PTSD has an effect on memory-related brain function despite intact memory functioning. In particular the hippocampal/parahippocampal regions and the prefrontal cortex show functional alterations during associative learning and memory.

Nicotine-dopamine-transporter interactions during reward-based decision making.

Our everyday-life comprises a multitude of decisions that we take whilst trying to maximize advantageous outcomes, limit risks and update current needs. The cognitive processes that guide decision making as well as the brain circuits they are based on are only poorly understood. Numerous studies point to a potential role of dopamine and nicotine in decision making but less is known about their interactions. Here, 26 healthy male subjects performed the Iowa Gambling Task (IGT) in two sessions following the administration of either nicotine or placebo. Striatal dopamine transporter (DAT) binding was measured by single-photon emission computed tomography (SPECT). Results indicate that lower DAT levels were associated with better performance in the IGT (p=0.0004). Cognitive modelling analysis using the prospect valence learning (PVL) model indicated that low DAT subjects' performance deteriorated following nicotine administration as indicated by an increased learning rate and a decreased response consistency. Our results shed light on the neurochemistry underlying reward-based decision making in humans by demonstrating a significant interaction between nicotine and the DAT. The observed interaction is consistent with the hypothesized associations between DAT expression and extracellular dopamine levels, suggestive of an inverted U-shape relationship between baseline dopamine and magnitude in response to a pro-dopaminergic compound. Our findings are of particular interest in the context of psychiatric disorders where aberrant decision making represents a part of the core symptomatology, such as addiction, schizophrenia or depression.

Attention interference for emotional stimuli in cardiac interoceptive awareness.

Previous research has shown that individuals with good perception of cardiac signals, referred to as cardiac interoceptive awareness, experience emotions more intensely. To investigate if emotional experience in high cardiac interoceptive awareness arises from biases in attention, we compared the performance of participants with high versus regular cardiac interoceptive awareness in an emotional Stroop task. Participants with high cardiac interoceptive awareness showed attention interference for negative words, whereas participants with regular cardiac interoceptive awareness showed attention facilitation for positive words. Our data provide further evidence for the emotion information process associated with cardiac interoceptive awareness. The results support the notion that better access to cardiac changes accompanying negative emotional conditions results in automatic vigilance for negative information and may interfere with cognitive processing.

The behavioral impact of baroreflex function: a review.

The baroreflex consists of a negative feedback loop adjusting heart activity to blood pressure fluctuations. This review is concerned with interactions between baroreflex function and behavior. In addition to changes in baroreflex cardiac control subject to behavioral manipulations, interindividual differences in reflex function predicted psychological and central nervous features. The sensitivity of the reflex was inversely related to cognitive performance, evoked potential amplitudes, experimental pain sensitivity, and the severity of clinical pain. Possible variables moderating the strength of the associations are tonic blood pressure, gender, and psychiatric disease. It is suggested that these observations reflect inhibition of higher brain function by baroreceptor afferents. While in many cases increased baroreflex function implies stronger inhibition, individual and situational factors modulate the behavioral impact of cardiac regulation.

Interoceptive awareness moderates neural activity during decision-making.

The current study examined the relationship between conscious perception of somatic feedback (interoceptive awareness) and neural responses preceding decision-making. Previous research has suggested that decision-making is influenced by body signals from the periphery or the central representation of the periphery. Using event-related fMRI, participants whose interoceptive awareness was assessed using a heartbeat perception paradigm performed the Iowa Gambling Task. The results show a positive relationship between the degree of interoceptive awareness and selection related activity in the right anterior insula and the left postcentral gyrus. Neural activity within the right anterior insula was associated with decision-making performance only in individuals with accurate but not in those with non-accurate interoceptive awareness. These findings support the role of somatic feedback in decision-making processes. They indicate that the right anterior insula holds a representation of somatic markers and that these are more strongly processed with increased interoceptive awareness.

Differential effects of alexithymia subscales on autonomic reactivity and anxiety during social stress.

OBJECTIVES: Alexithymia is characterized by a difficulty in identifying and describing one's emotions. Recent research has associated differential effects of the alexithymia facets to hypothalamic-pituitary-adrenal (HPA) axis markers during stress. This study aimed to analyze how the facets of alexithymia interact with autonomic reactivity as well as self- and observer-rated anxiety during a social stress task. METHODS: With the use of a public-speaking paradigm, skin conductance levels (SCLs) and heart rate (HR) during the defined periods of baseline, preparation, stress, and recovery were assessed in 60 volunteers (42 females, mean age 22.8) categorized as having either high (HDA) or low (LDA) degrees of alexithymia. RESULTS: We found smaller SCLs during preparation and speech in the HDA group. Regression analyses indicated that only the alexithymia facet "difficulty in describing feelings" (DDF) was associated with smaller electrodermal responses. In the HDA group, self- and observer-rated anxiety was higher in the HDA than in the LDA group, which was attributable to higher scores in the subscales "difficulty in identifying feelings" (DIF) and "externally oriented thinking" (EOT). CONCLUSIONS: Our data support and specify the decoupling hypothesis of alexithymia by showing that the facets of alexithymia are differentially related to autonomic reactivity as well as self- and observer-rated anxiety during social stress.

Implicit memory for emotional words is modulated by cardiac perception.

In the present study we investigated the impact of viscero-sensory feedback on memory performance. Participants with good and poor perception of their heart activity were presented with positive, negative and neutral words while heart rate and skin conductance were measured. After a distractor task, participants were asked to complete primed and unprimed wordstems. Implicit memory performance was assessed in terms of accuracy of completion. In our study, participants with good cardiac perception completed significantly more wordstems of previously presented positive and negative words, whereas no group differences were found for wordstems of neutral words and physiological measures during encoding. Our findings document a substantial role of visceral feedback in implicit memory processes. They are in line with Damasio's somatic marker hypothesis stating that access to information about somatic processes facilitates cognitive processing.

Interactions between systemic hemodynamics and cerebral blood flow during attentional processing.

The study explored interactions between systemic hemodynamics and cerebral blood flow during attentional processing. Using transcranial Doppler sonography, blood flow velocities in the middle cerebral arteries (MCA) of both hemispheres were recorded while 50 subjects performed a cued reaction time task. Finger arterial pressure and heart rate were also continuously monitored. Doppler sonography revealed a right dominant blood flow response. The extent of the increase measured in second two of the interstimulus interval showed a clear positive association with reaction speed. Task-related changes in blood pressure and heart rate proved predictive of changes in MCA flow velocities in limited time windows of the response. Besides an association between cerebral blood flow and attentional performance, the results suggest a marked impact of systemic hemodynamics on the blood flow response. All observed interactions are highly dynamic in time.

D-camphor-crataegus berry extract combination increases blood pressure and cognitive functioning in the elderly - a randomized, placebo controlled double blind study.

The present study investigated whether the D-camphor-crataegus berry extract combination Korodin elevates blood pressure and enhances cognitive performance in the elderly population. Eighty women aged between 50 and 80 years were examined based on a randomized, placebo controlled double blind design. Blood pressure was measured sphygmomanometrically and through continuous noninvasive recording. Cognitive performance was assessed by means of two tests measuring general information processing capacity and visuomotor speed. The administration of the drug led to a short term increase in blood pressure as well as in cognitive performance as compared to placebo. Potential physiological mechanisms of action mediating this effect, including hemodynamic alterations, sympathetic stimulation as well as improvement of cerebral metabolism are discussed.

Relationships between affective states and decision-making.

The study investigated relationships between affective states and decision-making performance using the Iowa Gambling Task. Playing the task involves making decisions between four card decks. Two decks yield high gains and high losses, and if chosen continuously these decks lead to net loss. In contrast, the other two decks yield small gains and small losses, but lead to net profit if they are selected continuously. Correlation and regression analyses revealed a positive relationship between trait-anxiety and decision-making performance and a negative relationship between self-reported emotion regulation and decision-making performance. In addition, anticipatory skin conductance responses were related positively to trait-anxiety and negatively to self-reported emotion regulation. These findings support the somatic marker hypothesis suggesting that emotions facilitate decision-making in complex situations that have uncertain future outcomes.

Enhanced cardiac perception is associated with benefits in decision-making.

In the present study we provide the first empirical evidence that viscero-sensory feedback from an internal organ is associated with decision-making processes. Participants with accurate vs. poor perception of their heart activity were compared with regard to their performance in the Iowa Gambling Task. During this task, participants have to choose between four card decks. Decks A and B yield high gains and high losses, and if played continuously, result in net loss. In contrast, decks C and D yield small gains and also small losses, but result in net profit if they are selected continuously. Accordingly, participants have to learn to avoid the net loss options in favor of the net gain options. In our study, participants with good cardiac perception chose significantly more of the net gain and fewer of the net loss options. Our findings document the substantial role of visceral feedback in decision-making processes in complex situations.