Prostate cancer is the most commonly diagnosed cancer and second leading cause of death in American men. Patients with localized prostate cancer may experience unique and multidimensional symptoms that are distressful from treatment and thereafter. This cross-sectional correlational study aimed to investigate the relationships among stress, symptoms, symptom distress, and symptom self-management and identify the effective strategies of symptom self-management in men with localized prostate cancer following prostatectomy or radiation therapy.Eight saliva samples and 3 questionnaires (Perceived Stress Scale, Symptom Indexes, and Strategy and Effectiveness of Symptom Self-Management) were obtained from each participant between 1 and 3 months following their first prostate cancer treatment. The sample consisted of 53 men with localized prostate cancer. Mean salivary cortisol concentrations for the entire sample ranged from 0.3 to 0.08 ug/dL. Cortisol was secreted in a circadian rhythm with heightened activity in the early morning and lowered activity late in the day. The circadian pattern of cortisol secretion was similar in both the prostatectomy and radiation therapy groups, although the values were slightly different. Two areas Under the Curve (AUC) of salivary cortisol were calculated. Three cortisol circadian rhythms were identified, but the majority of the sample had a typical negative consistent circadian rhythm.Patients with localized prostate cancer who underwent radical prostatectomy or radiation therapy had low perceived stress. Perceived stress was positively correlated with AUCg, noon salivary cortisol concentrations, and afternoon salivary cortisol concentrations. Subjects reported a moderate degree of symptoms and symptom distress on urinary, bowel, and sexual dysfunction 1-3 months following treatments. The most effective strategies of urinary symptom management were pad and kegel exercise; the most effective strategy of bowel symptom management was rest or endure; the most effective strategies of sexual dysfunction management included express their feelings or find alternative ways to express their affection. The symptom self-management strategies were significantly and positively correlated with symptom self-management effectiveness.Symptom distress and AUCg were significant and strong predictors of symptom self-management. Findings can help health care providers develop effective strategies for symptom self-management that enhance health related quality of life among men with localized prostate cancer.

Past research indicates that social rejection predicts a wide range of psychological problems (e.g., depression), but laboratory studies examining self-reports of negative affect after social rejection have reported inconsistent results. Salivary cortisol was measured before and after a social rejection/acceptance manipulation for objective assessment of psychological distress subsequent to peer rejection. Rejected participants were predicted to show significantly greater salivary cortisol than accepted or control participants. The present research also examined several factors that may moderate the relationship between acute rejection and cortisol. As predicted, rejected participants exhibited significantly higher cortisol than accepted or control participants. Defensiveness moderated the relationship between rejection and cortisol; highly defensive rejected participants showed significantly lower cortisol than less defensive rejected participants after peer rejection. Results indicate that social rejection causes psychological distress, but highly defensive individuals appear to be less susceptible than less defensive individuals to increases in salivary cortisol after acute social rejection.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18908号 / 人健博第22号 / 新制||人健||2(附属図書館) / 31859 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 菅沼 信彦, 教授 鈴木 眞知子, 教授 中原 俊隆 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

This study examined links of cumulative and present depressive symptoms with present cortisol diurnal profiles in oldest-old adults. Five waves of data from 50 older adults (M age = 89.05 years; 64% women) who participated in the Australian Longitudinal Study of Ageing were used to combine 15 years of longitudinal data with seven cortisol samples per day over a one-week period. Findings revealed that individuals with more past depressive symptoms showed a lower cortisol awakening response (CAR). Interestingly, present depressive symptoms were not associated with the CAR. These findings inform our understanding of distal health factors in very old age.

The study of stress is limited in professional nursing, but it is nearly non-existent in professional military nursing. The purpose of this study was to explore the relationships among psychological, environmental, biological and demographic factors of stress in new Army nurses during the Army Medical Department’s 8-week Officer Basic Leadership Course (OBLC). Using a descriptive prospective, correlational repeated measures design, 33 study participants completed two psychological stress measures (Perceived Stress Scale [PSS] and the Impact of Event Scale – Revised[IES-R]), an environmental measure (Life Experiences Survey [LES]), a biologic measure (salivary cortisol) and a demographic questionnaire at three different time points during OBLC: at the beginning of OBLC, during the field training exercise and at the end of OBLC. The majority of participants were single, Caucasian females under 30 years of age with no RN experience and no deployment experience. No significant gender differences were detected among study variables. A simple (single-group) repeated measures analysis of the PSS scores, IES-R scores, and salivary cortisol was conducted using the LES score as a covariate. While the PSS scores and salivary cortisol levels did not change significantly over time, the IES-R score did change significantly over time (p = 0.001). The environmental factor (LES score) was not significant as a covariate in any of the three models. The unique baseline findings in this study may provide a springboard for further studies in stress particularly with military nurses who will eventually be deployed and experience a variety of stressful events. Longitudinal research could yield important predictive information related to how the stress response evolves over the course of one’s military career which may include frequent deployments to the combat zone.

The purpose of this study was to examine whether physical activity status of healthy adult males (N = 59) while in a coping strategy condition (association, disassociation, or control) influences psychophysiological responses to an acute painful stimulus. Measures of pain tolerance, state anxiety, body awareness, and salivary cortisol were investigated. Results indicated no significant differences between physical activity groups for pain tolerance, stress responses (i.e., self-reported state anxiety and cortisol levels), or body awareness. Though, those who indicated using a disassociation coping technique during the exit interview tolerated the acute, surface pain longer. More research is required to further understand the effects of physical activity and coping strategies on pain perception and psychophysiological responses.

Doctor of Philosophy / Department of Human Ecology-Personal Financial Planning / Sonya L. Britt / There is limited research on physiological stress in the financial planning field. While the literature shows a clear relationship between physiological stress and physical health, little is known about the relationship between physiological stress and financial health perceptions. With Lazarus and Folkman’s (1984) theory of cognitive appraisal serving as the framework for this study, three multivariate regressions investigated the relationship between chronic physiological stress and financial health perceptions as measured by changes in financial satisfaction, changes in financial strain, and expectations about one’s financial situation in the future. The sample consisted of 703 individuals that were recruited from 2011-2014 to participate in the Midlife in the United States Refresher study. Based on non-imputed data, respondents were evenly split between male and female and between 25 and 76 years old with a mean age of 51 years old. Respondents were also mostly white, working, married, and had some college education. The sample reported mean household income of $71,052 and a net worth of $586,329. The mean salivary cortisol level was 16.06 Nanomoles per litre (nmol/L), and respondents reported better than the median score for self-reported health status. When comparing before the recession to present day, the mean responses from respondents indicated that their financial strain remained about the same, but financial satisfaction declined. Respondents reported better than the median score for expectations about their financial future. An ordinary least squares regression was used to model changes in financial satisfaction. A cumulative logistic regression was used to model changes in financial strain and expectations about one’s future financial situation. The model results provided support for several key hypotheses formed from the theoretical framework. In particular, salivary cortisol, the proxy for chronic physiological stress, had a statistically significant negative relationship with expectations about one’s future financial situation. An increase in chronic physiological stress was associated with lower expectations about the financial future. There was not a statistically significant relationship between salivary cortisol and changes in financial satisfaction or changes in financial strain. Given the sparse physiological stress research that exists in the financial planning field, this study provides researchers and practitioners with new information regarding the impact of chronic physiological stress on financial health perceptions. Measuring physiological stress in a non-experimental setting gives researchers a different approach to understanding the impacts of physiological stress. For practitioners, uncovering the relationship between chronic physiological stress and financial health perceptions might promote the use of stress reductions as part of holistic approach to financial planning.

A ansiedade ao atendimento odontológico, apesar do aprimoramento das técnicas e dos materiais, ainda é freqüente em pacientes de urgência. O objetivo deste trabalho foi relacionar ansiedade ao tratamento odontológico à concentração de cortisol salivar de pacientes em atendimento de urgência odontológica, com e sem queixa de dor. Foram entrevistados 73 pacientes entre 18 a 76 anos (média 38,22 anos) que compareceram ao Setor de Urgência Odontológica da Faculdade de Odontologia da Universidade de São Paulo (SUO-FOUSP), e coletadas amostras de saliva para mensuração do cortisol salivar antes do atendimento. A ansiedade foi medida através da Modified Dental Anxiety Scale (MDAS) e a intensidade da dor através da escala visual analógica (VAS). Foram classificados como ansiosos 30 participantes e 41 relataram dor. Os ansiosos relataram maior vivência de eventos traumatizantes (p<0,05), relacionados aos procedimentos mais invasivos. Não houve relação entre ansiedade e concentração de cortisol salivar. Entre os gêneros, só houve diferença no grupo dos não ansiosos (p<0,05). Pacientes não ansiosas independente da dor apresentavam menor concentração de cortisol que seus pares. Pacientes com dor eram mais jovens e apresentavam maior concentração de cortisol salivar (p<0,05). A concentração de cortisol aumentou com a intensidade da dor medida pela VAS. Houve diferença nos níveis de cortisol entre ansiosos com e sem dor (p<0,05), entre não ansiosos com dor e ansiosos sem dor (p<0,05) e entre os não ansiosos com e sem dor (p<0,05). Apesar da ansiedade ao tratamento odontológico ter efeito sobre os níveis de cortisol salivar, a dor desencadeia maior liberação do hormônio. / Dental anxiety is still prevalent in patients undergoing urgency attendance, despite technical and materials improvements. The purpose of this study was to determine the relationship between dental anxiety and salivary cortisol concentrations in urgency patients in Setor de Urgência Odontológica da Faculdade de Odontologia da Universidade de São Paulo (SUO-FOUSP).The mean age of participants was 38,22 years (range 18 to 76). 73 patients completed a questionnaire including the Modified Dental Anxiety Scale (MDAS) and provided a saliva sample prior to attendance. Pain intensity was assessed by a visual analogue scale (VAS). Among the participants 30 were dentally anxious and 41 had a pain complaint. There were no differences in gender and age between anxious and non anxious patients. Anxious patients reported more aversive experiences (p<0,05), mainly related to surgical and anesthetic procedures. There was no relationship between dental anxiety and salivary cortisol concentration. There was a difference between gender only in non anxious group (p<0,05). Non anxious female patients had lower concentration than their counterparts. Patients with pain complaint were younger and showed higher salivary cortisol concentrations (p<0,05). Salivary cortisol concentration increased with pain intensity measured by VAS, but there was no difference between the extremes (VAS until 10mm e VAS up to de 91mm). There was a statistical difference in salivary cortisol levels between anxious patients with and without pain (p<0,05), between non anxious patients with pain and anxious patients without pain (p<0,05) and between non anxious patients with and without pain (p<0,05). Although dental anxiety induces stress, pain was a stronger stimulus for increases in salivary cortisol concentration.

O presente projeto levantou uma discussão a respeito das condições psicológicas, fisiológicas e éticas pelas quais passam os cães de trabalho da Polícia Militar, com foco em investigar se a rotina de trabalho leva a condições de estresse e a influência desses fatores no desempenho reprodutivo e na qualidade de vida dos animais. O estudo foi realizado no Canil da Polícia Militar de Campinas, com a participação de oito cães machos de quatro diferentes raças (2 Pastor Alemão, 2 Belga Malinois, 2 Dobermann e 2 Rotwailler), sendo divididos em dois períodos: Período trabalho - animais que estavam em treinamento e trabalho e Período controle - animais que estavam no dia de descanso. Foram colhidas amostras de saliva para a dosagem de cortisol no método de eletroquimioluminescência, fez-se a observação comportamental através da elaboração e analise de um etograma de trabalho e houve a coleta e análise de sêmen. Os resultados mostraram concentrações médias de cortisol salivar no Período Controle de 0,361 à 0,438&micro;g/dl e no Período trabalho 0,312 à 0,592 &micro;g/dl, sendo os maiores valores encontrados após o retorno do trabalho. Nas avaliações de comportamento observamos que na maior parte do período, os animais apresentaram-se em repouso e poucos comportamentos estereotipados foram destacados e as raças Pastor Alemão, Belga Malinois e Dobermann apresentaram parâmetros seminais desejáveis. A raça Rotwailler apresentou cortisol elevado, comportamentos estereotipados e maior taxa de anormalidades espermáticas, portanto acreditamos que não seja a raça mais indicada para os trabalhos desenvolvidos pelas polícias Nosso estudo indica que os cães de trabalho avaliados adaptados ao ambiente desde filhote, apresentam boa capacidade de adaptação ao ambiente de confinamento rotina de trabalho e treinamento, uma vez que não sofrem distresse. / This project raised a discussion about the psychological and ethical conditions under which pass the military working dogs, on investigating whether routine work leads to stress conditions and the influence of these factors on reproductive performance and quality of animals life. The study was conducted at military police Kennel in Campinas, using 8 male dogs of 4 different races (2 German Shepherd, 2 Belgian Malinois, 2 Dobermann and 2 Rotwailler), divided into two periods: Period work - animals that were in training and work and control period - animals that were in day off. Saliva samples were collected for cortisol measurement in eletroquimioluminecence method, behavioral observation through the preparation and analysis of a ethogram and collection and analysis semen. Our results showed average concentrations of salivary cortisol in the control period of 0.361 to 0.438 and 0.312 to 0.592 working period, with the highest values found after returning from work. In behavioral assessments we observed that in most of the period, the animals showed up at rest and few stereotyped behaviors were highlighted and. The breeds German Shepherd, Belgian Malinois and Dobermann showed desirable semen parameters, which did not occur in Rotwailler. The Rotwailler breed had high cortisol, stereotyped behaviors and higher rate of sperm abnormalities, so we believe that it is not the most suitable breed for the military working dog. Our study indicates that the assessed working dogs adapted to the environment as a puppy, show good ability to adaptation to environmental containment routine work and training, since it does not suffer distress.

Orientador: Agnaldo Lopes da Silva Filho / Resumo: Introdução: Anualmente milhões de mulheres em todo o mundo são rastreadas para câncer de mama, sendo que algumas delas serão submetidas a procedimentos adicionais, entre eles a biópsia mamária. A biópsia de fragmento (core biopsy) guiada por ultrassonografia é um método minimamente invasivo para o diagnóstico de lesões mamárias suspeitas, e possui inúmeras vantagens quando comparada às biópsias cirúrgicas. A core biopsy é um procedimento ambulatorial no qual raramente é necessário o uso de medicações analgésicas após o procedimento. No entanto, qualquer procedimento invasivo, por menor que seja, vem acompanhado de experiências de ansiedade, dor e medo do desconhecido. A Medicina Anti-Estresse entende que os pensamentos, sentimentos, níveis de ansiedade e capacidade de lidar com eventos estressores podem afetar a saúde e a percepção de saúde. Programas de Medicina Anti Estresse reduzem o estresse e auxiliam os praticantes a terem atitudes positivas em seu cotidiano. O objetivo deste estudo controlado e randomizado foi avaliar o impacto das intervenções baseadas em Mindfulness (MBIs) em parâmetros quantitativos e qualitativos de estresse em pacientes submetidas a biópsias de mama guiadas por imagem. Métodos: Após assinarem o consentimento informado, 82 mulheres com indicação de biópsia de mama guiada por imagem foram randomizadas em dois grupos: grupo MBI ou grupo controle de cuidados padrão. Na semana anterior à biópsia, minutos antes na sala de espera e durante o procedimento... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Each year worldwide millions of women are screened for breast cancer and some of them will undergo additional investigations, including breast biopsy. Ultrasound guided core needle biopsy is a minimally invasive method for the diagnosis of suspected mammary lesions and has many advantages when compared to surgical biopsies. Core biopsy is an outpatient procedure and analgesic medication is rarely necessary after tissue removal. Nevertheless, any invasive procedure, however small it may be, is accompanied by experiences of anxiety, pain and fear of the unknown. Anti Stress Medicine recognizes that thoughts, feelings, levels of anxiety, and ability to cope with stressful events can affect health and health perception. Anti-Stress Medicine programs reduce stress and help practitioners to have positive attitudes in their daily lives. The purpose of this randomized controlled trial was to evaluate the impact of Mindfulness-based interventions (MBIs) on quantitative and qualitative stress parameters on patients undergoing imaging-guided breast biopsies. Methods: After giving informed consent, 82 women that needed percutaneous imaging-guided breast biopsy were randomized into two groups: MBI group or standard care control group. One week before the biopsy procedure, minutes prior to the biopsy procedure on the waiting room and during the biopsy procedure, the MBI group was exposed to audio guided meditations and relaxing music and the standard care control group receiv... (Complete abstract click electronic access below) / Doutor