Does stress response axis activation differ between patients with autoimmune disease and healthy people?

Many studies have shown that patients with autoimmune disease present a hypoactive hypothalamic-pituitary-adrenal (HPA) axis, but the results are controversial. Our objective was to study differences in stress response axis activity between patients with autoimmune disease and healthy people. The study sample consisted of 97 women divided into four groups: 37 healthy women (HW), 21 with systemic lupus erythematosus (SLE), 21 with Sjögren's syndrome (SS), and 18 with systemic sclerosis (SSc). After being exposed to a stress task, participants' skin conductance and salivary cortisol levels were measured in order to assess their response to psychological stress. Diurnal cortisol concentrations were assessed by measuring salivary cortisol in samples collected five times over one day. In addition, self-administered questionnaires were used to assess psychological variables. A time × group interaction effect was found (p = 0.003) in salivary cortisol secretion in response to stressful challenge. The healthy group presented normal activation, the SS and SLE groups showed no activation, and the SSc group presented a similar activation pattern to the HW group, except at the time of recovery. Total cortisol production (AUCg) was higher in the SSc group than in the HW group (p = 0.001). Differences were also observed in the cortisol AUCg collected over one day between healthy women and patients with SLE (p = 0.004) as well as with SSc (p = 0.001): women with SLE and SSc presented higher total hormone production than healthy women. Patients with autoimmune disease present a different HPA axis response, which may contribute to the harmful effects of stress in these diseases.

The relationship between the menstrual cycle and cortisol secretion: Daily and stress-invoked cortisol patterns.

The menstrual cycle involves significant changes in hormone levels, causing physical and psychological changes in women that are further influenced by stress. The aim of this study was to understand the relationship between menstrual cycle phase and salivary cortisol patterns during the day as well as the salivary cortisol response to the Virtual Reality Version of the Trier Social Stress Test (TSST-VR). Forty two women not taking oral contraceptives (24 in follicular phase and 18 in luteal phase) participated in the study. Five samples of salivary cortisol collected during the day and another five samples of cortisol during the TSST-VR were analyzed. Psychological stress measures and psychopathological symptomatology were also evaluated. A 2 × 4 mixed ANCOVA showed an interaction between the two groups on the TSST-RV invoked cortisol response to the [F(3,42) = 3.681; p = 0.023) where women in luteal phase showed higher cortisol post exposure levels (5.96 ±â€¯3.76 nmol/L) than women in follicular phase (4.31 ±â€¯2.23 nmol/L). No other significant differences were found. Our findings provide evidence that menstrual cycle phase tended to influence cortisol response to laboratory-induced mental stress, with more reactivity observed in the luteal phase.

Influence of upper limb disability, manual dexterity and fine motor skill on general self-efficacy in institutionalized elderly with osteoarthritis.

STUDY DESIGN: Descriptive, cross-sectional. INTRODUCTION: The impact of upper limb (UL) disability, dexterity and fine motor skill on self-efficacy in older adults with osteoarthritis (OA) is not well known yet. PURPOSES OF THE STUDY: To evaluate the self-efficacy and its relationship with UL function/disability in institutionalized OA. METHODS: Institutionalized adults (n = 45) over the age of 65 years with OA were evaluated in a single session, to determine pinch strength, active range of motion of the hand and UL disability and functionality. They were classified as self-efficacious or not based on their general self-efficacy level. The influence on self-efficacy on upper limb function was statistically analyzed using bivariate and multivariate regression analyses. RESULTS: Self-effective older adults showed significantly lower scores in disability and higher scores in pinch strength, dexterity and motion of thumb than those who were classified as non-self-effective. Self-efficacy was associated with pinch strength (p ≤ 0.038), disability (p < 0.001) and dexterity (p ≤ 0.048). Multiple regression analyses showed that disability explained almost 40% of the variability of self-efficacy. CONCLUSIONS: Older adults classified as non-self-effective have higher UL disability and less pinch strength, manual dexterity and thumb motion than those who are self-effective, suggesting a relationship between impairment and perceived ability.

A virtual reality approach to the Trier Social Stress Test: Contrasting two distinct protocols.

Virtual reality adaptations of the Trier Social Stress Test (TSST-VR) constitute useful tools for studying the physiologic axes involved in the stress response. Here, we aimed to determine the most appropriate experimental approach to the TSST-VR when investigating the modulation of the axes involved in the stress response. We compared the use of goggles versus a screen projection in the TSST-VR paradigm. Forty-five healthy participants were divided into two groups: the first one (goggles condition; 13 females, 11 males) wore goggles while performing the TSST-VR; the second (screen condition; 15 females, six males) was exposed to the TSST-VR projected on a screen. Sympathetic reactivity to stress was measured by continuously recording skin conductance (SC), while the hypothalamic-pituitary-adrenal axis (HPA) was evaluated by sampling salivary cortisol throughout the experiment. At the end of the task, there was an increase in SC and cortisol level for both means of delivering the TSST-VR, although the increase in SC was greater in the goggles condition, while salivary cortisol was comparable in both groups. Immersion levels were reportedly higher in the screen presentation than in the goggles group. In terms of sex differences, females experienced greater involvement and spatial presence, though comparatively less experienced realism, than their male counterparts. These findings help us determine which protocol of the TSST-VR is most suitable for the stress response under study. They also emphasize the need to consider the sex of participants, as males and females show distinct responses in each protocol.

Functional rehabilitation of upper limb apraxia in poststroke patients: study protocol for a randomized controlled trial.

BACKGROUND: Upper limb apraxia is a common disorder associated with stroke that can reduce patients' independence levels in activities of daily living and increase levels of disability. Traditional rehabilitation programs designed to promote the recovery of upper limb function have mainly focused on restorative or compensatory approaches. However, no previous studies have been completed that evaluate a combined intervention method approach, where patients concurrently receive cognitive training and learn compensatory strategies for enhancing daily living activities. METHODS/DESIGN: This study will use a two-arm, assessor-blinded, parallel, randomized controlled trial design, involving 40 patients who present a left- or right-sided unilateral vascular lesion poststroke and a clinical diagnosis of upper limb apraxia. Participants will be randomized to either a combined functional rehabilitation or a traditional health education group. The experimental group will receive an 8-week combined functional program at home, including physical and occupational therapy focused on restorative and compensatory techniques for upper limb apraxia, 3 days per week in 30-min intervention periods. The control group will receive a conventional health education program once a month over 8 weeks, based on improving awareness of physical and functional limitations and facilitating the adaptation of patients to the home. Study outcomes will be assessed immediately postintervention and at the 2-month follow-up. The primary outcome measure will be basic activities of daily living skills as assessed with the Barthel Index. Secondary outcome measures will include the following: 1) the Lawton and Brody Instrumental Activities of Daily Living Scale, 2) the Observation and Scoring of ADL-Activities, 3) the De Renzi Test for Ideational Apraxia, 4) the De Renzi Test for Ideomotor Apraxia, 5) Recognition of Gestures, 6) the Test of Upper Limb Apraxia (TULIA), and 7) the Quality of Life Scale For Stroke (ECVI-38). DISCUSSION: This trial is expected to clarify the effectiveness of a combined functional rehabilitation approach compared to a conservative intervention for improving upper limb movement and function in poststroke patients. TRIAL REGISTRATION: Clinical Trial Gov number NCT02199093 . The protocol registration was received 23 July 2014. Participant enrollment began on 1 May 2014. The trial is expected to be completed in March 2016.

Social stress increases cortisol and hampers attention in adolescents with excess weight.

OBJECTIVE: To experimentally examine if adolescents with excess weight are more sensitive to social stress and hence more sensitive to harmful effects of stress in cognition. DESIGN AND METHODS: We conducted an experimental study in 84 adolescents aged 12 to 18 years old classified in two groups based on age adjusted Body Mass Index percentile: Normal weight (n=42) and Excess weight (n=42). Both groups were exposed to social stress as induced by the virtual reality version of the Trier Social Stress Task--participants were requested to give a public speech about positive and negative aspects of their personalities in front of a virtual audience. The outcome measures were salivary cortisol levels and performance in cognitive tests before and after the social stressor. Cognitive tests included the CANTAB Rapid Visual Processing Test (measuring attention response latency and discriminability) and the Iowa Gambling Task (measuring decision-making). RESULTS: Adolescents with excess weight compared to healthy weight controls displayed increased cortisol response and less improvement of attentional performance after the social stressor. Decision-making performance decreased after the social stressor in both groups. CONCLUSION: Adolescents who are overweight or obese have increased sensitivity to social stress, which detrimentally impacts attentional skills.

Creation and design of a test for the Evaluation of Upper Limb Apraxia (EULA) based on a cognitive model: a pilot study.

INTRODUCTION: Apraxia is regarded as neurological disorder characterized by a loss of ability to execute and carry out skilled movements and gestures despite intact motor and sensory systems, coordination, and comprehension. As reflected in the specialized literature, there are currently few tests that provide a global evaluation of this syndrome. This research created and designed a test for the Evaluation of Upper Limb Apraxia (EULA), based on theoretical models of apraxia. SUBJECTS AND METHODS: A sample of 57 patients was selected with subjective cognitive manifestations (complaints of cognitive impairment) and 39 subjects without cognitive impairment. Both groups were given the EULA test as well as other tests. The structure of the EULA was verified with principal components factor analysis, and the reliability and validity of this instrument were also calculated. RESULTS: The factor analysis classified all of the items in the test in nine factors with an explained total variance of 69.91%. The high reliability of the test was reflected in a Cronbach's alpha of 0.929 and a Guttman split-half coefficient of 0.870. The construct validity was also satisfactory as shown in the significant correlation of six of the nine factors in the test with two other well-known apraxia subtests. CONCLUSIONS: The healthy subjects had a higher test score than the subjects with complaints of cognitive impairment, which confirmed the reliability and construct validity of the EULA.

TITLE: Creacion y diseño de un test para la evaluacion de la apraxia de los miembros superiores (EULA) basado en un modelo cognitivo: un estudio piloto.Introduccion. La apraxia es un trastorno neurologico caracterizado por la dificultad en la ejecucion de habilidades gestuales aprendidas a pesar de tener preservados los sistemas motores y sensoriales, la coordinacion y la comprension, asi como de una adecuada colaboracion. Actualmente, existen pocas herramientas validadas que evaluen este sindrome de manera global. En el presente estudio, se ha creado y diseñado un test para la evaluacion de la apraxia de los miembros superiores (EULA), basado en modelos teoricos. Sujetos y metodos. Se selecciono una poblacion de 57 pacientes con quejas subjetivas de deterioro cognitivo y 39 personas sin quejas ni deterioro cognitivo, a las cuales se les administro el test EULA, entre otros tests. Se realizo un analisis factorial de componentes principales y un calculo tanto de la fiabilidad como de la validez de dicho instrumento. Resultados. El analisis factorial agrupo en nueve factores todos los items de la prueba, con una varianza total explicada del 69,91%. El test ha mostrado una alta fiabilidad, con un alfa de Cronbach de 0,929 y un coeficiente de Guttman de 0,870 con el metodo de las dos mitades. El test tambien mostro tener una adecuada validez de constructo, al existir correlacion significativa entre seis factores del test y dos subtests de apraxia. Conclusiones. El test EULA, surgido de las propuestas de evaluacion a nivel teorico desarrolladas por diferentes autores, muestra una puntuacion superior en personas sanas respecto a personas con manifestaciones subjetivas de deterioro cognitivo, ademas de tener una alta fiabilidad y validez de constructo.

Creación y diseño de un test para la evaluación de la apraxia de los miembros superiores (EULA) basado en un modelo cognitivo: un estudio piloto / Creation and design of a test for the Evaluation of Upper Limb Apraxia (EULA) based on a cognitive model: a pilot study

Introducción. La apraxia es un trastorno neurológico caracterizado por la dificultad en la ejecución de habilidades gestuales aprendidas a pesar de tener preservados los sistemas motores y sensoriales, la coordinación y la comprensión, así como de una adecuada colaboración. Actualmente, existen pocas herramientas validadas que evalúen este síndrome de manera global. En el presente estudio, se ha creado y diseñado un test para la evaluación de la apraxia de los miembros superiores (EULA), basado en modelos teóricos. Sujetos y métodos. Se seleccionó una población de 57 pacientes con quejas subjetivas de deterioro cognitivo y 39 personas sin quejas ni deterioro cognitivo, a las cuales se les administró el test EULA, entre otros tests. Se realizó un análisis factorial de componentes principales y un cálculo tanto de la fiabilidad como de la validez de dicho instrumento. Resultados. El análisis factorial agrupó en nueve factores todos los ítems de la prueba, con una varianza total explicada del 69,91%. El test ha mostrado una alta fiabilidad, con un alfa de Cronbach de 0,929 y un coeficiente de Guttman de 0,870 con el método de las dos mitades. El test también mostró tener una adecuada validez de constructo, al existir correlación significativa entre seis factores del test y dos subtests de apraxia. Conclusiones. El test EULA, surgido de las propuestas de evaluación a nivel teórico desarrolladas por diferentes autores, muestra una puntuación superior en personas sanas respecto a personas con manifestaciones subjetivas de deterioro cognitivo, además de tener una alta fiabilidad y validez de constructo (AU)

Introduction. Apraxia is regarded as neurological disorder characterized by a loss of ability to execute and carry out skilled movements and gestures despite intact motor and sensory systems, coordination, and comprehension. As reflected in the specialized literature, there are currently few tests that provide a global evaluation of this syndrome. This research created and designed a test for the Evaluation of Upper Limb Apraxia (EULA), based on theoretical models of apraxia. Subjects and methods. A sample of 57 patients was selected with subjective cognitive manifestations (complaints of cognitive impairment) and 39 subjects without cognitive impairment. Both groups were given the EULA test as well as other tests. The structure of the EULA was verified with principal components factor analysis, and the reliability and validity of this instrument were also calculated. Results. The factor analysis classified all of the items in the test in nine factors with an explained total variance of 69.91%. The high reliability of the test was reflected in a Cronbach’s alpha of 0.929 and a Guttman split-half coefficient of 0.870. The construct validity was also satisfactory as shown in the significant correlation of six of the nine factors in the test with two other well-known apraxia subtests. Conclusions. The healthy subjects had a higher test score than the subjects with complaints of cognitive impairment, which confirmed the reliability and construct validity of the EULA (AU)

A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency.

OBJECTIVES: To investigate the effect of a mixed Kinesio taping treatment in women with chronic venous insufficiency. DESIGN: A double-blinded randomized clinical trial. SETTING: Clinical setting. PARTICIPANTS: One hundred and twenty postmenopausal women with mild-moderate chronic venous insufficiency were randomly assigned to an experimental group receiving standardized Kinesio taping treatment for gastrocnemius muscle enhancement and ankle functional correction, or to a placebo control group for simulated Kinesio taping. MAIN OUTCOMES VARIABLES: Venous symptoms, pain, photoplethysmographic measurements, bioelectrical impedance, temperature, severity and overall health were recorded at baseline and after four weeks of treatment. RESULTS: The 2 × 2 mixed model ANCOVA with repeated measurements showed statistically significant group * time interaction for heaviness (F = 22.99, p = 0.002), claudication (F = 8.57, p = 0.004), swelling (F = 22.58, p = 0.001), muscle cramps (F = 7.14, p = 0.008), venous refill time (right: F = 9.45, p = 0.023; left: F = 14.86, p = 0.001), venous pump function (right: F = 35.55, p = 0.004; left: F = 17.39 p = 0.001), extracellular water (right: F = 35.55, p = 0.004; left: F = 23.84, p = 0.001), severity (F = 18.47, p = 0.001), physical function (F = 9.15, p = 0.003) and body pain (F = 3.36, p = 0.043). Both groups reported significant reduction in pain. CONCLUSION: Mixed Kinesio taping-compression therapy improves symptoms, peripheral venous flow and severity and slightly increases overall health status in females with mild chronic venous insufficiency. Kinesio taping may have a placebo effect on pain.

Can decision-making skills affect responses to psychological stress in healthy women?

In recent studies showing how stress can affect an individual's decision-making process, the cognitive component of decision-making could also be considered a coping resource available to individuals when faced with a stressful situation. The Iowa Gambling Task (IGT) constitutes the standard test for the assessment of decision-making skills under conditions of uncertainty. Responses of the hypothalamic-pituitary-adrenal (HPA) axis to psychosocial stress, in turn, have been estimated by means of cortisol measurements. Our main objective in this study was to test if good and bad IGT performers show distinct HPA axis responses, when challenged in a classic psychosocial stress test. Because women have been shown to outperform men on the IGT under the influence of psychosocial stress, we chose a sample of 40 women to take the IGT before they were exposed to a public speaking task in a virtual environment. The activation of the HPA axis, involved in the stress response, was assessed by examining the levels of cortisol in the subjects' saliva at the following four stages: before the challenge, after the challenge, and 10 and 20 min after the task. Participants were divided into two groups according to their level of performance, good or poor, on the IGT. Results showed statistically significant differences between the groups for pre-exposure cortisol levels and for cortisol levels 20 min after exposure. Overall cortisol levels were significantly higher in the group with poor performance on the IGT. It appears that good decision-making, which may be an important resource for coping with stress, is associated with a lower HPA axis response to a psychosocial stressor.