A Novel AI Approach for Assessing Stress Levels in Patients with Type 2 Diabetes Mellitus Based on the Acquisition of Physiological Parameters Acquired during Daily Life.

Stress is the inherent sensation of being unable to handle demands and occurrences. If not properly managed, stress can develop into a chronic condition, leading to the onset of additional chronic health issues, such as cardiovascular illnesses and diabetes. Various stress meters have been suggested in the past, along with diverse approaches for its estimation. However, in the case of more serious health issues, such as hypertension and diabetes, the results can be significantly improved. This study presents the design and implementation of a distributed wearable-sensor computing platform with multiple channels. The platform aims to estimate the stress levels in diabetes patients by utilizing a fuzzy logic algorithm that is based on the assessment of several physiological indicators. Additionally, a mobile application was created to monitor the users' stress levels and integrate data on their blood pressure and blood glucose levels. To obtain better performance metrics, validation experiments were carried out using a medical database containing data from 128 patients with chronic diabetes, and the initial results are presented in this study.

How to see stress in chickens: On the way to a Stressed Chicken Scale.

For many species, scales are used to classify discomfort and stress (e.g., facial expression/pain scales). Although a significant number of vertebrates used for scientific purposes are chickens, a corresponding scale for birds has not yet been established. We developed a Stressed Chicken Scale (SCS) to investigate whether it is possible to assess discomfort in a chicken by its body posture. A selective review with additional handsearch was conducted to find suitable parameters for visual stress assessment. Seven potential body signals were identified: Tail and head position, eye closure, beak opening, leg and wing position, and plumage fullness (ruffled or fluffed up feathers). The SCS was evaluated for interobserver reliability with veterinary students (n = 20), using randomized pictures of stressed and unstressed chickens in lateral view (n = 80). Observers were able to identify the body signals on the pictures after a brief training session. Agreement scores for interobserver agreement ranged from κ = 0.31 (fair agreement) for eye closure to κ = 0.78 (substantial agreement) for beak opening. We found that the number of body signals displayed in a stressed expression had an impact on observers' overall assessment of the chickens, for example, chickens were more likely to be rated as stressed if more than 4 signals indicative of stress were present. We conclude that the 7 individual body signals can be used to identify discomfort in chickens.

Relationship between Ear Temperature, Behaviour and Stress Hormones in Guinea Pigs (Cavia porcellus) during Different Interactive Activities in Zoos.

Guinea pigs (Cavia porcellus) are used for interactive activities in zoos; therefore, it is important to investigate their welfare. This study aimed to evaluate the validity of measuring the guinea pigs' body temperature of guinea pigs through the ear canal and investigate the relationship among changes in the expression of negative behavior, changes in body temperature, and changes in salivary cortisol concentration, and examine the effects of different interactive activities. In the normal interactive activities performed at the site, the decreased body temperature of pigs was observed over time. In contrast, increased body temperature was observed in excessive interactive activities, which are not recommended. Among the negative behaviors, "Head turning" and "Locomotion" increased significantly in excessive interactions compared to normal interactions, but "Head tossing" decreased significantly over time in both types of interactions. "Freezing" was observed only in excessive interactions. Salivary cortisol concentration increased significantly for all activities. Investigating the relationship between the individual expression of negative behavior and changes in body temperature and changes cortisol level made it possible to uncover the potential for inferring an animal's physiological state. Combining ear temperature monitoring and behavioral observation during zoo interaction activities is recommended as an ethical and scientifically supported practice.

Robotic surgery and work-related stress: A systematic review.

Despite robot-assisted surgery (RAS) becoming increasingly common, little is known about the impact of the underlying work organization on the stress levels of members of the operating room (OR) team. To this end, assessing whether RAS may impact work-related stress, identifying associated stress factors and surveying relevant measurement methods seems critical. Using three databases (Scopus, Medline, Google Scholar), a systematic review was conducted leading to the analysis of 20 articles. Results regarding OR team stress levels and measurement methods were heterogeneous, which could be explained by differing research conditions (i.e., lab. vs. real-life). Relevant stressors such as (in)experience with RAS and quality of team communication were identified. Development of a common, more reliable methodology of stress assessment is required. Research should focus on real-life conditions in order to develop valid and actionable knowledge. Surgical teams would greatly benefit from discussing RAS-related stressors and developing team-specific strategies to handle them.

Predicting physical and mental health status through interview-based evaluation of work stress: initial attempts to standardize the interviewing method.

This study conducted an interview-based stress evaluation that considered the psychosocial models of work stress and verified the evaluation's predictive validity. A four-stage assessment comprising a pre-survey, pre-interview questionnaire, stress assessment interview, and post-survey after one month was conducted with 50 Japanese workers. Additionally, 16 occupational health professionals provided stress evaluations based on recorded interview videos. Variables based on intraclass correlation coefficients (ICCs) were computed in multiple ways to compare the agreement among the evaluators. The generalized estimating equation (GEE) was conducted to evaluate the prediction models. The overall ICC among the evaluators was 0.58. The GEE revealed that the mean score of the evaluators in the interview-based stress evaluation significantly predicted psychological symptoms (ß =2.02, p=0.019), burnout (ß =0.77, p<0.001), and well-being (ß =-0.64, p=0.007) one month later, even after adjusting for the self-reported stress levels measured in the pre-survey. The predictive validity of the proposed interview-based stress evaluation was confirmed. Although there are several challenges in standardizing this evaluation, semi-structured interviews are an effective tool for understanding work stress.

Parental stress in families of children with special educational needs: a systematic review.

Background: This systematic review aimed to identify the risk factors and protective factors for parental stress in families with children with special educational needs. Studies have indicated that the wellbeing of families is related to the physical, psychological, and social conditions of the children, as well as the family functioning, stress coping strategies, and social and professional support of their parents. The parents of children with special educational needs experience high levels of parental stress. Identifying the associated risk factors and protective factors may shed light on the provision of interventions to promote the mental wellbeing of these parents. Methods: Boolean operators were used to search multiple online databases, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied in this systematic review. Data were extracted into categories of population, age, region, the child's diagnosis, the stress-measuring instrument, and the risk factors and protective factors. Results: Twenty-six studies, including 5,169 parents and 3,726 children, were reviewed. The following four major risk factors and protective factors were found to be associated with parental stress: the sex of the parents, diagnosis-related coping issues, socioeconomic characteristics, and social isolation of the parents. Conclusions: This systematic review identified four significant risk factors and protective factors related to social support from couples, family members, and social circles. Various agencies may provide financial and manpower assistance and professional support and services to improve the parents' knowledge and coping skills, as well as affectional support, early screening, and continuous assessment of the parents' progress. Social policies and interventions offering continuous and diagnosis-related support to the parents of children with special educational needs are highly recommended.

The insufficiency of a simple stress question in assessing stress for chronic daily headache in clinical practice.

BACKGROUND: In managing chronic daily headaches (CDH), a comprehensive approach is necessary to evaluate stress, a closely linked factor. However, limited time and costs often lead to the use of a simple stress question in clinical settings. This study aims to assess the validity of using a simple stress question for CDH patients and explore its implications for clinical practice. METHODS: We recruited 103 patients with CDH who completed structured self-administered questionnaires, including a simple stress question ("Have you had any stress or concerns in the last 4 weeks?") and validated Korean versions of questionnaires for depression, anxiety, insomnia, and the Brief Encounter Psychosocial Instrument (BEPSI). A headache specialist conducted clinical interviews. The stress group consisted of patients who acknowledged overt stress (answering "yes" to the simple question) and covert stress (initially answering "no" but later admitting during the interview). Results showed no statistical difference between the subgroups, so they were combined as the "acknowledged stress" group. RESULTS: Out of 103 patients, 54.4% had chronic migraine, 45.6% had chronic tension-type headache, and 66 patients (64.1%) acknowledged experiencing stress. No significant differences were found in demographic and clinical characteristics, BEPSI stress assessment, or depression, anxiety, and insomnia profiles between patients with overt stress (n = 51) and covert stress (n = 15). The average BEPSI score was 2.3 ± 0.9, with 45.6% of patients exceeding the criteria (>2.4). Two (5.4%) patients in denial of stress had scores above the BEPSI criteria. Among patients below the criteria of BEPSI, 21 acknowledged stress, while 35 denied stress, with no significant differences observed. CONCLUSIONS: This study suggests the limitations of relying solely on a simple stress question for assessing stress in patients with CDH in clinical practice. It is possible to encounter covert stress, include individuals who do not exhibit noticeable stress, and misclassify stress levels. To overcome these limitations, it is necessary to foster a supportive environment for open communication on stress and implement a comprehensive assessment strategy when needed.

Evaluating the Mental Health of Physician-Trainees Using an SMS Text Message-Based Assessment Tool: Longitudinal Pilot Study.

BACKGROUND: Physician burnout is a multibillion-dollar issue in the United States. Despite its prevalence, burnout is difficult to accurately measure. Institutions generally rely on periodic surveys that are subject to recall bias. SMS text message-based surveys or assessments have been used in health care and have the advantage of easy accessibility and high response rates. OBJECTIVE: In this pilot project, we evaluated the utility of and participant engagement with a simple, longitudinal, and SMS text message-based mental health assessment system for physician-trainees at the study institution. The goal of the SMS text message-based assessment system was to track stress, burnout, empathy, engagement, and work satisfaction levels faced by users in their normal working conditions. METHODS: Three SMS text message-based questions per week for 5 weeks were sent to each participant. All data received were deidentified. Additionally, each participant had a deidentified personal web page to follow their scores as well as the aggregated scores of all participants over time. A 13-question optional survey was sent at the conclusion of the study to evaluate the usability of the platform. Descriptive statistics were performed. RESULTS: In all, 81 participants were recruited and answered at least six (mean 14; median 14; range 6-16) questions for a total of 1113 responses. Overall, 10 (17%) out of 59 participants responded "Yes" to having experienced a traumatic experience during the study period. Only 3 participants ever answered being "Not at all satisfied" with their job. The highest number of responses indicating that participants were stressed or burnt out came on day 25 in the 34-day study period. There were mixed levels of concern for the privacy of responses. No substantial correlations were noted between responses and having experienced a traumatic experience during the study period. Furthermore, 12 participants responded to the optional feedback survey, and all either agreed or strongly agreed that the SMS text message-based assessment system was easy to use and the number of texts received was reasonable. None of the 12 respondents indicated that using the SMS text message-based assessment system caused stress. CONCLUSIONS: Responses demonstrated that SMS text message-based mental health assessments are potentially useful for recording physician-trainee mental health levels in real time with minimal burden, but further study of SMS text message-based mental health assessments should address limitations such as improving response rates and clarifying participants' sense of privacy when using the SMS text message-based assessment system. The findings of this pilot study can inform the development of institution-wide tools for assessing physician burnout and protecting physicians from occupational stress.

An Innovative Random-Forest-Based Model to Assess the Health Impacts of Regular Commuting Using Non-Invasive Wearable Sensors.

Regular commutes to work can cause chronic stress, which in turn can cause a physical and emotional reaction. The recognition of mental stress in its earliest stages is very necessary for effective clinical treatment. This study investigated the impact of commuting on human health based on qualitative and quantitative measures. The quantitative measures included electroencephalography (EEG) and blood pressure (BP), as well as weather temperature, while qualitative measures were established from the PANAS questionnaire, and included age, height, medication, alcohol status, weight, and smoking status. This study recruited 45 (n) healthy adults, including 18 female and 27 male participants. The modes of commute were bus (n = 8), driving (n = 6), cycling (n = 7), train (n = 9), tube (n = 13), and both bus and train (n = 2). The participants wore non-invasive wearable biosensor technology to measure EEG and blood pressure during their morning commute for 5 days in a row. A correlation analysis was applied to find the significant features associated with stress, as measured by a reduction in positive ratings in the PANAS. This study created a prediction model using random forest, support vector machine, naive Bayes, and K-nearest neighbor. The research results show that blood pressure and EEG beta waves were significantly increased, and the positive PANAS rating decreased from 34.73 to 28.60. The experiments revealed that measured systolic blood pressure was higher post commute than before the commute. For EEG waves, the model shows that the EEG beta low power exceeded alpha low power after the commute. Having a fusion of several modified decision trees within the random forest helped increase the performance of the developed model remarkably. Significant promising results were achieved using random forest with an accuracy of 91%, while K-nearest neighbor, support vector machine, and naive Bayes performed with an accuracy of 80%, 80%, and 73%, respectively.

Mental Stress Assessment Using Ultra Short Term HRV Analysis Based on Non-Linear Method.

Mental stress is on the rise as one of the major health problems in modern society. It is important to detect and manage mental stress to prevent various diseases caused by stress and to maintain a healthy life. The purpose of this paper is to present new heart rate variability (HRV) features based on empirical mode decomposition and to detect acute mental stress through short-term HRV (5 min) and ultra-short-term HRV (under 5 min) analysis. HRV signals were acquired from 74 young police officers using acute stressors, including the Trier Social Stress Test and horror movie viewing, and a total of 26 features, including the proposed IMF energy features and general HRV features, were extracted. A support vector machine (SVM) classification model is used to classify the stress and non-stress states through leave-one-subject-out cross-validation. The classification accuracies of short-term HRV and ultra-short-term HRV analysis are 86.5% and 90.5%, respectively. In the results of ultra-short-term HRV analysis using various time lengths, we suggest the optimal duration to detect mental stress, which can be applied to wearable devices or healthcare systems.

Limited negative effects of the COVID-19 pandemic on mental health measures of Ghanaian university students.

BACKGROUND: Stress and mental health outcomes are negatively correlated among university students throughout the world. Reports of differences in stress perception by gender exist, but there is limited data on students from sub-Saharan African countries. This study describes the burden of perceived and financial stress; characterizes mood and degree of anxiety symptoms; examines stress coping mechanisms, including resilience and repetitive negative thinking (RNT); and explores how students at a Ghanaian university believed the COVID-19 pandemic affected these measures. METHODS: Students (n = 129) were recruited from the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana from October 2020 - January 2021. Validated surveys were used. Participants were asked "Are your answers to the questions affected by the COVID-19 pandemic?" RESULTS: No differences in mean scores were observed between genders. For female students, financial stress was positively associated with RNT (p = 0.009), negative mood (p = 0.002), and anxiety (p < 0.001). Males were more likely to report decreased stress during the pandemic (p = 0.002), but there was no difference in mental health outcomes by perceived stress (PS) change category among males. Effects of the pandemic on mental health outcomes were mixed, but substantial proportions of students reported improvements or no change in financial stress, mood, anxiety, and RNT. LIMITATIONS: Students from one university particiapted in this cross-sectional survey. CONCLUSIONS: This study adds to the understanding of how higher education students are experiencing stress and are coping with the uncertainties of the COVID-19 pandemic in Ghana.

Reliability and validity of the Chinese version of the New Brief Job Stress Questionnaire (New BJSQ) among workers in China.

This study aimed to develop the Chinese version of the New Brief Job Stress Questionnaire (New BJSQ) and investigate its reliability and validity. The survey was administered at two time-points separated by a two-week interval among Chinese workers. The Chinese version of the New BJSQ was developed according to the international guidelines. Cronbach's alpha, intra-class correlation coefficients (ICCs), and Pearson correlation coefficient were calculated to assess the reliability. A variance explained by the first factor was calculated to examine factor-based validity, and confirmatory factor analysis was performed (CFA) to determine the construct validity. Baseline and follow-up analyses included 516 and 52 workers, respectively. In most scales, sufficient internal consistency and test-retest reliability were observed, and principal component analyses demonstrated that the first factor explained more than 50% proportion of the variance. CFA showed that the four-factor model (Job demands, Task-level job resources, Workgroup-level job resources, and Organizational-level job resources) demonstrated a moderate fit, similar to the original version. The Chinese version of New BJSQ showed good reliability and moderate validity. Future studies should explore content and construct validities and the factor structure of the Chinese version of the New BJSQ in more detail.

Real-Time Stress Level Feedback from Raw Ecg Signals for Personalised, Context-Aware Applications Using Lightweight Convolutional Neural Network Architectures.

Human stress is intricately linked with mental processes such as decision making. Public protection practitioners, including Law Enforcement Agents (LEAs), are forced to make difficult decisions during high-pressure operations, under strenuous circumstances. In this respect, systems and applications that assist such practitioners to take decisions, are increasingly incorporating user stress level information for their development, adaptation, and evaluation. To that end, our goal is to accurately detect and classify the level of acute, short-term stress, in real time, for the development of personalized, context-aware solutions for LEAs. Deep Neural Networks (DNNs), and in particular Convolutional Neural Networks (CNNs), have been gaining traction in the field of stress analysis, exhibiting promising results. Furthermore, the electrocardiogram (ECG) signals, have also been widely adopted for estimating levels of stress. In this work, we propose two CNN architectures for the stress detection and 3-level (low, moderate, high) stress classification tasks, using ultra short-term raw ECG signals (3 s). One architecture is simple and with a low memory footprint, suitable for running in wearable edge-computing nodes, and the other is able to learn more complex features, having more trainable parameters. The models were trained on the two publicly available stress classification datasets, after applying pre-processing techniques, such as data pruning, down-sampling, and data augmentation, using a sliding window approach. After hyperparameter tuning, using 4-fold cross-validation, the evaluation on the test set demonstrated state-of-the-art accuracy both on the 3- and 2-level stress classification task using the DriveDB dataset, reporting an accuracy of 83.55% and 98.77% respectively.

Self-Report Stress Measures to Assess Stress in Adults With Mild Intellectual Disabilities-A Scoping Review.

Stress has a major negative impact on the development of psychopathology and contributes to the onset of adverse physical conditions. Timely recognition and monitoring of stress-related problems are therefore important, especially in client populations that are more vulnerable to stress, such as people with mild intellectual disabilities (MID). Recent research on the use of physiological measures to assess stress levels emphasize that, in addition to these measures, self-report instruments are necessary to gain insight into the individual perception and impact of stress on daily life. However, there is no current overview of self-report stress measures that focus on the experience of stress in the present moment or in daily life. To provide an overview of the existing self-report stress measures for clinicians and researchers, a scoping review was conducted. In addition, to advise clinical professionals on the use of self-report measures of stress for people with MID, the results of an expert consultation were used to refine the preliminary findings. A systematic scoping literature search resulted in a total of 13 self-reported stress measures that met the final inclusion criteria, of which three were developed specifically for assessing stress in adults with MID (GAS-ID, LI, and SAS-ID). For each included self-report stress measure, the psychometric quality, assessment procedure, and suitability for adults with MID were reported. These were supplemented by the findings from the expert consultation. Implications for clinical practice on the use of self-report stress measures, particularly for people with MID, are discussed. Recommendations for future research and development are given.

The Interactive Stress Assessment in Basic Animal Science Training.

In order to assess the extent to which the legally prescribed training for the acquisition of animal experimentation expertise provides scientific personnel with the necessary competence and expertise to carry out a correct harm-benefit analysis in the context of animal experimentation applications, we conducted an interactive stress assessment concerning the basic animal experimentation expertise course. First, before the practical part of the course and then, after the practical part, the participants assessed images and video material of healthy and stressed animals. The results were assessed comparatively and showed a significant increase in performance in all categories (p-value < 0.001). In addition, the results were comparatively assessed against those of scientists already experienced in animal experiments and experienced animal caretakers in research and clinics. In all groups, the vast majority of participants were able to recognise stress in laboratory animals. A significant proportion of the participants were also able to rate the level of stress correctly according to three degrees of severity: mild, moderate and severe. Nevertheless, a small number of participants were unable to distinguish between healthy and stressed animals and thus, the stress in the individual groups was assigned very differently from the different degrees of severity. The results of this study illustrate, on the one hand, the high significance that training must have in order to acquire the expertise, and, on the other hand, how strongly the assessment of stress is influenced by subjectivity.

Assessing stress variations in children during the strange situation procedure: comparison of three widely used respiratory sinus arrhythmia estimation methods.

Objective.The respiratory sinus arrhythmia (RSA) is a well-known marker of vagal activity that can be exploited to measure stress changes. RSA is usually estimated from heart rate variability (HRV). This study aims to compare the RSA obtained with three widely adopted methods showing their strengths and potential pitfalls.Approach.The three methods are tested on 69 healthy preschoolers undergoing a stressful protocol, the strange situation procedure (SSP). We compare the RSA estimated by the Porges method, the univariate autoregressive (AR) spectral analysis of the HRV signal, and the bivariate AR spectral analysis of HRV and respirogram signals. We examine RSA differences detected across the SSP episodes and correlation between the estimates provided by each method.Main results.The Porges and the bivariate AR approaches both detected significant differences (i.e. stress variations) in the RSA measured across the SSP. However, the latter method showed higher sensitivity to stress changes induced by the procedure, with the mean RSA variation between baseline and first separation from the mother (the most stressful condition) being significantly different among methods: Porges, -17.5%; univariate AR, -18.3%; bivariate AR, -23.7%. Moreover, the performances of the Porges algorithm were found strictly dependent on the applied preprocessing.Significance.Our findings confirm the bivariate AR analysis of the HRV and respiratory signals as a robust stress assessment tool that does not require any population-specific preprocessing of the signals and warn about using RSA estimates that neglect breath information in more natural experiments, such as those involving children, in which respiratory frequency changes are extremely likely.

Gaps identification in Saudi anesthesia residency training during early time of pandemic: Trainee view.

BACKGROUND: COVID-19 pandemic was declared a worldwide crisis, as a response the community established new protocols and clinical pathways to prepare the health system in adapting to the expected surge of cases. OBJECTIVES: In this study, we aim to assess the effect of the pandemic on the anesthesia training program residents from their own view. Identification of gaps in training programs will help to overcome the challenge like pandemic in order to have competent anesthesia practitioners. METHODS: We deployed an online survey in early May 2020 targeting the anesthesia residents in Saudi Arabia. We used mixed methods, containing both quantitative and qualitative questions. Our survey had 3 main sections: demographics, pandemic effect on the training, and pandemic effect on the trainees. RESULTS: Our survey showed that in the first 2 months of the pandemic there was a vast decrease in educational activities and clinical activities. However, after that both the Saudi Commission for Health Speciality (SCFHS) and local hospitals employed alternative education methods like electronic learning and simulation to adopt these changes. We also found the average stress level among residents was 6.5 out of 10 with number one stressor is transmitting Covid-19 to family or self. Finally, Wellbeing resources were available to residents however were not used sufficiently by residents. CONCLUSION: During times of pandemic, assessment and gap identification in postgraduate training programs are necessary to help overcome challenges of training anesthesiologists. Other than the clinical competency residents' wellbeing needs to be monitored and make available resources easy to reach for the residents.

Development of a method for heat shock stress assessment in yeast based on transcription of specific genes.

All living cells, including yeast cells, are challenged by different types of stresses in their environments and must cope with challenges such as heat, chemical stress, or oxidative damage. By reversibly adjusting the physiology while maintaining structural and genetic integrity, cells can achieve a competitive advantage and adapt environmental fluctuations. The yeast Saccharomyces cerevisiae has been extensively used as a model for study of stress responses due to the strong conservation of many essential cellular processes between yeast and human cells. We focused here on developing a tool to detect and quantify early responses using specific transcriptional responses. We analyzed the published transcriptional data on S. cerevisiae DBY strain responses to 10 different stresses in different time points. The principal component analysis (PCA) and the Pearson analysis were used to assess the stress response genes that are highly expressed in each individual stress condition. Except for these stress response genes, we also identified the reference genes in each stress condition, which would not be induced under stress condition and show stable transcriptional expression over time. We then tested our candidates experimentally in the CEN.PK strain. After data analysis, we identified two stress response genes (UBI4 and RRP) and two reference genes (MEX67 and SSY1) under heat shock (HS) condition. These genes were further verified by real-time PCR at mild (42°C), severe (46°C), to lethal temperature (50°C), respectively.

A Cross-National Validation of the Shortened Version of the Adolescent Stress Questionnaire (ASQ-S) Among Adolescents From Switzerland, Germany, and Greece.

The experience of stress is receiving increasing attention in the context of adolescent mental health, which is why a valid and reliable stress assessment instrument is of great importance. For this purpose, an English-language adolescent stress questionnaire (ASQ) was developed, which assesses the subjective stress experience of adolescents in different areas of life (e.g., at home, at school, and during leisure time). However, the latest long version of the questionnaire with 56 items (ASQ-2) was found to be too extensive, so a more economical short version ASQ-S with 27 items was developed. The aim of this study was to validate a German and a Greek version of the ASQ-S. In order to investigate the psychometric properties of the German and Greek ASQ-S confirmatory factor analysis, analyses of variance and correlations were applied to sample data from Switzerland, Germany, and Greece (N = 1,071 seventh-grade students; M age = 12.53; SD = 0.76). The results yielded only poor to moderate internal reliability across all three countries and the suggested 9-dimensional factor structure could not be confirmed. Instead, a modified 6-factor structure was tested which showed acceptable model fits while demonstrating form invariance across the three countries. Furthermore, the ASQ-S scales correlated positively with depressive symptoms and anxiety and negatively with self-esteem and life satisfaction, all of which supported adequate concurrent validity. The results revealed that the utility of the ASQ-S appears to be limited when translated to other languages and should be used with caution when administered in international contexts.

Differences in Immune Response During Competition and Preparation Phase in Elite Rowers.

Background: Metabolic stress is high during training and competition of Olympic rowers, but there is a lack of biomedical markers allowing to quantify training load on the molecular level. We aimed to identify such markers applying a complex approach involving inflammatory and immunologic variables. Methods: Eleven international elite male rowers (age 22.7 ± 2.4 yrs.; VO2max 71 ± 5 ml·min-1·kg-1) of the German National Rowing team were monitored at competition phase (COMP) vs. preparation phase (PREP), representing high vs. low load. Perceived stress and recovery were assessed by a Recovery Stress Questionnaire for Athletes (RESTQ-76 Sport). Immune cell activation (dendritic cell (DC)/macrophage/monocytes/T-cells) was evaluated via fluorescent activated cell sorting. Cytokines, High-Mobility Group Protein B1 (HMGB1), cell-free DNA (cfDNA), creatine kinase (CK), uric acid (UA), and kynurenine (KYN) were measured in venous blood. Results: Rowers experienced more general stress and less recovery during COMP, but sports-related stress and recovery did not differ from PREP. During COMP, DC/macrophage/monocyte and T-regulatory cells (Treg-cell) increased (p = 0.001 and 0.010). HMGB1 and cfDNA increased in most athletes during COMP (p = 0.001 and 0.048), while CK, UA, and KYN remained unaltered (p = 0.053, 0.304, and 0.211). Pro-inflammatory cytokines IL-1ß (p = 0.002), TNF-α (p < 0.001), and the chemokine IL-8 (p = 0.001) were elevated during COMP, while anti-inflammatory Il-10 was lower (p = 0.002). Conclusion: COMP resulted in an increase in biomarkers reflecting tissue damage, with plausible evidence of immune cell activation that appeared to be compensated by anti-inflammatory mechanisms, such as Treg-cell proliferation. We suggest an anti-inflammatory and immunological matrix approach to optimize training load quantification in elite athletes.