This is to my knowledge the first time a ten-year follow-up study of salivary cortisol concentrations measured by immunoassays in relation to posttraumatic symptoms according to the Impact of Event Scale (IES) is made. The study was performed on 78 Swedish UN soldiers after a 6-months mission in the former republic of Yugoslavia. Follow-up investigations were performed six months, twelve months and ten years after their return to Sweden. Morning and evening salivary cortisol concentrations were determined by radioimmunoassay (RIA) and enzyme-linked immunoassay (EIA) and subjective posttraumatic avoidance and intrusion symptoms were measured with the IES (see Appendix I).   This study concerns the methodological description of the EIA for determination of salivary cortisol and the comparison of the results from all three follow-up investigations. Post-traumatic stress symptoms according to IES (intrusion subscale and total score) increased significantly over ten years of time. There was an significant interrelationship between the change in both morning and evening salivary cortisol concentrations, measured with immunoassays, and changes in self-rated posttraumatic intrusive symptoms, according to IES, during ten years follow-up, after a six months mission in Bosnia in the way that salivary cortisol concentrations showed a tendency to decrease over ten years of time in subjects with a higher IES score. The rise in morning salivary cortisol, from awakening until 30 minutes later, was significantly correlated with the ratings of posttraumatic stress symptoms according to the IES ten years after the mission.

Fatigue is common in the general population, and is the hallmark of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Although the occurrence of sleep difficulties is known to be common in subjects with fatigue, research on insomnia in such subjects is absent. The current study sought to examine the impact comorbid insomnia has on level of fatigue in subjects with chronic fatigue. The aim of this study is to assess the relationship between insomnia and chronic fatigue, and examine if the relationship is affected by the endocrine activity in the HPA axis. The following hypotheses were tested: 1) Do patients with chronic fatigue and comorbid insomnia experience more fatigue than patients with chronic fatigue without comorbid insomnia? 2) Do patients with chronic fatigue and with initially comorbid insomnia experience more fatigue after treatment than chronic fatigue patients without comorbid insomnia? 3) Do patients with chronic fatigue who experience improvement in insomnia after treatment also experience less fatigue by the end of treatment compared with patients who do not experience improvement in insomnia? 4) Is the potential relationship between insomnia and chronic fatigue influenced by the activity of the HPA axis as expressed by variation in cortisol output measured by Trier Social Stress Test for Groups (TSST-G)? The study sample consisted of 75 patients with chronic fatigue. Thirty-three met criteria for insomnia, while 42 did not. While staying at Hysnes Rehabilitation Center in Trondheim, Norway, they received a work-related Acceptance and Commitment Therapy (ACT) treatment intervention lasting 3.5 weeks. In addition, they participated in a standardized stress test (Trier Social Stress Test) pre- and post-treatment. Saliva cortisol samples were collected during the test in order to measure variation in cortisol output. The current finding is the first description of how insomnia in patients with chronic fatigue is associated with higher levels of fatigue (p < .05). Further, this study gives preliminary support indicating that remission of insomnia in patients with chronic fatigue can significantly reduce levels of fatigue (p < .05), and furthermore improve the physiological stress-response (p < .05). These results might encourage clinicians to assess and provide specific treatment for insomnia in patients with chronic fatigue as this might improve their treatment results. An aim for further research should be to investigate the effect of specified treatment for insomnia in patients with chronic fatigue.

PILEGGI, F.O. Análise do nível do cortisol salivar em crianças portadoras de fimose e tratadas com corticóide tópico. 2008. 60 f. Tese (Doutorado) Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 2008. O tratamento da fimose, apesar de muita controvérsia, tem como primeira escolha o uso de corticóide, topicamente e se realiza a postectomia apenas se existe falha do tratamento clínico. Os bons resultados relatados em diversos trabalhos publicados na literatura médica, desencadeou o uso indiscriminadamente, em vários ciclos, por prolongados períodos, sem orientação correta da higiene prepucial. O uso prolongado do corticóide ocasiona efeitos adversos tanto locais como sistêmicos, e a absorção desse corticóide, utilizado em pequenas dosagens, aplicado topicamente, ainda não foi bem esclarecida. Alguns trabalhos citam a ausência de efeitos adversos locais, alguns estudos mostram a absorção, mas sem estudar a supressão do eixo hipotálamo-hipófise-adrenal (H-H-A) (Kelly, Cains et al., 1991; Golubovic, Milanovic et al., 1996; Yanagisawa, Baba et al., 2000). Para analisar a absorção do corticóide, no tratamento tópico do anel fimótico, 31 crianças foram submetidas à coleta do cortisol salivar basal, às 9h, e em 10 destas crianças realizaram-se coletas às 9h e 23h, a fim de observar o ritmo circadiano e, também, para distinguir cortisol endógeno do exógeno. As dosagens do cortisol salivar variaram de 60 a 3790 ng/dl e não houve diferença (p=0,85), entre o período antes e após o tratamento, porém, apesar do teste estatístico não mostrar diferença, 2 crianças apresentaram supressão do eixo H-H-A, sugerindo que este tratamento não é inócuo. Pode-se então, concluir que o tratamento clínico da fimose, com aplicação de corticóide duas vezes ao dia, durante oito semanas é seguro, desde que a dosagem do cortisol salivar basal seja feito, para se obter um valor de referência, quando o tratamento for repetido ou prolongado por mais que duas semanas e necessitar de um controle. Palavras-chave: fimose, cortisol salivar, corticóide tópico, tratamento conservador, proprionato de clobetasol. / PILEGGI, F.O. Analysis of the level of salivary cortisol in children carryng of phimosis and treated with corticosteroid topical. 2008. 60 f. Thesis (Doctoral) Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 2008. Phimosis has always been the reason of much discussion. Currently, the use of topical steroid is a well established alternative that is indicated in great number of cases. Since good results has been showed in the literature an indiscriminate use of topical steroid has been observed with long and repeated cycles. The local absorption of low doses of topical steroid is still not well understood. Reports in the medical literature show that prolonged use of topical steroid can cause local and/or systemic adverse effects. (Kelly, Cains et al., 1991; Golubovic, Milanovic et al., 1996; Yanagisawa, Baba et al., 2000) Concerned with this, we analysed the absorption of clobetasol in the topical treatment of the phimotic ring. Thirty-one children were submitted to the dosage of salivary cortisol was done prior and after treatment at 9 oclock AM, and in 10 of these children at 9 AM and 11 PM, in order to observe the circadian rhythm and also differentiate endogenous from exogenous cortisol. Salivary cortisol values varied from 60 to 3790 ng/dl no statistical test of Wilcoxon (p=0,82). Although the values of prior and after treatment were similar we cannot state that the treatment is completely harmless due 2 children that presented dosages showing the suppression of axle hypothalamic- hypophysis- adrenal (H-H-A). In conclusion, the clinical treatment of phimosis with topical clobetasol, twice a day during 8 weeks is safe, however we suggest that dosage of cortisol should be done before and during the treatment when a prolonged treatment is proposed. Keywords: phimosis, salivary cortisol, topical corticosteroid, conservative treatment, clobetasol proprionate.

Submitted by (edna.saturno@ufrpe.br) on 2016-10-21T14:59:20Z No. of bitstreams: 1 Raissa Ivna Alquete de Arreguy Baptista.pdf: 2230272 bytes, checksum: cef42ffe53e9331ff98354f138a3b404 (MD5) / Made available in DSpace on 2016-10-21T14:59:20Z (GMT). No. of bitstreams: 1 Raissa Ivna Alquete de Arreguy Baptista.pdf: 2230272 bytes, checksum: cef42ffe53e9331ff98354f138a3b404 (MD5) Previous issue date: 2012-02-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Two articles were made to assessed the behavioral and physiological parameters of pigs housed in individual stalls and metabolism cages. The first article was to evaluate the effects of period (before and during), type of housing (individual stall and metabolic cage) and feeding treatment (T1, T2, T3 and T4) in salivary cortisol concentrations. Was collected from the oral fluid of 16 crossbred pigs [Pietrain x (Large White x Duroc)] castrated males, in early growth stages, with initial average weight of 23.6 ± 6.5 kg and mean age of 63 days. In the period “before”, all animals were housed in individual cages and in the “during” period, half of the animals (n=8) remained in individual pens and the other half (n=8) were transferred to metabolic cages. During this period, the animals began to receive four types of diets with different formulations (T1, T2, T3 and T4). Thereafter, cortisol was measured and analyzed by immuno-assay (EIA). According to the data, the animals showed a circadian pattern with highest values by the morning. There was no significant difference (p>0,05) in salivary cortisol levels in “before” and “during” periods in individual stalls. The animals housed in individual pens, even being feeded with different diets (T2, T3 and T4) did not show cortisol levels consistent with stress. The animals housed in metabolic cages, when feeded with different diets (T2, T3 and T4) may have stress, which can be evidenced by the flattening of the circadian rhythm. In the second article the aim was to evaluate the effects of period (before and during), type of housing (individual stalls and metabolic cage) and feeding treatment (T1, T2, T3 and T4) in the behavior and physiological parameters such as frequency respiratory and surface body temperature for growing pigs. We used 25 crossbred pigs [Pietrain x (Large White x Duroc)], castrated in early growth stages, with a mean age of 63 days. According to the results, the behavior can be modified according to the feeding schedule, type of accommodation, type of treatment and ambient temperature. The respiratory rate is not influenced by the period “before” and “during”, but is influenced by the type of accommodation and type of treatment and ambient temperature and; The surface temperature is influenced by period, by type of accommodation and type of treatment and ambient temperature. / Foram feitos dois artigos que avaliaram o comportamento e os parâmetros fisiológicos de suínos alojados em baias individuais e gaiolas metabólicas. O primeiro artigo teve como objetivo avaliar os efeitos do período (antes e durante), tipo de alojamento (baia individual e gaiola metabólica) e tratamento alimentar (T1, T2, T3 e T4) nas concentrações de cortisol salivar. Foi feita a coleta do fluido oral de 16 suínos mestiços [Pietrain x (Large White x Duroc)], machos castrados, em fase inicial de crescimento, com idade média de 63 dias. No período antes, todos os animais foram alojados em baias individuais e no período durante, metade dos animais (n=8) permaneceu nas baias individuais e a outra metade (n=8) foi transferida para as gaiolas metabólicas. Nesse período os animais passaram a receber quatro tipos de ração com formulações diferentes (T1, T2, T3 e T4). De acordo com os dados, não houve diferença significativa (p>0,05) nos níveis de cortisol salivar entre o período antes e durante, em baias individuais. Os animais alojados em baias individuais, mesmo sendo alimentados com dietas diferentes (T2, T3 e T4) não apresentaram níveis de cortisol compatíveis com estresse. Os animais alojados em gaiolas metabólicas, quando alimentados com dietas diferentes (T2, T3 e T4) podem apresentar estresse, que pode ser evidenciado pelo achatamento do ritmo circadiano. No segundo artigo o objetivo foi avaliar os efeitos do período (antes e durante), tipo de alojamento (baia individual e gaiola metabólica) e tratamento alimentar (T1, T2, T3 e T4) no comportamento e nos parâmetros fisiológicos, tais como a frequência respiratória e temperatura corporal superficial de suínos em crescimento. Foram utilizados 25 suínos mestiços [Pietrain x (Large White x Duroc)], machos castrados, em fase inicial de crescimento, com idade média de 63 dias. De acordo com os resultados, o comportamento pode ser modificado de acordo com os horários de arraçoamento, tipo de alojamento, tipo de tratamento e temperatura ambiental; A frequência respiratória não é influenciada pelo período antes e durante, mas é influenciada pelo tipo de alojamento e tipo de tratamento e temperatura ambiental e; A temperatura superficial é influenciada pelo período, pelo tipo de alojamento e tipo de tratamento e temperatura ambiental.

Fibromyalgia (FM) is a chronic pain syndrome of unknown etiology. It was previously suggested that patients with fibromyalgia were, in early life, often subjected to either psychological or physiological trauma. It is, in general, known that early life experiences and attachment to primary caregivers can influence physiological function in adult life, especially those functions related to stress vulnerability. Many studies have been performed on fibromyalgia patients but most of them investigated either psychological or physiological aspects. The purpose of this study was to investigate the psychological profile (attachment style, preferred way of thinking as well as prevalence of depression and anxiety) and physiological aspects (autonomic nervous system function and cortisol levels) simultaneously in an attempt to see whether a link exists between the two aspects and whether a specific psychoneurological profile could be discerned for fibromyalgia patients. Sixteen patients (14 females, 2 males) with fibromyalgia, and 15 age- and sex-matched controls (13 females, 2 males) were studied. Patients were diagnosed according to the American College of Rheumatology (ACR, 1990) criteria for fibromyalgia. The Patient Health Questionnaire gathered information on the patient’s past health problems, operations, accidents and the prevalence of traumatic events. The Fibromyalgia Impact Questionnaire and Review of Current Symptoms Questionnaire were completed to assess the severity of the disorder. The Experiences in Close Relationships – Revised Questionnaire determined attachment styles. Hemisphere dominance (preferred way of thinking) was evaluated by the Herrmann Brain Dominance Instrument (HBDI), heart rate variability (HRV) by recording R-R intervals and calculating time and frequency domain parameters and salivary cortisol levels by ELISA. Significant differences were seen between patients and controls for cortisol levels; the total number of symptoms; the number of adverse events in lifetime; anxiety and avoidance subscales of the ECR-R; FIQ total scores; and scores for scales within the FIQ. R-R spectral analysis revealed distinct lowered overall HRV in patients. An orthostatic test revealed a weakened shift towards sympathetic dominance upon standing. During a psychological stressor (filling out the ECR-R), the patients’ autonomic nervous system failed to respond with lower HRV as with the controls. As far as the hemispheric dominance of the patients was concerned, the majority appeared to be right-brain orientated with thinking styles preferences strongly influenced by limbic functions. Preference for thinking styles influenced by right limbic structures increased during stress. A link existed between anxiety and depression and the severity of the fibromyalgia symptoms. The results of individual psychological and physiological parameters found in this study are largely in concordance of that of other studies. Significant differences exist between the psychoneurological variables of fibromyalgia patients and healthy controls: The patient group in this study were characterised by a high prevalence adverse events, insecure attachment styles, high emotionality in the absence of rationality, multiple somatic symptoms, and altered stress-axes activity reflected in low HRV, an inability to mount an appropriate sympathetic response to acute stressors and elevated baseline cortisol levels. It can be concluded that fibromyalgia patients in the present study presented with a distinct psychoneurological profile. / Dissertation (MSc (Physiology))--University of Pretoria, 2007. / Physiology / unrestricted

Social anxiety disorder (SAD) is one of the most common anxiety disorders and understanding its symptoms and risk factors is vital for developing treatments and prevention strategies. Atypical physiological responses have been observed in anxious individuals and their consequences present a human and economic burden. This dissertation includes two studies that explore the subjective and physiological responses to an acute stress in the context of treatment and risk factors for SAD. The goal of the first study was to examine whether cognitive behavioural group therapy (CBGT) and a mindfulness-based stress reduction (MBSR) program differentially influenced the subjective and physiological response to a speech task. Participants in the treatment groups performed two speech tasks, before and after treatment, while a healthy control group completed it only once. Results indicated significant differences for the subjective, but not the physiological measures of stress. Patients with SAD reported higher subjective anxiety than the healthy control group and these scores were significantly reduced following treatment. Greater improvements were noted in the CBGT group; nonetheless, the study did indicate promising results for MBSR. The second study aimed to explore the effects of behavioural inhibition (BI), parental bonding variables and their interaction on the subjective and physiological responses to a similar speech task in healthy children. BI was related to subjective anxiety in a predictive manner, but was generally unrelated to the physiological measures. Parental bonding variables were not related to any of the stress responses and no interaction between BI and parental bonding was observed. These studies contribute to the literature by demonstrating treatment differences and their subjective and physiological consequences on stress reactions and exploring the extent to which risk factors for SAD affect the stress response in healthy children.

La restriction des apports alimentaires est une méthode couramment utilisée pour perdre du poids dans les sports à catégories de poids. La réduction des apports caloriques se traduit par une activation des systèmes physiologiques du stress, au niveau central et périphérique, visant à préserver l’homéostasie énergétique. Néanmoins, l’influence sur les paramètres physiologiques, psychologiques et physiques reste controversée et ne permet pas de définir clairement un impact négatif de la restriction alimentaire sur la santé et le niveau de performance. L’objectif de ce travail était d’évaluer l’influence d’une restriction alimentaire sur les indicateurs psychophysiologiques du stress, ainsi que le niveau de performance chez des haltérophiles de haut niveau. Nos résultats ont montré que la restriction alimentaire ne modifiait pas le niveau de performance en haltérophilie, mais induisait une altération des paramètres psychologiques. La période de restriction alimentaire se traduisait par une dissociation de l’activité des systèmes physiologiques du stress, ainsi qu’une modification des réponses hormonales à une compétition simulée d’haltérophilie. Il reste à définir les répercussions à long terme de l’altération des paramètres psychophysiologiques sur la santé et la capacité de performance du sportif. Il serait également intéressant d'étudier l'influence de la restriction alimentaire sur le microbiote intestinal et les répercussions éventuelles sur l'axe intestin-cerveau. / Restricting dietary intake is a widespread method for losing weight in weight categories sports. Reduction of calorie intake results in an activation of the physiological stress systems, both at central and peripheral levels, aiming at preserving energy homeostasis. Nevertheless, the influence on physiological, psychological and physical parameters remains controversial and do not allows to clearly defining a negative impact of dietary restriction on health and performance level. The objective of this study was to evaluate the influence of a dietary restriction period on the psychophysiological indicators of stress, as well as the level of performance in high-level weightlifters. Our results showed that dietary restriction did not modify weightlifting performance level, but resulted in an alteration of the psychological parameters. The dietary restriction period resulted in a dissociation of the activity of the physiological stress systems, as well as a modification of the hormonal responses to a simulated weightlifting competition. It remains to define the long-term impacts of the alteration of psychophysiological parameters on the athlete’s health and performance capacity. It would also be interesting to evaluate the influence of dietary restriction on intestinal microbiota and the possible influence on the gut-brain axis.

La schizophrénie est un trouble psychiatrique répandu qui affecte grandement la vie de l’individu touché. Même si certains facteurs ont été identifiés comme causes de cette maladie, notamment des facteurs génétiques, ceux-ci n’expliquent pas entièrement les bases biologiques qui la sous- tendent. Certaines causes infectieuses ont été soulevées, dont la « toxoplasmose ». Celle-ci réfère à une infection par un parasite, Toxoplasma gondii (TG), qui touche environ le tiers de la population humaine mondiale. Des études animales ont montré que ce parasite peut manipuler le comportement de son hôte en menant à une diminution de la peur et à une augmentation de la prise de risque. Les résultats d’autres études portent à croire que ces types de comportements pourraient également être affectés par ce parasite chez l’humain, et ce, peut-être de manière plus importante chez les personnes souffrant de schizophrénie. La peur et la prise de risque étant toutes deux fortement associées aux réponses de stress, nous avons émis l’hypothèse que TG pourrait être relié à des différences au niveau de la réponse de stress chez l’humain, particulièrement chez la personne souffrant de schizophrénie. Nous avons testé si les biomarqueurs de stress (cortisol salivaire et des cheveux) diffèrent chez des personnes avec un diagnostic de schizophrénie et des contrôles en fonction de l’infection par TG. Nous avons aussi vérifié si TG était relié à des symptômes psychotiques spécifiques et/ou à de l’impulsivité (comme marqueur proxy des comportements de prise de risque). Dans cette étude, nous avons utilisé des échantillons de sang, de salive et de cheveux pour mesurer les anticorps TG, les niveaux de cortisol circulant et la sécrétion de cortisol à long terme, respectivement. Les résultats montrent que les personnes avec une schizophrénie infectées par TG présentent des concentrations de cortisol des cheveux significativement plus élevées que les personnes avec une schizophrénie non infectées, un effet qui n'a pas été trouvé chez les participants contrôles. Aucune différence de cortisol salivaire n'a été observée entre les participants infectés par TG et non infectés, autant dans le groupe schizophrène que contrôle. De plus, il n'y a aucune association entre TG et les symptômes psychotiques positifs ou entre TG et l'impulsivité. Ces résultats suggèrent que l’infection par TG est associée à des différences dans la production de cortisol à long terme chez les personnes avec une schizophrénie, mais pas dans la sécrétion de cortisol à court terme. / Schizophrenia is an important psychiatric disorder that greatly affects the life of the affected individual. Although some factors have been identified as causes of this disease, including genetic factors, these do not fully explain the biological basis behind it. Some infectious causes have been raised, including the “toxoplasmosis”. It refers to an infection by a parasite, Toxoplasma gondii (TG), which affects approximately one third of the world's human population. Animal studies have shown that this parasite can manipulate its host's behavior leading to decreased fear and increased risk taking. The results of other studies suggest that these types of behaviors could also be affected by this parasite in humans, and perhaps to a greater extent in people with schizophrenia. Since fear and risk-taking are both strongly associated with stress responses, we hypothesized that TG might be related to differences in the stress response in humans, particularly in people suffering from schizophrenia. We tested whether stress biomarkers (salivary and hair cortisol) differ in people with schizophrenia and controls depending on TG infection. We also checked whether TG was related to specific psychotic symptoms and/or impulsivity (as a proxy marker of risk-taking behaviors). In this study, we used blood, saliva, and hair samples to measure TG antibodies, circulating cortisol levels, and long-term cortisol secretion, respectively. Results show that TG-infected people with schizophrenia had significantly higher hair cortisol concentrations than uninfected people with schizophrenia, an effect that was not found in control participants. No difference in salivary cortisol was observed between TG- infected and uninfected participants, neither in the schizophrenic group nor in the control group. Moreover, there was no association between TG and positive psychotic symptoms or between TG and impulsivity. These results suggests that TG infection is linked to differences in long-term cortisol secretion in people with schizophrenia, but not in short-term cortisol secretion.

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.

O objetivo deste trabalho foi avaliar o efeito do estresse, provocada pela presença de espectadores participativos, no controle motor O estresse foi avaliado através de medidas fisiológicas (frequência cardíaca e cortisol salivar). Em cada teste a tela do computador apresentava de início um pequeno círculo central (diâmetro de 0,4 cm), um segundo círculo do mesmo tamanho, situado cerca de 6,3 cm verticalmente abaixo do circulo central e um terceiro círculo, na parte superior da tela, cerca de 4,1cm verticalmente acima do círculo central. Os três círculos representam, respectivamente, a bola, o cobrador do pênalti e o goleiro A tarefa do voluntário era inclinar uma alavanca no exato momento do contato, e se possível na direção oposta à movimentação do goleiro. Na situação com estresse, o índice de erro ficou por volta de 25% Tanto a frequência cardíaca quanto o cortisol salivar apresentaram aumento estatisticamente significativo na presença de torcida. O estresse parece exercer uma influência negativa na tomada de decisão na execução de um movimento / The aim of this study was to evaluate the effect of stress, caused by the presence of participative audience ,in the motor control. Stress was assessed by physiological measurements (heart rate and salivary cortisol). In each test the computer screen showed only a relatively small central circle (diameter 0.4 cm), a second circle the same size, located about 6.3 cm vertically below the central circle and a third circle on top the screen, about 4.1 cm vertically above the center circle. The three circles represent, respectively, the \"ball\", the \"kicker\" of the penalty and the \"keeper\". The task of the volunteer was tilting lever at the precise moment of contact, and if possible in the opposite direction to the movement of the goalkeeper. In the situation with stress, the error rate was around 25%.. Both the heart rate as salivary cortisol showed a statistically significant increase in the presence of spectators. The stress seems to exert a negative influence on decision making in the execution of a movement.