Self-perceived Stress Levels Research Articles

Modified interteaching sessions as application-based examinations reduce student exam stress in an upper-level pathophysiology class

Testing is a highly important tool, used ubiquitously in academia, to assess student comprehension and understanding of material. Unfortunately, the emphasis placed on test grades has resulted in a modern epidemic of test-related anxiety, which can have adverse health effects on students. Over time, novel testing strategies have been developed to more precisely assess individual skills such as remembering, analyzing, and synthesizing. Yet there exist few strategies that were also developed to simultaneously reduce stress in the testing environment. We posit here a teaching innovation whereby we modified the classic interteaching session developed in the social sciences to serve as a stress-reduction testing format that also builds student communication and critical thinking skills in an upper-level pathophysiology course. After implementing this novel testing approach, we anonymously surveyed the students in the class to understand how the testing format affected their self-perceived stress levels, their self-perceived learning, and to identify their testing preferences. Of 28 students, 12 responded (43%). Our survey data highlight that students largely preferred partnered, open-response, case-based exams to multiple choice exams. Moreover, students perceived themselves as having lower test-related stress when taking partnered, open-response, case-based exams, as well as strong overall agreement that partnered, open-response, case-based exams enhanced their learning. We posit this application of modified interteaching can be employed in upper-level physiology or pathophysiology courses as a stress-reduction testing strategy.

Changes in the self-efficacy and communication of nursing, occupational therapy, and speech-language pathology students participating in a simulated patient simulation

BackgroundThis study aimed to examine changes in self-efficacy and communication of nursing, occupational therapy, and speech-language pathology students through participation in an interprofessional patient simulation. Methods: Twenty-two occupational therapy graduate students, 16 speech-language-pathology graduate students, and 25 undergraduate nursing students participated. Participants completed the Self-Efficacy for Interprofessional Experiential Learning (SE-12), the Interprofessional Collaboration Scale (ICS) pre and post simulation, and an open-ended post-simulation questionnaire on self-perceived stress levels. ResultsEach discipline group demonstrated significant changes in perceived self-efficacy (p < .001) and communication (p < .001). Analysis of the open-ended questions revealed a consistent pattern in reducing stress levels from before the simulation to the post-simulation assessment. ConclusionIncorporating interprofessional patient simulation experiences into pre-professional health programs significantly enhances interprofessional communication skills and self-efficacy and reduces self-reported stress, serving as a valuable tool for preparing students to collaborate effectively in interdisciplinary teams to provide high-quality patient care.

Self-Perceived Stress in Association with Emotional Experiences Following Patient Death and Coping Adequacy among Clinical Nurses in Lithuania: A Cross-Sectional Study.

(1) Background: Stress is defined as a psychological sensation related to a change in both human physiology and behavior in response to a threat or challenge. As the prevalence of stress is increasing globally, nurses represent a risk group for exposure to stress-related psychological alterations. The aim of this study was to explore how clinical nurses in Lithuania cope with the perceived chronic stress in relation to additional emotional experiences following the death of a patient. (2) Methods: During a four-week period of October 2023, a total of 283 female nurses, aged between 20 and 70 years old, were enrolled in a single cross-sectional study. The PSS-10 (perceived stress scale) and the Brief-COPE (Coping Orientation to Problems Experienced) questionnaires were applied to assess the level of self-perceived stress and the use of coping styles along with the adequate strategies. Furthermore, the nurses' emotions, evoked following patient death, were classified depending on their valence. Both the multiple linear and logistic regression statistical analyses were conducted to examine the associations between dependent and independent variables. (3) Results: The study identified that more than half of the nurses experienced patient death several times a month. A moderate-to-high level of the symptoms of mental chronic stress were suffered by 76% of caregivers. The psychological arousal following the death of a patient may induce the occurrence of emotional complexity that refers to competitive feelings, namely, helplessness (adjusted odd ratio (AOR) 1.7, 95% confidence interval (95% CI) 1.1; 2.9), disappointment (AOR 1.9, 95% CI 1.1; 3.5), anxiety (AOR 1.9, 95% CI 1.2; 4.2), and guilt (ORadj 4.7, 95% CI 1.4; 5.7), and can serve as a potential trigger for chronic stress development in clinical nurses. In terms of emotion-focused stress control (β 0.1, 95% CI -0.1; -0.2, R2 = 0.12), Lithuanian nurses had low control of the perceived chronic stress. The use of problem-focused coping (β -0.2, 95% CI -0.3; -0.1, R2 = 0.09) was also not addressed to an appropriate extent. The use of the avoidance coping style was associated with moderate-high levels of chronic stress perceived by nurses (β 0.5, 95% CI 0.4; 0.7, R2 = 0.24). Furthermore, the avoidant coping strategy related to behavioral disengagement was significantly related to resilience to chronic stress in an adverse way. The cognitive process of self-blame was considered as a meaningful maladaptive behavior component for magnifying chronic stress in nurses. (4) Conclusions: The study highlights the need to implement the recommendations for boosting the nurses' mental health. Hospitals should contribute to psychological assistance along with providing necessary training on stress-coping strategies for clinical nurses. In order to promote the sustainability of mental health through additional social support interventions, it would be useful to upgrade the clinical nurses' daily routines with mindfulness-based trainings.

SELF-PERCEIVED COGNITIVE CHANGES IN OLDER BLACK ADULTS DURING COVID-19

Abstract The COVID-19 pandemic has had myriad effects on health and well-being. Contracting the COVID-19 virus and concerns of social and physical consequences during pandemic-related restrictions have been proven to negatively impact health. To better understand possible effects of COVID-19 on Black community-dwelling older adults’ perceived cognitive changes, we conducted a pilot study with 48 community-dwelling African Americans with measures obtained over 24 months from 10/2020 to 10/2022. Participants were recruited from the Wayne State University Institute of Gerontology Healthier Black Elders Center, and Michigan Alzheimer’s Disease Research Center, and the general Detroit Area (Mage=73.07, Range=65-87 years). The Cognitive Change Index (CCI) was used as a self-report measure of perceived change over the last five years. The COVID Impact Survey (CIS) was used to assess the burden of COVID-19 on daily living. To evaluate emotional-being, the Perceived Stress Scale (PSS responses referred to the last month) and the Geriatric Depression Scale (GDS, within the last week) were administered. Stepwise regression models showed CIS outcome measures did not predict CCI. GDS outcome measures predicted CCI to some degree (R2adj = .15, p = .008), whereas PSS was the strongest predictor (R2adj = .50, p &amp;lt; .001). Results suggest that for older community-dwelling African Americans, past COVID-19 pandemic experiences did not affect their self-evaluated cognitive changes. Higher levels of self-perceived stress within the last month best predicted their subjective cognitive decline. Future research should involve interventions focused on stress reduction, and clinicians should consider stress level when diagnosing cognitive status in older adults.

Burnout Among Social Workers. Exploratory Research in Botosani City

The present work aims to explore the presence of symptoms associated with the burnout syndrome in a number of 24 social workers who work within the General Direction for Social Work and Child Protection (DGASPC) Botoșani. The objectives of the investigation were the following: a) exploring possible stress factors at the organizational level according to the six categories identified by Christine Maslach and Leiter Michael (1999) and b) identifying the level of self-perceived stress by social workers.&#x0D; The results of the study indicate a favorable self-perception of the existence of burnout or at least an increased level of stress felt at work, by identifying some variables evaluated as unfavorable for the achievement of work in a fair, transparent and balanced framework.

Diets, Lifestyles and Metabolic Risk Factors among Corporate Information Technology (IT) Employees in South India.

(1) Information Technology (IT) Business Process Outsourcing (BPO), the largest employment sector of India, contributes to rapid economic growth. However, the work of IT employees is sedentary, and the food environments of their worksites expose them to an obesogenic environment. This study aimed to assess their metabolic and lifestyle risk factors. (2) Methods: To examine the health and nutrition status of IT employees, anthropometric, biochemical and clinical assessments were conducted among 183 employees from three IT organizations of varied operational sizes. Their health-, diet- and physical activity-related practices were assessed using a questionnaire. The prevalence of MetS was assessed. Selected biomarker levels were assessed and associated with their self-perceived stress levels. (3) Results: The median age of the employees was 30 years (26-35 years). While 44.02% of employees were overweight, 16.85% of employees were obese. About 3.89% of employees were found to be diabetic, and HDL-C levels were lower than recommended in 64.93% of employees. In all, 29.87% of the study population were considered to have metabolic syndrome since they had metabolic risk scores ≥ 3. Those with metabolic syndrome were significantly older (p = 0.000), and levels of MDA (p = 0.003), homocysteine (p = 0.001), IL-6 (p = 0.017) and IL-4 (p = 0.000) were significantly higher among them. Although the prevalence of MetS was significantly lower among those aged >30 years, the lifestyle risk factors were significantly higher among them. (4) Conclusions: The assessed parameters indicate a high risk of developing NCDs among employees in the IT industry in India. This shows the need for the modification of lifestyle and workplace food and physical activity environments.

The Level of Self-Perceived Stress among International School Teachers During Post-Pandemic Period

The Level of Self-Perceived Stress among International School Teachers During Post-Pandemic Period

A case-control study of 10,757 individuals to assess potentially modifiable risk factors, including stress, for breast cancer among Chinese patients in Hong Kong.

e22522 Background: Breast cancer is the most common cancer in women worldwide. Both intrinsic and environmental factors contribute to the disparities in breast cancer incidence across different regions. In Hong Kong, the incidence has been increasing in the past decades. With over 4700 women diagnosed in 2019, breast cancer is responsible for 27% of all female cancers in Hong Kong. Apart from intrinsic non-modifiable risk factors, some risk factors are modifiable and may reduce cancer risk. Methods: We conducted a case-control study that involved breast cancer patients from the Hong Kong Breast Cancer Registry with matched healthy controls from the community between 2014 and 2017. A standardized written questionnaire was used through face-to-face interviews of all study participants. The questionnaire collected information on participants’ demographics, general health, smoking history and other lifestyle factors including physical activity, self-assessed dietary habits (balanced, vegetarian, meat and dairy-rich diets), self-perceived stress levels (measured with a 4-point Likert scale, and high stress level was defined as having over 50% of the participant’s time with stress being scored 3 or above out of a Likert scale of 4), body mass index, family history, menstrual and reproductive history, and history on the use of oral contraceptives and hormone replacement therapy. Multiple logistic regression was fitted to compare all risk factors. Results: A total of 5,186 breast cancer patients and 5,571 controls were recruited. Modifiable risk factors that were shown to be associated with an increased risk of breast cancer included self-perceived high stress level (adjusted odd ratios [aOR] = 3.44; 95% CI = 3.13-3.78), meat-rich diet (aOR = 1.77; 95% CI = 1.54-2.04), dairy-rich diet (aOR = 3.33; 95% CI = 2.01-5.52), overweight/obese status (aOR = 1.21; 95% CI = 1.10-1.32), delayed child-bearing (aOR = 2.23; 95% CI = 1.79-2.79), nulliparity (aOR = 1.21; 95% CI = 1.08-1.35) and ever use of oral contraceptives (aOR = 1.34; 95% CI = 1.22-1.47), while exercise (OR = 0.62; 95% CI = 0.56-0.68) and breast-feeding (aOR = 0.76; 95% CI = 0.69-0.83) were associated with reduced risk. Conclusions: In Hong Kong, high stress level, meat- and dairy- rich diet, overweight/obese, reproductive history and use of oral contraceptives were identified to be modifiable risk factors for breast cancer. Adjusting these factors through lifestyle modification may curb the increasing trend of breast cancer incidences in the coming decades.

Productivity costs associated to voice symptoms, low sleep quality, and stress among college professors during homeworking in times of COVID-19 Pandemic

Objective. To estimate the productivity reduction costs associated to self-reported voice symptoms, low sleep quality, and high stress levels among college professors during homeworking in times of COVID-19 pandemic. Methods. This cross-sectional study included fifty-eight college professors who reported their reduction in productivity at work due to self-perceived stress levels, sleep quality, and voice symptoms. Results. High stress levels were reported by 24% of the participants, whereas 19% reported voice symptoms, and 3% low sleep quality. Costs associated with the three conditions were calculated for twenty-nine subjects. Productivity costs associated with high stress levels were higher (COP$32.345.925) than those for voice symptoms (COP$1.872.703) and low sleep quality (COP$319.733). Conclusion: Productivity reduction costs were higher for professors who reported high levels of stress followed by participants with self-reported voice symptoms and low sleep quality, which highlight the importance of prioritizing activities to reduce stress levels and voice symptoms in workplace health promotion programs implemented in educational settings.

Yoga as an adjunct activity for medical students learning anatomy

BackgroundMedical students experience high levels of stress during training due to demanding course loads which often leaves less time for self-care. This study combines the self-care technique of yoga with learning anatomical locations, innervations, actions, and functions of the muscles and organs to determine if anatomy tests scores are improved and whether students’ stress levels attenuate from participating in yoga.MethodsIn this randomized controlled study, 64 student volunteers were randomized into either a yoga intervention group or wait list control group throughout the M1 anatomy course. The yoga group (n = 32) participated in 8 yoga sessions synced with the anatomy topics they were learning in lecture. The wait list group (n = 32) went through their normal anatomy curriculum but had an option to participate in the same yoga sessions after the anatomy course. The primary research purpose was to determine whether yoga improved anatomy exam performance by comparing four anatomy exam scores between the two groups. The secondary research purposes included the following: to determine whether yoga classes including anatomy teaching still conferred acute and long-lasting stress relief by, respectively, comparing a students’ own pre- and post-yoga stress level and self-perceived stress levels between the two groups; and to determine if a student’s confidence in anatomy was improved after a yoga session.ResultsThere was no significant difference in anatomy exam performance between students who received yoga and those on the waitlist (all p > 0.05). For students who received yoga, their average self-reported stress levels decreased after each yoga session, their average DASS (Depression, Anxiety and Stress Scale) score decreased after a yoga session, but they were not significantly less stressed than their waitlist peers prior to an exam, and their self-reported confidence in anatomy material related to the back, upper extremity, head and neck, and abdomen/pelvis increased.ConclusionWith this sample, there was no evidence that yoga sessions paired with anatomy lecture material improved overall anatomy exam performance, as opposed to only the musculoskeletal portion which other studies have looked at. However, yoga acutely reduced stress levels, and subjective feelings of knowledge improvement were noted by participants. Both of these can provide benefits to medical students.

Association between Psychological Stress and Neck Pain among College Students during the Coronavirus Disease of 2019 Pandemic: A Questionnaire-Based Cross-Sectional Study.

The coronavirus disease of 2019 (COVID-19) greatly affected people’s lifestyles. We used an online, cross-sectional survey during a COVID-19-related lockdown in Israel, with the aim of investigating the effects of such lockdowns on students’ self-perceived stress and neck pain (NP). College students (N = 295) completed questions on sociodemographic characteristics, the Neck Disability Index (NDI), the Perceived Stress Scale, the Visual Analogue Scale (VAS), and NP frequency (four-point scale). Logistic regression models were calculated with the NDI as the dependent variable. In total, 35.6% of students experienced at least moderate NP-related disability (NDI ≥ 15), more during than before the lockdown. NP increased gradually, from a lifetime mean of 1.80 to a lockdown mean of 3.07 (χ2 = 316.72; p < 0.001). Students’ self-perceived stress was moderate, and 59.3% reported experiencing study-related stress. Higher levels of self-perceived stress, study-related stress, sitting >3 h/day, and a higher VAS score were associated with a higher risk of an NDI ≥ 15 (Nagelkerke’s R2 = 0.513, p < 0.001). The transition from on-campus to online learning seems to have exacerbated students’ NP, which was correlated to their study stress and lifestyles. These findings advocate for the need to promote the physical and mental health of students via e.g., mental health services and occupational and ergonomic consulting services.

Self-Perceived Stress During the Quarantine of COVID-19 Pandemic in Paraguay: An Exploratory Survey.

Introduction: Any viral pandemic is a global health and mental health issue. The World Health Organization and mental health associations have warned that the current COVID-19 pandemic will lead to a drastic increase of stress-related conditions and mental health issues globally.Materials and Methods: An online web-based survey has been launched from 10 to 15 April 2020 in Paraguay in order to collect information regarding the stress related to the quarantine during the COVID-19 pandemic. It has been spread through social media (“WhatsApp,” “Twitter,” and “Facebook”). Two thousand two hundred and six Paraguayan citizens, over 18 years of age, completed the survey voluntarily. Socio-demographics as well as ratings at Self-perceived Stress Scale have been collected and analyzed.Results: Two thousand two hundred and six subjects (74.12% men) aged between 18 and 75 with an average of 34 ± 11 years old completed the survey. 12.42% (276 subjects) of sample reported a preexisting diagnosis of mental disorder, and 175 participants (7.93%) reported an increase of preexisting symptoms with the onset of COVID-19 quarantine. 41.97% of them had anxiety and 54.38% did not receive any specific treatment. The general population rated 18.10 ± 5.99 at Self-perceived Stress Scale, which indicates a moderate level of self-perceived stress. Significant association was found between higher levels of stress and female sex, being single, or reporting preexisting mental disorder, above all anxiety and depression (p < 0.01). In fact, in 63.87% of mentally ill subjects (n = 175), the quarantine has worsened symptoms of preexisting mental disorders.Conclusion: This study suggests a stressful impact of COVID-19 pandemic, with the majority of participants reporting a moderate level of self-perceived stress. We suggest mental health services to provide a phone-based or web-based support to the general population in order to contrast the psychological impact of the pandemic. This approach may improve the accessibility to mental healthcare services in Paraguay, especially in times of social distancing.

Adolescents with borderline personality disorder show a higher response to stress but a lack of self-perception: Evidence through affective computing

Stress reactivity is a complex phenomenon associated with multiple and multimodal expressions and functions. Herein, we hypothesized that compared with healthy controls (HCs), adolescents with borderline personality disorder (BPD) would exhibit a stronger response to stressors and a deficit in self-perception of stress due to their lack of insight.Twenty adolescents with BPD and 20 matched HCs performed a socially evaluated mental arithmetic test to induce stress. We assessed self- and heteroperception using both human ratings and affective computing-based methods for the automatic extraction of 39 behavioral features (2D + 3D video recording) and 62 physiological features (Nexus-10 recording). Predictions were made using machine learning. In addition, salivary cortisol was measured. Human ratings showed that adolescents with BPD experienced more stress than HCs. Human ratings and automated machine learning indicated opposite results regarding self- and heteroperceived stress in adolescents with BPD compared to HCs. Adolescents with BPD had higher levels of heteroperceived stress than self-perceived stress. Similarly, affective computing achieved better classification for heteroperceived stress. HCs had an opposite profile; they had higher levels of self-perceived stress, and affective computing reached a better classification for self-perceived stress. We conclude that adolescents with BPD are more sensitive to stress and show a lack of self-perception (or insight). In terms of clinical implications, our affective computing measures may help distinguish hetero- vs. self-perceptions of stress in natural settings and may offer external feedback during therapeutic interaction.

Relation between self-perceived stress, psychopathological symptoms and the stress hormone prolactin in emerging psychosis

BackgroundPsychosocial stress and the stress hormone prolactin are assumed to play an important role in the pathogenesis of schizophrenia and related psychoses, and have been frequently observed to be increased in antipsychotic-naïve patients with a clinical high risk for psychosis (CHR-P) or first episode of psychosis (FEP). The aim of this study was to further elucidate the relationships between self-perceived stress, psychopathological symptoms and prolactin levels in these patients. MethodsIn this cross-sectional study, 45 healthy controls, 31 CHR-P patients and 87 FEP patients were recruited from two different study centers. Prolactin was measured under standardized conditions between 8 and 10 am. All patients were antipsychotic-naïve and not taking any prolactin influencing medication. Self-perceived stress during the last month was measured with the perceived stress scale (PSS-10) immediately before blood taking. ResultsBoth CHR-P and FEP patients showed significantly higher levels of self-perceived stress and prolactin than controls. Hyperprolactinemia (i.e. prolactin levels above the reference range) was observed in 26% of CHR-P and 45% of FEP patients. Self-perceived stress was significantly positively associated with affective symptoms, but not with other symptoms. There was no significant association between self-perceived stress and prolactin levels. ConclusionOur results confirm that CHR-P and FEP patients have higher stress levels than healthy controls and frequently have hyperprolactinemia, independent of antipsychotic medication. However, although it is well established that prolactin increases in response to stress, our results do not support the notion that increased prolactin levels in these patients are due to stress.

Comparison of the HRV of Emergency Physicians in the HEMS During Helicopter Operations: Analysis of Differences as a Function of Number of Operations and Workload.

Chronic stress can lead to physiological illness. Emergency physicians in danger of developing such illnesses due to their demanding working environment. The aim of this study was to investigate the physiological stress level of emergency physicians (EPs) of the Helicopter Emergency Medical Service (HEMS) between emergency operations in one shift. Furthermore, the phases of the operations were compared with respect to the activity of the autonomic nervous system. The physiological and self-perceived stress levels of 20 EPs were recorded on a HEMS air-rescue-day (age: M = 44.95, SD = 4.80). The measurement of the heart rate variability (HRV) was performed during a complete air-ambulance day and examined using analyses of variance. The heart rate rises significantly at the beginning of the emergency operationto its highest valueafter landing at the operation site. The HRV parameter standard deviation of all NN intervals shows a significant decrease between the alarm phase and the end of the operation. Furthermore, high values were reached regarding chronic stress. On the Symptom Checklist-90 the EPs show lower values than the norm sample. In conclusion, over the course of three emergency operations, no physiological fatigue indicators were found. In contrast, the subjective stress load was assessed as high among EPs and on average higher than the norm sample. Compared to standard values, the EPs showed lower HRV values, which indicates a strong activation of the autonomic nervous system. These lower HRV findings might be caused by a high psychological stress load.

Association of Perceived Stress Levels With Long-term Mortality in Patients With Peripheral Artery Disease

Identifying modifiable risk factors, such as stress, that could inform the design of peripheral artery disease (PAD) management strategies is critical for reducing the risk of mortality. Few studies have examined the association of self-perceived stress with outcomes in patients with PAD. To examine the association of high levels of self-perceived stress with mortality in patients with PAD. This cohort study analyzed data from the registry of the Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) study, a multicenter study that enrolled patients with new or worsening symptoms of PAD who presented to 16 subspecialty clinics across the US, the Netherlands, and Australia from June 2, 2011, to December 3, 2015. However, the present study included only patients in the US sites because assessments of mortality for patients in the Netherlands and Australia were not available. Data analysis was conducted from July 2019 to March 2020. Self-perceived stress was quantified using the 4-item Perceived Stress Scale (PSS-4), with a score range of 0 to 16. A score of 6 or higher indicated high stress in this cohort. Missing scores were imputed using multiple imputation by chained equations with predictive mean matching. Stress was assessed at baseline and at 3-, 6-, and 12-month follow-up. Patients who reported high levels of stress at 2 or more follow-up assessments were categorized as having chronic stress. All-cause mortality was the primary study outcome. Such data for the subsequent 4 years after the 12-month follow-up were obtained from the National Death Index. The final cohort included 765 patients, with a mean (SD) age of 68.4 (9.7) years. Of these patients, 57.8% were men and 71.6% were white individuals. High stress levels were reported in 65% of patients at baseline and in 20% at the 12-month follow-up. In an adjusted Cox proportional hazards regression model accounting for demographics, comorbidities, disease severity, treatment type, and socioeconomic status, exposure to chronic stress during the 12 months of follow-up was independently associated with increased risk of all-cause mortality in the subsequent 4 years (hazard ratio, 2.12; 95% CI, 1.14-3.94; P = .02). In thie cohort study of patients with PAD, higher stress levels in the year after diagnosis appeared to be associated with greater long-term mortality risk, even after adjustment for confounding factors. These findings suggest that, given that stress is a modifiable risk factor for which evidence-based management strategies exist, a holistic approach that includes assessment of chronic stress has the potential to improve survival in patients with PAD.

Continuous HRV analysis of HEMS emergency physicians to specify the work load over the different working days.

Up to date, there has been little research about the acute stress load of emergency physicians of the Helicopter Emergency Medical Service (HEMS). Therefore, this study investigates the physiological stress level between an air-rescue day, a clinic day, and a day off (control day). Furthermore, phases of activity and resting were compared to assess the activity of the autonomic nervous system (ANS). In this field study (within-subjects design), heart rate variability (HRV) and self-perceived stress levels were monitored on an air-rescue day, a clinic day, and a control day of 20 HEMS EPs [three females, 17 males; age: mean (M) = 44.95, standard deviation (SD) = 4.80]. When comparing the activity phases, significant differences were found for HR and HRV. The highest HR was found on the air-rescue day during the phase of landing at the operation site with M = 107.30bpm (SD = 22.66bpm), which was significantly higher than during activity phases of the clinic day (M = 88.28bpm, SD = 11.81bpm) and the control day (M = 83.28bpm, SD = 14.83bpm). The SDNN is significantly higher on the air-rescue day for the phase before the alarm (M = 72.23ms, SD = 38.60ms), the phase of the alarm (M = 77.52ms, SD = 40.52ms), and the average of all phases (M = 60.04ms, SD = 34.07ms) than on the clinic day (M = 38.42ms, SD = 15.16ms) and the control day, where the lowest value was reached (M = 39.11ms, SD = 17.65ms). The highest LF/HF was found during activity phases of the clinic day with M = 1281.84% (SD = 587.33%), which was significantly higher than the first five phases of the emergency operations and the average of all phases of the emergency operations of the air-rescue day, where a maximum of M = 896.57ms (SD = 681.79ms) during the phase before the alarm and a minimum of M = 764.69ms (SD = 372.28ms) during the phase of landing at the operation site. The lowest LF/HF for all testing days was found during the activity phases of the control day with M = 693.74% (SD = 404.73%). Overall, 60 observations were analyzed. In the psychological assessment, on average, the EPs shows lower values than the norm sample. In the comparison of the activity phases, significant effects were found on the clinic day and during the phases of the emergency operations of the air-rescue day for the HR and HRV. Hereby, a significant activation of the EPs ANS and an outweigh of the sympathetic nervous system could be shown, whereby the subjective stress load was reported mainly as low. For the resting phases, no significant differences were found between all testing days. We interpret this as a good sign for the ability of regeneration between the phases of high stress load.

Stress load of emergency service: effects on the CAR and HRV of HEMS emergency physicians on different working days (N = 20).

The occupation of the emergency physicians (EPs) of helicopter emergency medical services (HEMS) can be characterized as a high-strain occupation (Karasek in Adm Sci Q 24(2):285-308. https://doi.org/10.2307/2392498 , 1979). Therefore, the aim of this study was to measure and compare the stress load of the EPs of HEMS on duty on air ambulance workdays and on 2 control days. In this field study (within-subjects design), hormonal, physiological, and self-perceived stress levels of 20 EPs [3 females, 17 males; mean age (M) = 44.95 years, SD = 4.80, 95% confidence interval (CI) (42.71, 47.19)] of HEMS, were recorded on different test days. Measurements of the cortisol awakening response (CAR) and the heart rate variability (HRV) were performed while on duty on the air ambulance and during workdays at the outpatient clinic as well as at home on days of rest. There were significant differences in the CAR (area under the curve with respect to ground F(2,38) = 12.81, p < 0.001) between the 3 test days with the highest values on the workday at the outpatient clinic [M = 81.24; 98.75% CI (61.24, 101.24)] and not on the air ambulance day [M = 61.82; 98.75% CI (45.18, 78.46)] or on the day of rest [M = 52.96; 98.75% CI (38.17, 67.76)]. In addition, the HRV parameter SDNN [F(2,38) = 6.369; p = 0.004] presented significant differences between the 3 test days with lower levels on the day at the outpatient clinic [M = 101.44; 98.75% CI (83.50, 119.38)] in contrast to the air ambulance day [M = 120.16; 98.75% CI (100.02, 140.30)] and to the resting day [M = 123.79; 98.75% CI (106.49, 141.10)]. Furthermore, there were significant differences in the HRV parameter LF/HF [F(2,38) = 6.215; p = 0.005] between the 3 testing days with the highest values on the workday at the outpatient clinic [M = 8.69; 98.75% CI (6.29, 11.09)] compared to the air ambulance day [M = 6.54; 98.75% CI (4.50, 8.57)] and the day of rest [M = 6.43; 98.75% CI (4.57, 8.29)]. Compared with the standard values and previous studies, EPs of HEMS have an increase in hormonal reactivity in the morning and a lack of recovery of the ANS. It can be concluded that-with respect to the psychobiological stress model by McEwen and Lasley (The end of stress as we know it, National Academic Press, Washington, 2003)-work-related stressors persist too long or the stress response is exaggerated (allostatic load) due to chronic stress induction and lack of recovery.

The physiotherapist, an untapped resource for headaches: a survey of university students

Background: Physiotherapeutic interventions are beneficial in headache treatment. However, knowledge of the benefits of physiotherapy for headache appears to be lacking.Aims: The main aim of this study was to investigate how many undergraduate students at a large university in Sweden are aware that they can turn to a physiotherapist for headache-related problems. A secondary aim was to map out the prevalence and frequency of headache, and investigate students’ level of stress and physical activity, and whether they seek help for their headache and, if so, from which profession. Further, possible correlations between headache frequency and self-perceived stress levels, as well as physical activity levels, were evaluated.Method: A questionnaire was distributed to 270 students in a classroom setting.Results: Of the respondents (99%), 26% answered that they knew they could turn to a physiotherapist for headache. Altogether 94% had suffered from headaches during the past year and 4% had sought help from a physiotherapist.Conclusion: The study suggests that the physiotherapist is an untapped resource in headache treatment. Headache is very common in university students; yet of the surveyed students 74% were unaware that they could turn to a physiotherapist if they had headache-related problems.

Neural Plastic Effects of Working Memory Training Influenced by Self-perceived Stress in Stroke: A Case Illustration.

This case study examined the effects of auditory working memory (WM) training on neuroplastic changes in stroke survivors and how such effects might be influenced by self-perceived stress. Two participants with a history of stroke participated in the study. One of them had a higher level of self-perceived stress. Both participants underwent a course of auditory WM training and completed baseline and post-training assessments such as self-perceived stress, performance satisfaction questionnaires, behavioral task performance, and functional magnetic resonance imaging. They were trained on a computerized auditory WM task (n-back) 5 days a week for 6 weeks, for a total of 20 h. Participant 1 had high levels of perceived stress, both pre- and post-training, and showed improvement on the satisfaction aspect of functional engagement only. Participant 2 had lower levels of perceived stress and demonstrated improvements on all performance tasks. Neuroimaging results showed evidence of improved neural efficiency on the trained task for participant 2. The results shed light on the need to evaluate psychological influences, e.g., stress, when studying the neuroplastic changes in people with stroke. However, the case design approach and other factors that might have positively influenced outcomes mean that these results must be interpreted with a great deal of caution. Future studies using a larger sample are recommended to verify the findings.