Somos uma construção social, a nossa produção de sentido, a compreensão que temos do mundo resulta das relações sociais e dos vínculos afetivos, subjetivados e resubjetivados desde a fase especular da infância. A linguagem, condição para a estruturação do inconsciente, inscreve e inaugura o sujeito no universo simbólico. A interação do sujeito com o entorno dá-se de acordo com as significações que faz sobre o mundo em que vive, e o objetivo da tese centra-se em compreender a construção dos significantes de stress. Os significantes de stress desenvolvidos e manifestados na atividade profissional resultam da produção de sentido do sujeito, foram construídos ao longo do tempo, permeados pelo contexto e por elaborações imaginário-simbólicas. Nesta tese, para dar conta do fenômeno estudado, mostrou-se a possibilidade de aproximação teórica entre a psicanálise lacaniana, no que se refere à dimensão imaginário-simbólica constitutiva do sujeito, com a teoria de stress psicológico de Lazarus para viabilizar aqui neste trabalho, a compreensão da origem do stress psicológico. Analisou-se a produção de sentido de stress em profissionais que exercem atividade gerencial, destacando os conteúdos ideativos das dimensões imaginário- simbólica, como constituintes da origem do stress psicológico e buscou-se na análise, entender a relação entre as significações de stress atribuídas à atividade pesquisada e à experiência de stress do sujeito. A pesquisa empírica, realizada com 20 sujeitos, constou de entrevistas-narrativa, com roteiro focal semi-estruturado. Escolheu-se o método de análise do discurso, seguindo dois modelos: Análise do Discurso-AD e Análise do Discurso do Sujeito Coletivo-DSC, utilizando- se o recurso do software Qualiquantisoft. Os resultados encontrados apontam que as significações sobre o trabalho são centrais na vida dos homens e mulheres entrevistados. Os significantes de stress mais lembrados por eles, estão canalizados para as situações de trabalho, em que o estressor mais intenso está vinculado ao cumprimento das metas de prazos curtos. Em segundo lugar, foi lembrado o stress por não ter o controle da situação estressante. Quanto às significações de stress, os homens centram-se nos stressores externos e por sua vez, as mulheres apontam os sintomas como significantes de stress. A maioria dos homens, tem uma lembrança idealizada da infância, sem a presença de stress, sendo que os demais, 30% consideram ter tido uma infância difícil, e identificaram os stressores da infância. As mulheres, também, em sua maioria consideram a infância como um período muito bom de suas vidas, conseguindo identificar stress ocorrido nessa fase. Quanto às lembranças do stress da infância, predomina nos homens entrevistados, a categoria de não se lembrar de tido stress infância, o que não aconteceu no caso das mulheres, para elas, a infância foi muito boa, mas guardam na lembrança ativa, a primeira vez que sentiram stress, tal como o significam atualmente. Elas afirmaram que o stress atual é o mesmo stress da infância, confirmando a repetição significante, de acordo com psicanálise. Com relação aos processos de coping, a diversidade evidenciou-se nas respostas dos homens e das mulheres. As escolhas dos homens mostram três de categorias de coping: Eu enfrento o stress de frente, como um desafio; Eu me afasto para pensar melhor; Relaxar por meio de leituras de auto ajuda. O coping das mulheres também revelou diversidade de respostas quanto a enfrentar seus stressores: 40% tenta se acalmar primeiro, esquivando-se da situação e, depois enfrentam o stressor; 30% toma um calmante leve, uma faz terapia para fortalecer-se e aprender a lidar com os stressores, principalmente para aprender a dizer não às pressões sofridas. Uma afirmou enfrentar prontamente os stressores e sua estratégia consiste em diminuir os seus efeitos para poder controlá-los. Foi citado por outra entrevistada, o procurar relaxar e espairecer por meio de um lazer prazeroso com a família nos finais de semana. Fazer amigos e buscar apoio e trocar idéias foi citado como eficaz processo de coping. O estudo sobre a construção imaginário-simbólica do stress psicológico possibilitou desvelar a origem dos significantes de stress, à luz do saber lacaniano e a pesquisa empírica permitiu um olhar convergente, mas não conclusivo. / We are social constructions, our sense production, the comprehension we have of the world result from the social relations and of affective links, subjectively created since the infant´s mirror stage. The language, condition to the unconcious structuration, inscribes and inaugurates the subject in the symbolic universe. The subject interaction with the environment is realized in accordance with the significations that are made about the world in which the subject lives. The objective of this thesis centers in the comprehension of the construction of stress significants. The stress significants developed and manifested in the professional activity result from the subject´s sense production, and were constructed during the life time, permeated by the context and by imaginary-symbolic elaborations. In this thesis, in considering the studied phenomenon, it was shown the possibilities of a theoretical approximation between the lacanian psychoanalysis, in what it refers to subject´s imaginary-symbolic constitutive dimension, with Lazarus´ theory of psychological stress, to make viable the comprehension of the origin of the psychological stress. It was analyzed the production of stress sense in professional people in managerial activities, emphasizing the ideative contents of the imaginary-symbolic dimensions as constitutive of the origin of the psychological stress, searching to understand, in the analysis made, the relation between the stress significations addressed to the analyzed activities and to the subject´s experience of stress. The empirical research, realized with 20 subjects, was based on an interview/narrative approach, with semistructured focal survey. The method of discourse analysis was chosen following two models: the Discourse Analysis and the Collective Subject Discourse through the use of the Qualiquantisoft software.The results point that the significations about the work are central in the interviewed men and women´s lives. The most recalled stress significant pointed by them is directed to work situations in which the most intense stressor are linked to the achievement of short time goals. In second place it was recalled the stress by having no control over stressing situations. Concerning to the stress significations, men are centered in external stressors and women point the symptom as stress significant. The majority of men have an idealized remembrance of childhood, without the presence of stress, having 30% considered they had a difficult childhood and identified the childhood stressors. The majority of women also considered the childhood as a very good period of their lives and identify stress in this period. As the remembrance of stress in childhood prevails in the men the category do not recall stress in childhood, what have not happened with women. The childhood was to them very good, but keeping in the active memory the first sensation of stress as the same significant of nowadays. They have asserted that the present stress is the same stress of childhood confirming the significant repetition according to the psychoanalysis. In relation with the coping processes the diversity appeared in the response of men and women. Men´s choices show three categories of coping: I face the stress as a challenge, I step aside to think better, I relax reading self-help books.Women´s coping also revealed the diversity of answers when managing the stressors. 40% of them try to calm down first, avoiding the situation and then facing the stressor, 30% takes a light sedative, one of them makes therapy to become stronger and learn how to handle stressors, specially to learn how to say no to pressure situations. One of them declared promptly facing the stressor, being her strategy to diminish the effects of the situation to better control them. Another one searches to relax and distract herself by means of a joyful leisure weekend with the family. Making friends, search support, changing ideas with other people, was mentioned as effective coping process. The study about the imaginary-symbolic construction of the psychological stress made possible to unveil the origin of stress significants according to the lacanian psychoanalysis, having the research permitted a convergent view, despite of being not conclusive.

O estudo objetivou analisar sintomas ansiedade e depressão em pacientes com lesão medular e investigar sua correlação com a incidência da perda dos papéis ocupacionais, bem como as estratégias adotadas por profissionais da saúde para a promoção de saúde mental a essa população. Trata-se de um estudo correlacional de corte transversal, com abordagem predominantemente quantitativa, sendo uma etapa qualitativa. Para a coleta de dados, foram utilizados os seguintes instrumentos: Ficha de Identificação; Inventário de Depressão de Beck (IDB); Inventário de Ansiedade Traço-Estado (IDATE); Critério de Classificação Econômica do Brasil (CCEB); Lista de Identificação de Papéis Ocupacionais (LIPO); e entrevistas semiestruturadas com profissionais do Serviço de Atendimento Domiciliar (SAD). Participaram do estudo 30 pacientes com lesão medular traumática atendidos no referido serviço, de ambos os sexos, entre 19 anos e 72 anos de idade, e 10 profissionais da saúde do SAD. Para a análise estatística da etapa quantitativa, utilizou-se o programa IBM SPSS Statistic versão 25, e na etapa qualitativa, a Análise de Conteúdo de Bardin. Os resultados identificaram média de escores de sintomas de ansiedade média e depressão leve/moderada entre os participantes, sendo que a variável significantemente associada à depressão foi apenas o estado civil; já a variável associada à ansiedadeestado foi o apoio familiar, e à ansiedade-traço, as atividades de autocuidado. Os papéis que sofreram mais perdas foram os de trabalhador e passatempo/amador, e aqueles considerados menos importantes, de estudante e participação em organizações. Importância maior foi atribuída pelos participantes aos papéis de membro da família, amigo, trabalhador e religioso, sendo os dois primeiros os mais desempenhados no passado, presente e com pretensão no futuro. Identificou-se relação entre ansiedade e depressão e perdas de papéis ocupacionais, de modo que aqueles que vivenciaram mais perdas apresentaram mais sintomas de ansiedade e depressão, e aqueles que continuaram exercendo mais papéis após a lesão apresentaram menos sintomas de ansiedade e depressão. Os resultados da etapa qualitativa e referentes às entrevistas com os profissionais evidenciaram a construção de sete categorias analíticas e 12 categorias empíricas. A análise das categorias permitiu verificar que as estratégias adotadas pelos profissionais de saúde para a promoção de saúde mental a essa população ainda se encontram limitadas, dada a ausência de serviços especializados e o difícil encaminhamento para profissionais da área. Além disso, a falta de posturas sociais mais benevolentes para com essa população acentua a dificuldade de assegurar acessibilidade e oportunidades mais igualitárias a essas pessoas. Considera-se necessário conferir maior atenção à associação de doenças físicas a quadros psiquiátricos, visto que perder ou resgatar um papel desempenhado anteriormente pode não estar relacionado apenas à disfunção física, mas também a um quadro psíquico / The study´s aim was to analyze anxiety and depression symptoms in patients with spinal cord injury, their correlation with the incidence of the loss of occupational roles and what was the exist strategies of health professionals to promote their mental health. This research is based on the correlation between cross-section and a quantitative approach predominantly, this being a qualitative stage. The instruments used for evaluation were: Identification Card; Beck Depression Inventory (IDB); TraitState Anxiety Inventory (IDATE); Brazilian Economic Classification Criteria (CCEB); Identification List of the Occupational Roles (LIPO) and semi-structured interview with the of the Home Care Service´s professionals (SAD). A total of 30 subjects with traumatic spinal cord injury, had participated, both male and female, aged 19 years and 72 years, attended by SAD, and also 10 health service professionals in the study. For the statistical analysis the quantitative´s stage, the IBM SPSS Statistics version 25 program was used, in the qualitative step the Bardin Content Analysis was used. The results has identified a average symptoms of medium anxiety and mild to moderate depression scores among participants, in which the variable significantly associated with depression was related only the marital status; the variable associated with anxiety-state was correlated with family support and the anxiety-trait self-care with activities. The roles who suffered the most losses were the roles of worker and hobbyist /amateur. The roles who was considered less important were student and participation in organizations; the most important roles were family member, friend, worker and religious, the first two were the ones most played in the past, present and as a future ambition. We had identify the connexion between anxiety and depression with occupational roles´s loss, in which those who had with more losses they showed more anxiety and depression symptoms and those who continued to have varied roles after the injury presented fewer symptoms of anxiety and depression. According with the results of the qualitative stage, relative to the interviews with the professionals, seven analytical categories were found and 12 empirical categories were deployed. The analysis of the categories has allowed to verify that the strategies for the mental health´s promotion in this population are limited yet, since, there are not specialized services and the referencing to area specialty professional is difficult to access, besides, the lack of social attitudes to benefit this population which corroborate the with the difficulty in their accessibility and opportunities. More attention are needed regarding the association of physical diseases with psychiatric conditions, since the loss of a role played or the recovery of it, may not be related only to physical dysfunction, but also to psychic dysfunction

Este trabalhou avaliou o stress e a ansiedade em 30 casais, que se submeteram à reprodução assistida no momento anterior à coleta dos óvulos e/ou espermatozóides, tendo um tempo de infertilidade que variou de 1 a 17 anos. Para avaliação da ansiedade foi aplicado o STAI-STATE TRAIT ANXIETY INVENTORY (STAI) e o Stress foi avaliado através do SCOPE-STRESS. No STAI foi acrescentada uma escala visual analógica para medir também a intensidade da ansiedade. A Ficha de Identificação avaliou questões como: idade, sexo, nacionalidade, profissão, ocupação, religião, grau de instrução, renda mensal, estado civil, tempo de casado e questões como: tempo de infertilidade, filhos naturais ou adotivos, profissionais implicados no tratamento, a existência de tentativas anteriores e os momentos de maior tensão emocional nas tentativas anteriores e a atual. Dentre os 36 sujeitos que já haviam feito tentativas anteriores de Reprodução Assistida, um dos três momentos de maior tensão emocional foi o de aguardar a gravidez. Dentre os 60 sujeitos, ou seja, todos os que estão na tentativa atual, aguardar a gravidez foi também um dos três momentos que geraram maior tensão. O diagnóstico de infertilidade foi misto em 33,3% dos casais, apenas feminino em 20% e apenas masculino em 46,7% dos casais. As mulheres apresentaram grau de ansiedade significantemente maior que os homens quanto às escalas Stai-Trait freqüência e intensidade e semelhantes quanto às escalas Stai-State freqüência e intensidade. Não houve diferença significante entre os escores médios dos homens e mulheres quanto às medidas descritivas do Scope-Stress. / This work evaluated stress and anxiety in 30 couples submitted to assisted reproduction, with an infertility period that ranged from 1 to 17 years, the moment just before the oocyte retrieval and/or semen sample. For anxiety evaluation the Stai-State Trait Anxiety Inventory (STAI) was applied, and stress was evaluated using the Scope-Stress. While applying STAI, a visual analogic scale was added to measure the intensity of anxiety. The identification form included information such as: age, gender, nationality, profession, occupation, religion, school level, monthly income, marital status, married time and issues such as: infertility period, existence of natural or adoptive children, professionals involved in infertility treatment, existence of previous attempts and the moments of major emotional stress during the previous attempts and during the present one. Among the 36 subjects submitted to previous attempts of Assisted Reproduction, one of the three moments of major emotional stress was the attendance of pregnancy confirmation. Among the all 60 subjects submitted to the present attempt, attendance of pregnancy confirmation also was one of the three moments of major emotional stress. Infertility diagnosis was mixed in 33,3% of the couples, exclusively feminine in 20% and exclusively masculine in 46,7% of the couples. Women presented a significantly higher anxiety degree than men, regarding the STAI-TRAIT scales of frequency and intensity and similar regarding the STAI-STATE scales of frequency and intensity. There was no significant difference between the mean scores of men and women regarding descriptive measures of the SCOPE-STRESS.

There is evidence of a prospective association between wellbeing and health outcomes including disease risk and longevity. The aim of this thesis was firstly to further explore whether wellbeing is a risk factor for specific chronic physical diseases, and secondly, to identify potential mediators and moderators of the association between wellbeing and disease risk or longevity. Chapter 1 provides an overview of research into associations between wellbeing and physical health. In addition, we outline theoretical models of how the experience of high wellbeing might impact physical health. In chapters 2 and 3, we build on research into wellbeing and chronic physical disease risk. In these chapters, we tested whether the association between wellbeing and disease risk was similar across different types of disease, and, whether different theoretical domains of wellbeing varied in their association with disease risk. We found particularly strong associations - that were not explained by demographic or health behaviour differences - between higher wellbeing and lower risk of arthritis, diabetes or chronic lung disease. In chapter 4, we further explore the association between wellbeing and arthritis risk using mediation analysis. Specifically, we tested whether this association was mediated by inflammatory biomarkers. We found that the biomarker C-reactive protein accounted for a small proportion of the association between wellbeing and a reduced risk of arthritis. The focus of the next two chapters was on potential moderators of the association between wellbeing and mortality risk. In chapter 5, we examined whether the association between higher wellbeing and lower mortality risk varied across individualist and collectivist cultures. We found a significant interaction between individualism and wellbeing such that the association between wellbeing and risk of mortality from cardiovascular disease was stronger in more individualistic countries. In chapter 6, we examined how positive affect (a subdomain of wellbeing), interacted with another psychosocial factor, namely subjective stress. Here, we tested Pressman and Cohen's (2005) stress buffering hypothesis that positive affect may be most strongly related with health under stressful conditions. In support of this hypothesis, we found that the association between positive affect and all-cause mortality risk was stronger in people reporting higher stress. In the final chapter, we summarise our findings, discuss the limitations of our approach and make recommendations for future research.

O câncer e o processo de hospitalização comumente cursam com forte impacto psicológico sobre as crianças e adolescentes, gerando estresse e fadiga. Isto aplica-se especialmente, para àqueles sob quimioterapia, pois esta, constitui-se em uma das experiências mais estressantes e ameaçadoras que pode exacerbar os sintomas relacionados ao câncer e levar a uma diminuição da qualidade de vida (QV). O estresse associado ao desenvolvimento do câncer pode causar disrupturas no eixo hipotálamo-hipófise-adrenal, e suprimir importantes vias neuroimunoendócrinas. Assim, intervenções destinadas a atenuar as alterações fisiológicas relacionadas ao estresse podem favorecer a recuperação do sistema imune e induzir alterações neuroimunoendócrinas para potencializar a vigilância imunológica durante o tratamento oncológico. Com o aumento da incidência de câncer, é crucial que os profissionais de saúde desenvolvam intervenções eficazes para o manejo dos sintomas oncológicos, de modo a aliviar a sobrecarga do tratamento nesses pacientes durante o processo de hospitalização, de modo a contribuir para um melhor prognóstico da doença. Ademais, pacientes pediátricos oncológicos podem se beneficiar de intervenções não-farmacológicas, por exemplo, a intervenção dos clowns, para aliviar os sintomas relacionados ao câncer. Contudo, poucos estudos têm investigado os mecanismos moleculares envolvendo a intervenção dos clowns. Nosso objetivo principal foi investigar os efeitos da intervenção dos clowns sobre o estresse psicológico e a fadiga-relacionada ao câncer (FRC) em pacientes pediátricos oncológicos sob quimioterapia. Além disso, nós investigamos se alterações nos níveis de cortisol, ?-amilase (sAA), citocinas e metaloproteinases de matriz (MMP-9) estão associadas com estresse psicológico e com FRC de pacientes pediátricos com osteossarcoma submetidos à intervenção dos clowns. Trata-se de um estudo quase-experimental pré-teste/pós-teste. Foram colhidas oito amostras de saliva em momentos idênticos, isto é, no baseline (pré-intervenção) e no pós-intervenção (+ 1h, + 4h, + 9h e + 13h após o despertar). As concentrações de cortisol salivar, sAA, citocinas e MMP-9 foram mensuradas por ELISA. Dados sociodemográficos e clínicos foram coletados via prontuários médicos, além disso, foram aplicadas a Escala de Estresse Infantil-ESI(TM) e a Escala Multidimensional de Fadiga-PedsQL(TM). Os escores das escalas foram comparados entre o baseline e o pós-intervenção, e também, foram correlacionados com os níveis dos biomarcadores. Para análise dos dados, utilizou-se da estatística descritiva e estatística não paramétrica. Em comparação com as medidas do baseline, observamos que os níveis de estresse psicológico total, bem como os de fadiga geral dos pacientes pediátricos oncológicos, melhoraram significativamente após a intervenção dos clowns ( p= 0.003; p= 0.049, respectivamente). Não houve correlações significativas entre as Áreas sob Curva (AUC) da sAA e do cortisol no baseline e nem no pós-intervenção. Além disso, a intervenção dos clowns reduziu os níveis de IL-1? e de cortisol nos pacientes pediátricos com osteossarcoma. A AUC da IL-1? correlacionou-se positivamente com AUC do cortisol e com a AUC da sAA no pósintervenção. Inversamente, os níveis de IL-6, TNF-?, IL-12p70, IL-10, TGF-? e MMP-9 não mostraram diferenças significativas no pós-intervenção. Em síntese, nossos resultados sugerem que a intervenção dos clowns é uma boa intervenção não-farmacológica para reduzir o estresse psicológico e a FRC em pacientes pediátricos oncológicos sob quimioterapia / Cancer and the hospitalization process often have a psychological impact on the children and adolescents, usually leading to intense stress as well as fatigue. This especially applies to children and adolescents who have been submitted to chemotherapy, since it still constitutes a stressful and threatening experience for them and may exacerbate cancer symptom burden clusters, leading to a decrease in their health related quality of life (QoL). In addition, stress associated with cancer development leads to disturbances/disruption in the hypothalamicpituitary-adrenal (HPA) axis and suppresses important neuroimmunoendocrine pathways. Hence, interventions aimed at attenuating the physiological changes related to stress favor the recovery of the immune system and, consequently, induce alterations in neuroimmunoendocrine factors that increase immunological surveillance during cancer treatment. With the increase in cancer rates, it is crucial that healthcare professionals develop effective interventions to support pediatric cancer patients during the hospitalization process in order to relieve the burden of cancer treatment, which may contribute to a better prognosis of the disease. In an attempt to alleviate some of the cancer-related symptoms, pediatric oncology patients can take advantage of non-pharmacological interventions, including clown intervention, which can be a very advantageous approach to reduce unpleasant symptoms in pediatric cancer patients. However, few studies have investigated the molecular mechanisms that mediate health outcomes of clown intervention. The main purpose of this study was to investigate the effects of the clown intervention on psychological stress and cancer-related fatigue (CRF) in pediatric cancer inpatients undergoing chemotherapy. Also, we aimed to investigate whether changes in the levels of biomarkers, including cortisol, ?-amylase (sAA), cytokines, and matrix metalloproteinase-9 (MMP-9) are associated with psychological stress and CRF levels in pediatric osteosarcoma inpatients following clown intervention. A pretestposttest quasi-experimental study was undertaken with pediatric cancer inpatients. Eight nonfasting saliva samples were collected at identical times upon clown intervention, i.e., at baseline (pre-intervention) and post-intervention (+ 1h, + 4h, + 9h, and + 13h post awakening). Salivary cortisol, sAA, cytokines and MMP-9 concentrations were measured using high sensitivity Enzyme-Linked Immuno Sorbent Assay. Sociodemographic and clinical data, and Child Stress Scale-ESI(TM) and PedsQL(TM) Multidimensional Fatigue Scale were applied and the results were compared at baseline and after the clown intervention, and also correlated with biomarker trajectories. Data analysis was performed using nonparametric statistical tests. In comparison with baseline measurements, the overall psychological stress for pediatric cancer inpatients as well as their perception of fatigue improved upon clown intervention (p= 0.003; p= 0.049, respectively). There were no significant correlations between sAA and cortisol for both Areas Under Curve (AUC) at baseline or at post-intervention. Also, clown intervention reduced IL1? and salivary cortisol levels in pediatric osteosarcoma inpatients. Additionally, AUC for IL1? positively correlated with AUC for cortisol as well as with AUC for sAA at postintervention. In contrast, levels of IL-6, TNF-?, IL-12p70, IL-10, TGF-? and MMP-9 did not show significant differences upon clown intervention. Overall, our results suggest that clown intervention is a good non-pharmacological intervention to reduce psychological stress and CRF in pediatric cancer inpatients undergoing chemotherapy

Thesis (Ph.D. (Electronical Engineering))--North-West University, Potchefstroom Campus, 2008.

Background: Second to Finland, Sweden has the world’s highest incidence of type 1 diabetes. Experiences of serious life events have retrospectively been shown to constitute a risk factor for the development of this disease, probably via the biological stress response. Parenting stress and maternal attachment insecurity are other important sources of stress in early childhood. Psychological stress increases the need for insulin and may induce insulin resistance, which might add extra pressure on the insulin-producing beta cells in the pancreas (beta-cell stress). The aim of the current thesis was to propose and start investigating a stress hypothesis – namely that psychological stress may induce insulin resistance leading to beta-cell stress, which could trigger an autoimmune reaction towards beta-cells in genetically predisposed children. When all the beta cells have been destroyed, insulin can no longer be produced in the body and type 1 diabetes becomes manifest. Methods: Families from the prospective population-based ABIS-project, which follows approximately 17 000 children, participated in the empirical studies of the current thesis. The mothers completed questionnaires, including various measures of psychological stress (e.g. parenting stress and experiences of serious life events) and socio-demographic background, at the birth of the child and when the child was 1 as well as 2.5 years of age. Maternal attachment insecurity was assessed with the Adult Attachment Interview. Blood samples drawn from the children at 1 and 2.5 years of age were analyzed for type 1 diabetes-related autoantibodies towards Tyrosine phosphatase (IA-2) and Glutamic Acid Decarboxylase (GAD). Findings and Conclusions: Parenting stress and experiences of serious life events like divorce and maternal exposure to violence were associated with the induction of diabetes-related autoimmunity in early childhood, possibly via insulin resistance and beta-cell stress. The risk of developing diabetesrelated autoimmunity after parental divorce or mothers’ exposure to violence was about threefold. None of the results were explained by any of the potential confounding factors analyzed. These results support and strengthen the stress hypothesis, which warrants further investigation. Mothers’ attachment insecurity was not associated with the induction of diabetes-related autoimmunity in their infants. However, this lack of association was perhaps due to methodological constraints. The vast majority of the parents were calmed or unaffected concerning their participation in the ABIS-project, suggesting that large-scale medical screening-projects in the general population are not in themselves a cause for worry and can be performed without causing increased anxiety. / On the day of the public defence the working title of article III was: Psychosocial correlates of parenting stress, lack of support and lack of confidence – A study of all babies in Southeast Sweden (ABIS). The status of article IV was: Manuscript to be submitted shortly; the status of article V was: Manuscript in preparation.

Šiame darbe pirmą kartą Lietuvoje kompleksiškai vertinami visuomeninio maitinimo įmonių darbuotojų darbo sąlygos, psichosocialiniai veiksniai bei sveikata. Šis tyrimas galėtų atkreipti atsakingų institucijų dėmesį į sveikatos nusiskundimus susijusius su sveikatos riziką, kurią įtakoja ergonominės, higieninės ir psichosocialinės sąlygos. Tai įgalintų laiku užkirsti kelią profesinių ir neprofesinių ligų išsivystymui. Darbo tikslas - ištirti Kauno miesto visuomeninio maitinimo įmonių darbuotojų (padavėjų, barmenų) darbo sąlygas, veikiančius psichosocialinius veiksnius bei nusiskundimus sveikata, pasiūlyti priemones sveikatos pakenkimų prevencijai. Tyrimo metodika. Tyrimas atliktas 2006 metų birželio – rugpjūčio mėnesiais. Atsitiktine tvarka buvo atrinkta 15 Kauno miesto didžiųjų viešojo maitinimo įmonių. Anoniminės anketinės apklausos būdu ištirta 200 darbuotojų. Atsako dažnis buvo 79,1 proc. Duomenims rinkti buvo naudojami standartizuoto tipo ir negatyvaus elgesio darbe klausimynai. Statistiniams ryšiams įvertinti buvo naudojamas SPSS 12 statistinis paketas. Rezultatai. 67,5 proc. respondentų nurodo, kad jų darbo aplinka yra triukšminga. Viešojo maitinimo įmonių darbuotojai po darbo jaučia fizinį (97,5 proc.) ir psichologinį (93 proc.) nuovargį. 9,5 proc. apklaustųjų patiria psichologinį terorą, 14,0 proc. patiria stresą savo darbo vietoje. Išvados. Respondentai po darbo jaučia fizinį ir psichologinį nuovargį. Viešojo maitinimo įmonių darbuotojai (tiek vyrai, tiek moterys)... [toliau žr. visą tekstą] / This work first time in Lithuania fully analyses working conditions, psychosocial factors and health of public catering companies’ employees. This research should pay attention of responsible institutions to health complaints, involving health risk, which result from ergonomic, hygienic and psychosocial conditions. It could prevent development of professional and non professional diseases. Aim of the study. Analyze working conditions of Kaunas public catering employees (waiters, bartenders), acting psychosocial factors and health complaints; suggest prevention means to health disorders. Methods. The research was carried out in June - August, 2006. 15 public catering companies in Kaunas were randomly chosen. 200 employees were given anonymous questionnaires. Answer response was 79,1 %. We used standard and negative behavior in the work questionnaires to collect the data. To estimate statistical relations we used SPSS 12 statistical packet. Results. 67,5 % of the respondents claim, they have noisy working conditions. Employees of public catering companies feel physical (97,5 %) and psychological (93 %) tiredness. 9,5 % of respondents feel psychological terror, 14,0 % feels stress in their working place. Conclusions. Respondents feel physical and psychological tiredness after work. Employees of public catering companies (both men and women) averagely smoke and use alcohol more often than population in Lithuania. Main health problems are-short sight, headache, cough, sore... [to full text]

Objectives: Dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis has frequently been reported in multiple sclerosis (MS). So far, HPA axis function in MS has predominantly been studied under pharmacological stimulation which is associated with a series of methodological caveats. Knowledge of circadian cortisol patterns and cortisol awakening response (CAR) is still limited. Methods: A total of 77 MS patients (55 relapsing-remitting MS (RRMS)/22 secondary-progressive MS (SPMS)) as well as 34 healthy control (HC) subjects were enrolled. Diurnal cortisol release was assessed by repeated salivary cortisol sampling. Neurological disability was rated by the Kurtzke’s Expanded Disability Status Scale (EDSS). Depressive symptoms and perceived stress were assessed by self-report measures. Results: RRMS but not SPMS patients differed in circadian cortisol release from HC subjects. Differences in cortisol release were restricted to CAR. Treated and treatment naïve RRMS patients did not differ in CAR. In a RRMS follow-up cohort (nine months follow-up), RRMS patients with EDSS progression (≥0.5) expressed a significantly greater CAR compared to HC subjects. RRMS patients with a stable EDSS did not differ from HC subjects. Neither depressive symptoms nor perceived stress ratings were associated with CAR in RRMS patients. In a step-wise regression analysis, EDSS at baseline and CAR were predictive of EDSS at follow-up (R2 = 67%) for RRMS patients. Conclusions: Circadian cortisol release, in particular CAR, shows a course specific pattern with most pronounced release in RRMS. There is also some evidence for greater CAR in RRMS patients with EDSS progression. As a consequence, CAR might be of predictive value in terms of neurological disability in RRMS patients. The possible role of neuroendocrine-immune interactions in MS pathogenesis is further discussed.

The rapid growth of biotechnology has promoted industries to harness the market in the field of human energy systems. A growing literature of research has linked human energy systems to weight loss, major diseases or illnesses. In our modern society, the general public is exposed to everyday stress, which often results in the development of chronic stress. Therefore, stress becomes an important area of medicine. It has been postulated that suppressing these physiological responses may help in disease prevention. Consequently, there is an urge for defining a model integrating stress with the human energy model. Over the past decades, a large amount of research has been put forward in defining the physiological responses or changes when an individual experiences psychological or environmental changes such as interpersonal dysfunction, traumatic experiences and diseases. Interestingly, it reveals that blood glucose fluctuation tends to be the end product of most psychological or physiological stressors. The blood glucose system is one of the major subsystems of the complete metabolic fuel system in humans. In this study, an empirical model and procedure for the derivation of the model due to various psychological influences on the human energy system are presented. This study can be divided into two main sections. An overview of a previously developed unit (ets: equivalent teaspoon sugar) for blood glucose quantification is given in the first section. Stress quantification methods are derived in the second section and a link between these methods and ets is drawn. A verification study of the derived model is also presented in the second section. Stress can be divided into physiological stress and psychological stress. Between the two types of stress, a generalised model based on studies of physiological stress has been drawn and accepted by the public. However, the generalised model does not account for psychological stress. Evidence shows that depending on the specific nature of a stressful circumstance, it can cause different activations of central circuits leading to the release of different neurotransmitters. However, these neurotransmitters have a common effect of increasing blood glucose concentrations. A substantial amount of literature shows that, when stress involves mental effort, epinephrine (EPI) is the main endocrine response. However, stress that does not require mental effort mainly induces cortisol release. The response models for different types of stress were derived using these relations. Furthermore, it is known that prolonged stress may lead to the development of disease. Several studies have used this observation and associated chronic stress with the relative risk factor of cardiovascular disease (CVD). Previously, different quartiles of risk factors for CVD have been related to blood glucose energy and ets expenditure. This link was further utilised to quantify chronic stress in this study. Increases in either of the two endocrine concentrations have been shown to raise the blood glucose level. In order to demonstrate the benefits of applying the ets concept, the cortisol and epinephrine responses were further quantified using the new glucose quantification method, the equivalent teaspoon sugar (ets) concept. The models derived in this study were verified against measured data. The models reveal a strong agreement with the measured data and therefore support the feasibility of these quantification methods. In conclusion, a link does exist between blood glucose energy and stress, and the highly accurate models derived for this association may serve as an adjunct tool for glycaemic control and stress management. / Thesis (Ph.D. (Electronical Engineering))--North-West University, Potchefstroom Campus, 2008.