Estilos de vida relacionados con la salud en estudiantes de Enfermería / Lifestyles health related in Nursing students

Introducción: los cambios de conductas saludables a las no saludables ponen en riesgo la salud, los universitarios son una población muy vulnerable para adoptar estilos de vida que puedan favorecer su calidad de vida. El consumo de alcohol y tabaco como conducta es un tema importante en esta etapa de formación profesional. Objetivo: determinar las conductas de estilo de vida relacionados con la salud como el consumo de cigarrillos, alcohol y drogas, hábitos alimentarios, forma física, control del estrés y seguridad que realizan los estudiantes de la Licenciatura en Enfermería de la Universidad Juárez Autónoma de Tabasco, México. Metodología: estudio de tipo cuantitativo, descriptivo, transversal en una muestra de 666 estudiantes de la Licenciatura en Enfermería seleccionados por muestreo no probabilístico. Resultados: predominó el género femenino con 83%, el 62.8% presenta un buen estilo de vida, seguido del 30.3% que tiene un excelente estilo de vida; el 79.1% corresponde a los estudiantes que no fuman y el 37.8% de los estudiantes tiene una buena alimentación. Los estudiantes calificaron su forma física como regular en el 41% de los casos, seguida de mala con el 34.5%. En cuanto a la práctica de control del estrés calificaron como buena con un 50.8% y excelente con 26.1%. Conclusión: los estudiantes de Enfermería tienen un nivel de estilo de vida bueno relacionado con la salud, los más practicados corresponden a las dimensiones de consumo de alcohol, hábitos alimentarios, control de estrés y seguridad. Es importante considerar la dimensión relacionada con la forma física (práctica de ejercicio físico), ya que se practica ocasionalmente, lo que demuestra que los estudiantes llevan un estilo de vida sedentario.

Introduction: Changes from healthy to unhealthy behaviors put health at risk, so university students are a very vulnerable population to adopt lifestyles that can favor their quality of life. The consumption of alcohol and tobacco as conduct is an important issue at this stage of professional training. Objective: To determine the lifestyle behaviors related to health such as the consumption of cigarettes, alcohol and drugs, eating habits, physical fitness, stress control and safety carried out by the students of the Bachelor of Nursing at the Universidad Juárez Autónoma de Tabasco, in Mexico. Methodology: Quantitative, descriptive, cross-sectional study in a sample of 666 Nursing undergraduate students selected by non-probabilistic sampling. Results: The female gender predominated with 83%, 62.8% have a good lifestyle, followed by 30.3% who have an excellent lifestyle; 79.1% corresponds to students who do not smoke and 37.8% of students have a good diet. The students rated their physical fitness as fair in 41% of the cases, followed by poor with 34.5%. Regarding the practice of stress control, they qualified as good with 50.8% and excellent with 26.1%. Conclusion: Nursing students have a good level of lifestyle related to health, the most practiced correspond to the dimensions of alcohol consumption, eating habits, stress control and safety. It is important to consider the dimension related to physical fitness (practice of physical exercise), since it is only practiced occasionally, which shows that students lead a sedentary lifestyle.

Nível de estresse e humor em estudantes de Educação Físicano último ano de graduação / Nivel de estrés y de humor en estudiantes en estudiantes de Educación Física en el último año de graduación / Stress and mood level in Physical Education studentsin thelast year of graduation

RESUMO: Introdução: As dificuldades e a pressão do último ano da graduação podem afetar negativamente a saúde mental de estudantes universitários. Objetivo: Verificar o nível de estresse e humor em estudantes de Educação Física no último ano de graduação. Métodos: A amostra foi composta por 38 estudantes (idade: 25,51 ± 4,24 anos), concluintes do curso de Educação Física. Para análise do nível de estresse e humor foram utilizados os questionários da Escala de Percepção de Estresse PSS14 e a Escala de humor de Brunel, respectivamente. Resultados: O teste inferencial não paramétrico de Friedman verificou que há diferença significativa (p<0,001) entre os níveis de estresse: Nunca (4,94%), Quase nunca (15,02), Às vezes (23,87), Pouco frequente (23,46) e Muito frequente (32,72) e entre as respostas ao questionário de humor (p=0,026) com: Nada (38,27), Pouco (17,65), Moderadamente (16,23), Bastante (14,36) e extremamente (13,49). Conclusão: Diante dos resultados da investigação, concluímos que os participantes do estudo se apresentaram em condições de estresse, entretanto não expuseram perda de humor.

RESUMEN: Introducción: Las dificultades y la presión del último año de graduación pueden afectar negativamente la salud mental de los estudiantes universitarios. Objetivo: Verificar el nivel de estrés y estado de humor en los estudiantes de Educación Física en su último año de graduación. Métodos: La muestra consistió en 38 estudiantes (25,51 ± 4,24 años), graduados del curso de Educación Física. Para el análisis del nivel de estrés y estado de ánimo, se utilizaron los cuestionarios de la Escala de percepción del estrés PSS14 y la escala del estado de ánimo de Brunel, respectivamente. Resultados: La prueba inferencial no paramétrica de Friedman encontró que existe una diferencia significativa (p<0,001) entre los niveles de estrés Nunca (4,94%), Casi nunca (15,02), A veces (23,87), Poco común (23,46) y Muy frecuente (32,72) y entre las respuestas al cuestionario de estado de ánimo (p = 0,026) con Ninguno (38,27), Poco (17,65), Moderado (16,23), Bastante (14, 36) y extremadamente (13,49). Conclusión: en vista de los resultados de la investigación, concluimos que los participantes del estudio estaban en condiciones de estrés, sin embargo, no mostraron pérdida de humor.

ABSTRACT: Introduction: The difficulties and pressure of the last year of graduation can negatively affect the mental health of university students. Objective: To verify the level of stress and mood in Physical Education students in the last year of graduation. Methods: The sample consisted of 38 students (age: 25,51 ± 4,24 years), graduating from the Physical Education course. Stress Perception Scale questionnaires PSS14 and Brunel's mood scale, respectively, were used to analyze the level of stress and mood. Results: Friedman's non-parametric inferential test found that there is a significant difference (p<0,001) between stress levels: Never (4,94%), Almost Never (15,02), Sometimes (23,87), Uncommon (23,46) and Very frequent (32,72) and among the responses to the mood questionnaire (p=0,026) with: Nothing (38,27), Little (17,65), Moderately (16,23), Quite (14,36) and Extremely (13,49). Conclusion: In view of the results of the investigation, we concluded that the study participants were in conditions of stress, however they did not exhibit loss of mood.

Prevalence and factors associated with depression, anxiety, and stress symptoms among older adults: A cross-sectional population-based study.

Despite population aging and the increase in mental health problems, studies on the mental health of older people in developing countries are lacking. This population-based cross-sectional study estimated the prevalence and associated factors for depression, anxiety and stress symptoms among older adults in Nepal. Community-dwelling older adults (N = 794) were interviewed using a questionnaire which consisted of the 21-item Depression Anxiety Stress Scales; and a wide range of sociodemographic, health-related, and lifestyle characteristics; functional ability, social support, participation in social activities, and adverse life events. The prevalence of symptoms was 15.4% for depression, 18.1% for anxiety, and 12.1% for stress. Risk factors for symptoms included female gender, working in agriculture, lower household wealth, perceived poor health, smoking, chronic conditions, migration of adult children, and exposure to adverse life events. Receiving an allowance, physical exercise, functional ability, social support, and participation in social activities were found to have protective effects. The findings indicate the need for community-based interventions, including appropriate diagnosis and treatment of mental health conditions, and mental health promotion programs targeting the risk and protective factors.

Correlations among life stress, smoking behavior, and depressive symptoms in adolescents: A descriptive study with a mediating model.

The major objective of this study was to investigate how smoking behavior mediates the relationship between life stress and depressive symptoms in adolescents. A descriptive correlational study was conducted from February to June 2017 at a vocational high school in northern Taiwan, and 226 students were recruited through convenience sampling. Results indicated that smoking behavior played a pivotal role by partially mediating the relationship between life stress and depressive symptoms in adolescents. Life stress in adolescents significantly increased the risk of experiencing depressive symptoms, and adolescents who smoked were also at a greater risk. Assessments between the objective and self-reported smoking behavior were significantly correlated. Therefore, integrated methods for assessing life stress, smoking behavior, and depressive symptoms in adolescents are needed for teachers and clinical professionals. Implementing appropriate policies for discouraging tobacco use for adolescents experiencing life stress in order to decrease depressive symptoms in school settings is paramount.

How well do cancer survivor self-classifications of anxiety, depression and stress agree with a standardised tool? Results of a cross-sectional study.

BACKGROUND: There is poor uptake of psychosocial interventions offered to people with cancer who record high scores on distress screening scales. Intervention uptake may be influenced by a mismatch between consumer (bottom-up) and professional (top-down) paradigms of wellbeing. The current research aims to compare cancer survivors' 'self-judgements' about their levels of anxiety, depression and stress, to classifications derived via a professional-driven measure, the Depression, Anxiety and Stress Scale (DASS-21). METHODS: A cross-sectional study was undertaken with haematological cancer survivors recruited from three population-based cancer registries in Australia. Consenting participants were mailed a questionnaire package; and non-responders received a second questionnaire package after 3-weeks and a reminder call after 6-weeks. The consumer-driven perspective was assessed via three separate single items asking survivors to self-classify their levels of anxiety, depression and stress over the past week on a scale from 'normal' to 'extremely severe'. The professional-driven classification was assessed via the DASS-21. Kappa statistics were used to assess agreement between consumer- and professional-driven measures. RESULTS: Of 2,971 eligible haematological cancer survivors, 1,239 (42%) provided written consent and were mailed a questionnaire package. Of these, 984 (79%) returned a completed questionnaire. The simple kappa for agreement between the DASS-21 and self-classified measures for anxiety was 0.47 (95% CI: 0.39 to 0.54, p<0.0001). The weighted kappa for agreement between the DASS-21 and self-classified measures of depression was 0.60 (95% CI: 0.53 to 0.67, p<0.0001) and for measures of stress was 0.51 (95% CI: 0.44 to 0.59, p<0.0001). CONCLUSIONS: Moderate agreement between self-classification and professional-driven assessments was found. The value of screening is predicated on the assumption that those with identified needs will be offered and take up services that will benefit them. Our results suggest that to improve the utility of distress screening it may be important to include assessment of survivor views about their symptoms.

Early Term Delivery and Breastfeeding Outcomes.

OBJECTIVE: Higher rates of adverse outcomes have been reported for early term (37 0 to 38 6 weeks) versus full term (≥ 39 0 weeks) infants, but differences in breastfeeding outcomes have not been systematically evaluated. This study examined breastfeeding initiation and exclusivity in early and full term infants in a large US based sample. METHODS: This secondary analysis included 743 geographically- and racially-diverse women from the Measurement of Maternal Stress Study cohort, and 295 women from a quality assessment at a hospital-based clinic in Evanston, IL. Only subjects delivering ≥ 37 weeks were included. Initiation of breastfeeding (IBF) and exclusive breastfeeding (EBF) were assessed via electronic medical record review after discharge. Associations of IBF and EBF with early and full term delivery were assessed via univariate and multivariate logistic regression. RESULTS: Among 872 women eligible for inclusion, 85.7% IBF and 44.0% EBF. Early term delivery was not associated with any difference in frequency of IBF (p = 0.43), but was associated with significantly lower odds of EBF (unadjusted OR 0.61, 95% CI 0.466, 0.803, p < 0.001). This association remained significant (adjusted OR 0.694, 95% CI 0.515, 0.935, p = 0.016) after adjusting for maternal diabetes, hypertensive disorders of pregnancy, cesarean delivery, maternal age, race/ethnicity, parity, Medicaid status, NICU admission, current smoking, and delivery hospital. CONCLUSIONS FOR PRACTICE: Despite comparable breastfeeding initiation frequencies, early term infants were significantly less likely to be exclusively breastfed compared to full term infants. These data suggest that women with early term infants may benefit from counseling regarding the potential for breastfeeding difficulties as well as additional breastfeeding support after delivery.

Cross-cultural adaptation and validation of the Moral Distress Scale-Revised for nurses / Adaptación cultural y validación de la Moral Distress Scale-Revised para enfermeros / Adaptação cultural e validação da Moral Distress Scale Revised para enfermeiros

ABSTRACT Objective: Cross-culturally adapt and validate the Moral Distress Scale-Revised for nurses. Method: Quantitative, analytical cross-sectional study conducted with 157 nurses of two hospital institutions of Southern Brazil, one public and one philanthropic. Procedures conducted: cultural adaptation of the instrument according to international recommendations; validation for the Brazilian context. Results: Face and content validation was considered satisfactory as assessed by a specialist committee and a pretest. The instrument demonstrated satisfactory internal consistency through frequency and intensity analysis per question in the 157 items and per subgroups of the various hospital units. Cronbach's alpha was 0.88 for the instrument and between 0.76 and 0.94 for hospital units. Pearson's correlation found a moderate association for moral distress among nurses. Conclusion: The Moral Distress Scale-Revised - Brazilian version is a valid instrument for the assessment of moral distress in nurses.

RESUMEN Objetivo: Adaptar culturalmente y validar la Moral Distress Scale Revised para enfermeros. Método: Estudio cuantitativo, transversal, analítico, realizado con 157 enfermeros de dos instituciones hospitalarias del Sur de Brasil, una pública y otra filantrópica. Se efectuó: adaptación cultural del instrumento según recomendaciones internacionales; y su validación para el contexto brasileño. Resultados: La validez de interfaz y contenido fue considerada satisfactoria según evaluación de comité de expertos y realización de prueba piloto. El instrumento demostró consistencia interna satisfactoria, aplicándosele análisis de frecuencia e intensidad por pregunta a los 157 cuestionarios y por subconjuntos de las diferentes unidades hospitalarias; con alfa de Cronbach 0,88 para el instrumento y de 0,76 a 0,94 para las unidades hospitalarias. La correlación de Pearson identificó moderada asociación de sufrimiento moral de enfermeros. Conclusión: la Moral Distress Scale Revised - versión brasileña es un instrumento válido para ser utilizado en medición del sufrimiento moral de enfermeros.

RESUMO Objetivo: Adaptar culturalmente e validar a Moral Distress Scale Revised para enfermeiros. Método: Estudo quantitativo, transversal analítico, realizado com 157 enfermeiros de duas instituições hospitalares do Sul do Brasil, uma pública e uma filantrópica. Realizou-se: a adaptação cultural do instrumento segundo recomendações internacionais; e a sua validação para o contexto brasileiro. Resultados: A validade de face e conteúdo foi considerada satisfatória mediante avaliação de comitê de especialistas e realização de pré-teste. Mediante análise de frequência e intensidade por questão nos 157 questionários e por subconjuntos das diferentes unidades hospitalares, o instrumento demonstrou consistência interna satisfatória, com alfa de Cronbach 0,88 para o instrumento e entre 0,76 e 0,94 para as unidades hospitalares. A correlação de Pearson identificou moderada associação de sofrimento moral nos enfermeiros. Conclusão: o Moral Distress Scale Revised - versão brasileira é um instrumento válido para ser utilizado na avaliação de sofrimento moral de enfermeiros.

Use of the Distress Thermometer in a cancer helpline context: Can it detect changes in distress, is it acceptable to nurses and callers, and do high scores lead to internal referrals?

PURPOSE: To improve understanding about; (1) the validity of the Distress Thermometer (DT) as a measure of changes in distress after a cancer helpline call, (2) the impact of a helpline call on callers' distress, (3) caller and helpline nurses' comfort with use of the DT, and (4) the extent to which DT scores over the critical threshold, are associated with referral to internal support services for follow-up psychosocial care. METHODS: Callers (people diagnosed with cancer and their family/friends: N = 100) completed a questionnaire that included DT ratings (three time-points), the Depression Anxiety and Stress Scale-21 (DASS-21) and measures of comfort with the DT tool. Nurses recorded referrals to internal services and their comfort in using the DT in each call. RESULTS: The DT correlated with the DASS-21 depression (r = 0.45, p < 0.001), anxiety (r = 0.56, p < 0.001) and stress (r = 0.64, p < 0.001) subscales demonstrating validity. Callers' self-rated distress was significantly lower after the call, regardless of gender or caller type (F(2, 97) = 63.67, p < 0.01, partial eta squared = 0.57). Over 74% of people diagnosed with cancer, 80% family/friends and 89.3% of nurses felt comfortable with DT use. Only 16% of participants were referred on to follow-up internal support services despite 90% of people with cancer and 75% of family/friends' DT scores' suggesting they required follow-up care. CONCLUSIONS: The DT is a valid and acceptable tool for use by cancer helplines. Improved documentation of referrals is required to better understand referral patterns.

How much psychological distress is experienced at home by patients with palliative care needs in Germany? A cross-sectional study using the Distress Thermometer.

OBJECTIVE: The aims of the present study were (1) to describe the prevalence of psychosocial distress in palliative care patients living at home and the related factors, and (2) to test implementation of the Distress Thermometer (DT) within a home-based palliative care service. METHOD: Ours was a 15-month prospective study beginning in September of 2013 in western Germany with consecutive patients cared for by a home care palliative care service. The research was implemented during the first visit by the home care team. Patients were excluded if they were under 18 years of age, mentally or physically unable to complete the assessment questionnaires as judged by their healthcare worker, or unable to understand the German language. During the first encounter, the Distress Thermometer (DT), a Problem List (PL), and a structured questionnaire for evaluation were applied and sociodemographic and medical data collected. RESULTS: A total of 103 patients (response rate = 70%; mean age = 67; female = 54%; married = 67%; oncological condition = 91%; Karnofsky Performance Status [KPS] score 0-40 = 34%, 50-70 = 60%, >80 = 6%) were included. The incidence of distress (DT score ≥4) was 89.3% (mean = 6.3 ± 2.5). No statistical association was found between level of distress and sociodemographic or medical factors. The five most reported problems were "fatigue" (90%), "getting around" (84%), "eating" (63%), "bathing/dressing" (60%), and "sleep" (57%). The number of problems reported correlated with level of distress (ρ = 0.34). The DT was comprehensible, and 80% considered its completion as unremarkable, while 14% found it "relieving." SIGNIFICANCE OF RESULTS: A significant proportion of patients treated at home reported symptoms of distress. The most oft-mentioned problems were physical and emotional in nature. The findings of our study highlight the importance of creating new concepts and structures in order to address the psychosocial needs of patients in home care with palliative needs.

[Screening psychological distress in breast cancer patients on treatment]. / Dépistage de la détresse psychologique chez les patientes en cours de traitement du cancer du sein.

OBJECTIVE: The aim of our study was to evaluate emotional distress among women with breast cancer treated by radiotherapy, using a Visual Analogue Scale (an adaptation of the "Distress Thermometer" French version) associated with a Needs Scale with several items, in order to identify patients requiring psychological care. METHOD: Our sample is composed of 277 women treated for breast cancer with radiotherapy. Our psychological evaluation is made of a first enquiry using a visual analogue distress scale and complemented by a Needs Scale with several items. A grade above 3 on the visual analogue distress scale is a reliable indicator; a grade above 4 out of 20 leads us to propose the patient a consultation with a psychologist. RESULTS: Two hundred and sixty-four female patients with a mean age of 61 years are the object of the study. Among them, 59.2% of patients display a disarray of low intensity (psychological suffering graded between 0 and 2) whereas 40% show a grade equal or superior to 3, considered as pathological on a psychological side: 30% of the patients have a grade between 3 et 5 and less than 2% of the patients display a grade reaching 9 or 10. Concerning the Needs Scale, more than 80% of the patients show a total score below 10 out of 20 and we observe a positive correlation between the total score of the Needs Scale with several items and the Visual Analogue Distress Scale score. CONCLUSION: Our results highlight the difficulty for most of the patients to cope with emotional distress linked to their disease. We discuss the necessity to increase awareness among caregivers on this psychological distress, through the use of simple tools such as a Visual Analogue Scale associated with a Needs Scale, so as to provide a holistic care for women with breast cancer.

Effort-reward-imbalance in healthy teachers is associated with higher LPS-stimulated production and lower glucocorticoid sensitivity of interleukin-6 in vitro.

BACKGROUND: According to the effort-reward-imbalance (ERI) model, a lack of reciprocity between costs and gains at work increases the risk for adverse health outcomes. Inflammation has been shown to play a crucial role in a variety of stress-related diseases and alterations in immune system glucocorticoid sensitivity may help to explain the increased risk for cardiovascular disease (CVD) and depression related to chronic work stress. METHODS: Changes in lipopolysaccharide (LPS)-induced interleukin (IL)-6 production and inhibition of IL-6 production by dexamethasone in reaction to the Trier Social Stress Test (TSST) were assessed in forty-six healthy school teachers to test whether chronic work stress is accompanied by alterations in inflammatory activity and glucocorticoid sensitivity of the innate immune system. RESULTS: High ERI was associated with an increase in pro-inflammatory potential, reflected in elevated IL-6 production before and after stress and with a lower capacity of dexamethasone to suppress IL-6 production in vitro over all measurement time points. ERI was not associated with stress-related changes in GC sensitivity. CONCLUSION: The present findings suggest a less effective anti-inflammatory regulation by glucocorticoids in teachers suffering from chronic work stress.

A comparison of activation patterns of cells in selected prefrontal cortical and amygdala areas of rats which are more or less anxious in response to predator exposure or submersion stress.

This study had two purposes. First: to compare predator and water submersion stress cFos activation in medial prefrontal cortices (mPFC) and the medial amygdala (MeA). Second: to identify markers of vulnerability to stressors within these areas. Rats were either predator or submersion stressed and tested 1.75 h later for anxiety. Immediately thereafter, rats were sacrificed and cFos expression was examined. Predator and submersion stress equally increased anxiety-like behavior in the elevated plus maze (EPM) and hole board. To examine vulnerability, rats which were less anxious (LA) and more (highly) anxious (MA) in the EPM were selected from among handled control and stressed animals. LA stressed rats were considered stress non-responsive while MA stressed rats were considered stress responsive. Predator stress, but not submersion stress, activated MeA cFos. CFos expression of mPFC cells was elevated in LA rats and reduced in MA rats in predator stressed animals only, correlating negatively with anxiety. These findings are consistent with data implicating greater mPFC excitability in protection against the effects on affect of traumatic stress. The findings also suggest that this conclusion is stressor specific, applying to predator stress but not submersion stress. Both stressors have been suggested to model hyperarousal and comorbid anxiety aspects of PTSD in humans. Hence the use of these paradigms to identify brain bases of vulnerability and resilience to traumatic stress in PTSD has translation potential. On the other hand, our evidence of stressor specificity of vulnerability/resilience markers raises a caution. The data suggest that preclinical markers of vulnerability/resilience in a given stress paradigm are at best suggestive, and translational value must ultimately be confirmed in humans.

Acceptability of the Distress Thermometer and Problem List to community-based telephone cancer helpline operators, and to cancer patients and carers.

BACKGROUND: Cancer can be a distressing experience for cancer patients and carers, impacting on psychological, social, physical and spiritual functioning. However, health professionals often fail to detect distress in their patients due to time constraints and a lack of experience. Also, with the focus on the patient, carer needs are often overlooked. This study investigated the acceptability of brief distress screening with the Distress Thermometer (DT) and Problem List (PL) to operators of a community-based telephone helpline, as well as to cancer patients and carers calling the service. METHODS: Operators (n = 18) monitored usage of the DT and PL with callers (cancer patients/carers, >18 years, and English-speaking) from September-December 2006 (n = 666). The DT is a single item, 11-point scale to rate level of distress. The associated PL identifies the cause of distress. RESULTS: The DT and PL were used on 90% of eligible callers, most providing valid responses. Benefits included having an objective, structured and consistent means for distress screening and triage to supportive care services. Reported challenges included apparent inappropriateness of the tools due to the nature of the call or level of caller distress, the DT numeric scale, and the level of operator training. CONCLUSIONS: We observed positive outcomes to using the DT and PL, although operators reported some challenges. Overcoming these challenges may improve distress screening particularly by less experienced clinicians, and further development of the PL items and DT scale may assist with administration. The DT and PL allow clinicians to direct/prioritise interventions or referrals, although ongoing training and support is critical in distress screening.

Stress enhancement of fear learning in mice is dependent upon stressor type: Effects of sex and ovarian hormones.

In three experiments, chronic stress enhancement of subsequent fear learning was investigated in C57Bl/6 mice. The first experiment focused on the influence of stressor type on subsequent Pavlovian fear learning. Male mice were subjected to 7d of either repeated restraint stress or chronic variable stress before undergoing a fear conditioning procedure with three tone-shock trials. Subsequent tests were conducted of contextual and tone fear, through measures of the freezing response. Repeated restraint altered pre-training activity and the unconditional response to shock, but was ineffective in influencing conditional fear. Chronic variable stress significantly inflated contextual fear without altering tone fear. In a second experiment, investigating potential sex differences in the fear-enhancing effects of stress, female mice were subjected to the very same procedures. Among females, chronic variable stress selectively altered tone fear, rather than contextual fear. A final experiment investigated the potential role of ovarian hormones by subjecting female mice to either ovariectomy or sham surgery before the stress procedures. Ovariectomy had no significant effect on the ability of stress to enhance fear in females. In sum, the experiments indicate that stressor type significantly influences subsequent fear learning, that males and females are differentially sensitive to fear enhancement by stress, and that the mechanisms mediating these sex differences lie outside of the immediate influence of ovarian hormones. The findings should allow for refinement of animal models of human psychiatric disorders and for further investigations into the genetic and molecular substrates of significant gender differences in fear and anxiety.

Neuroendocrine dysfunction in fibromyalgia and migraine.

Fibromyalgia (FM) and migraine are common chronic disorders that predominantly affect women. The prevalence of headache in patients with FM is high (35%-88%), with migraine being the most frequent type. A particular subgroup of patients with FM (approximately half) presents with a combined clinical form of these two painful disorders, which may exhibit a different manner of progression regarding symptomatology and impact on daily activities. This article reviews several common aspects of the pathophysiology regarding pain control mechanisms and neuroendocrine dysfunction occurring in FM and migraine, particularly in the chronic form of the latter. We also discuss the participation of hypothalamic and brainstem centers of pain control, the putative role played by neurotransmitters or neuromodulators on central sensitization, and changes in their levels in the cerebrospinal fluid. Understanding their mechanisms will help to establish new treatment strategies for treating these disabling brain disorders.

Putting it all behind: long-term psychological impact of an inconclusive DNA test result for breast cancer.

PURPOSE: An inconclusive DNA-result for breast cancer may leave women with uncertainty that cannot be relieved. We assessed the influence of beliefs women held about their inconclusive DNA-result on psychological well-being and whether women had been able to put the period of DNA testing behind them. METHODS: In total, 215 women completed a baseline and a follow-up questionnaire 2.5 till 7 years after DNA test disclosure. Within the group of 147 women who received an inconclusive result (either a personal result or the result of an affected family member) multiple regression analyses were applied to investigate the relevance of women's personal beliefs. RESULTS: Personal beliefs and ambivalence about an inconclusive DNA-result were associated with cancer-related worry and distress (P < 0.05). Moreover, these beliefs seemed to be an especially strong predictor of whether women had been able to leave the period of DNA testing behind them, even after controlling for all measures of psychological distress (P < 0.001). DISCUSSION: Psychological distress measures may provide an important but incomplete picture of how women make sense of an inconclusive DNA-result. These findings underscore the importance of discussing counselees' beliefs and expectations openly to enhance well-being and adaptation on the long term.

Salivary alpha amylase and cortisol responses to different stress tasks: impact of sex.

Neuro-endocrine markers such as salivary alpha amylase (sAA) and cortisol (CORT) play an important role in establishing human responses to stressful events. Whereas sAA levels reflect sympathetic system activity, salivary cortisol appears to be a valid measure for HPA axis activity. Although many studies looked at either sAA or CORT responses in reaction to stress, work still has to be done to look at the way these systems interact, especially when both systems are activated. Additionally, sex effects in CORT responses have been investigated relatively often, but possible sex differences in sAA levels and responses, or the way both systems interact has not been the focus of sufficient studies to yield a univocal conclusion. In this study we presented a group of healthy participants (n=80) with two mildly stressful tasks, consisting of an aversive picture rating task and a cold pressor stress (CPS) task. The second task was compared with a control task. We expected a rise in sAA level in response to the first task and sAA as well as CORT responses on the second task and explored the interaction between the two responses. Results indicate that sAA is indeed a sensitive marker in both psychologically and physically induced arousal paradigms, whereas a cortisol response was only observed in the CPS task. Men had higher sAA levels than women during the complete course of the study, but men and women were comparable in their responsivity to the tasks. No strong correlations between sAA and CORT responses were found.

Workplace stressors and lifestyle-related cancer risk factors among female physicians: assessment using the Occupational Stress Index.

This study examined the relationship between work stressors and lifestyle-related cancer risk factors (LRCRF): smoking, obesity, sedentariness and alcohol consumption, among 112 female physicians in Novi Sad, a region of high LRCRF prevalence. The participation rate was 92.6%. Participants completed the physician-specific version of the Occupational Stress Index (OSI). Self-reported data concerning LRCRF and working conditions were cross-validated with medical records, as well as with worksite measurements and expert observations. A total of 35 (31.3%) of the physicians were current smokers and 10 (8.9%) were heavy smokers (>20 cigarettes/day); 23 (20.5%) had a body mass index (BMI) of 28 or more, and 11 (9.8%) were obese (BMI> or =30). Only 27 (24.1%) regularly engaged in recreational physical activity (PA). Slightly over 5% consumed alcohol daily. Altogether 15 (13.4%) had a low lifestyle-related cancer risk profile (not a current smoker, BMI<28, regular recreational PA and no daily alcohol consumption). Total OSI and several OSI aspects, particularly threat avoidance alone or in combination, showed significant multivariate associations with LRCRF, as did individual OSI elements. The latter included long work hours, restricted problem-solving strategy, insufficient help with clinical difficulties and supervisory responsibility (obesity and/or sedentariness) and problems hampering patient care (smoking). There is an urgent need to lower the LRCRF among female physicians in this high risk region. Our findings suggest that diminishing the work stressor burden should be considered when developing intervention strategies aimed at these risk factors.

Estresores en las unidades de cuidado intensivo / Stressors at Intensive Care Units

Con el propósito de determinar el nivel de estrés e identificar los estresores que afectan al personal de enfermería que labora en la unidad de cuidados intensivos (UCI) en el municipio de Cúcuta Norte de Santander, Colombia, durante el primer semestre de 2005, se desarrolló un estudio descriptivo de corte transversal, en una muestra conformada por 22 enfermeras y 59 auxiliares de enfermería para un total de 81 sujetos. Para obtener la información se aplicó el cuestionario: “Estresores laborales para enfermería”, diseñado por Reig y Caruana, en el que se presentan 68 estresores, valorando en qué medida cada situación representa una fuente de estrés. Se encontró que la mayor parte del personal de enfermería que labora en la UCI presenta algún grado de estrés (94 porciento); los niveles altos y máximos de estrés son producidos por situaciones relacionadas con “conflicto con los superiores” (52 porciento), seguido de la “sobrecarga laboral” (40 porciento) y el “contacto con el dolor y la muerte” (26 porciento). Se observó un mayor grado de estrés en el personal de enfermería con el cargo de enfermeras, jóvenes, con estado civil casado, con menor experiencia laboral, que trabajan en instituciones privadas y que tienen contratación a término indefinido.

Caring for a loved one with advanced cancer: determinants of psychological distress in family caregivers.

BACKGROUND: Family caregivers caring for a patient with terminal cancer may experience significant psychological distress. OBJECTIVE: The purpose of this study was to determine the extent to which the family caregivers' psychological distress is influenced by the patients' performance status while taking into account individual characteristics of caregivers and their unmet needs. METHODS: Two hundred twelve family caregivers were assigned to three cohorts according to the patient's performance status, as measured by the Eastern Collaborative Oncology Group Functional Scale (ECOGS). Interview information was collected on the services and care provided, as well as on the caregivers' characteristics and level of psychological distress. RESULTS: Family caregivers' psychosocial distress is strongly associated with the patients' terminal disease progress and declined functioning. The level of psychological distress varies from 25.2 to 33.5 (p = 0.0008) between the groups. Moreover, the percentage of caregivers with a high level of psychological distress varies from 41% to 62%, while this percentage is estimated at 19.2% in general population. A high distress index was significantly associated with the caregiver's burden, the patient's young age, the patient's symptoms, the caregiver's young age and gender, a poor perception of his/her health and dissatisfaction with emotional and tangible support. CONCLUSIONS: Family caregivers of patients in the advanced stages of cancer experience a high level of psychological distress, which increases significantly as the patient loses autonomy. Health care policies and programs need to be revisited in order to take the reality of these patients and their families into account.