High Levels Of Psychosocial Stress Research Articles

The Interdisciplinary Family Consultation in Pediatrics - An Integrative Approach to Complex Burdened Families of Chronically ill Children

For families of chronically ill children with a high level of psychosocial stress, it is necessary to involve child and adolescent psychiatric or psychosomatic specialists directly in the pediatric treatment process. For this purpose, a family consultation was set up in the Heidelberg University Pediatrics as part of a model project, which deals with these families in an interdisciplinary and systemic way. It shows that the implementation of the consultation works despite a high organizational effort and is regularly used. The first evaluation results confirm the already described high levels of psychosocial stress in the affected families. They indicate a positive assessment of the consultation and a desire for a permanent offer. First follow-up results indicate a significant decrease in treatment-related concerns, uncertainty and a reduction in treatment-related problems. The lack of a viable funding model poses a challenge for long-term implementation.

Abstract P2075: The Effects Of Maternal Psychosocial Stress During Pregnancy On Offspring Heart Health

Maternal health has a substantial effect on offspring well-being and health. A significant contributing factor to maternal health is psychosocial stress. Psychosocial stress results from adverse experiences in everyday life and the inability to cope with them, resulting in anxiety and depression. Unfortunately, it is estimated that ~75% of mothers will suffer a stressful life event the year their infants are born, and upwards of 20% suffer depression. These already high levels of psychosocial stress have been exacerbated by the COVID-19 pandemic. However, it is not known if maternal psychosocial stress during pregnancy affects offspring heart health. Thus, the purpose of this study was to investigate the effects of maternal psychosocial stress during pregnancy on the heart health of offspring. We hypothesize that maternal psychosocial stress during pregnancy will have an adverse effect on offspring heart health. Methods: We used a well-established model of maternal psychosocial stress during pregnancy- restraint stress. Pregnant dams were stressed by placing them in a 50 mL conical tube (with air holes) for 2 hours / day on gestational days 10-17. Offspring heart health was assessed via echocardiography (Vevo 3100, MX550D transducer). Results: As early as one week of age (equivalent age of infancy in humans), we observed that offspring born to stressed dams exhibited decreased left ventricular fractional shortening. Further analysis using speckle tracking echocardiography was performed on offspring at 4 (equivalent age of juveniles in humans) and 12 (equivalent age of young adult in humans) weeks of age. Our data indicate that offspring from stressed dams had decreased heart performance (measured as stroke volume), remodeling observed as hypertrophy (measured as left ventricular posterior wall thickness at diastole), and diastolic dysfunction (measured as E’/A’). Conclusion: Our data indicate maternal psychosocial stress during pregnancy results in blunted left ventricular contractile and diastolic dysfunction in offspring, as well as displays adverse remodeling (i.e., hypertrophy) during infancy and through young adulthood. These data indicate that maternal psychosocial stress during pregnancy is detrimental to offspring heart health.

Microbial modulation via cross-fostering prevents the effects of pervasive environmental stressors on microglia and social behavior, but not the dopamine system.

Environmental toxicant exposure, including air pollution, is increasing worldwide. However, toxicant exposures are not equitably distributed. Rather, low-income and minority communities bear the greatest burden, along with higher levels of psychosocial stress. Both air pollution and maternal stress during pregnancy have been linked to neurodevelopmental disorders such as autism, but biological mechanisms and targets for therapeutic intervention remain poorly understood. We demonstrate that combined prenatal exposure to air pollution (diesel exhaust particles, DEP) and maternal stress (MS) in mice induces social behavior deficits only in male offspring, in line with the male bias in autism. These behavioral deficits are accompanied by changes in microglial morphology and gene expression as well as decreased dopamine receptor expression and dopaminergic fiber input in the nucleus accumbens (NAc). Importantly, the gut-brain axis has been implicated in ASD, and both microglia and the dopamine system are sensitive to the composition of the gut microbiome. In line with this, we find that the composition of the gut microbiome and the structure of the intestinal epithelium are significantly shifted in DEP/MS-exposed males. Excitingly, both the DEP/MS-induced social deficits and microglial alterations in males are prevented by shifting the gut microbiome at birth via a cross-fostering procedure. However, while social deficits in DEP/MS males can be reversed by chemogenetic activation of dopamine neurons in the ventral tegmental area, modulation of the gut microbiome does not impact dopamine endpoints. These findings demonstrate male-specific changes in the gut-brain axis following DEP/MS and suggest that the gut microbiome is an important modulator of both social behavior and microglia.

Is it safe outside? Tales from a home visiting service for families during the COVID pandemic

AbstractA description of a mentalization informed home‐based project, an adaptation of the ECID project (Equipo Clínico de Intervención a Domicilio), into a time‐limited first aid mental health team in response to heightened mental health needs during the COVID Pandemic in Barcelona, Spain is offered. ECID is a project with a developmental psychodynamic understanding of psychopathology and relational dynamics informing a highly flexible treatment approach. This paper describes a focus on the need for clinicians to take an active role whilst adapting to the specific needs and situation of each child and family, instead of continuing to ask them to adapt to what services can or are prepared to offer. Clinical examples are given to illustrate the value of an integrative community approach informed by both systemic and psychodynamic lenses. Specifically, we reflect on the benefits of a mentalization informed approach to working with families during high levels of psychosocial stress for both families and practitioners. We illustrate how of a mentalization informed clinical service can promote and support the development of a therapeutic alliance when internal safety is impacted by a very real external threat. Finally, preliminary data is presented regarding the impact of parental stress and trauma on children and adolescents' adaptation to a potentially traumatic situation as well as their capacity for returning to a progressive development pathway.

“Scanxiety” and a sense of control: the perspective of lung cancer survivors and their caregivers on follow-up - a qualitative study

ObjectivesLung cancer survivors often suffer from physical, emotional and social long-term effects of disease and treatment. Caregivers are also affected by the cancer diagnosis throughout the course of the disease and are frequently burdened by high levels of psychosocial stress. However, little is known about how follow-up care after the completed treatment phase can help to improve long-term quality of life. In the context of patient-centred cancer care, considering the survivors’ and caregivers’ perspectives is an important step toward improving care structures. We therefore explored how lung cancer survivors and their caregivers experience follow-up examinations and their possible psychosocial effects on everyday life in order to shed light on what support is helpful for improving their quality of life.Material and Methods25 survivors after curative lung cancer treatment and 17 caregivers underwent a face-to-face semi-structured, audio-recorded interview that was analysed using qualitative content analysis.ResultsEspecially burdened cancer survivors and caregivers described recurring anxiety before a follow-up appointment influencing their everyday life. At the same time, follow-up care also provided reassurance of still being healthy and helped regain a sense of security and control until the following scan. Despite possible long-term consequences in everyday life, the interviewees reported that the survivors´ psychosocial needs were not explicitly assessed or discussed. Nevertheless, the interviewees indicated that conversations with the physician were important for the success of “good” follow-up care.ConclusionAnxiety surrounding follow-up scans, also known as “scanxiety”, is a common problem. In this study, we expanded on previous findings and found a positive aspect of scans, namely regaining a sense of security and control, which can strengthen the psychological well-being of the survivors and their families. To optimize follow-up care and improve the quality of life of lung cancer survivors and caregivers, strategies to integrate psychosocial care, like the introduction of survivorship care plans or increased use of patient-reported outcomes, should be explored in the future.

Psychosocial Effects of COVID-19 pandemic on Yemeni healthcare workers: A Web-based, Cross-sectional Survey

ABSTRACT Yemeni healthcare workers (HCWs) experience high levels of psychosocial stress. The current study provides a psychosocial assessment of Yemeni HCWs during the COVID19 pandemic and the factors that influence this. Between 6 November 2020, and 3 April 2021, 1220 HCWs inside Yemen self-reported levels of stress, anxiety, insomnia, depression and quality of life using a web-based, cross-sectional survey. According to the findings, 73.0%, 57.3%, 49.8%, 53.2%, and 85.2% of all HCWs reported moderate or severe stress, insomnia, anxiety, depression, and a lower quality of life, respectively. Significant positive correlations were found between stress and anxiety, insomnia, and depression scores, as well as anxiety and insomnia and depression, and insomnia and depression (p < 0.001). There was also a significant inverse relationship between wellbeing scores and stress, anxiety, insomnia, and depression scores (p < 0.001). A high percentage of respondents (85.8%) were 40 years old or younger and 72.7% had fewer than 10 years’ experience, suggesting that experienced medics leave Yemen for safer and more secure jobs elsewhere. Psychosocial support to assist in building resilience to the prevailing conditions may need to be embedded in medical school training and continuing professional development to help support HCWs within Yemen and prevent even more from leaving the country.

Pregnant nurses' experiences of working shifts: a qualitative systematic review protocol.

The proposed systematic review will synthesize the experiences of nurses working in any shifts during pregnancy. Nurses are among the most burdened health care workers and are at risk of diseases of the circulatory system due to prolonged standing. For pregnant nurses, this could reduce blood circulation and blood flow to the uterus and placenta. Contributing factors include long working hours and frequent heavy lifting, which may induce uterine contractions and premature birth; irregular shifts, which exacerbate fatigue; and high levels of psychosocial stress. There is no qualitative evidence as to what nurses are experiencing while working shifts when pregnant. This review will evaluate and integrate the current available findings related to the experience of shift-working nurses who are pregnant. This review will include qualitative studies focusing on the experience of shift work among pregnant nurses. No language or date limits will be applied. All types of pregnancy among nurses will be included. The databases to be searched will include CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycINFO (EBSCOhost), and Igaku Chuo Zasshi (the Japan Medical Abstracts Society). Sources of gray literature will include MedNar and DANS, as well as the websites of the American Nurses Association and the Japanese Nursing Association. Study selection, critical appraisal, data extraction, and data synthesis will be performed independently by 2 reviewers. The synthesized findings will be graded according to the ConQual approach for establishing confidence in findings. PROSPERO CRD42022309674.

Stress Overload and DNA Methylation in African American Women in the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure Study.

Introduction:Experiencing psychosocial stress is associated with poor health outcomes such as hypertension and obesity, which are risk factors for developing cardiovascular disease. African American women experience disproportionate risk for cardiovascular disease including exposure to high levels of psychosocial stress. We hypothesized that psychosocial stress, such as perceived stress overload, may influence epigenetic marks, specifically DNA methylation (DNAm), that contribute to increased risk for cardiovascular disease in African American women.Methods:We conducted an epigenome-wide study evaluating the relationship of psychosocial stress and DNAm among African American mothers from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) cohort. Linear mixed effects models were used to explore the epigenome-wide associations with the Stress Overload Scale (SOS), which examines self-reported past-week stress, event load and personal vulnerability.Results:In total, n = 228 participants were included in our analysis. After adjusting for known epigenetic confounders, we did not identify any DNAm sites associated with maternal report of stress measured by SOS after controlling for multiple comparisons. Several of the top differentially methylated CpG sites related to SOS score (P < 1 × 10−5), mapped to genes of unknown significance for hypertension or heart disease, namely, PXDNL and C22orf42.Conclusions:This study provides foundational knowledge for future studies examining epigenetic associations with stress and other psychosocial measures in African Americans, a key area for growth in epigenetics. Future studies including larger sample sizes and replication data are warranted.

Psychosocial and psychiatric-related stress and cigarette smoking among Black and Latinx adults with psychiatric disorders

While the cigarette smoking prevalence in the United States has decreased, smoking disparities persist for individuals with psychiatric disorders and individuals who identify as racial/ethnic minorities. These groups also experience higher levels of psychosocial stress. This study was the first to examine the relationship between psychosocial and psychiatric-related stressors and cigarette smoking status in a sample of Black and Latinx adults with psychiatric illness. Stress associated with friend strain, lifetime discrimination, and attending appointments for psychotropic medication management were associated with cigarette smoking. The present results have implications for integrating smoking cessation interventions into mental health treatment settings.

Attending work with chronic pain is associated with higher levels of psychosocial stress

ABSTRACT Background and Aims: Much is known about the impact of pain in terms of medical costs and missed work. Less is known about its associations when individuals are present for work. This study examines “presenteeism” by analyzing the psychosocial costs of pain in the workplace, using the 2015 European Working Conditions Survey (EWCS). Methods: We conducted cross-sectional analysis of 2384 individuals with chronic pain and 2263 individuals without pain (matched by age and sex) using data from the 2015 EWCS. We compared groups in terms of the following psychosocial factors: supervisor support, job responsibility, team cohesion, discrimination, threats/abuse, job competency, job reward, sexual harassment, stress, and job security. The groups were also compared in terms of days lost due to illness. Results: People with pain were 64% less likely to view their job as rewarding (odds ratio [OR] = 0.61; 95% confidence interval [CI], 0.57–0.65), 47% more likely to be subjected to threats/abuse in the workplace (OR = 0.68; 95% CI, 0.63–0.73), 30% more likely to report poor supervisor support (OR = 0.77; 95% CI, 0.73–0.82), and 28% more likely to perceive discrimination in the workplace (OR = 0.78; 95% CI, 0.71–0.85). People with pain missed approximately nine more days of work per year than respondents without pain. Conclusions: Chronic pain was associated with lower vocational fulfillment and feelings of being ostracized in the workplace. These findings suggest that the presence of pain in the workplace goes well beyond lost productivity due to absenteeism.

Макросомія плода: акушерські, психологічні та соціальні аспекти

One of the main markers of socially unfavorable pregnancy is anthropometric indicators of newborns. They reflect not only the narrow medical problems of complicated gestation but also social problems in general, the quality and access to the medical care. The objective: to determine the risk factors for fetal macrosomia in pregnancy with high levels of psychosocial stress. Materials and methods. The course of pregnancy and childbirth, demographic and medical risk factors for a fetal macrosomia were analyzed in 140 pregnant women with different levels of psychosocial stress. They were divided into 2 groups: 1 group (main) – 56 women-forced migrants from Luhansk and Donetsk regions, 2 group – 84 women with low and moderate level stress according to the questionnaires and psychological tests (L. Reeder, Spielberg–Khanin scale). Results. Gestational diabetes was the main reason for the birth of heavy children in both groups. Women–forced migrants had late manifestation of impaired tolerance to carbohydrates and a higher frequency of pathological weight gain. Male neonates are at risk for macrosomia. Childbirth in women with macrosomia is accompanied by a high frequency of complications and abnormal births. Conclusions. The frequency of births of macrosomic children in women - forced migrants is higher than in women at low risk of psychosocial stress. Risk factors in this group of pregnants include: the level of stress and behavioral responses to stress, impaired carbohydrate tolerance due to gestational diabetes, abnormal weight gain due to malnutrition and male sex of the fetus. Keywords: macrosomia, pregnancy, childbirth, women–forced migrants psychosocial stress, gestational diabetes, weight gain.

Impact of psycho-social stress levels on clinical profile of acute central serous chorioretinopathy patients

Introduction: To study the impact of the level of psycho-social stress on varied clinical presentations of acute Central serous chorioretinopathy (CSCR) patients.&#x0D; Methods: This prospective observational study included 83 patients with acute central serous chorioretinopathy who presented to our out-patient department. All confirmed cases of acute CSCR were subjected to a questionnaire based on social readjustment rating score which included 43 life events that analyzed if psycho-social stress contributed to their present illness. Patients underwent a comprehensive ocular evaluation including best corrected visual acuity, slit lamp examination of anterior segment, fundus examination using slit lamp with a contact lens or non-contact lens, indirect ophthalmoscopy, digital fundus photography, of Spectral Domain-Optical Coherence Tomogram(SD-OCT) and Fundus FluoresceinAngiography(FFA). The stress scores obtained were statistically analyzed with clinical and angiographic parameters obtained in patients.&#x0D; Results:A total of 83 patients were included in the present study. 72(86.74%) patients were males,the majority of them presenting with unilateral involvement (n=70; 84.33%). The prevalence of stress level was mild in 5(6.02%); moderate in 31(37.34%) and severe in 47(56.62%) subjects. Severe level of psycho-social stress was significantly associated with bilateral presentation of serous detachment in posterior pole of fundus (17/47; p-value=0.04)as well as multiple angiographic leaks on FFA(19/50; p-value=0.03).&#x0D; Conclusion:Higher levels of psycho-social stress can lead to more severe forms of presentation in acute CSCR with a possible sub-optimal visual recovery. Avoidance of stress and relaxation therapies can help in preventing severe forms of acute CSCR.&#x0D;

Lifetime Psychosocial Stress Exposure Associated with Hypertensive Disorders of Pregnancy.

Hypertensive disorders of pregnancy (HDP) complicate 5 to 10% of all pregnancies and are a major cause of pregnancy-related morbidity. Exposure to psychosocial stress has been associated with systemic inflammation and adverse birth outcomes in pregnant women. Thus, it is probable that psychosocial stress and inflammation play a role in the development of HDP. The primary objective of this analysis was to determine if a woman's lifetime psychosocial stress exposure was associated with an increased risk of HDP. Additionally, we examined whether serum inflammation was an underlying biological mediator for this relationship. A multisite prospective study was conducted in a sociodemographically diverse cohort of 647 pregnant women. At a study visit between 12 and 206/7 weeks' gestation, maternal psychosocial stress was assessed with six validated assessments and inflammation was measured via log-transformed serum concentrations of interferon-γ, interleukin (IL)-10, IL-13, IL-6, IL-8, and tumor necrosis factor-α. A composite stress score was calculated for each participant from the six stress assessments. The diagnosis of HDP was abstracted from the medical record and was defined as the presence of gestational hypertension after 20 weeks of pregnancy and/or preeclampsia. The association between composite stress and HDP was determined using binary logistic regression. Inflammation, using the six inflammatory biomarkers, was tested as a potential mediator between stress and HDP. Participants with higher composite stress scores were more likely to develop HDP (odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.06-2.12). When adjusted for known risk modifiers, including maternal age, race/ethnicity, parity, pre-pregnancy body mass index, diabetes, chronic hypertension, and smoking during pregnancy, the risk remained unchanged (OR: 1.50, 95% CI: 1.03-2.20). No mediation effect by inflammation was observed. Independent of known risk factors, women exposed to greater composite stress burden across the life course are at increased risk of developing HDP. · This study was conducted to determine if women with high levels of psychosocial stress have differences in risk for hypertensive disorders of pregnancy (HDP).. · Independent of known risk factors, women with increased lifetime psychosocial burden are at higher risk for HDP.. · A model that captures multiple domains of life stress may better predict HDP than a unimodal stress assessment..

IDENTIFICATION OF RISK FACTORS IN ARTERIAL HYPERTENSION PATIENTS WITH PARTICIPATION OF A NURSE

Arterial hypertension (AH) is the most frequent among cardiovascular diseases (CVD).About 31% of people suffer from it. The data of epidemiological studies indicate thatoccurrence of the disease is considerably caused by the level of modified and nonmodified risk factors (RF).Under conditions of reforms in the health care system of Ukraine implementation ofqualitatively new measures concerning AH prevention and activity to form a healthy lifestyle have become rather important. Management of a complicated behavior and life styleof AH patients requires experience and mutual efforts of various medical professionals.Professional competence of nurses enables to involve them in realization of up-to-datetechnologies in order to prevent diseases and strengthen health.Timely detection of RFs, elimination of their action, organization of patients’ education isone of the important tasks of nurses.Purpose of the study. To investigate the effect of modified risk factors on the developmentof arterial hypertension and determine the role of a nurse in the management of thedisease on the level of primary health care.Material and methods. 120 AH patients were involved into the study by means of a surveyincluding 43,3% of men and 56,7% of women aged from 23 to 79 (48,33±12,93). Theirarterial pressure was measured and risk factors were found. The results obtained wereprocessed by means of the common statistical methods using the packages of computersoftware STATISTICA V.6.0. The results of the study are presented in the number ofobservations, percentage, and accurate p value.Discussion. The period of arterial hypertension varied widely, though the majorityof patients (82%) suffered from it more than 10 years. The main part of patients – 73(60,83%) were afflicted with I degree of AH, 29 patients (24,17%) had II degree and 18individuals (15%) – III degree. The overweight patients and those with I – II degree ofobesity prevailed (81,67%). For example, 60 patients (50%) had android (abdominal)type of the adipose tissue distribution, which is indicative of metabolic disorders in thebody. All the patients were diagnosed to have moderate and high levels of psychosocialstress, which might be associated with an intensive and stressful life style. The majority ofpatients were characterized by a low (62,5%) and moderate (34,12%) levels of physicalactivity; and only 3,33% of them had sufficient level of physical activity. The surveyfound that 42 (35%) individuals smoked having a mixed type of smoking habits, moderate(40%) and mild (31%) degree of nicotine abuse. The majority of patients mentionedexcessive intake of salt, fats and cholesterol, disturbed dietary habits, insufficient intakeof vegetables and fruit.Conclusions. The amount of modified risk factors promoting development ofcardiovascular diseases increases in AH patients with age. Detection of RFs, educationof patients concerning their elimination is an integral part of nurse’s everyday work. Itwill promote improvement of life quality, prevention, optimization of a comprehensivetreatment and stabilization of arterial hypertension.

Depression, stress and vascular function from childhood to adolescence: A longitudinal investigation

BackgroundPsychological distress is associated with risk markers for cardiovascular disease, including increased arterial stiffness and high blood pressure, but it's unclear when these first manifest. This study aims to investigate the effect of psychosocial stress and depression on arterial stiffness and blood pressure in a cohort study of Australian children followed through to adolescence. MethodDepression and psychosocial stress in 520 young people (265 boys; M age = 11.6 y) were assessed via the Children's Depression Inventory and Children's Stress Questionnaire respectively. Carotid-femoral pulse wave velocity was assessed using applanation tonometry, with further assessments of supine brachial blood pressure and percent body fat (dual x-ray absorptiometry). All measures were repeated four years later at age 16-years. ResultsWe found no cross-sectional or longitudinal evidence that children self-reporting higher levels of psychosocial stress or depressive symptoms had greater arterial stiffness. Children reporting an increase in depressive symptoms had an increase in diastolic blood pressure and mean arterial pressure over time. An effect was also evident for pulse pressure, where higher pulse pressure was found in children with lower psychosocial stress at baseline and in children self-reporting a decrease in stress between baseline and follow-up. ConclusionsFindings from the current study contribute to the scant paediatric literature but only provide limited support for any influence of psychological factors on blood pressure. Depressive symptoms in apparently healthy adolescents may exert some influence on later risk for cardiovascular disease via increases in diastolic blood pressure and mean arterial pressure, but these effects were small.

Psychosocial stress associated with memory performance in older South African adults

ABSTRACTOlder adults with past or current chronic stress exposure perform poorly on memory assessments and are at higher risk for Alzheimer’s disease (AD). In low- or middle-income countries, many older adults are, or have been, exposed to stress-provoking events. Few published studies examine such populations, however, and few take multiple measures of stress. In a sample of South African older adults with mild-to-moderate AD (n = 65) and healthy controls (n = 69), we assessed relations between stress (psychosocial and physiological), memory performance, and patient status. Participants, all aged > 60, were administered the Perceived Stress Scale (a questionnaire assessing subjective psychosocial stress) and the Cambridge Cognitive Examination-Revised (CAMCOG-R; a test battery measuring performance across several cognitive domains). We measured their salivary cortisol concentrations as a proxy for physiological stress. Patients reported significantly higher levels of psychosocial stress than controls, p = .008. Logistic regression showed that psychosocial stress, but not cortisol, predicted AD patient status. CAMCOG-R Memory subscale scores were significantly associated with psychosocial stress, r = −.18, p = .040, but not with cortisol levels. These findings are the first on the topic to emerge from a low-or middle-income country. We replicated findings from previous studies conducted in high-income countries, with data supporting predictions derived from the glucocorticoid cascade/neurotoxicity hypothesis. The results suggest that clinical interventions focused on increasing resilience of older adults to effects of chronic stress may help protect against declining memory performance and reduce the risk for AD.

Influences of continuous sitting and psychosocial stress on low back kinematics, kinetics, discomfort, and localized muscle fatigue during unsupported sitting activities

Continuous seated postures may increase the risk of adverse health outcomes such as low-back pain, and this risk may be influenced by several modifying factors. In the present study, we aimed to quantify the effects of continuous sitting and psychosocial stress under an unsupported sitting condition. Fourteen participants completed continuous, 40 min. periods of computer-based tasks, involving both low and higher levels of psychosocial stress, while using a laptop computer without a desk. Continuous sitting significantly increased perceived discomfort (particularly in the upper and lower back), trunk flexion and metrics of localized muscle fatigue. A higher level of psychosocial stress increased estimated lumbosacral compression forces (by ∼12%). Only weak correlations were found between subjective and objective measures, while various fatigue metrics showed a good level of correspondence with each other. These results could support the future evaluation or design of diverse seated work configurations.Practitioner Summary: Continuous, 40 min. periods of unsupported sitting had broad impacts on subjective and objective outcomes, including discomfort, postures, spine loads and localized muscle fatigue, while psychosocial stress only had a substantial influence on lumbosacral compression. These results extend our understanding of sitting behaviors and provide information for designing future sitting environments.

Exercise is medicine in the 21st century – Emphasis on efficacy, dosing, and safety/toxicity

Substantial evidence from epidemiologic and cohort studies has established the critical importance of physical activity (PA), exercise training (ET), and overall levels of cardiorespiratory fitness (CRF) in the prevention and treatment of cardiovascular diseases (CVD). In fact, low levels of CRF may be the strongest CVD risk factor and predictor of higher mortality, and many studies show that relatively fit subjects with certain disorders, such as obesity, hypertension, dyslipidemia and diabetes, have considerably better prognosis than do unfit subjects without these disorders. The role of low PA as the fundamental cause of obesity will be discussed, as well as low levels of CRF explaining the obesity paradox. The potential benefits of PA/ET and increases in CRF to protect against CVD will be discussed, especially the impact on psychological risk factors, such as depression, anxiety and hostility and overall high levels of psychosocial stress to increase mortality risk, especially in patients with established CVD, such as coronary heart disease (CHD). Even small improvements in CRF and peak VO2 can produce marked reductions in depression and psychological risk factors and lead to marked reductions in mortality risk in cohorts of CVD patients, such as CHD and heart failure. Most of the evidence indicates that the ET benefits especially occur at low doses; in fact, in our major running studies, quite low doses of running appear to produce the greatest reductions in CVD- and all-cause mortality during long-term follow-up studies. On the other hand, high doses of running may be associated with some loss of the ET/running benefits; and very high levels of ET (e.g. marathons and triathlons) are associated with potential cardiotoxicity, which will be briefly discussed. Exercise is Medicine and optimal dosing for this potentially beneficial therapy will be discussed for long-term prevention of chronic diseases, especially CVD and premature mortality.

Psychological Interventions for the Management of Bipolar Disorder

Background: Bipolar disorder is a chronic relapsing and mostly severe psychiatric disorder accompanied with a significant psychiatric comorbidity, considerable role impairment, and significant risk of suicide attempts according to recent researches. Mood stabilizers and antipsychotic medications have proved to be effective in managing symptoms for many patients. Nevertheless, medication noncompliance for some patients is a raising concerns. Additional risk for increased symptom severity and relapse when subjected to high levels of psychosocial stress, such as living in a negative family environment has also been reported. Psychosocial treatments, such as cognitive-behavioral therapy (CBT) and family-focused therapy (FFT) were hence introduced in hope of an integrated strategy for the management of bipolar disorder. Objective of the Study: This article is intended to review the optimal approach for the management of bipolar disorder. Advances in biopsychosocial treatments are also briefly reviewed, including new health service models for providing care. Methods: Electronic search in the scientific database from 1960 to 2017– The studies in this comprehensive review were selected for inclusion based on clinical relevance, importance, and robustness of data related to diagnosis and treatment of bipolar disorder. The search terms that were initially used on MEDLINE/PubMed and Google Search terms included “bipolar disorder,” “mania,” “bipolar depression,” “mood stabilizer,” “atypical antipsychotics,” and “antidepressants.” High-quality, recent reviews of major relevant topics were included to supplement the primary studies. Results: Bipolar disorder is a major public health concern. Management includes a lifetime course of medication and attention to psychosocial issues for patients and their families. Standardized treatment guidelines for the management of acute mania have been developed. New potential treatments are being investigated. Conclusion: Bipolar disorder have a very dynamic and chronic nature and thus, careful selection of a treatment should be tailored to the phases of the disorder, together with the safety profile identified in clinical trials. Nevertheless, Psychosocial interventions, such as CBT and FFT should be employed in combination with pharmacological therapy for bipolar patients in order to increase medication compliance, decrease depressive symptoms and recognize early warning signs of an affective episode should ideally help to optimize the course and outcome of this devastating condition.

P.4.f.006 - Cardiovascular reactions to psychosocial stress, Type D personality and trait anxiety in patients with coronary artery disease

The relation between high levels of psychosocial stress and the development of coronary artery disease (CAD) has been increasingly recognized, especially in women. We hypothesized that simple biomarkers of stress, urinary catecholamines/cortisol levels, are associated with more coronary artery calcium (CAC), an indicator of CAD, and that this relation is stronger in women compared with men. Using data from the Multi-Ethnic Study of Atherosclerosis Stress study, we examined the relation between urinary catecholamines/cortisol and CAC. The study cohort (n = 654) was 53% women, and 56.4% of the cohort had detectable CAC. Multivariable regression analyses assessed the relation between urinary catecholamines/cortisol and CAC (odds CAC >0 through logistic and ln CAC through Tobit model). There was an association between increased cortisol and increased CAC and an inverse association between dopamine and CAC. These relations were seen in men and women, with no difference between the genders. In conclusion, higher cortisol and lower dopamine levels are independently associated with higher CAC to a similar degree in men and women. These simple urinary biomarkers contribute to our understanding of the role of stress in the pathogenesis of CAD and may be incorporated into future strategies to prevent and treat CAD.