Psychometric properties of the University of California Los Angeles Loneliness Scale version 3: the European Portuguese version / Propiedades psicométricas de la Escala de Soledad de Los Ángeles versión 3: la versión portuguesa europea

Currently, the golden standard measure to assess loneliness is the University of California, Los Angeles Loneliness scale version 3 (UCLA v3). Objective. The aim of this study was to analyze the psychometric properties of UCLA v3 for the European Portuguese population. Method. A sample of 282 participants was surveyed in Portugal. Results. Confirmatory factor analysis (CFA) supported a model portraying a global loneliness bifactor solution for positive and negative wording items, which achieved optimal fitness. Multi-group CFA indicates scalar and metric invariance across gender. Loneliness test scores (global score, positive items and negative items) correlated with well-established mental health indicators such as psychological stress, depressive and anxiety symptomatology, or psychological inflexibility. Internal consistency of the loneliness test scores was optimal for the global measure (a = .91; ? = .91) as well as for the positive (a = .87; ? = .87) and the negative factors (a = .86; ? = .88). Conclusions. Results support UCLA v3 as a reliable and valid measure of loneliness for future research studies interested in examining the prevalence of loneliness and impact in health in the context of Covid-19 in the Portuguese population and as a health indicator in health promotion and clinical.(AU)

Actualmente, la medida estándar mayormente utilizada para evaluar la soledad es la versión 3 de la escala de Soledad de la Universidad de California de Los Angeles (UCLA v3). Objetivo. Analizar las propiedades psicométricas de UCLA v3 para la población portuguesa europea. Método. Una muestra total de 282 personas fue encuestada en línea en Portugal. Resultados. El análisis factorial confirmatorio (AFC) respaldó un modelo que representa una solución global de soledad con dos factores relativos al contenido positivo y negativo de los ítems, y logrando un ajuste óptimo. El AFC multigrupo indicó invariancia métrica y escalar según género. Los puntajes de la prueba de soledad (puntaje global; ítems positivos e ítems negativos) correlacionaron con indicadores de salud bien establecidos como el estrés psicológico, la sintomatología depresiva y ansiosa o la inflexibilidad psicológica. La consistencia interna de los puntajes de la escala de soledad fue óptima tanto para la medida global (a = .91; ? = .91) como para las medidas positiva (a = .87; ? = .87) y negativa (a = .86; ? = .88). Conclusiones. Los resultados apoyan a la UCLA v3 como una medida confiable y válida de la soledad para futuros estudios de investigación interesados en examinar la prevalencia de la soledad y su impacto en la salud en el contexto de Covid-19 en la población portuguesa, y como un indicador de salud en programas de promoción de salud y de intervenciones clínicas.(AU)

Metabolic Health, Mitochondrial Fitness, Physical Activity, and Cancer.

Cancer continues to be a significant global health issue. Traditional genetic-based approaches to understanding and treating cancer have had limited success. Researchers are increasingly exploring the impact of the environment, specifically inflammation and metabolism, on cancer development. Examining the role of mitochondria in this context is crucial for understanding the connections between metabolic health, physical activity, and cancer. This study aimed to review the literature on this topic through a comprehensive narrative review of various databases including MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. The review highlighted the importance of mitochondrial function in overall health and in regulating key events in cancer development, such as apoptosis. The concept of "mitochondrial fitness" emphasizes the crucial role of mitochondria in cell metabolism, particularly their oxidative functions, and how proper function can prevent replication errors and regulate apoptosis. Engaging in high-energy-demanding movement, such as exercise, is a powerful intervention for improving mitochondrial function and increasing resistance to environmental stressors. These findings support the significance of considering the role of the environment, specifically inflammation and metabolism, in cancer development and treatment. Further research is required to fully understand the mechanisms by which physical activity improves mitochondrial function and potentially reduces the risk of cancer.

Inflammation in COVID-19 and the Effects of Non-Pharmacological Interventions during the Pandemic: A Review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the coronavirus disease 2019 (COVID-19) pandemic that hit the health systems worldwide hard, causing a collapse of healthcare systems. One of the main problems of this new virus is the high inflammatory response it provokes, which is the cause of much of the symptoms. Different pharmacological approaches tried to stop the advance of the pandemic, but it seems that only vaccines are the solution. In this line, different nonpharmacological approaches have been made in order to improve symptomatology, contagion, and spread of COVID-19, the principal factors being the physical activity, nutrition, physiotherapy, psychology, and life patterns. The SARS-CoV-2 virus produces a disproportionate inflammatory response in the organism of the guest and causes complications in this that can end the life of the patient. It has been possible to see how different nonpharmacological interventions based on physical activity, nutritional, psychological, and physical therapy, and lifestyle changes can be functional tools to treat this inflammation. Thus, in the present review, we aim to provide an overview of the role of inflammation in COVID-19 and the nonpharmacological interventions related to it.

Transdiagnostic model of psychological factors and sex differences in depression in a large sample of Ecuador

Background/Objective: Depression represents a leading cause of disability and a major contributor to the overall global burden of disease with women systematically reporting a higher prevalence than men. This study aimed to examine the predictive value and relation of three transdiagnostic psychological factors (perceived stress, psychological inflexibility and loneliness) on depression and its sex differences for the general population in a large sample of Ecuador.Method: A non-probabilistic and non-clinical sample of 16.074 people from across Ecuador were online surveyed using a cross-sectional design. The structural equation model was based on scores from standardized questionnaires as measures of depression, psychological perceived stress, psychological inflexibility, and loneliness.Results: Women reported significantly higher levels of depression, mediated by differences in perceived stress, psychological inflexibility and loneliness. Perceived stress was the most important predictor of depression and mediated the effect of loneliness on depression. Complementarily, psychological inflexibility partially mediated the effect of perceived stress and loneliness on depression. The overall model accounted for the 78% of the total variance in depression.Conclusions: Results of this study provide a novel and robust transdiagnostic model of sex differences on depression and insights on how to design effective programs for preventing depression targeting modifiable transdiagnostic risk factors. (AU)

Transdiagnostic model of psychological factors and sex differences in depression in a large sample of Ecuador.

Background/Objective: Depression represents a leading cause of disability and a major contributor to the overall global burden of disease with women systematically reporting a higher prevalence than men. This study aimed to examine the predictive value and relation of three transdiagnostic psychological factors (perceived stress, psychological inflexibility and loneliness) on depression and its sex differences for the general population in a large sample of Ecuador. Method: A non-probabilistic and non-clinical sample of 16.074 people from across Ecuador were online surveyed using a cross-sectional design. The structural equation model was based on scores from standardized questionnaires as measures of depression, psychological perceived stress, psychological inflexibility, and loneliness. Results: Women reported significantly higher levels of depression, mediated by differences in perceived stress, psychological inflexibility and loneliness. Perceived stress was the most important predictor of depression and mediated the effect of loneliness on depression. Complementarily, psychological inflexibility partially mediated the effect of perceived stress and loneliness on depression. The overall model accounted for the 78% of the total variance in depression. Conclusions: Results of this study provide a novel and robust transdiagnostic model of sex differences on depression and insights on how to design effective programs for preventing depression targeting modifiable transdiagnostic risk factors.

Prevention of Alcohol Consumption Programs for Children and Youth: A Narrative and Critical Review of Recent Publications.

Background: Youth substance use is a public health problem globally, where alcohol is one of the drugs most consumed by children, and youth prevention is the best intervention for drug abuse. Objective: Review the latest evidence of alcohol use prevention programs in empirical research, oriented to all fields of action among children and youth. Methods: A narrative and critical review was carried out within international databases (PsychInfo, Pubmed, Web of Science, and Scopus) in August 2021 and was limited to empirical studies that appeared in the last five years (2017-2021). A flow diagram was used according to the PRISMA statements. Empirical research articles in English with RCTs and quasi-experimental design that included alcohol, children, and young people up to 19 years of age (universal, selective, or indicated programs) were included. The authors examined the results and conceptual frameworks of the Prevention programs by fields of action. Results: Twenty-two articles were found from four fields of action: school (16), family (2), community (2), and web-based (2), representing 16 alcohol prevention programs. School-based alcohol prevention programs are clinically relevant [Theory of Planned Behavior, Refuse, Remove, Reasons, Preventure, The GOOD Life, Mantente REAL, Motivational Interviewing (BIMI), Primavera, Fresh Start, Bridges/Puentes], they are effective in increasing attitudes and intentions toward alcohol prevention behavior, while decreasing social norms and acceptance of alcohol, reducing intoxication, and increasing perceptions with regards to the negative consequences of drinking. Discussion: This narrative and critical review provides an updated synthesis of the evidence for prevention programs in the school, family, community, and web-based fields of action, where a more significant number of programs exist that are applied within schools and for which would have greater clinical relevance. However, the prevention programs utilized in the other fields of action require further investigation.

Gender Differences in Transdiagnostic Predictors of Problematic Alcohol Consumption in a Large Sample of College Students in Ecuador.

Background: Alcohol use is one of the main risk factors that leads to detrimental health effects and support for a transdiagnostic approach to alcohol use disorders is growing. However, the role of transdiagnostic predictors of problematic alcohol consumption in Ecuador are understudied. Objective: The aim of this study was to examine gender differences in psychological stress and inflexibility as transdiagnostic predictors of problematic alcohol consumption in a large sample of college students in Ecuador. Methods: A total of 7,905 college students (21.49 years, SD = 3.68; 53.75% females) were surveyed using the following standardized scales: Alcohol Use Disorders Identification Test, Perceived Stress Scale-14, and Acceptance and Action Questionnaire (AAQ-7). Macro Process for SPSS (models 4 and 7) was used to analyze mediation and moderation effects. Results: Reported alcohol consumption was significantly higher in men than women students. On the other hand, women reported significantly higher levels of perceived stress and psychological inflexibility than men students. Gender, age, psychological stress, and inflexibility were significant predictors of alcohol consumption. Moreover, psychological inflexibility mediated the impact of stress on alcohol consumption, particularly in women (for men b = 0.065, 95% CI [0.048 to 0.083], for women b = 0.070, 95% CI [0.051 to 0.089]). Discussion: Results of this study support psychological stress and psychological inflexibility as critical transdiagnostic variables related to increased rates of alcohol consumption among Ecuadorian college students. These conclusions contribute to the development of transdiagnostic comprehensive programs, which encompasses promotive, preventive, and treatment services that allow to alleviate the burden of alcohol, as well as to enrich the growing research on alcohol consumption in this population from a gender perspective.

The Distinctive Role of Grounded Optimism and Resilience for predicting Burnout and Work Engagement: A study in Professional Caregivers of Older Adults.

BACKGROUND: Resilience and optimism have been proposed as psychological resources which may help to cope better with work demands, preventing negative consequences of stress, whereas external locus of control (ELC) is considered an intra-psychic vulnerability factor associated with increased burnout. Noteworthy, the specific role of these overlapping constructs on the prevention of burnout and promotion of work engagement, respectively, remains unclear. OBJECTIVE: The main aim of this study was to compare the differential significance of resilience and optimism, joined with ELC, on the prediction of burnout and work engagement. METHOD: A sample of 265 professional caregivers of dependent older adults was assessed using an extensive standardized protocol. Optimism and ELC were measured using the Palenzuela's Battery of Generalised Expectancies of Control, and the Connor-Davidson Scale was used to estimate resilience. Moreover, the Maslach Burnout Inventory and the Utrecht Work Engagement Scale were used to measure burnout and work engagement, respectively. Different hierarchical regression models were conducted with burnout and work engagement as dependent factors. RESULTS: The results showed that more than half (51%) variance in resilience was accounted by grounded optimism scores. The ELC was the main explanatory factor of burnout, whereas optimism and resilience were the best predictors of work engagement. Finally, even after controlling the effect of resilience, the effect of optimism remained significant for predicting work engagement. CONCLUSIONS: These findings support distinctive role resilience and optimism, two closely related psychological constructs, for promoting work engagement and reducing burnout in professional caregivers of older adults.

Psychophysiological and Psychosocial Profile of Patients Attending Drug Addiction Centers.

Drug treatment centres provide the highest level of rehab services for patients diagnosed with drug addictions. Most inpatient drug rehab programs focus on medical detox and mental health interventions. However, how to optimize the later remains a challenge. The aim of this study was to examine the psychophysiological and psychosocial profile of patients attending drug addiction centres in comparation with the general population. A total of 105 inpatient drug rehab patients and 50 participants from the general population were compared based on standardized psychophysiological and psychosocial measures. Results of this study suggest that patients attending drug addiction centers differ from general population in several different psychophysiological and psychosocial factors. Patients reported significantly lower levels of physical activity and increased sympathetic responsiveness, and significantly higher levels in loneliness, psychologically inflexibility and neuroticism. The results of this study highlight the importance of address healthy lifestyle behaviors such as sport practice and psychological variables such as loneliness, psychological (in)flexibility and neuroticism to improve current programs aim to prevent or reduce problematic drug consumptions.

Psychological Inflexibility and Loneliness Mediate the Impact of Stress on Anxiety and Depression Symptoms in Healthcare Students and Early-Career Professionals During COVID-19.

Background: The current mental health state of healthcare professionals and students during the COVID-19 pandemic in Ecuador remains understudied and how to improve their mental health is a challenge. Objective: This study aimed to explore the anxiety and depressive symptomatology among healthcare students and professionals in Ecuador and to examine the role of psychological inflexibility, loneliness, and psychological stress as predictors of anxiety and depression symptoms. Methods: A total of 191 undergraduate and graduate healthcare students in clinical practice (early-career healthcare professionals) in Ecuador were surveyed between January and March 2021 using standardized measures of psychological stress (PSS), psychological inflexibility (AAQ), loneliness (UCLA), alcohol consumption (AUDIT-C), and anxiety and depressive symptomatology (PHQ). Macro Process for SPSS (models 4 and 7) were used to test mediation effects. Results: Alcohol consumption varied between men and women and anxiety and depression symptomatology was generally low among the sample. Psychological inflexibility and loneliness mediated the impact of stress on anxiety and depressive mood in participants, regardless of gender and previous personal history of COVID-19. Discussion: Implications of psychological inflexibility and the prevention and coping with stress in healthcare professionals during COVID-19 are further discussed.

The Impact of the COVID-19 Pandemic on Mental Disorders. A Critical Review.

The COVID-19 pandemic has impacted the lives of the worldwide population. Citizens suffer the social, economic, physiological, and psychological effects of this pandemic. Primary sources, scientific articles, and secondary bibliographic indexes, databases, and web pages were used for a consensus critical review. The method was a narrative review of the available literature to summarize the existing literature addressing mental health concerns and stressors related to the COVID-19 pandemic. The main search engines used in the present research were PubMed, SciELO, and Google Scholar. We found the pandemic has had a direct impact on psychopathologies such as anxiety, increasing its ratios, and depression. Other syndromes such as burnout and post-traumatic stress disorder have increased with the pandemic, showing a larger incidence among medical personnel. Moreover, eating disorders and violence have also increased. Public authorities must prepare healthcare systems for increasing incidences of mental pathologies. Mental health apps are one of the tools that can be used to reach the general population.

Performance of Fuzzy Multi-Criteria Decision Analysis of Emergency System in COVID-19 Pandemic. An Extensive Narrative Review.

The actual coronavirus disease 2019 (COVID-19) pandemic has led to the limit of emergency systems worldwide, leading to the collapse of health systems, police, first responders, as well as other areas. Various ways of dealing with this world crisis have been proposed from many aspects, with fuzzy multi-criteria decision analysis being a method that can be applied to a wide range of emergency systems and professional groups, aiming to confront several associated issues and challenges. The purpose of this critical review was to discuss the basic principles, present current applications during the first pandemic wave, and propose future implications of this methodology. For this purpose, both primary sources, such as scientific articles, and secondary ones, such as bibliographic indexes, web pages, and databases, were used. The main search engines were PubMed, SciELO, and Google Scholar. The method was a systematic literature review of the available literature regarding the performance of the fuzzy multi-criteria decision analysis of emergency systems in the COVID-19 pandemic. The results of this study highlight the importance of the fuzzy multi-criteria decision analysis method as a beneficial tool for healthcare workers and first responders' emergency professionals to face this pandemic as well as to manage the created uncertainty and its related risks.

Accelerated forgetting in temporal lobe epilepsy: When does it occur?

OBJECTIVE: The main goal of the study was to analyse differences in the forgetting rates of Temporal Lobe Epilepsy (TLE) patients at different intervals (30 sec, 10 min, 1 day and 1 week) compared with those of healthy controls. A secondary aim of this research was to provide an assessment of the relationship between clinical epilepsy-related variables and forgetting rates in TLE patients. METHOD: The sample was composed of 14 TLE patients and 14 healthy matched controls. All participants underwent a full standardised neuropsychological assessment including general intelligence, executive functioning, memory, language and other variables, such as depression, anxiety or everyday memory failures. Two specific memory tasks, consisting of cued recall of 4 short stories and 4 routes, were carried out at four different intervals. RESULTS: There was a significant difference between groups at 10-min interval on the stories task, with the TLE group displaying greater forgetting than healthy controls. None of the other intervals on either task showed significant group differences. No differences were found when controlling for clinical epilepsy-related variables. CONCLUSION: Forgetting of verbal information at 10 min was greater in patients with TLE compared with controls, but accelerated longer term forgetting was not found. This study suggests that a late consolidation process is not necessarily impaired in TLE patients.

The role of education in executive functions, behavioral problems and functional performance in people with schizophrenia.

OBJECTIVE: This cross-sectional study examined the influence of education on executive functions, behavioral problems and functional performance in people with chronic schizophrenia. METHOD: Our sample was composed of 116 subjects with a schizophrenia diagnosis (evolution time = 17.5 ± 9.5 years) from consecutive referrals to the Rehabilitation Unit of Benito Menni Hospital (Valladolid, Spain). All participants completed an extensive standardized protocol including a neuropsychological testing of executive functions (processing speed, working memory, inhibition, interference control, mental flexibility), the assessment of behavioral symptoms, and functional performance. Hierarchical regression models (HRMs) were carried out to determine whether education (in years) relates to executive functions after controlling for the effect of demographics, IQ, and clinical factors. RESULTS: Both IQ and years of education were associated with a later onset of the illness. Specifically, high education (in years) significantly correlated with fewer behavioral problems and better functional performance in daily life. Further, HRMs showed that education was associated with digit span and sematic verbal fluency tasks after controlling for the effect of age, sex, and IQ as covariates. CONCLUSIONS: Higher education may ameliorate executive deficits in patients with chronic schizophrenia and, in turn, diminish the behavioral and functional problems of the illness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological (In)Flexibility Mediates the Effect of Loneliness on Psychological Stress. Evidence from a Large Sample of University Professors.

Psychological stress, loneliness, and psychological inflexibility are associated with poorer mental health and professional performance in university teachers. However, the relationship between these variables is understudied. The aim of the present study is to analyze the mediating role of psychological (in)flexibility on the effect of loneliness on psychological stress. A total of 902 professors from 11 universities in Ecuador were analyzed using standardized scales: the Perceived Stress Scale (PSS-14) to assess psychological stress, the Loneliness Scale Revised-Short (UCLA-3) for loneliness, and the Avoidance and Action Questionnaire (AAQ-7) and Life Engagement Test as double measures of psychological (in)flexibility. Mediation was tested by using PROCESS macro for SPSS. The results indicated that psychological flexibility mediated the relationship between loneliness and stress in university professors, regardless of sex and the measure of psychological (in)flexibility considered. The practical implications of the results are discussed herein.

Psychometric Properties and Factor Structure of the Spanish Version of the Acceptance and Action Questionnaire-II (AAQ-II) in Ecuador.

(1) Background: The Acceptance and Action Questionnaire-II (AAQ-II) is the most well-known self-report measure to assess psychological inflexibility, a transdiagnostic pathological process, and targets for interventions. Objective: The aim of this study was to analyze the psychometric properties and factorial structure of the Ecuadorian Spanish version of the AAQ-II in a large sample of college students in Ecuador. (2) Methods: A total of 7905 students, 46.26% male and 53.75% female, from 11 Ecuadorian universities were surveyed. The AAQ-II was tested for factorial structure, reliability, and correlations with other health-related measures. (3) Results: The AAQ-II showed an unidimensional factorial structure, accounting for 66.87% to 70% of the total variance and showing a good fit of the data to the model (comparative adjustment index (CFI) = 0.995; goodness of fit index (GFI) = 0.992; Standardized Root Mean Squared Residual (SRMR) = 0.037; mean square approximation error (RMSEA) = 0.047, CI90% = 0.038-0.056). Reliability was optimal (Cronbach's α = 0.919; ω = 0.928), and AAQ-II scores significantly correlated with multiple health indicators. Psychological inflexibility was significantly higher in women than men. (4) Conclusions: The Spanish version of the AAQ-II showed good psychometric properties, which further supports psychological inflexibility, not just as a transdiagnostic process.

Predictors of Athlete's Performance in Ultra-Endurance Mountain Races.

BACKGROUND: In previous studies, ultra-endurance performance has been associated with training and psychological variables. However, performance under extreme conditions is understudied, mainly due to difficulties in making field measures. AIM: The aim of this study was to analyze the role of training, hydration, nutrition, oral health status, and stress-related psychological factors in athletes' performance in ultra-endurance mountain events. METHODS: We analyzed the variables of race time and training, hydration state, nutrition, oral health status, and stress-related psychological factors in 448 ultra-endurance mountain race finishers divided into three groups according to race length (less than 45 km, 45-90 km, and greater than 90 km), using a questionnaire. RESULTS: Higher performance in ultra-endurance mountain races was associated with better oral health status and higher accumulative altitude covered per week as well as higher positive accumulative change of altitude per week during training. In longer distance races, experience, a larger volume of training, and better hydration/nutrition prior to the competition were associated with better performance. CONCLUSIONS: Ultra-endurance mountain athletes competing in longer races (>90 km) have more experience and follow harder training schedules compared with athletes competing in shorter distances. In longer races, a larger fluid intake before the competition was the single best predictor of performance. For races between 45 and 90 km, training intensity and volume were key predictors of performance, and for races below 45 km, oral health status was a key predictor of performance. Psychological factors previously reported as ultra-endurance mountain race performance predictors were inconsistent or failed to predict the performance of athletes in the present research.

Predicting Caregiver Burden in Informal Caregivers for the Elderly in Ecuador.

Informal caregivers are the main providers of care for the elderly. The aim of this study is to examine the predictive value of different variables regarding caregivers and their elderly patients with respect to the caregiver's burden. A convenience sample of 688 informal caregivers and 688 elderly people from Ecuador was surveyed. Only households with one caregiver and one elderly person were considered for the study. For informal caregivers, the following standardized measures were obtained: burden (Zarit Burden Interview), neuroticism (Eysenck Personality Questionnaire Revised-Abbreviated, EPQR-A), caregiver's general health (GHQ-12), and social support (modified Duke-UNC Functional Social Support Questionnaire, FSSQ11). For the elderly, we employed standardized measures of cognitive function (short portable mental status questionnaire, SPMSQ), Pfeiffer's test, and functional dependency (Barthel scale/Index, BI). Females were over-represented in caregiving and reported significantly higher burden levels than those of males. In both male and female caregivers, the burden was best predicted by the time of caring, neuroticism, and elderly cognitive impairment. However, some predictors of burden were weighted differently in males and females. The functional independence of the elderly was a significant predictor of burden for male caregivers but not females, while caregiver competence was a significant predictor for females but not males. These variables accounted for more than 88% of the variability in informal caregivers.

Psychometric properties of the three versions of the Perceived Stress Scale in Ecuador.

BACKGROUND: . The Perceived Stress Scale (PSS) is the most well-known self-report measure to assess perceived psychological stress. OBJECTIVE: . The objective of the study was to analyze the psychometric properties of three versions of the Perceived Stress Scale (PSS-4, PSS-10 and PSS-14) in Ecuador. METHODS: . A sample of 7905 university students (46% men and 54% women) from Ecuador were surveyed using all three versions of PSS. RESULTS: . All three versions showed a satisfactory adjustment with a bifactorial structure based on the item structure rather than underlying dimensions of psychological stress. The reliability was also adequate, with Alpha and Omega coefficients [α = 0.85 and ω = 0.80 for PSS-14; α = 0.85 and ω = 0.87 for PSS-10; α = 0.74 and ω = 0.78 for PSS-4] respectively. Psychological stress scores positively correlated with multiple health indicators such as loneliness, psychological inflexibility, alcohol consumption, and presence of anxiety and depression symptoms, and negatively with resilience. CONCLUSIONS: . The use of PSS-10 based on its best goodness of fit and PSS-4 as the shortest version are recommended to measure psychological stress, rather than the original PSS-14 version. Psychological stress was significantly higher in women than men.