The psychobiological links between chronic stress-related diseases, periodontal/peri-implant diseases, and wound healing.

Chronic stress is a relevant disease to periodontal practice, encompassing 25%-28% of the US population (American Psychological Association 2015). While it is well established that chronic psychologic stress can have significant deleterious systemic effects, only in recent decades have we begun to explore the biochemical, microbial, and physiologic impacts of chronic stress diseases on oral tissues. Currently, chronic stress is classified as a "risk indicator" for periodontal disease. However, as the evidence in this field matures with additional clinically controlled trials, more homogeneous data collection methods, and a better grasp of the biologic underpinnings of stress-mediated dysbiosis, emerging evidence suggests that chronic stress and related diseases (depression, anxiety) may be significant contributing factors in periodontal/peri-implant disease progression and inconsistent wound healing following periodontal-related therapeutics. Ideal solutions for these patients include classification of the disease process and de-escalation of chronic stress conditions through coping strategies. This paper also summarizes periodontal/implant-related therapeutic approaches to ensure predictable results for this specific patient subpopulation.

Therapeutic considerations related to stress levels associated with hand eczema: A clinico-etiological study.

Understanding the etiological factors, stress and quality of life have important implications in the management. There is dearth of the literature in this subject, assessing the stress levels in hand eczema and disparities exist in results of the available literature. Primary objective of this study is to assess the clinico-etiological factors in cases of hand eczema. The secondary objectives include to find any correlation between morphological types and the etiological factors, and to determine the role of stress level in these patients. Patients with hand eczema who attended the outpatient department of our tertiary care institution were enrolled in this descriptive study. Sociodemographic and clinico-etiologic data were collected and patch testing of all patients were done. Stress levels were assessed with Perceived stress scale (PSS). Among the 62 patients enrolled, allergic contact dermatitis predominated with 37 (59.7%) cases and patch test was positive in 41 (66.1%). Potassium dichromate was the most common allergen in males, and fragrance mix in females. Significant levels of stress were seen in 67.7% of the subjects. There was no significant correlation between morphological subtypes and the identified aetiologies. Hand eczema is most commonly due to allergic contact dermatitis, and patch testing is helpful in reaching an etiological diagnosis in most of the cases. A large proportion of patients have high stress levels, and hence stress management should also be a part of treatment in addition to traditional treatment.

Effects of Active Mastication on Chronic Stress-Induced Bone Loss in Mice.

Chronic psychologic stress increases corticosterone levels, which decreases bone density. Active mastication or chewing attenuates stress-induced increases in corticosterone. We evaluated whether active mastication attenuates chronic stress-induced bone loss in mice. Male C57BL/6 (B6) mice were randomly divided into control, stress, and stress/chewing groups. Stress was induced by placing mice in a ventilated restraint tube (60 min, 2x/day, 4 weeks). The stress/chewing group was given a wooden stick to chew during the experimental period. Quantitative micro-computed tomography, histologic analysis, and biochemical markers were used to evaluate the bone response. The stress/chewing group exhibited significantly attenuated stress-induced increases in serum corticosterone levels, suppressed bone formation, enhanced bone resorption, and decreased trabecular bone mass in the vertebrae and distal femurs, compared with mice in the stress group. Active mastication during exposure to chronic stress alleviated chronic stress-induced bone density loss in B6 mice. Active mastication during chronic psychologic stress may thus be an effective strategy to prevent and/or treat chronic stress-related osteopenia.

Mediating Effect of Self-Control on the Relationship between Obesity-Related Stress and Weight Control Behavior among Female College Students with Overweight and Obesity.

BACKGROUND: This study aimed to determine whether self-regulation acts as a mediating factor in the relationship between obesity-related stress and weight control behavior, targeting Korean female college students. Obesity-related stress and weight control behaviors are important factors affecting an individual's health and well-being, and self-control, a psychological trait, can play a pivotal role in regulating how individuals respond to stress and engage in weight management behaviors. METHODS: This study employed a descriptive correlational design. A total of 109 female college students with overweight and obesity participated in the study. We used a self-report questionnaire to measure obesity-related stress, self-control, and degree of weight control behavior. Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and bootstrapping using Hayes' PROCESS macro for mediation. RESULTS: Significant relationships between obesity-related stress and weight control behavior (r = 0.25, p < 0.001), obesity-related stress and self-control (r = -0.36, p < 0.001), and weight control behavior and self-control (r = 0.26, p < 0.001) were observed. Self-control showed an indirect mediating effect on the relationship between obesity-related stress and weight control behavior (Β = 0.37, p = 0.001). CONCLUSIONS: Through the research results, it was confirmed that self-control is a factor that has a mediating effect in the relationship between obesity-related stress and weight control behavior among female college students with overweight and obesity. These results underscore the importance of addressing self-control strategies in interventions aimed at promoting healthy weight management among female college students with overweight or obesity.

A Two-Sample Mendelian Randomization Study of Neuroticism and Sleep Bruxism.

Sleep bruxism (SB) affects a considerable part of the population and is associated with neuroticism, stress, and anxiety in various studies. However, the causal mechanisms between neuroticism and SB have not been examined. Understanding the reasons for SB is important as understanding bruxism may allow improved comprehensive management of the disorders and comorbidities related to it. Previous studies on the association of risk factors to SB have provided important symptomatic insight but were mainly questionnaire based or limited in sample size and could not adequately assess causal relationships. The aim of this study was to elaborate the possible causal relationship of neuroticism as a risk factor for SB through a Mendelian randomization (MR) approach by combining questionnaires, registry data, and genetic information in large scale. We performed a two-sample MR study using instrumental genetic variants of neuroticism, including neuroticism subcategories, in the UK Biobank (n = 380,506) and outcome data of probable SB using FinnGen (n [cases/controls] = 12,297/364,980). We discovered a causal effect from neuroticism to SB (odds ratio [OR] = 1.38 [1.10-1.74], P = 0.0057). A phenotype sensitive to stress and adversity had the strongest effect (OR = 1.59 [1.17-2.15], P = 0.0028). Sensitivity analyses across MR methods supported a causal relationship, and we did not observe pleiotropy between neuroticism and SB (MR-Egger intercept, P = 0.87). Our findings are in line with earlier observational studies that connect stress and SB. Furthermore, our results provide evidence that neurotic traits increase the risk of probable SB.

Pre-assembled ECMO: Enhancing efficiency and reducing stress in refractory cardiac arrest care.

Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during refractory cardiac arrest presents significant medical and psychological challenges for healthcare providers. Beyond managing cardiac arrest and preparing for potential coronary angiography, the ECMO circuit must be assembled and primed under strictly sterile conditions, contributing to additional psychological stress and potential delays in ECMO cannulation. This pragmatic study thought to evaluate whether pre-assembled and pre-primed ECMO circuits (pre-primed group) maintain sterility over a 21-day period, expedite ECMO initiation in ECPR patients and alleviate the psychological burden on the ECPR team, compared to newly assembled and primed ECMO circuits (on-demand group). Methods: In a prospective manner, ECMO circuits were either pre-assembled and pre-primed under sterile conditions, maintained for 21 days with culture samples taken every seventh day, or newly assembled and primed during the acute emergency situation. The transition from on-demand assembly and priming of ECMO circuits to pre-primed ECMO circuits occurred on January 1st, 2021. The interval between patients' arrival in the cardiac catheterization laboratory and the initiation of ECMO was recorded and retrospectively compared between the two treatment groups. The ECPR team, comprising experienced cardiologists and nurses, was prospectively surveyed using the modified Perceived Stress Questionnaire (PSQ-20). Results: All aseptically pre-assembled and pre-primed ECMO circuits demonstrated sterile cultures for aerobic and anaerobic microorganisms as well as fungal agents over the 21-day period: 0/120 positive cultures (0 %, 95 % CI for binomial probability 0-0.03). The time to ECMO initiation was significantly reduced in the pre-primed group compared to the on-demand group: 13 [IQR 9-17] versus 31 [IQR 27-44] minutes, P < 0.001. Responses from ECPR physicians and nurses on the PSQ-20 were similar across all items. With the use of pre-primed ECMO circuits, all ECPR professionals reported a greater sense of settled inner feeling, considerably less psychological tension, fewer worries and insecurities, as well as more effective ICU shifts with improved personal goal achievement. However, treating ECPR patients with pre-primed ECMO circuits did not lead to increased job satisfaction or higher physical energy levels. Conclusion: Aseptically pre-assembled and pre-primed ECMO circuits maintain sterility for multiple weeks, significantly reducing ECMO initiation times and alleviating psychological strain on the ECPR team. Consequently, implementing these circuits in ECPR centers could enhance both patient outcomes and healthcare provider well-being.

Effect of Coronavirus Disease 2019 Pandemic and Vaccination on Menstrual Cycle Among King Saud University Students in Riyadh: A Retrospective Online Survey.

Objectives We aimed to evaluate the prevalence of menstrual cycle changes following the COVID-19 pandemic and the COVID-19 vaccination among female students at King Saud University in Riyadh, Saudi Arabia. Methods A cross-sectional retrospective study using an online questionnaire was conducted between October 2022 and December 2022. Data were collected concerning demographic variables, clinical conditions, menstrual cycle characteristics, COVID-19 infection status, and vaccination history. Results Of the 525 female students who participated in the study (mean age, 21.5 ± 3.9 years; mean body mass index, 22.7 ± 4.7 kg/m2), 246 (46.9%) had tested positive for COVID-19, 15 (2.9%) had visited the emergency room, and eight (1.5%) had been hospitalized. The average duration between menstrual cycles increased significantly among the study sample (pre-pandemic, 25.9 ± 5.3 days; post-pandemic, 26.8 ± 6.7 days; p = 0.016). Pre-pandemic, 221 (42.1%) participants reported less than two days of variance between their shortest and longest cycles, as compared with 175 (33.3%) post-pandemic (p < 0.001). Regarding vaccination, 393 (74.9%) participants had received three vaccinations, and 110 (21%) had received two vaccinations. Post-vaccination, 184 (35%) participants reported no changes to their menstrual cycle, 154 (29.3%) reported less disruption, and 44 (8.4%) experienced more disrupted menstrual cycles. Conclusion This study highlights potential associations between the COVID-19 pandemic, subsequent vaccinations, and changes in menstrual patterns, which can help to elucidate the physiological and psychological effects of pandemics and vaccination campaigns on women's health. Future studies must consider biological and psychosocial factors to elucidate underlying mechanisms and causal relationships.

Non-thyroidal Illness Syndrome in an Infant With Acute Anorexia and Psychological Stress.

Non-thyroidal illness syndrome (NTIS), a remarkable ensemble of changes in serum thyroid hormone concentration during acute illness, was first reported in the 1970s. While NTIS is not a form of hypothyroidism, it is characterized by a decrease in serum triiodothyronine (T3) or thyroxine (T4) or both with normal or decreased thyroid-stimulating hormone (TSH). Notably, it typically resolves without thyroid hormone replacement therapy. We report a case of paralytic ileus caused by NTIS in an infant with psychological stress. This case illustrates the development of NTIS during psychological stress, which can lead to severe symptoms such as those seen in pathological hypothyroidism.

Effect of anxiety and psychologic stress on periodontal health: a systematic review and meta-analysis.

OBJECTIVE: The primary objective of this meta-analysis (PROSPERO No: CRD42019124695) was to assess the association between psychologic stress, anxiety, and periodontitis. DATA SOURCES: The electronic search was conducted using PubMed, Embase, and Scopus, by three independent reviewers till December 2019. The search was limited to human studies published only in English language. The fixed-effect model and random-effects model were used to obtain the overall mean difference, odds ratio (OR), and its 95% CI for all studies. The heterogeneity was calculated by I2 statistics. The Newcastle--Ottawa scale was used to assess the risk of bias in the included studies. Out of 775 potentially relevant articles, 25 studies were selected for systematic review and only 14 studies could be used for meta-analysis in three subsets. The pooled OR for stress and periodontitis was 1.78, which was statistically highly significant (I2 = 98.6%, P = .00). Mean salivary cortisol levels as a measure of stress in patients with periodontitis was 4.81 nmol/L (I2 = 98.0%, P = .08). State-Trait Anxiety Inventory value was seen as -1.28 (I2 = 0.0%, P = .06) for state anxiety and -0.11 (I2 = 0.0%, P = .85) for trait anxiety in patients with periodontitis. CONCLUSION: The findings indicate a role of psychologic stress and anxiety in the progression of periodontitis.

Atrial Fibrillation and Stress: A 2-Way Street?

The accumulating literature linking stress with negative health outcomes, including cardiovascular disease (CVD), is extensively reported yet poorly defined. Stress is associated with a higher risk of hypertension, acute myocardial infarction, arrhythmogenesis, and heart failure. Stress mediates its effect through direct neuronal, endocrine, autonomic, and immune processes and indirectly by modifying lifestyle behaviors that promote CVD progression. Stress occurs when an individual perceives that internal or external demands exceed the capacity for an adaptive response. Psychologic stress is increasingly recognized in the atrial fibrillation (AF) population, although the pathophysiology remains unclear. There appears to be a bidirectional relationship between AF and stress with a complex interplay between the 2 entities. Stress modulates the immune and autonomic nervous systems, key drivers in AF initiation and potentiation. AF leads to increasing anxiety, psychologic distress, and suicidal ideation. Recently, lifestyle modification has emerged as the fourth pillar of AF management, with stress reduction a potential reversible risk factor and future target for intervention. This review examines proposed mechanisms linking AF and stress and explores stress reduction as an adjunct to the AF management armamentarium.

Impact of Vitiligo on Life Quality of Patients: Assessment of Currently Available Tools.

BACKGROUND: How different tools for evaluating health-related quality of life (QoL) reflect the burden of vitiligo has rarely been compared. In this study, we aim to evaluate the impact of vitiligo on QoL using currently available tools. METHODS: A single-center, cross-sectional study of vitiligo patients was performed. QoL was evaluated using the dermatology life quality index (DLQI), short form-36 (SF-36), and willingness to pay (WTP). As the original DLQI cutoff score (>10) indicating aginificantly impated QoL was found to underestimate QoL, receiver operating characteristic (ROC) curve was use to determine a new cutoff point discriminating vitiligo patients with positive mental stress (SF-36 mental health ≤ 52). RESULTS: Of the 143 patients enrolled, 24.5% were identified having significant mental stress by SF-36 mental health domain score ≤ 52 while there were only 13.3% patients with significantly hampered QoL indicated by DLQI >10. Using ROC analysis, DLQI ≥ 7 was found to be a more appropriate DLQI cutoff value for identifying mental stress in vitiligo patients. Additionally, the median WTP for treating vitiligo was comparable to other inflammatory skin diseases. CONCLUSIONS: There exist discrepancies in the outcomes identifying significant disease burden of vitiligo using DLQI and SF-36, making the current DLQI cutoff score (>10) for identifying significantly affected QoL inappropriate for these patients.

Timing of Exposure to ICU Diaries and Its Impact on Mental Health, Memories, and Quality of Life: A Double-Blind Randomized Control Trial.

Optimal time for ICU diary delivery and impact on mental health (MH), anxiety-depression, post-traumatic stress symptoms (PTSS), quality of life (QOL), and memories is unclear. We evaluated the effect of ICU diaries, dispatched at different time points, on outcomes in an Indian cohort. DESIGN: Double-blind randomized controlled trial. SETTING: A 1,000-bedded teaching hospital in East India. PATIENTS: Mechanically ventilated (>24 hr) adults were recruited, excluding those dead or incapable of meaningful-communication at discharge or follow-up. Eighty-three patients, aged 46.2 ± 17.2 years, Acute Physiology and Chronic Health Evaluation II scores 13.7 ± 4.9 were assessed. Length of ICU stay was 8.2 ± 7.1 days with 3.7 ± 3.2 ventilator days. INTERVENTION: Of 820 screened, 164 had diaries created. Including photographs, diaries were comaintained by healthcare workers and family members. Ninety patients were randomized at 1-month follow-up: diary sent to 45 at 1 month (group ID1) and to 45 at 3 months (ID3). MEASUREMENTS AND MAIN RESULTS: Anxiety-depression, memory, and QOL were assessed telephonically or home visits by a psychologist using the Hospital Anxiety-Depression Scale (HADS) and other tools at ICU discharge, 1-month (prerandomization), and 3 months of discharge. ID3 was reassessed after receiving diaries at 3.5 months. Primary outcome was anxiety-depression; secondary outcomes included PTSS, QOL, and memories. There was 100% follow-up. At 3 months, ID1 patients had a significant (p < 0.001) reduction in HADS from baseline when compared with ID3 that had not received diaries (4.16 ± 2.9 vs 2.15 ± 1.8; 95% CI, 2.8-1.2). PTSS scores were likewise better (p < 0.001). ID3 patients demonstrated significant improvement (p < 0.01) in QOL and memories along with HADS and PTSS when assessed at 3.5 months. CONCLUSIONS: ICU diaries improve MH but not QOL when delivered at 1 month and assessed 2 months thereafter. Assessed after 15 days, delayed exposure at 3 months significantly improved QOL and memories in addition to MH.

Development and Evaluation of a Global Burnout Index Derived from the Use of the Copenhagen Burnout Inventory in Portuguese Physicians.

INTRODUCTION: The Copenhagen Burnout Inventory was developed to overcome what some authors have proposed as potential limitations of existing burnout measures. Specifically, the Copenhagen Burnout Inventory measures the main component of burnout (i.e. exhaustion) in three domains: personal-, work- and patient-related. Additionally, some authors have argued the necessity to have available a global burnout index. MATERIAL AND METHODS: This study followed a cross-sectional design in a sample of Portuguese physicians (n = 1348). A confirmatory factor analyses was conducted and the Copenhagen Burnout Inventory´s three-factor structure was tested. In addition, a model with a 2nd order factor was tested with the goal of achieving a one-factor structure that would allow a global burnout index. RESULTS: The confirmatory factor analyses showed a good model fit for both the three-factor and one-factor model, having the latter a significant better fit. The Copenhagen Burnout Inventory showed good psychometric properties for both structures, with good reliability according to Chronbach`s alphas and average variance extracted between factors. The Copenhagen Burnout Inventory I was statistically and positively correlated with depression, anxiety and stress symptoms, as well as rumination, and negatively correlated with life satisfaction. DISCUSSION: The current study shows that the Copenhagen Burnout Inventory is a psychometrically valid measure of burnout in Portuguese physicians, and contributes with an instrument able to produce a global index of burnout. This measure provides comprehensive information on different dimensions associated with the development of burnout, as well as presents a global burnout score. Results show that participants who had more burnout also presented higher levels of depressive, anxiety and stress symptoms, as well as present more ruminative thinking, and less life satisfaction. CONCLUSION: The Copenhagen Burnout Inventory is a psychometrically valid measure of burnout that allows for exploratory studies on the overall level of exhaustion, thus making it possible the comparison between groups in a way that is not restricted to occupation specific aspects.

Introdução: O Inventário de Burnout de Copenhaga foi desenvolvido de forma a ultrapassar as limitações dos instrumentos de avaliação de burnout existentes. Especificamente, o Inventário de Burnout de Copenhaga mede o componente principal do burnout, a exaustão, em três domínios: pessoal, relacionado com o trabalho, e relacionado com o doente. Além disso, alguns autores têm sugerido a necessidade de um índice global de burnout. Material e Métodos: Este estudo seguiu um desenho transversal em uma amostra de médicos portugueses (n = 1348). Os símbolos estatísticos aparecem a itálico. Foram realizadas análises fatoriais confirmatórias e a estrutura dos três fatores do Inventário de Burnout de Copenhaga foi testada. Adicionalmente, foi testado o ajustamento de um modelo com um fator de segunda ordem que permitisse medir um índice global de burnout. Resultados: A análise fatorial confirmatória mostrou um bom ajustamento dos modelos, quer do modelo com três fatores, quer do modelo unifatorial, tendo o último um melhor ajustamento. O Inventário de Burnout de Copenhaga mostrou boas propriedades psicométricas para ambas as estruturas, com boa confiabilidade de acordo com os alfas de Cronbach e a variância extraída da média entre os fatores. O Inventário de Burnout de Copenhaga global correlaciona-se positivamente com a depressão, ansiedade, e sintomas de stress, assim como com a ruminação, e negativamente com a satisfação com a vida. Discussão: O presente estudo apresenta resultados que sugere que o Inventário de Burnout de Copenhaga é uma medida válida de burnout nos médicos portugueses, contribuindo com um instrumento capaz de produzir um índice global de burnout. Este instrumento permite fornecer informação compreensiva sobre as diferentes dimensões associadas ao desenvolvimento de burnout, assim como apresentar um valor global do burnout. Os resultados mostraram que os participantes que apresentaram niveis mais elevados de burnout também têm mais sintomatologia depressiva, ansiosa e de stress, mais ruminação, e menos satisfação com a vida. Conclusão: A existência de um índice global de burnout permite estudos exploratórios sobre o nível de exaustão global, possibilitando a sua comparação entre diferentes grupos de forma não circunscrita a aspetos específicos da profissão.

Estresse juvenil de curta frequência e intensidade não afeta a substância branca cerebral de ratos / Juvenile stress of short frequency and intensity does not affect rats´ brain white matter

O objetivo deste estudo foi avaliar os efeitos duradouros de dois tipos de estresse sobre o corpo caloso (CC). Foram estudados 42 ratos Wistar machos divididos aleatoriamente em três grupos: Grupo Controle (GC), Estresse Físico (EF, imobilização) e Estresse Psicológico (EP, exposição ao predador). Os procedimentos de estresse ocorreram durante três dias consecutivos na idade juvenil (P25-P27) e foram analisados na idade adulta (P74). Os cérebros foram coletados, processados com a técnica de Klüver-Barrera, e secções foram analisadas por meio de morfometria. Os resultados demonstraram que não houve alterações em aspectos gerais como peso dos animais, e histológicos como espessura do CC e quantidade dos núcleos gliais nesta região. O estudo sugere que os efeitos duradouros de ambos os modelos de estresse juvenil de curta frequência (3 dias) e intensidade (90 minutos/EF e 20 minutos/EP) não foram nem prejudiciais e nem protetores, o que pode ser considerado uma adaptação positiva.

The current study evaluates the lasting effects of two types of stress on the corpus callosum (CC). Forty-two male Wistar rats were randomly divided into three groups: Control Group (CG), Physical Stress (FS, immobilization) and Psychological Stress (PS, exposure to predators). Stress procedures occurred for three consecutive days at the juvenile stage (P25-P27) and analyzed at the adult age (P74); brains were retrieved and processed by Klüver-Barrera technique and sections were analyzed by morphometry. Results showed that there were no changes in the general aspects such as animal weight, and in the histological aspects such as CC thickness and quantity of the region´s glia nuclei. Current research suggests that the lasting effects of both models of juvenile stress of short frequency (3 days) and intensity (90 minutes/FS and 20 minutes/PS) were neither detrimental nor protective, featuring a positive adaptation.

What is role of sex and age differences in marital conflict and stress of patients under Cardiac Rehabilitation Program?

BACKGROUND: To investigate the role of sex and age differences in marital conflict and stress of patients who were under cardiac rehabilitation (CR) program. METHODS: The data of this cross-sectional study were collected from the database of the CR Department of Imam Ali Hospital, Kermanshah, Iran. The demographics and medical data of 683 persons were collected from January 2003 and January 2010 using medical records, the Beck Anxiety Inventory, the Beck Depression Inventory, the Hudson's Index of Marital Stress, and the Structured Clinical Interview for axis I disorders. Data were analyzed through Analysis of Covariance and Bonferroni test. RESULTS: About 74.8% of the subjects were male. After adjustment for age, educational level, anxiety, and depression-the findings showed that women in CR program had a higher level of marital stress compared to men (54.75 ± 2.52 vs. 49.30 ± 0.89; P = 0.042). Furthermore, it was revealed that women who aged 56-65 years and more experienced higher level of marital stress compared to younger patients (P < 0.050); however, no significant difference was observed between different age groups in male patients (P > 0.050). CONCLUSION: Marital conflict and stress threaten healthiness of women who aged 56-65 years more prominently than does in males or younger patients. Regarding the effect of marital stress on recurrence of the disease and cardiac-related morbidity and mortality in women, providing effective education and interventions to this group of patients, especially older women and even their spouses could be one of the useful objectives of CR programs.

Relationship between psychosocial stress dimensions and salivary cortisol in military police officers / Relación entre las dimensiones del estrés psicosocial y el cortisol en la saliva de policías militares / Relação entre as dimensões do estresse psicossocial e o cortisol salivar em policiais militares

Abstract Objective: to analyze the relationship between psychosocial stress dimensions and salivary cortisol in military police officers. Method: cross-sectional and analytical study with 134 military police officers. The Effort-Reward Imbalance (ERI) Model scale has been used to assess psychosocial stress. Salivary cortisol was collected in three samples. The following tests were used: Student's t-test, Mann-Whitney, ANOVA, Bonferroni, Kruskal-Wallis and Dunn. Pearson and Spearman correlation methods were used, as well as multiple linear regression. Cortisol at night showed an ascending statistical association with the psychosocial reward (p=0.004) and a descending association with the effort-impairment scores (p=0.017). Being part of the Special Tactical Operations Group (GATE) and the diastolic blood pressure explained 13.5% of the variation in cortisol levels on waking up. The sectors GATE, Special Patrol of the Elite Squad of the Military Police and Motorcyclists explained 21.9% of the variation in cortisol levels 30-minute after awakening. The variables GATE sector and Effort Dimension explained 27.7% of the variation in cortisol levels at night. Conclusion: it was evidenced that salivary cortisol variation was influenced by individual, labor and psychosocial variables.

Resumen Objetivo: analizar la relación entre las dimensiones del estrés psicosocial y el cortisol en la saliva en policías militares. Método: estudio transversal y analítico con 134 policías militares. La escala del Modelo Desequilibrio Esfuerzo-Recompensa (DER) evaluó el estrés psicosocial. El cortisol en la saliva fue recolectado en tres muestras. Fueron utilizados las pruebas: t de Student, Mann-Whitney, ANOVA, Bonferroni, Kruskal-Wallis y Dunn. Se hicieron correlaciones de Pearson y de Spearman, así como regresión linear múltiple. El cortisol noche presentó asociación estadística ascendente con la recompensa psicosocial (p=0,004) y descendente con los puntajes de esfuerzo-comprometimiento (p=0,017). Pertenecer al Grupo de Operaciones Tácticas Especiales (GATE) y la presión arterial diastólica explicaron 13,5% de la variabilidad del cortisol al despertar; los sectores GATE, Patrulla Especial de la Tropa de Elite de la Policía Militar y Motociclistas explicaron 21,9% de la variabilidad del cortisol de 30 minutos después de despertar; y las variables sector GATE y la Dimensión Esfuerzo explicaron la variabilidad del cortisol noche en 27,7%. Conclusión: se evidenció que la variación del cortisol en la saliva fue influenciada por variables individuales, laborales y psicosociales.

Resumo Objetivo: analisar a relação entre as dimensões do estresse psicossocial e o cortisol salivar em policiais militares. Método: estudo transversal e analítico com 134 policiais militares. A escala do Modelo Desequilíbrio Esforço-Recompensa (DER) avaliou o estresse psicossocial. O cortisol salivar foi coletado em três amostras. Foram utilizados os testes: t de Student, Mann-Whitney, ANOVA, Bonferroni, Kruskal-Wallis e Dunn. Fez-se correlações de Pearson e de Spearman, bem como regressão linear múltipla. O cortisol noite apresentou associação estatística ascendente com a recompensa psicossocial (p=0,004) e descendente com os escores de esforço-comprometimento (p=0,017). Pertencer ao Grupo de Operações Táticas Especiais (GATE) e pressão arterial diastólica explicaram 13,5% da variabilidade do cortisol ao acordar; os setores GATE, Patrulha Especial da Tropa de Elite da Polícia Militar e Motociclistas explicaram 21,9% da variabilidade do cortisol de 30 minutos após acordar; e as variáveis setor GATE e a Dimensão Esforço explicaram a variabilidade do cortisol noite em 27,7%. Conclusão: evidenciou-se que a variação do cortisol salivar foi influenciada por variáveis individuais, laborais e psicossociais.

Evaluation of stress in korean patients with diabetes mellitus using the problem areas in diabetes-Korea questionnaire.

BACKGROUND: It is known that diabetes and stress are directly or indirectly related, and that it is important to evaluate stress in patients with diabetes. The relationship between Korean diabetics and diabetes-related stress has never been reported. The objective of this study was to develop a stress questionnaire suitable for use with Korean diabetics and to evaluate its utility. METHODS: This study subjects were 307 Korean diabetics, aged 40 to 74 years old, who visited the Department of Endocrinology and Metabolism at Gachon University Gil Hospital, Yeungnam University Medical Center, and Inha University Hospital in Korea between March 2006 and February 2008. We developed a Korean version of Polonsky's Problem Areas in Diabetes (PAID) stress questionnaire (PAID-K) and used it to assess degrees of stress in our sample of Korean patients. We evaluated the utility of the questionnaire and analyzed the relationships between clinical characteristics of the study subjects and degrees of stress. RESULTS: Cronbach's alpha for PAID-K was 0.95, and PAID-K scores were significantly correlated with Hypoglycemia Fear Survey scores (r=0.44, P<0.05) and State Trait Anxiety Inventory-6 scores (r=0.21, P<0.05). PAID-K scores were significantly higher in patients with longer durations of diabetes, patients using insulin, and female patients (P=0.02, P=0.038, and P=0.001, respectively). The score also tended to increase as HbA1c levels increased, except for very high HbA1c levels (above 11%) (P for trend<0.05). CONCLUSION: We developed the PAID-K questionnaire and demonstrated its utility to evaluate levels of stress in diabetic patients in Korea.