Low back pain (LBP) is a common occupational problem and continues to be the leading cause of occupational disability.  Among diverse known risk factors, sitting is commonly considered as an important exposure related to LBP.  Both modern living and contemporary work involve increased sedentary lifestyles, including more frequent and prolonged sitting.  At present, however, the causal role of sitting on LBP development is controversial due to the contribution of several moderating factors (e.g., task demands, duration of exposures, and presence of muscle fatigue).  A few studies have assessed low back loads in seated postures, but none has investigated the effects of prolonged sitting or time-dependent variations on spinal structure and spinal loading.  Adverse effects of muscle fatigue on low back pain are well documented, yet the specific relationship between muscle fatigue and sitting-related low back pain are not fully established.  In addition to these fundamental limitations in our understanding of the physical consequences of sitting, there is also little evidence regarding the effects of task requirements on muscle fatigue and spine loading.   Therefore, the main objectives of this work were, in the context of sitting, to: 1) develop and evaluate a method to assess paraspinal muscle fatigue using electrical stimulation; 2) develop and evaluate a method (model) to quantify biomechanical loads on the lumbar spine in a seated posture; and 3) quantify the effects of prolonged seated tasks on low back loads, body discomfort, and localized muscle fatigue (LMF).  The primary hypothesis was that exposure to sitting-related LBP risks is influenced by task requirements and sitting duration.   A muscle stimulation protocol was developed to measure stimulation responses in the lumbar extensors.  A stimulation protocol, which included one conditioning train along with three 16-second stimulation train at 2 Hz, was recommended as appropriate to measure those muscles potentially fatigued during prolonged seated tasks.  A three-dimensional, sitting-specific, fatigue-sensitive, time-dependent, electromyography (EMG)-based biomechanical model of the trunk was developed to investigate the effects of seated tasks and time-dependent variations on lumbosacral loading during sitting. Reasonable levels of correspondence were found between measured and predicted lumbosacral moments under a range of seated tasks.  Lastly, the effects of prolonged sitting and psychosocial work stress on low back were quantitatively identified.  Only prolonged sitting significantly increased trunk flexion angles and led to muscle fatigue.  Relatively weak correlations were found between subjective and objective measures, though the two fatigue measurement methods (based on EMG and stimulated responses) showed a good level of correspondence.   Overall, this work provides a quantitative assessment of biomechanical exposures associated with seated tasks.  The methods developed in this work make a contribution in terms of measurement/modeling approaches that can be used to assess LBP-relevant risks during prolonged sitting.  The results of this work provide a better understanding of the effects of prolonged sitting on the risk of developing sitting-related LBP.  Finally, results regarding the influences of prolonged sitting and psychosocial demands can be used to guide future job design. / Ph. D.

Objektiv: Psychosoziale Stressoren wurden seit langem für ihren Beitrag zur Entwicklung einer arteriellen Hypertonie untersucht, aber ihre Rolle dabei bleibt umstritten. In dieser Post-hoc-Analyse der bundesweiten Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) wurden die Beziehungen von objektiv gemessenen Stressoren und selbst berichtetem Stresslevel auf den Blutdruck bestimmt. Methoden: Die Stichprobe der Studie umfasste 3352 Teilnehmer, die jünger als 65 Jahre alt waren, und derzeit in einem Beschäftigungsverhältnis standen und keine antihypertensive Medikation einnahmen. Der neu entwickelte Overall-Job-Index wurde zur Bewertung des arbeitsrelevanten Stressniveaus verwendet und der selbst wahrgenommene chronische Stress mit der Trierer Inventar zur Erfassung von chronischem Stress Screening-Skala (TICS-SSCS) gemessen. Ergebnisse: Bivariate Tests zeigten signifikante und negative Assoziationen zwischen dem durch TICS-SSCS gemessenen, selbst berichteten Stress mit dem systolischen (Schätzer = -0,16, Standardfehler [SE] = 0,03, p <0,001) bzw. diastolischen Blutdruck (Schätzer = -0.10, SE = 0,02, p <0,001), während der Overall-Job-Index positive signifikante Assoziationen für systolischen (Schätzer = 0,44, SE = 0,11, p <0,001) und diastolischen Blutdruck aufwies (Schätzer = 0,20, SE = 0,07, p = 0,005). Nach Adjustierung für Alter, Geschlecht und Body-Mass-Index blieb TICS-SSCS signifikant mit systolischem und diastolischem Blutdruck assoziiert, nicht aber mit dem Overall-Job-Index. Als Alkoholkonsum, Raucherstatus, körperliche Aktivität, Verkehrsdichte, sozioökonomischer Status, soziale Unterstützung, Pflege von Angehörigen und Leben in Partnerschaft als weitere Kovariablen zu den vorherigen Modellen zugegeben wurden, blieb TICS-SSCS weiterhin mit systolischem und diastolischem Blutdruck assoziiert (p = 0,007 und p = 0,001). Schlussfolgerungen: In einer großen und repräsentativen deutschen Studie wurde festgestellt, dass ein höher wahrgenommenes Stressniveau mit niedrigem Blutdruck assoziiert ist, während die in dieser Analyse untersuchten objektiven Stressfaktoren nicht signifikant mit Blutdruck korreliert waren. Diese Ergebnisse deuten darauf, dass Stress den Blutdruck auf verschiedenen Wegen beeinflusst und dass die Wahrnehmung von Stress das Ergebnis einer komplexen physiologischen Reaktionsantwort ist, die die Regulierung des Blutdrucks einschließt.

Background. There are a number of studies showing that general practice is oneof the most stressful workplaces for health care workers. Since the Baltic States regained independence in 1990, a reform of the health care systems took place in which a new role and more responsibilities were allocated to general practitioners. This study aimed to explore the psychosocial stress level among Lithuanian general practitioners (GPs) and examine the relationship between their psychosocial stress and work characteristics. Methods. A cross-sectional study was madeof 300 Lithuanian general practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the Karasek scale. The analyses included descriptive statistics, interrelationship analysis between the different characteristics, and multivariate logistic regression to estimate odd ratios for each of the independent variables in the model. Results. The study shows that 48% of the respondents could be classified as suffering from work related psychosocial stress by the Reeder scale. The highest job strain prevalence was among widowed, single and female GPs. The lowest job strain prevalence was among males and GPs of older age. Job strain occurs when job demands are high and jobdecision latitude is low. Conclusions. The greatest risk tophysical and mental health from stress occurs to general practitioners facing high psychological workload demands combined with low decision latitude in meeting those demands. High job demands, patient load more than 18 patients per day and young age of general practitioners can predict a statistically significant effect on job strain. / <p>ISBN 91-7997-095-8</p>

The aim of this work is to identify what helped young adults during their childhood to cope with stress situations, which was for them the divorce of their parents, what their coping made worse, how they look on that situation with the passage of time and whether they already feel balanced with it. In the theoretical part are the key issues the divorce and coping strategies. Attention is focused especially on experiencing and coping with divorce by children. For coherence of this topic this part also touches the short-term and long-term impact of divorce on children and family structure after divorce. The empirical part is based on a qualitative analysis of 12 interviews with young adults who experienced parental divorce during childhood. For data evaluation is used thematic analysis. The results revealed protective and risk factors that correspond with the findings mentioned in scientific literature. Keywords: Divorce, family, psychosocial stress, coping strategies

The World Health Organization has called stress-related illness “the health epidemic of the 21st century.” While the biochemical pathways associated with the acute stress response are well-characterized, many of the pathways behave differently under conditions of chronic stress. The purpose of this project is to apply high-sensitivity mass spectrometry (MS)-based targeted and untargeted metabolomics approaches to generate new insights into the biochemical processes and pathways associated with the chronic stress response, and potential mechanisms by which chronic stress produces adverse health effects. Chapter 1 describes the application of sets of targeted and untargeted metabolomics approaches to analyze serum samples from a human epigenetic model of chronic stress in order to identify potential targets for further analysis. To test the resulting hypothesis that oxidative stress is a key feature of chronic stress, a new targeted multiple reaction monitoring (MRM)-MS assay was developed for the accurate quantitation of aldehyde products of lipid peroxidation, as described in Chapter 2. In Chapter 3, the validated method for quantitation of malondialdehyde (MDA) was t applied to mouse plasma samples from a model of chronic social defeat stress to determine whether animals exposed to psychosocial stress show increases in oxidative stress. Mouse plasma samples from this model were also analyzed by untargeted metabolomics using Fourier-transform (FT)-MS to identify other important metabolite features, particularly those that overlap with metabolites identified in the human epigenetic model. Analysis of metabolomic data from two very different models of chronic stress supports the consistent detection of a metabolomic phenotype for chronic stress that is characterized by the dysregulation of energy metabolism associated with decreased concentrations of diacyl-phospholipids in blood. Increased blood concentrations of fatty acids, carnitines, acylcarnitines, and ether phospholipids were also observed. In addition to metabolites associated with energy metabolism, chronic stress also significantly influenced metabolites associated with amino acid metabolism and cell death. This characteristic pattern of differences in metabolite concentrations was observed in the plasma of mice exposed to chronic social defeat stress, irrespective of whether or not they displayed outward signs of a chronic stress response; In fact, mice that were “resilient” to the behavioural effects of chronic social defeat stress displayed an exaggerated phenotype over mice that showed depressive-like symptoms following chronic stress exposure. This may suggest that the observed changes in fatty acid composition are protective against stress. However, changes in fatty acid composition are also known to be associated with a wide variety of pathologies including heart disease, neurodegenerative diseases, and mood disorders, so the lipidomic changes associated with chronic stress may also contribute to its health impact. Overall, the results provide further evidence that changes in energy metabolism are a central part of allostatic adaptation to chronic stress. / Graduate / 0487 / csobsey@gmail.com

Einleitung: Methylphenidat (MPH) als Medikament der ersten Wahl bei Patienten mit einem Aufmerksamkeitsdefizit- /Hyperaktivitätssyndrom (ADHS) ist für die Therapie von Kindern aber auch von Erwachsenen weit verbreitet. Weil es immer noch Sicherheitsbedenken gegen dieses Medikament gibt, wurde in der vorliegenden Studie untersucht, ob die Langzeiteinnahme von MPH unschädlich hinsichtlich eines zytogenetischen Effektes ist. Ein weiteres Ziel war die Beurteilung von chronischer psychosozialer Stressbelastung von Patienten im Vergleich zu Kontrollprobanden und zu beurteilen ob die Medikation einen Einfluss auf die Höhe des Stresses hat. Nicht zuletzt war das dritte Ziel der Studie zu untersuchen, ob Stress selbst zu zytogenetischen Schäden führt. Material und Methoden: Lymphozyten von 72 (42 ADHS- und 28 gesunde Kontrollprobanden) geschlechts- und altersgematchte Probanden im Alter von 18-28 Jahren, wurden aus venösem Blut für den Mikronukleusassay isoliert. Hauptendpunkt der Studie war die Mikrokernanzahl in binukleären Zellen. Die psychosoziale Stressbelastung der letzten drei Monate wurde mit dem Trier Inventar zum chronischen Stress (TICS) gemessen. Zusätzlich wurden Speichelproben für eine Cortisolmessung gesammelt. Ergebnisse: Ein Einfluss der MPH-Einnahme auf die Mikrokernfrequenz konnte nicht gefunden. ADHS-Patienten wiesen eine signifikant höhere Stressbelastung im Vergleich zu den Kontrollprobanden auf. Ein signifikanter positiver Einfluss auf das chronische Stresserleben unter MPH-Einnahme konnte bei Einnahme von mehr als 1 Jahr beobachtet werden. Die Stressbelastung der ADHS-Patienten und Kontrollprobanden zeigte keine Korrelation zu zytogenetischen Endpunkten. Eine kleine Untergruppe, ADHS-Patienten mit Komorbidität Depression, zeigte jedoch signifikante erhöhte Mikrokernfrequenzanzahlen unter stark erhöhtem chronischen Stress. Aussichten: Aus unserer Sicht kann MPH auch in der Langzeittherapie sicher hinsichtlich eines Krebsrisikos in gewichts- und symptomadaptierter Dosis eingesetzt werden. Weitere Studien sind nötig um das Krebsrisiko bei chronischer erhöhter Stressbelastung abzuschätzen. / Introduction: Methylphenidate (MPH) as first line treatment for patients with attention deficit hyperactivity disorder (ADHD) is widely used not only for therapy in children but also in adults. Because there are still safety concerns for this medication this study investigated if the long term treatment of MPH is harmless regarding to cytogenetic effects. A further aim was to compare the psychosocial stress levels of ADHD patients to those in control subjects and to investigate if MPH medication has an influence on self-perceived stress levels in ADHD. The third aim of this study was to explore if psychosocial stress leads to cytogenetic damage. Materials and methods: Lymphocytes of 72 subjects (42 ADHD and 28 healthy control subjects), matched in age and gender(aged 18-28 years) were isolated from venous blood for micronucleus assay. Main endpoint was the micronucleus frequency in binucleated cells. Psychosocial stress exposure of the last three month was measured by Trier Inventory for Chronic Stress (TICS). Additionally saliva samples were collected for cortisol measurement. Results: An influence of MPH intake on cytogenetic markers could not be found. ADHD patients showed significantly higher stress levels in comparison to control subjects. Patients taking MPH for more than one year displayed significantly lower chronic psychosocial stress levels than patients taking it less than one year or not-treated patients. Stress exposure of ADHD patients and control subjects showed no correlations to cytogenetic endpoints. A small subgroup of ADHD patients with comorbid depression showed significantly higher micronuclei frequencies and reported greater increased chronic stress. Views: We conclude that MPH in weight - and symptom - adjusted dose can be safely used also for long term treatment regarding to cancer risk. Further studies are necessary to estimate cancer risk for increased chronic stress exposure.

Background: Chronic wounds are a significant health problem in various populations. Psychosocial stress is a lifestyle factor that has been shown to directly influence wound healing. Current findings support roles for assessment and reduction of psychosocial stress in the comprehensive management of chronic wounds, however, a gap remains between current research and current clinical practice. Purpose: To develop a novel method by which to educate nurses about the effects of psychosocial stress on wound healing while incorporating state-of-the-art technology that is sensitive to the needs of individuals with various learning styles. Objectives: To review current literature documenting the relationship between chronic psychosocial distress and delayed wound healing to identify essential content to include in educational modules for nurses. To develop three educational modules for nurses in inpatient and outpatient settings that address the relationship between chronic psychosocial distress and delayed wound healing, and the effects of stress-reduction interventions in formats that meet the needs of different learning styles. To conduct a focus group discussion with nurse-participants regarding educational module content and delivery methods in order to evaluate and improve these educational modules. Methods: A series of literature reviews were performed between June, 2010 and October, 2013, using articles identified through searches using the databases PubMed and CINAHL. Essential content regarding psychosocial stress and its impact on wound healing was identified, and was used in the development of educational modules, designed to meet the basic needs of individuals with different learning styles. A purposive sample of nurses was recruited through the use of flyers, reviewed the educational modules online, and met for a focus group to discuss their experiences with these modules. Outcomes: A novel method was developed by which to deliver educational material to nurses about psychosocial stress and delayed wound healing. Participants were motivated to learn, had self-awareness of their preferred learning styles, and responded positively to this method of education delivery; they were able to articulate the basic concepts presented in the modules. These findings may be generalizable to a larger audience and may inform the development of future education-delivery approaches in this area.

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Atualmente há uma grande preocupação ética em promover o bem-estar de animais cativos e semi-cativos. Uma das formas mais eficientes de se fazer isso é aplicar técnicas de enriquecimento ambiental. Para avaliar sua eficácia, a abordagem da etologia se encaixa ao utilizarmos estímulos ambientais e analisarmos as mudanças comportamentais causadas por eles, correlacionando com possíveis funções adaptativas. Este trabalho analisou a influência de um método de enriquecimento ambiental sequencial e cumulativo no comportamento de 27 indivíduos de um grupo de macacos-prego (Sapajus sp) semi-cativos no Parque Ecológico do Tietê, São Paulo. O fornecimento de pedras e de cocos para a tarefa de quebra de coco foi utilizado como enriquecimento cognitivo-alimentar e redes em suspensão foram utilizadas como enriquecimento físico. O delineamento experimental foi composto por quatro condições: 1) Linha de Base, observações feitas antes da introdução do enriquecimento; 2) Enriquecimento com cocos Protocolo I, os cocos eram fornecidos em apenas um sítio de quebra; 3) Enriquecimento com cocos Protocolo II, os cocos eram distribuídos igualmente em três sítios de quebra; e 4) Enriquecimento Físico, duas redes foram colocadas em clareiras da ilha, além do fornecimento de cocos em três sítios. O registro dos comportamentos foi feito pelos métodos Varredura Focal e Todas as Ocorrências. Os machos adultos subordinados foram os únicos indivíduos do grupo que apresentaram comportamentos anormais, devido ao maior estresse psicossocial que sofrem na hierarquia do grupo. A frequência de comportamentos anormais foi alterada, especialmente na condição Enriquecimento Físico, quando houve diminuição drástica desses comportamentos. A introdução das redes ofereceu refúgio e evitação de conflitos, aumentando a sensação de controle do ambiente. Além disso, alguns desses indivíduos tiveram um aumento da proximidade espacial e de interações afiliativas com outros subordinados, o que seria uma estratégia adaptativa adotada para reduzir o estresse. Houve aumento das taxas de comportamentos agonísticos no grupo ao introduzirmos o enriquecimento cognitivo-alimentar. O aumento da competição direta intragrupo já era esperado devido às características do enriquecimento oferecido e essa alteração comportamental do grupo pode ser considerada típica em primatas de vida livre. Não houve aumento significativo das taxas de catação e de brincadeira social em nenhuma condição. Houve alteração significativa da coesão grupal apenas na condição Enriquecimento Físico, onde obtivemos as maiores medidas de distância interindividual e a formação de novas relações de proximidade no grupo. O aparecimento de novas díades envolvidas em catação e a diminuição do tamanho do grupo devido à alta mortalidade explicam o aumento da coesão grupal observado nessa condição. A introdução de redes em estratos superiores eliciou menor terrestrialidade, havendo um aumento significativo da frequência do uso de substratos Acima de 1,5m em detrimento do uso de substratos ao nível do solo na condição Enriquecimento Físico, demonstrando uma preferência por substratos acima do solo pelos animais desse grupo. A técnica de enriquecimento empregada se justifica por ser um elemento novo na rotina desses animais que fez com que empregassem seu tempo, esforço e capacidade cognitiva e interagissem socialmente / Nowadays there is a big ethic concern in improving the well-being of captive and semi-captive animals. One of the most efficient forms of doing that is applying environmental enrichment techniques. To evaluate its efficiency, the ethological approach applies environmental stimuli and analyzes the behavioral changes caused by them by correlating with possible adaptive functions. This work has analyzed the influence of a sequential and cumulative environmental enrichment method on the behavior of 27 individuals of a semi-captive group of capuchin monkeys (Sapajus spp.) at Parque Ecológico do Tietê, São Paulo. The provision of rocks and nuts for the task of nutcracking was utilized as cognitive-food enrichment, whereas suspended nets were utilized as physical enrichment. The experimental design was composed of four conditions: 1) Base Line, observations made before the introduction of the enrichment; 2) Enrichment with nuts Protocol I, the nuts were provided at a single cracking site; 3) Enrichment with nuts, Protocol II, the nuts were equally distributed at three cracking sites; and 4) Physical Enrichment, two nets were placed in open areas of the island, beside the provision of nut at three sites. The registry of behavior was made using the Focal Scan and All Occurrences methods. The adult subordinate males were the only individuals of the group that presented abnormal behaviors, as they were under great psychosocial stress in the group hierarchy. The frequency of abnormal behaviors was altered, especially in the Physical Enrichment condition, when a drastic decrease of these behaviors was seen. The introduction of nets provided refugee and enabled conflict avoidance, increasing the sensation of environment control. Besides that, some of the individuals had a increase of spatial proximity and showed affiliative behaviors with other subordinates, which would be an adaptive strategy adopted to reduce stress. The rate of agonistic behaviors was seen to have increased with the introduction of cognitive-food enrichment. The increase of intergroup direct competition was already expected due to the characteristics of the enrichment provided and this behavioral change of the group can be considered typical of wild primates. There was no significant increase in grooming and social play rates at any of the conditions. There was significant change of the group cohesion only under the Physical Enrichment condition, where the biggest interindividual distance measures and the formation of new proximity relations in the group were seen. The appearance of new dyads involved in grooming and the reduction of the group size due to high mortality explain the increased group cohesion observed under this condition. The introduction of nets on superior layers elicited less terrestriality, by having a significant increase of the frequency of use of substrates Above 1,5m in detriment of use of substrates at the ground level under the Physical Enrichment condition, showing a preference for substrates above the ground by these animals. The enrichment technique applied is justified by the fact that it is a new element on the routine of these animals, which helped them use their time, effort and cognitive capacity and interact socially