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Bakgrund: ALS är en obotlig neurologisk sjukdom som leder till försvagning av muskler efter en nedbrytande process i nervsystemet. Det finns en ärftlig komponent, men i många fall går det inte att fastställa orsaken bakom sjukdomens uppkomst. Att diagnostiseras med en obotlig sjukdom där kroppsliga funktioner avtar samtidigt som de kognitiva förmågorna och känseln består innebär ofta ett stort lidande för patienterna. Att beskriva patienters erfarenheter av sjukdomen kan öka förståelsen och skapa en möjlighet att närma sig lidandet. Syfte: Syftet var att beskriva patienters upplevelse av att leva med ALS. Metod: Studien är en litteraturöversikt som baserades på 15 vetenskapliga artiklar. Dessa återfanns i databaserna Pubmed och CINAHL. Artiklarna granskades med hjälp av Sophiahemmets Högskolas formulär för kvalitetsgranskning och analyserades genom en integrerad analys. Resultat: Ur analysen framträdde tre kategorier: “Upplevelsen av maktlöshet”, “Upplevelsen av att vara en börda” och “Upplevelsen av att anpassa sig till en ny tillvaro”. I resultatet framkom att patienter med ALS upplevde ett lidande som de själva beskrev i olika termer, men likaså återgav de positiva erfarenheter och hur dem utvecklade strategier för att hantera sin nya tillvaro. Slutsats: Denna litteraturöversikt beskriver hur patienter med ALS hanterar sin verklighet, vilket till viss del skiljer sig åt. Lidandet som patienterna upplever kan bli del av personlig utveckling, samtidigt som risken finns att hela livsperspektivet påverkas negativt om patienterna fastnar i lidandet. Sjuksköterskan har en viktig roll i att lindra patienters lidande och litteraturöversikten upplyser om hur ett personcentrerat förhållningssätt, som bland annat innefattar lyhördhet till hur patienterna upplever sin tillvaro, kan bidra till detta. / Background: ALS is an incurable neurological disease that leads to muscle deterioration following a degrading process in the nervous system. There is a hereditary component, but in many cases it is not possible to determine the cause behind the onset of the disease. Being diagnosed with an incurable disease in which bodily functions decline at the same time as the cognitive abilities and tactile sense remains often results in great suffering for the patients. Describing patients' experiences of the disease can increase understanding and create an opportunity to approach suffering. Aim: The aim was to describe patients' experiences of living with ALS. Method: The study is a literature review based on 15 articles. These were found in the databases PubMed and CINAHL. The articles were reviewed with the use of Sophiahemmets Högskola's form for quality review and were analyzed through integrated analysis. Results: From the analysis three categories appeared: “The experience of powerlessness”, “The experience of being a burden” and “The experience of adapting to a new existence”. The results showed that patients with ALS experienced suffering that they themselves described in different terms, but they also portrayed positive experiences and how they developed strategies to manage their new situation. Conclusions: This literature review describes how patients with ALS manage their reality, which differs to some extent. The suffering that the patients experience may be part of personal development, while there is a risk that the entire life perspective will be adversely affected if the patients become stuck in the suffering. The nurse plays an important role in relieving patients suffering and the literature review informs how a person-centered approach, which includes, among other things, responsiveness to how patients experience their lives, can contribute to this.

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<p>Stress is known to play an important role in the natural history of gastrointestinal diseases, and functional disorders in particular. In health, activation of the stress response serves to maintain homeostasis in response to harmful stimuli. However, prolonged activation of the stress response can become maladaptive and contribute to the initiation and maintenance of symptoms in disorders such as irritable bowel syndrome (IBS). The mechanisms underlying this detrimental effect are unclear. This thesis investigates this relationship by examining the influence of 10 days of water avoidance stress on a murine model of acute bacterial gastroenteritis; a known trigger in a subset of IBS patients. Results indicate that stress can increase the level of the stress hormone norepinephrine in the gut. However, the overall influence of host stress during infection proves to be beneficial in this model, with decreased colonic inflammation and earlier clearance of the pathogen. Next, we utilized the olfactory bulbectomy (OBx) model of depression comorbid anxiety, which shows a heightened stress response, to examine mechanism underlying stress-mediated susceptibility in a more chronic setting. OBx resulted in increased neural activity and motility in the gut, and a change in composition of gut microbiota. These responses were not accompanied by changes in gut permeability or immune activation. Thus stress alters the habitat of commensal bacteria via a neurally mediated change in colonic motility. These results have bearing on the ability of stress to alter the microbiota: a feature of functional GI disorders.</p> / Doctor of Philosophy (Medical Science)

Introduktion/Bakgrund: Karies- och parodontal sjukdom är globalt de två mest förekommande orala sjukdomarna och kan leda till smärta, svårigheter att tugga och försämrad livskvalité. Psykisk stress påverkar en individ både fysiologiskt och psykologiskt. Den psykiska stressen har ökat i samhället och långvarig psykisk stress påverkar olika organsystem i kroppen negativt vilket kan leda till sårbarhet för sjukdom. Dessutom kan psykisk stress utgöra en risk för att utveckla karies- och parodontal sjukdom. Syfte: Syftet med denna litteraturstudie var att beskriva den psykiska stressens påverkan på karies- och parodontal sjukdom. Metod: En litteraturstudie genomfördes genom att systematisk samla in aktuell kunskap inom ämnesområdet från databaserna PubMed och CINAHL. Granskningsmallar för kvantitativa studier användes vid kvalitetsgranskning av de inkluderade studierna. Totalt inkluderades tio studier i resultatet där samtliga var kvantitativa med mixad metod. Resultat: Resultatet presenteras i följande teman; “Psykisk stress och biologisk påverkan”, “Den psykiska stressens påverkan på beteende och hanteringsstrategier”, och “Psykisk stress och sociala faktorers påverkan”. Studiens resultat rapporterar att höga nivåer av psykisk stress påverkar karies- och parodontal sjukdom. Slutsats: Psykisk stress tillsammans med parodontal sjukdom ger ökad bennedbrytning av det alveolära benet och försämrade resultat vid parodontal behandling. Psykisk stress är associerat med sociala faktorer och bidrar till negativa munhälsobeteenden vilket utgör en risk för karies- och parodontal sjukdom. Hanteringsstrategier för psykisk stress kan verka skyddande mot utveckling av dessa orala sjukdomar. / Introduction/Background: Dental caries and periodontal disease are the two most common oral diseases globally and can lead to pain, difficulty when chewing and reduced quality of life. Psychological stress affects an individual both physiologically and psychologically. Psychological stress has increased in society and longterm psychological stress negatively affects various organ systems in the body, which can lead to vulnerability to disease. In addition, psychological stress can pose a risk för dental caries and periodontal disease. Aim: The aim of this literature study was to describe the impact of psychological stress on dental caries and periodontal disease. Method: A literature study was carried out by systematically retrieving current knowledge in the subject area from the databases PubMed and CINAHL. Review templates for quantitative studies were used in the quality review of the included studies. A total of ten studies were included in the result, all of which were quantitative with mixed methods. Results: The results are presented in the following themes; “Psychological stress and biological influence”, “The psychological stress influence on behavior and coping strategies”, and “Psychological stress and the influence of social factors”. The study results report that high levels of psychological stress have an impact on dental caries and periodontal disease. Conclusion: Psychological stress together with periodontal disease cause reduced bone-level of the alveolar bone and worsened results in periodontal treatment. Psychological stress is associated with social factors and contributes to negative oral health behaviors, which pose a risk for dental caries and periodontal disease. Coping strategies for psychological stress can be protective against the development of these oral diseases.

Thesis (MSc (Physiological Sciences))--University of Stellenbosch, 2011. / Includes bibliography. / ENGLISH ABSTRACT: The hypothalamic-pituitary-adrenal-(HPA) axis has long been closely associated with psychological stress-induced activation of the adrenal cortex and subsequent glucocorticoid production. Another, less known peripheral limb of the psychological stress response, is the sympatho adrenal medullary pathway. We hypothesized that the sympatho-adrenal medullary system constitutes the primary response to acute psychological stress, with the HPA-axis functioning as a secondary response. We tested our hypothesis by manipulating a model of acute mild psychological stress (restraint) by blocking IL-6, a valuable constituent of the sympatho-adrenal medullary system. Serum corticosterone concentration increased in response to stress (7 ± 3 vs. 57 ± 4 ng/ml; P<0.0001), a response attenuated when IL-6 was blocked (17 ± 7 ng/ml). Stress increased pituitary mass only when IL-6 was blocked (38 ± 3 vs. 65 ± 6 mg; P <0.001). Stress increased left adrenal mass only in the presence of IL-6 (34 ± 1 vs. 73 ± 8 mg; P <0.00001). Stress did not influence the circulating levels of TNF-α, IL-1β or IL-6 significantly. IL-1β and TNF-α concentrations in the unstressed rats were lower when IL-6 was blocked. We then manipulated the stress model by administering S. frutescens extract to elucidate both the central and peripheral effects of acute S. frutescens administration on the psychological stress response. Restraint caused decreases in hippocampal GR levels when compared to respective controls. S. frutescens administration and exposure to restraint synergistically decreased hippocampal GABAAR levels. In addition, exposure to both stress and S. frutescens led to a noteworthy increase in pituitary mass (P = 0.078), as well as pituitary ACTH levels (P < 0.01). Similarly, differences in circulating ACTH levels showed an effect of stress on ACTH secretion only in the presence S. frutescens (P < 0.05). Adrenal mass was significantly increased in S. frutescenstreated animals that were also exposed to restraint (P < 0.05). Adrenal levels of ACTH showed a reciprocal trend to pituitary and circulating ACTH levels. No statistically significant differences were seen in adrenal IL-6 content. However, marked increases in IL-6 levels were seen at this level with administration of S. frutescens stress exposure and a cumulative increase seen with both S. frutescens-treatment and stress exposure. Hippocampal GABAAR, pituitary mass, pituitary ACTH and circulating ACTH levels showed a similar trend towards a synergistic effect of S. frutescens and restraint in activation of the psychological stress response, while adrenal ACTH levels showed an inverse trend. Hippocampal GR did not show any effect of stress or S. frutescens-treatment. The results from these two experiments indicate that the sympatho-adrenal medullary system constitutes the primary response to acute mild psychological stress and that the HPA-axis is only activated during an exacerbated stress response or when the sympatho-adrenal medullary contribution is inadequate. Furthermore, the acute administration of S. frutescens possibly led to a functional shift in GABAergic function, resulting in activation of the stress response. The anecdotal reports of a “docile” effect of S. frutescens most likely results from activation of the mesolimbic dopaminergic system by the hippocampus and amygdala. These results have dramatic consequence in GABA-based anxiety-treatments. / AFRIKAANSE OPSOMMING: Die hipotalamo-pituïtêre-adrenale (HPA)-as is lank bekend as ‘n primêre rolspeler in die respons op emosionele stres en daaropvolgende glukokortikoïed produksie. ‘n Ander, minder bekende arm van die sielkundige stres respons is die simpatiese bynier-medulla-sisteem. Ons hipotese was dat die laasgenoemde simpatiese bynier-medulla-sisteem die primêre respons tot sielkundige stres behartig terwyl die HPA-as ‘n sekondêre respons bied. Ons het ons hipotese getoets deur die manupilering van ‘n beproefde stres model waar ons IL-6, ‘n waardevolle rolspeler in die simpatiese bynier-medulla-sisteem, onderdruk het. In respons op stress, het serum kortikosteroon konsentrasies toegeneem slegs in die teenwoordigheid van IL-6 (7 ± 3 vs. 57 ± 4 ng/ml; P<0.0001), maar nie wanneer IL-6 onderdruk is nie (17 ± 7 ng/ml). Stres het ‘n verhoging in hipofise massa teweeggebring slegs tydens die onderdrukking van IL-6 (38 ± 3 vs. 65 ± 6 mg; P <0.001). Stres het ook linker-byniermassa verhoog slegs wanneer voldoende IL-6 beskikbaar was (34 ± 1 vs. 73 ± 8 mg; P <0.00001). Stres alleen het geen invloed gehad op serum IL-1β, IL-6 of TNF-α nie, maar die onderdrukking van IL-6 het wel ‘n inhiberende effek op basale IL-1β en TNF-α gehad. Daarna het ons weer eens die stresmodel manipuleer deur die rotte ‘n S. frutescens ekstrak te gee in ‘n poging om beide die sentrale en perifere effekte daarvan op die sielkundige stres respons te evalueer. Stres alleen het gelei tot ‘n afname in GR terwyl ‘n kombinasie van stres en S. frutescens administrasie tot ‘n afname in GABAARα1 in die hippokampus gelei het. Hierdie kombinasie het ook tot ‘n merkwaardige toename in hipofise massa (P = 0.078) sowel as ACTH-inhoud van die hipofise (P < 0.01) gelei. ‘n Soortgelyke patroon is waargeneem betreffende sirkulerende ACTH en byniermassa met P < 0.05 vir elk. Bynier ACTH inhoud, aan die ander kant, het ‘n omgekeerd eweredige verhouding met ACTH in die hipofise en in sirkulasie getoon. Bynier IL- 6 inhoud het geen statisties beduidende verskille getoon nie, maar ‘n merkwaardige verhoging is weereens gesien met ‘n kombinasie van stres en S. frutescens administrasie. Die soortgelyke tendens wat waargeneem word in GABAAR in die hippokampus, asook hipofise- en sirkulerende ACTH vlakke, en dui op ‘n samewerkende rol van stres en S. frutescens in die aktivering van die sielkundige stres respons. GR in die hippokampus toon geen veranderinge nie. Die resultate van die twee eksperimente dui op ‘n primêre rol van die simpatiese bynier-medulla-sisteem in die respons op ‘n akute stressor en dat die HPA-as net geaktiveer word tydens ‘n ooreiste stres reaksie of indien die simpatiese bynier-medulla-sisteem onderdruk word. Die waargenome “verdowings”-effek van S. frutescens word moontlik deur aktivering van die mesolimbiese dopamien pad deur die hippokampus en amigdala bewerkstellig. Die resultate mag ook lei tot die heroorweging van GABA-gebaseerde angs medikasies.

This diploma thesis deals with the psychical and physical stress of nurses working in anesthesiology and intensive medicine. In the theoretical part, the problems of psychical and physical stress are presented, as well as the role of nurses and their activities undertaken in the units of anesthesiology and intensive care. The practical part deals with a research that aims to obtain data revealing indicators of mental and physical stress of nurses working in anaesthesiology and intensive medicine. The research took place in four selected hospitals in their departments of anesthesiology and intensive care and intensive care units of neurosurgical clinics. Respondents were divided into two groups - respondents of anesthesiology and intensive care and respondents from department of neurosurgery. Groups were compared and results are presented in tables and graphs. Key words Anesteziology, intensit medicine, roles of nurses, physical stress, psychological stress, departemnt of ICU

Title: Significantly influence subjective psychological Stress perceived Factor Analysis. Objectives: The main Aim of this Work is subjective perceived psychological Stress changing comparation of professional Soldiers Group before and after psychological Stress, They receive every Day in their Job. Methods: The Method used in this Work is Research by standard Questionnaire consists of two Parts. One of Them was realised before psychological Stress and the second One was realised after the psychological Stress. Both Parts of Questionnaires was analyzed and statisticaly evaluated. Results: By the Research was found, that from researching Age, Education and Length of Service in Unit Factors, the most significant Influence on Changes of subjective perceived psychological Stress have the Age and the Length of Service Factors. After that was found, the subjective perceived psychological Stress at the End of all-day Duty have increased. Keywords: Stress, psychological Stress, Frustration, Trauma, Post-traumatic Stress Disorder, peacekeeping Operation, Soldier.

Title: Experiance with joga for tennis coaches Objectives of work: The aim of my thesis is to analyze the possitive effects of yoga on the mental and physical health of tennis players. The data is gained by quality data collection methods. The secondary objective is, on the basis of information obtained from short interviews with coaches, to create a theoretical model of categorization. Method: In this thesis we used the method of interview and narrative interview. The data collected from the interviews, was used to create a theoretical model of categorization. A method of narrative interview with elements of the interview was used as a key method of collecting data from selected subjects. Results: Following numerous interviews with various subjets including coaches and trainers, I have come to the conclution, that yoga has a positive effect on the mental and physical health of tennis players. The main effects of yoga include: increased confidence and concentration on the court, accelerated healing, reduced pain in the spine (notibly in lumbar region), therefore increasing the flexibility of joints and improving the performance of players. In terms of categorization on the effects of yoga, both in mental and physical health of tennis players, I classified the effects into two major categories: the...

The stress system comprises the hypothalamic-pituitary-adrenal (HPA) and the sympathetic-adrenal-medullary (SAM) axes. The two operate synergistically to regulate metabolic and biological processes, maintain homeostasis, and manage physiological responses towards various environmental challenges, known as stressors. Numerous studies have observed impaired HPA response among White breast cancer survivors followed by an eventual normalization of the HPA axis, but little is known about SAM functioning, the complementary relationship between physiological and psychological stress, and the influence of culturally related factors. This dissertation aims to address these gaps in the literature via three studies. In Study 1, we examined the diurnal and reactive patterns of salivary alpha-amylase, a SAM biomarker, in a sample of predominantly White women with and without a prior diagnosis of breast cancer. The purpose was to establish an initial understanding of SAM functioning in relation to the participants’ HPA activity as measured by cortisol responses (complementary to a previously published study in the laboratory). Results of Study 1 revealed no abnormal response to stress. Virtually identical alpha-amylase slopes were observed between breast cancer survivors and control participants, except that breast cancer survivors had elevated basal levels of alpha-amylase, thus suggesting a “heightened sympathetic tone”. In Study 2 acute and diurnal cortisol profiles and their accompanying psychological stress responses were examined in a sample of Chinese and White women with and without a prior diagnosis of breast cancer. In the same participants, we also examined chronic stress levels via hair cortisol concentrations which was the subject of Study 3. In both studies 2 and 3, we assessed the potential influences of cultural orientation and ethnocultural group membership on physiological and psychological stress patterns. For the most part, Study 2 supported previous findings from the literature and our laboratory: Breast cancer survivors displayed a blunted cortisol response and their diurnal profile was comparable to that of control participants. But contrary to our hypotheses, ethnocultural membership and cultural orientation did not influence physiological patterns of stress. However, an interaction between ethnocultural group, health status, and time (i.e., from baseline to one hour after stress induction) was observed in the subjective appraisal of an acute stressor. Specifically, White breast cancer survivors reported significantly lower levels of perceived stress than the other three groups. These results suggest that health-related stress may supersede the effects of culturally related stress and indicate the potential presence of posttraumatic growth among our sample of White breast cancer survivors only. Study 3 revealed no differences in hair cortisol concentrations between breast cancer survivors and control participants, nor between Chinese and White breast cancer survivors. However, it was observed that healthy Chinese women exhibited significantly higher levels of hair cortisol concentrations than their Western counterpart. Further analyses revealed that health status and cultural orientation did not significantly predict the observed patterns of physiological or psychological stress. Although non-significant, Study 3 results offered preliminary evidence that higher orientation towards both the dominant and non-dominant cultures is associated with higher levels of chronic physiological and psychological stress. Collectively, our studies may provide support for the long-term recovery of the HPA axis via the examination of acute, diurnal, and chronic patterns of cortisol, but further research will be required. The dissertation also highlights several important key points regarding culturally related factors, health, and stress: (1) The perception of stress is influenced by one’s degree of cultural orientation and (2) effects of health-related stress may supersede those of culturally related stress, but (3) among healthy women, ethnocultural minorities may have more stressful encounters than their Western counterpart, thus having important clinical implications for ethnocultural minorities who are newly diagnosed with a chronic condition. Together, results of the studies highlight the importance of further investigating the enduring and acute implications of psychosocial variables – particularly the influence of cultural orientation – on the experience and perception of stress.