Average Stress Score Research Articles

STRESS IN FEMALE MEDICAL DOCTORS

In present era stress remains a favorite subject of research especially in medicalprofession because with high competitive roles and responsibilities, this profession serves theneed of mankind. Objective: Assessment of professional stress in female medical doctorsemployed at different tertiary care hospitals of Karachi, Pakistan. Study Design: The crosssectionalnon-experimental survey. Setting: Different tertiary care hospitals of Karachi. Period:November, 2012 to July, 2013. Methodology: Internationally validated and standardizedquestionnaire was used as survey tool for present research. It was distributed to total twohundred and twenty eight 228 female medical doctors. Results: Total 191 respondents filledthe research survey. 64.39% were MBBS, 20.42% were BDS and 15.18% were postgraduaterespondents. Cronbach’s alpha was 73.60%. Mean age of respondents was 29.32 ± 6.96years, average stress score was 12.09 ± 4.33 with average years of experience were 4.58 ±5.57 years. Stress scores on the basis of demographic variables like age groups, experience,qualification and marital status showed average scores in range between10-12 units. However,high frequency of respondents scored moderate to severe stress when probed on the basis oflevels of stress they have possess. Categorizing the equation for stress scores observed in thepresent survey as, MBBS respondents showed more stress units i.e., 12.50, BDS doctors havehad 11.50 units stress and postgraduate respondents had 10 units stress scores. Conclusions:Results concluded that stress in female medical professionals is never underestimated as itis clearly indicated through present survey that all female respondents possess average jobstress which need to address.

Mobile phone-based education and counseling to reduce stress among patients with diabetes mellitus attending a tertiary care hospital of India.

Background:Stress among diabetic patients is much more as compared to normal individuals. A delayed recognition of stress undoubtedly worsens the prognosis for survival for many diabetic patients. Hence, this study was planned to develop an intervention model for the reduction of stress among diabetic patients and to evaluate the developed intervention model in the proposed group.Methods:This study was conducted in endocrinology outpatient department of a tertiary care hospital. Starting at random, the patients were allocated to control group and test group. Controls were given printed educational materials. Test group were counseled with intense lifestyle education using both printed materials and computers; they were contacted by telephones by the investigator every 3 weeks for 3 months and SMS were sent every week containing some educational tips.Results:Mean age was 54 ± 11.5 years overall ranging from 30 years to 80 years. About two-third of participants were males with similar distribution in both the groups (intervention = 66%, control = 64%). Half (50%) of the participants lived in joint families, followed by nuclear families (40%). Most (83%) were married and with either graduate or above graduate education (n = 39%). No significant difference was observed in socio-demographic characteristics among both control and intervention groups (P > 0.05). The average stress scores were similar (18.9) at baseline for control and intervention arms. At 3-month follow-up, however, these scores reduced to 17.05 in the intervention arm while they increased to 20.7 in the control arm. At 3 months follow-up, higher proportion of stress reduction was seen in the intervention group.Conclusions:Intervention in the form of intensive lifestyle education and phone calls and SMS significantly decrease their stress score. Mobile-based education has great potential to improve their mental status and increase patient-provider communication, and to decrease stress.

Parental stress: a study from a pediatric intensive care unit in Mangalore

Background: Pediatric intensive care unit (PICU) is a highly stressful environment to most parents. Knowledge of stress allows us to plan counselling strategies for the suffering parents. The objectives were to identify common parental stressors during their child’s critical illness and to examine the relationship of demographic variables with their stress.Methods: It was a prospective observational study done in PICU of a tertiary care medical college hospital in Mangalore. One hundred parents of children (1 month to 15 years) admitted to PICU for at least 24 hours were interviewed using the Parental Stress Scale (PSS: PICU), which rates 22 factors on a scale from 1 (not stressful) to 5 (extremely stressful). The demographic and clinical characteristics of children were also recorded and analysed statistically.Results: The average parental stress score was 3.5. The main causes of extremely stressful situations were the sight of their child being unresponsive, sight of monitors & equipment in PICU, other sick children in PICU, crises in other children in the PICU. Parents of children who got admitted in PICU for the first time were more stressed. Younger parents were more stressed than older parents, irrespective of the illness and clinical status. Age of the child, sex, socioeconomic status, urban/rural, father/mother did not vary stress levels, all had similar stress level (score>3). Among the procedures, majority (52%) parents felt intravenous cannulation as more stressful followed by blood sampling (43%).Conclusions: Young parents and first PICU admission were more stressful. Socioeconomic status, residential area and age of children did not affect level of stress. Many of these stress factors can be looked into and remedial steps can be taken to relieve some of these stressors.

A cross-sectional study assessing the relation between stress and chronic periodontitis in state transport employees in the city of Pune

Background and Objective: The aim of this study was to assess the association between Stress and Chronic Periodontitis in the Pune Mahanagar Parivahan Mahamandal Limited (PMPML) workers in Pune city, in the State of Maharashtra, India. Study Design: In this cross-sectional study, 1014 PMPML workers were examined for periodontal parameters and were given questionnaires to fill. The workers were broadly categorized as bus drivers (Group I), bus conductors (Group II), and office bearers/workers (Group III). Subjects and Methods: The clinical parameters such as the plaque index (PI), gingival index (GI), probing depth, gingival recession, and clinical attachment levels (CALs) were recorded. Stress was measured by using the occupational stress index. Results: The average PI, GI, probing depth(PD), gingival recession, CAL and stress score was significantly higher among bus drivers (Group I) and bus conductors (Group II) when compared to office bearers/workers (Group III), but did not differ significantly between bus drivers (Group I) and bus conductors (Group II). None of the periodontal parameters correlated significantly with stress levels in the group of office bearers/workers (Group III), whereas all periodontal parameters positively and significantly correlated with stress levels in bus drivers (Group I) and bus conductors (Group II). Conclusion: Stress can be a risk factor for chronic periodontitis because stress alters the immunity of an individual. Furthermore, the person's behavioral changes lead to altered oral hygiene habits, thus causing the accumulation of plaque. Hence, if good oral hygiene is combined with regular periodontal check-ups, it can drastically reduce the effects of stress on the periodontium.

농촌과 도시 중학생의 카페인 함유 기호식품에 대한 인식 및 섭취실태 비교

This study was conducted to identify middle school students' caffeine intake from their favorite foods containing caffeine as well as several factors related to their intake. The objects of the investigation were 369 middle school students in the urban area of Changwon-si and 358 middle school students in the rural area of Haman-gun. The average height was 162.3cm, average weight was 52.3 kg and average BMI was 19.8. The food habit score was generally positive at an average of 3.37. The food habit scores of rural area students were higher than those of urban area students (p<.05). The average stress score was somewhat low at 2.82. The stress index for rural students was lower than that of urban students (p<.01). The recognition of caffeine in favorite foods was 8.12 out of a 12 point scale. The average nutritional knowledge score regarding caffeine was very low at 3.08 out of a 10 point scale. The main reason for selecting favorite foods was 'taste'. The percentage of students who don't check food labels was 49.1%. 'House' was the main location while 'good taste' was the biggest reason for eating caffeine-containing foods. The main side effect of caffeine intake was 'nausea'. The average daily caffeine intake for all subjects was 26.96 mg, with the urban students averaging 27.90 mg and the rural students averaging 25.99 mg. The correlations between several factors and caffeine intake were examined. Food habit showed a negative correlation with stress score and caffeine intake. Nutritional knowledge and recognition of caffeine had positive correlations with caffeine intake. Hence nutritional education about caffeine should be emphasized to improve students' healthy food habits.

Higher stress scores for female medical students measured by the Kessler Psychological Distress Scale (K10) in Pakistan.

The aim of this study was to determine the stress level of medical students and the relationship between stress and academic year. A cross-sectional, descriptive study was conducted at an undergraduate medical school with a five-year curriculum, in Pakistan, from January 2014 to April 2014. Medical students in the first four years were included in the study. The Kessler Psychological Distress Scale (K10), a self-administered questionnaire, was distributed to the students. A total of 445 medical students completed the questionnaire. The average stress score was 19.61 (SD=6.76) with a range from 10 to 43. Stress was experienced by 169 students (41.7%). The scores of female students were higher than scores of males, indicating a higher stress level (P=0.011). The relationship between stress and academic year was insignificant (P=0.392).

Individual variation in temporal relationships between stress and functional somatic symptoms

ObjectiveMedically unexplained or functional somatic symptoms (FSSs) constitute a major health problem because of their high prevalence and the suffering and disability they cause. Psychosocial stress is widely believed to be a precipitating or perpetuating factor, yet there is little empirical evidence to support this notion. Prior studies mainly focused on comparing groups, which has resulted in the obscuring of temporal complexity and individual differences. The aim of this study is to elucidate the relationship between stress and FSSs over time within individual patients. MethodsTwenty patients (17 females, ages 29–59) with multiple, persistent FSSs were included in the study. They used electronic diaries to report stress and FSSs twice daily over the course of 12weeks. For each individual data set, Vector autoregressive (VAR) modelling was used to investigate possible associations between daily average stress and FSSs scores. ResultsIn six subjects (30%), an increase in stress was followed by an increase in one or more FSSs. In three subjects (15%), an increase in FSSs was followed by an increase in stress. Additionally, negative and mixed associations were found. Only two subjects (10%) showed no cross-lagged association between stress and FSSs in either direction. We did not find specific types of symptoms to be more stress-related than others. ConclusionAlthough stress does not seem to be a universal predictor of FSSs, an increase in stress precedes an increase in symptoms in some individuals. Identifying these individuals using time-series analysis might contribute to a more patient-tailored treatment.

Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico

The objective of this clinical trial was to identify the Traditional Chinese Medicine (TCM) diagnoses for stress symptoms that responded to auriculotherapy. Subjects were 75 nursing professionals of a teaching hospital, with average and high stress scores according to Vasconcelos’ List of Stress Symptoms. The subjects were randomized into three groups (control without treatment, auriculotherapy with needles, and auriculotherapy with seeds), treated weekly in the Kidney, Brain stem and Shenmen , for eight sessions. Analysis of variance showed significant differences after treatment (p=0.023) only between the needle and group controls, with 21 symptoms showing differences (p<0.05) in the Student’s t-test. In conclusion, auriculotherapy reduced stress with best result for needles than seeds, and the main identified diagnoses were: Stagnation of Qi in the chest, Stagnation of the Liver and the tendinomuscular meridians, Yin Deficiency of the Liver, Kidneys and Xue (Blood). Descriptors: Nursing; Auriculotherapy; Medicine, Chinese Traditional; Diagnosis.

Empowering the Impoverished and Reducing Healthcare Costs

Background:Socioeconomic disadvantage is a major risk factor for poor health and a consistent contributor to chronic stress, both of which are disempowering to individuals and communities. Poverty has been linked to a higher prevalence of many health conditions, including increased risk of chronic disease, injury, deprived infant development, anxiety, depression, premature death, and the negative impact of allostatic load associated with chronic stress. With the rising costs of healthcare, there is an urgent and ongoing need for effective strategies for the impoverished to diminish the negative impact of the stress response and enhance their level of empowerment.Method:Individuals associated with a community-based organization that assists impoverished individuals to move toward self-sufficiency were invited to attend a HeartMath (HM) two-session workshop series (4 weeks apart), and an additional discussion-only session was scheduled 4 weeks after the second session. Participants completed Personal and Organizational Quality Assessments (POQAs) at both workshop sessions to gather pre- and post-intervention data. Each session 1 participant received a Quiet Joy CD and was asked to practice the techniques that they learned between sessions 1 and 2. A third session was scheduled 4 weeks after session 2 as a check-in with participants to determine if they continued to use the HeartMath techniques and for them to share their experiences as a result of exposure to the information.Results:Twenty individuals participated in workshop session 1; 14 participated in workshop session 2; and 11 individuals attended session 3. Although an equal-pair comparison was not possible, pre and post POQA analysis results demonstrated a general improvement in emotional well-being and reduction in stress symptoms for the group. However, there was a slight but notable reduction in two areas: positive outlook and gratitude. Individuals showed reduced symptoms in the six General Health Stress Symptoms categories, and the Group Average Stress Score was reduced by 40 on the post assessment. In the third, group-discussion-only session, participants shared anecdotally their experiences with emotion regulation and stress transformation since participation in the two-session workshop. The majority reported that they continued to use the HeartMath techniques and generally reported that they felt at ease more often and, in most cases, were better able to regulate their stress responses associated with the challenges of their lower socioeconomic status.Conclusion:Although HeartMath cannot be solely depended upon to resolve all matters associated with poverty, it is believed that it holds potential as an additional resource for those facing the daily stressors and the negative biopsychoemotional impacts associated with it. Consistent practice and application of the HeartMath techniques hold potential to enhance people's emotion-regulation ability, to build and sustain psychophysiological resilience, and to increase some level of control in their lives. Thus, HeartMath is being promoted as an intermediate pathway to improve physical health and psycho-emotional well-being, increase individual and community empowerment, and ultimately reduce healthcare costs among those of lower socioeconomic status.

Identification of Coping Strategies in Patients with Inflammatory Bowel Disease: A Cross-sectional Study

Purpose: The deleterious psychosocial impact of inflammatory bowel disease (IBD) is well-established. Less is known about coping behavior of IBD patients. The aim of this study is to identify the coping strategies used by patients with ulcerative colitis (UC) and Crohn's disease (CD). Methods: Outpatients aged 18 years or older with confirmed diagnosis of IBD were recruited. Disease activity was measured using the Harvey Bradshaw index and Modified Mayo Score for CD and UC, respectively. Stress level was assessed with the Perceived Stress Scale, and coping behavior was measured with the Carver Brief COPE Inventory. A logistic regression model was applied to identify associations between patients' coping strategies and disease activity. Covariates included disease status (CD or UC), disease severity (remission/normal, mild/moderate/severe disease) and average stress score. All analyses were performed with Statistical Analysis System (SAS) version 9.3. Results: Sixty patients, 35 with CD and 25 with UC, completed the study. There was no statistical difference between groups in terms of age, gender, ethnicity, and annual household income. Smoking status differed between groups. 26% of CD and 4% of UC patients were current smokers (p=0.02). Venting, self-distraction, behavioral disengagement, use of instrumental support, and religion to cope with IBD were associated with high personal stress. IBD patients with active disease (mild/moderate/severe flare) were more likely to cope with venting and acceptance strategies (p=0.048, OR = 15), compared to patients in remission, (p=0.007, OR = 14) respectively. In addition, 60% of CD patients, compared with 36% of UC, are three times as likely to cope with the disease via positive reframing (p=0.049). Conclusion: Patients cope with IBD by using venting, self-distraction, instrumental support, religion, acceptance, positive reframing, and behavioral disengagement strategies. Coping strategies differed as a function of disease activity and illness type. Future research should attempt to determine which coping methods are most and least effective, and how targeted, evidence-based behavioral intervention may enhance these skills and patient quality of life.

Employing a Community Based Participatory Research Approach to Bear Witness: Psycho–Social Impact of the 2010 Earthquake on Haitians in Somerville, MA

We employed a community-based participatory research approach to assess mental health among the Haitian community in the Somerville, MA area. The development of the survey coincided with the 2010 earthquake in Haiti, and so several questions related to the natural disaster were included in the analysis to increase understanding of the impact locally. We surveyed a convenience sample of 64 Haitians recruited with the assistance of the Somerville Haitian Coalition. The survey assessed demographic data, reasons for migrating to the area, response to the 2010 earthquake, and mental health. Mental health measures included the short versions of the Center for Epidemiologic Studies Depression Scale (CES-D) and the Perceived Stress Scale. Participants reported high rates of stress and depression post-earthquake. On the CES-D, men reported higher average depression and stress scores than women (13.8 vs. 11 and 20.6 vs. 17.6). Our results suggest that social and family support resources may be beneficial to Haitians in our sample.

Parental stress in a paediatric intensive care unit in Punjab, India

Paediatric intensive care is a fast-growing specialty in India. There are studies on parental stress in paediatric intensive care unit (PICU) in developed countries, but limited data from developing countries, where many factors may be different, are available. This paper describes various stressors in Indian parents. One hundred parents were interviewed using the Parental Stress Scale (PSS: PICU), which rates 22 factors on a scale from 1 (not stressful) to 5 (extremely stressful). The average parental stress score was 3.0. The main causes of extremely stressful situations were: the parents' child having breathing difficulty; their child suffering pain; their child being unresponsive; crises in other children in the PICU. Factors least associated with stress included: not being alone with baby; and the presence of monitors and equipment. Nearly all parents (99) felt that prayer was of help. The majority (67) felt stressed during procedures, and 59 parents felt stressed by the sights and sounds of the PICU. Factors significantly related to increased stress included: the severity of illness as measured by higher paediatric risk of mortality scoring (P = 0.0136); for mothers rather than fathers (P = 0.0054): for parents <30 years (P = 0.0114); and parents of a male child (P = 0.0482). It is concluded that there is significant stress among parents of children admitted to an Indian PICU, and stress factors are different from studies done in developed countries. Mothers and young parents were more stressed. Type of family, income, education, number and age of children did not affect level of stress.

Correlations between stress and anxiety levels in nursing students

Objective: Transversal, descriptive, and correlational study with 71 professionalizing Nursing students, with the purpose of describing social-demographic data, to verify and to correlate stress and anxiety levels. Methods: Data collection was performed on January 2011, from Vasconcelo’s List of Stress Symptoms and Spielberger’s Inventory of Trait and State Anxiety. Results: There were 90.44% female students with an average 28.87 years of age; 32.39% obtained average stress score and 64.79% high score; 43.66% for high score in Trait and State Anxiety; 43.66% and 36.62% for moderate score respectively for Trait and State Anxiety. At Pearson correlation the following coefficients were obtained: LSS/Trait-Anxiety ( r =0.656/ p =0.000); LSS/State-Anxiety ( r =0.512/ p =0.000). Conclusion: Students presented high levels of stress and anxiety and correlations between these variables were positive. Future studies are necessary with higher samples.

The Effect of Merit Score Towards the Stress Score Among First Year Student

The paper presents the result of the relationship between merit score and stress score among first year undergraduate students of the Faculty of Allied Health Sciences (FSKB) of session 2009/2010. A cross sectional study among students living in university residences, that is (College) Tun Syed Nasir, has been choosen using the stratified sampling. The merit score has been divided into three groups which is less than 30, between 31 to 59 and above 60. The stress score was modified from the the Inventory of College Students’ Recent Life Experience (ICSRLE). The study showed that the average stress score was moderate (44.42±11.61). Furthermore, there was significant weak relationship between merit score and stress score (r=0.187, p<0.05). The comparison of stress score indicated that there was no significant difference between male and female students (p>0.05). Moreover between bumiputra (indigenous) and non-bumiputra there was no significant mean differences of stress score (p>0.05). One way analysis of variance showed that there was no difference of mean score merit between the stress score (p>0.05). In conclusion, the study showed that the stress score was not influenced by merit score among first year undergraduates of FSKB for the academic session 2009/2010. However, the undergraduates of FSKB that achieved higher merit score do have a higher mean of stress score.

Antenatal Depression and Anxiety Affect Postpartum Parenting Stress: A Longitudinal, Prospective Study

Postpartum depression has been associated with parenting stress, impacting attachment and child development. However, the relation between antenatal depression or anxiety and postpartum parenting stress has not been investigated. We studied the effect of antenatal depression and anxiety and treatment with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors (antidepressants [ADs]) on postpartum parenting stress. Ninety-four pregnant women (part of a larger study examining prenatal AD exposure on infants) were prospectively monitored for depression and anxiety during the third trimester and 3- and 6-months postpartum using the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale. Parenting stress was assessed using the Parenting Stress Index-Short Form at 3- and 6-months postpartum. Both antenatal third trimester depression and anxiety were significant predictors of 3- and 6-month postpartum parenting stress, after controlling for maternal age, number of children, and exposure to prenatal ADs (all Ps < 0.001). Third trimester depression accounted for 13% to 22% of the variance in postpartum stress at 3 and 6 months. Prenatal AD use was not a significant predictor in any of the models (all Ps > 0.2). Twenty of 41 mothers on ADs achieved remission (HDRS = 7) in pregnancy and had average parenting stress scores of about 1 standard deviation lower than those who did not at 3- and 6-months postpartum (t = 3.32, df = 32, P = 0.002 and t = 2.52, df = 32, P = 0.02, respectively). Our findings indicate that antenatal depression and anxiety directly impact postpartum parenting stress, regardless of antenatal AD treatment. Ongoing maternal mental illness in pregnancy is an important predictor of postpartum parenting stress. Early recognition and treatment to remission is key.

Correlation among Dietary Habits Score, Life Stress Score and Health-Related Quality of Life (HRQL) Score for Female College Students with Functional Constipation

The study purpose was to investigate correlations among dietary habits score, life stress score and health-related quality of life (HRQL) score for female college students with functional constipation (FC). The data were collected in 2008 from 265 female college students: 86 with FC and 179 without FC. The diagnosis of FC was based on the Rome II criteria, and life stress and HRQL were assessed using self-administered life stress questionnaire and SF-36, respectively. The correlations among dietary habit score, life stress score, and HRQL score were evaluated. The averages of age, height, weight, body fat percentage and body mass index (BMI) of female college students were 20.8 years, 160.9 ㎝, 53.7 ㎏, 27.8%, and 20.7 ㎏/㎡, respectively. The average dietary habit score of “having meals with diverse foods” was significantly lower in the FC group than in the normal group (p ＜ 0.05). The average faculty problem (p ＜ 0.05), grade problem (p ＜ 0.05), economy problem (p ＜ 0.05), value problem (p ＜ 0.05), and total stress (p ＜ 0.01) scores of the FC group were significantly higher than those of the normal group. The average HRQL score was 70.4 in the FC group and 74.3 in the normal group (p ＜ 0.05). There were significantly negative correlations between total stress score and total food habits score (r = -0.221; p ＜ 0.01) and HRQL score (r = -0.539; p ＜ 0.01) in the FC. These results suggest that female students with FC are highly perceptive to stress and have low HRQL. In addition, female students with FC may require nutritional education about eating diversity.

Work stress and workload of full-time anesthesiologists in acute care hospitals in Japan

The number of anesthesiologists per population in Japan is small compared with that in Europe and North America. While there is a growing concern that hard work causes anesthesiologists' fatigue and may compromise patient safety, the workload and physical stress, as well as the impact of staff support on physicians' stress have not been assessed in detail. The goal of this study was to evaluate the working environment, anesthesia workload, and occupational stress of anesthesiologists in Japan. A questionnaire survey was performed targeting 1010 members of the Japanese Society of Anesthesiologists working as anesthesiologists affiliated with acute care hospitals in Japan. Data on background information, working environment, operation anesthesia duties, and stress were collected, and the relationship of work stress with background, environment, and anesthesia duties was evaluated by linear regression analysis. Responses were obtained from 383 full-time anesthesiologists (response rate, 43.9%). The total anesthesia time per week was 23.6 h on average. The work stress score was 114.3 +/- 30.2 (mean +/- SD) when the average workers' work stress score in Japan was 100. The work stress score was significantly associated with "years of experience" (with experience < 10 years considered as the reference; 10-19 years: beta = -0.18, P = 0.02, > or = 20 years: beta = -0.15, P = 0.04), "hospital with > or = 500 beds" (with a hospital with < or = 299 beds considered as the reference; beta = 0.15, P = 0.04), "total time of anesthesia per week" (beta = 0.18, P.02), "estimated annual cases managed by an anesthesiologist" (beta = 0.12, P = 0.04) and "no-support stress" (beta = 0.21, P < 0.01) on linear regression analysis (R(2) = 0.12). Our results provide a quantitative assessment of the duties of anesthesiologists and show that work stress among anesthesiologists is related to workload and other factors.

The Frequency of Perceived Stress, Anxiety, and Depression in Patients with Common Pathologies Affecting Voice

The study's objectives were to investigate (1) the frequency of perceived stress, anxiety, and depression for patients with common voice disorders, (2) the distribution of these variables by diagnosis, and (3) the distribution of the variables by gender. Retrospective data were derived from self-report questionnaires assessing recent stress (Perceived Stress Scale-10), anxiety, and depression (Hospital Anxiety and Depression Scale) in a cohort of new patients presenting to a voice clinic. Data are presented on 160 patients with muscle tension dysphonia (MTD), benign vocal fold lesions, paradoxical vocal fold movement disorder (PVFMD), or glottal insufficiency. Pooled data indicated that average stress, anxiety, and depression scores were similar to those found for the healthy population. However, 25.0%, 36.9%, and 31.2% of patients showed elevated stress, anxiety, and depression scores, respectively, compared to norms. Patients with PVFMD had the most frequent occurrence-and patients with glottal insufficiency had the least frequent occurrence of elevated stress, anxiety, and depression. Stress and depression were more common with MTD than with lesions, whereas reverse results were obtained for anxiety. More females than males had elevated stress, anxiety, and depression scores. The data are consistent with suggestions that stress, anxiety, and depression may be common among some patients with PVFMD, MTD, and vocal fold lesions and more common for women than men. However, individual variability in the data set was large. Further studies should evaluate the specific role of these conditions for selected categories of voice disorders in susceptible individuals.

Competition load and stress in sports: a preliminary study in biathlon.

International sports calendars are being increasingly filled with competitive events and fatiguing travel, at the risk of overloading the athletes involved. The Medical Committee of the International Biathlon Union, in order to check for any significant changes, analysed seven recent competitive seasons, calculating the number of races and total and daily numbers of racing kilometers for each season. A theoretical model for stress was subsequently developed, based on identification and quantification of favourable and unfavourable factors, with establishment of average and maximal stress scores for each season. A questionnaire was distributed to athletes to collect data about daily stress levels, and the correspondence between the theoretical model and the athletes' responses was determined. This analysis demonstrates that the biathlon has become more demanding for those athletes in the racing circuit, with significant increases in number of races, total and daily numbers of kilometers raced, and average stress scores for athletes of both sexes. The self-reported daily stress levels for some athletes show an interesting correspondence with the theoretical stress model. If such correspondence is confirmed, this model might constitute an instrument with which international sports federations, considering the concentration of races, related travel and recovery times, could plan sustainable competitive calendars.