Cortisol, Health, and Coping in Patients with Nonspecific Low Back Pain.

Subjective health complaints (SHC), including nonspecific low back pain (LBP) as the most common single complaint, are the main reasons for long-term sick leave in many western countries. These complaints are often attributed to "stress". Cortisol has frequently been considered a biomarker reflecting sustained physiological HPA-axis activity, and is characterized by a high cortisol awakening response (CAR) and low evening values. The aim of the study was to investigate whether LBP patients had a normal characteristic cortisol profile, and whether possible deviations were related to coping and health. 305 patients on long-term sick leave for LBP participated in the study, and saliva cortisol profiles were compared to a reference population consisting of Danish workers. Cortisol was measured upon awakening, after 30 min, and in the evening. Additionally, patients answered questionnaires about SHC, fatigue, pain, coping, and social support. The patients showed a seemingly normal cortisol profile. However, CAR was larger among patients compared to the reference population. Patients with low cortisol reactivity had more SHC, pain, and fatigue, and those with higher evening cortisol reported higher scores on coping. The results are discussed in terms of theory, practical considerations, and possible mechanisms for the association between cortisol, health, and coping.

Diurnal rhythm in British Antarctic personnel.

INTRODUCTION: The diurnal rhythm of saliva cortisol and its association to adaptation, performance and health were examined in personnel over-wintering at two British Antarctic stations. METHODS: In total, 55 healthy individuals (49 males, 6 females) participated in the study. Cortisol in saliva was sampled on 3 consecutive days (at awakening, 15 and 45 min after waking, at 15.00 h, and 22.00 h) immediately after arrival at the station, midwinter, and the last week before departure. Subjective health complaints were also measured at arrival, midwinter, and the last week before departure, while depression (Burnam screen for depression) and positive and negative affect (PANAS) were measured at midwinter only. At the end of the winter appointment, base commanders evaluated the performance of all personnel. RESULTS: The variations in external light (darkness during winter, midnight sun during arrival and departure) did not influence the diurnal rhythms. The normal peak level in the morning, and the normal and gradual fall towards the evening were observed at arrival, midwinter, and before departure. Immediately after arrival the cortisol values were relatively high and correlated positively with base commander's evaluation of performance. During midwinter, approximately 58% scored for depression on the Burnam scale. However, when examining these data more closely, only 4 participants (7%) reported depression, the main reason for the high score on the depression scale was related to sleep problems and tiredness. CONCLUSIONS: There was no indication that over-wintering led to any disturbance in the diurnal rhythm of cortisol in British Antarctic personnel. There were no other indications of any 'over-wintering syndrome' than reports of subjective sleep problems and tiredness.

Coffee, stress and cortisol in nursing staff.

According to cognitive activation theory, long-lasting work demands without rest or lack of coping may lead to sustained activation and pathology. Cortisol is one of the most important stress hormones in humans and increased basal levels of cortisol are considered a valid marker for sustained activation. In order to investigate this association further, we investigate the relationships between salivary cortisol profiles, job stress, work load (effort/reward, demand/control) and health (subjective health complaints and health-related quality of life) in a population of health care workers. Forty-four women filled in a questionnaire and collected five saliva samples on two consecutive working days (1: wake-up time, 2: wake-up time+30 min, 3: wake-up time+45 min, 4: 1500 h and 5: 2200 h). There was no relationship between psychosocial factors at work and cortisol levels in the morning (cortisol level at wake-up time and awakening cortisol response (ACR)). Only the confounding variable tobacco reached a significant level in the hierarchical regressions analyses. Our significant findings are limited to the afternoon decline and the evening values. The decrease during the day relates to decision authority, physical functioning, general health, and vitality in the single, unadjusted regression analyses. The decrease also relates to coffee intake, which we included originally as a confounding variable. In the final hierarchical regression of the evening values, only decision authority and coffee were significantly related to cortisol levels in the evening.

Saliva cortisol levels in construction workers in the Arctic (78°N).

OBJECTIVES: The aim was to investigate how working in an extreme and isolated environment in the Arctic affected the diurnal rhythm of saliva cortisol. STUDY DESIGN: Field study. METHODS: Twenty-five male tunnel workers were screened during 3 different working cycles with different light conditions during a 9-month construction period; April/May (24 hours [h] light), September/October (approximately 12 h light and 12 h darkness) and November/December (24 h darkness). The work schedule was 10 h on/14 h off, 21 days at work/21 days off work. The workers alternated between the day shift in 1 work period and the night shift in the next. Four saliva samples were collected on day 14 in all 3 periods; immediately after awakening, and then 30 minutes, 6 hours and 12 hours after awakening. RESULTS: Regardless of shift schedule, the workers' cortisol levels were significantly lower in the period with 24 hours of light per day compared to the period with "normal" light conditions. There were no differences in the cortisol levels of the workers on night shifts in the period with 24 hours of darkness compared to those in the period with "normal" light conditions, but the workers who were on day shifts in the period with 24 of hours darkness had a disturbed cortisol rhythm (lower peak after awakening and lack of the normal decrease during the day). CONCLUSIONS: External light conditions and shift schedule were important factors in regulating the workers' cortisol rhythm. It seems to be easier to adapt to a night rhythm than an early morning rhythm in an isolated and extreme environment.