Self-reported Stress Scores Research Articles

Stress responses in surgical trainees during simulation-based training courses in laparoscopy

BackgroundSimulation-based training courses in laparoscopy have become a fundamental part of surgical training programs. Surgical skills in laparoscopy are challenging to master, and training in these skills induces stress responses in trainees. There is limited data on trainees’ stress levels, the stress responses related to training on different laparoscopic simulators, and how previous experiences influence trainees’ stress response during a course. This study investigates physiologic, endocrine and self-reported stress responses during simulation-based surgical skills training in a course setting.MethodsWe conducted a prospective observational study of trainees attending basic laparoscopic skills training courses at a national training centre. During the three-day course, participants trained on different laparoscopic simulators: Two box-trainers (the D-box and P.O.P. trainer) and a virtual reality simulator (LAPMentor™). Participants’ stress responses were examined through heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6). The correlation between previous laparoscopic experiences and stress response measurements was explored.ResultsTwenty-four surgical trainees were included in the study. Compared to resting conditions, stress measures were significantly higher during simulation-training activity (the D-box (SDNN = 58.5 ± 23.4; LF/HF-ratio = 4.58 ± 2.71; STAI-6 = 12.3 ± 3.9, P < 0.05), the P.O.P trainer (SDNN = 55.7 ± 7.4; RMSSD = 32.4 ± 17.1; STAI-6 = 12.1 ± 3.9, P < 0.05), and the LAPMentor™ (SDNN = 59.1 ± 18.5; RMSSD = 34.3 ± 19.7; LF/HF-ratio = 4.71 ± 2.64; STAI-6 = 9.9 ± 3.0, P < 0.05)). A significant difference in endocrine stress response was seen for the simulation-training activity on the D-box (saliva cortisol: 3.48 ± 1.92, P < 0.05), however, no significant differences were observed between the three simulators. A moderate correlation between surgical experience, and physiologic and endocrine stress response was observed (RMSSD: r=-0.31; SDNN: r=-0.42; SD2/SD1 ratio: r = 0.29; Saliva cortisol: r = 0.46; P < 0.05), and a negative moderate correlation to self-reported stress (r=-0.42, P < 0.05).ConclusionTrainees have a significant higher stress response during simulation-training compared to resting conditions, with no difference in stress response between the simulators. Significantly higher cortisol levels were observed on the D-box, indicating that simulation tasks with time pressure stress participants the most. Trainees with more surgical experience are associated with higher physiologic stress measures, but lower self-reported stress scores, demonstrating that surgical experience influences trainees’ stress response during simulation-based skills training courses.

Academic stress, hair and saliva cortisol, and their relationship with body mass index and fat percentage in first year medical students.

Although a large part of the population may be exposed to various pressures that can lead to mental or eating problems and increased perceived stress, the transition from adolescence to adulthood has been shown to be a crucial stage. Medical students are particularly vulnerable during the transition period as they must adapt to new circumstances, which may contribute to increased perceived stress. Cortisol plays an important role between stress, weight gain, and the development of obesity. We designed a study to investigate the association between stress, eating behaviour, cortisol, and body weight in a sample of first-year medical students. We determined 75 first-year medical students' hair and salivary cortisol concentrations by ELISA and related it to self-reported stress, eating behaviour, and anthropometric measurements throughout the academic period. The prevalence of overweight and obesity in females was 25% and 10%, and in males was 35% and 6%, respectively. We report an increase in hair cortisol, higher self-reported stress scores, and BMI mainly in females. Finally, we found evidence of positive associations between hair cortisol and BMI in females (r = 0.348) and males (r = 0.423). There is a low association between short-term single-point cortisol measures and long-term cortisol, mainly in males. Hence, short-term cortisol reactivity is moderately associated with long-term cortisol reactivity when both are evaluated simultaneously. These results support the previous evidence of positive associations between cortisol with body fat percentage and BMI, and finally, that eating behaviours are modified by academic stress perception, mainly in females.

The influence of time-management on medical resident's perceived stress scale and overtime: A tertiary care hospital experience from Switzerland

Background and Aim: Many physicians express challenges in managing time demands during clinical practice. Effective time-management skills may counter the negative effects of high workload and time pressures, and subsequently improve productivity as well as professional and personal wellness. The objective is to determine the impact of time-management training on medical residents' overtime hours and self-reported stress scores. Materials and Methods: The present study employed a within-subjects, single group pretest-posttest design. Convenience sampling was used to recruit 27 medical residents from a tertiary care hospital in Saint Gall, Switzerland. Each resident participated in a single, 2-h interactive time-management workshop. Each resident completed the Perceived Stress Scale-10 (PSS-10) 1-week before and 8-week after the time-management intervention. Overtime of every resident was documented during the same time intervals using a hospital-based computer system. Finally, we recorded whether residents experienced any stressful life events during this 8-week study. Results: Residents worked significantly fewer overtime hours after the time-management intervention than before the intervention (P = 0.01). There was also a significant reduction in mean PSS scores following the intervention, but only for residents who reported experiencing stressful life events during the study (P = 0.028). The intervention had no effect on mean PSS scores for residents who did not report a stressful life event (P = 0.36). Conclusion: The present study reported an effect of time-management training on overtime and perceived stress in residents. We argue that time-management can help residents cope with external stressors, and that individuals who experience stressful life events may especially benefit from time-management training.

Instant Stress: Detection of Perceived Mental Stress Through Smartphone Photoplethysmography and Thermal Imaging.

BackgroundA smartphone is a promising tool for daily cardiovascular measurement and mental stress monitoring. A smartphone camera–based photoplethysmography (PPG) and a low-cost thermal camera can be used to create cheap, convenient, and mobile monitoring systems. However, to ensure reliable monitoring results, a person must remain still for several minutes while a measurement is being taken. This is cumbersome and makes its use in real-life situations impractical.ObjectiveWe proposed a system that combines PPG and thermography with the aim of improving cardiovascular signal quality and detecting stress responses quickly.MethodsUsing a smartphone camera with a low-cost thermal camera added on, we built a novel system that continuously and reliably measures 2 different types of cardiovascular events: (1) blood volume pulse and (2) vasoconstriction/dilation-induced temperature changes of the nose tip. 17 participants, involved in stress-inducing mental workload tasks, measured their physiological responses to stressors over a short time period (20 seconds) immediately after each task. Participants reported their perceived stress levels on a 10-cm visual analog scale. For the instant stress inference task, we built novel low-level feature sets representing cardiovascular variability. We then used the automatic feature learning capability of artificial neural networks to improve the mapping between the extracted features and the self-reported ratings. We compared our proposed method with existing hand-engineered features-based machine learning methods.ResultsFirst, we found that the measured PPG signals presented high quality cardiac cyclic information (mean pSQI: 0.755; SD 0.068). We also found that the measured thermal changes of the nose tip presented high-quality breathing cyclic information and filtering helped extract vasoconstriction/dilation-induced patterns with fewer respiratory effects (mean pSQI: from 0.714 to 0.157). Second, we found low correlations between the self-reported stress scores and the existing metrics of the cardiovascular signals (ie, heart rate variability and thermal directionality) from short measurements, suggesting they were not very dependent upon one another. Third, we tested the performance of the instant perceived stress inference method. The proposed method achieved significantly higher accuracies than existing precrafted features-based methods. In addition, the 17-fold leave-one-subject-out cross-validation results showed that combining both modalities produced higher accuracy than using PPG or thermal imaging only (PPG+Thermal: 78.33%; PPG: 68.53%; Thermal: 58.82%). The multimodal results are comparable to the state-of-the-art stress recognition methods that require long-term measurements. Finally, we explored effects of different data labeling strategies on the sensitivity of our inference methods. Our results showed the need for separation of and normalization between individual data.ConclusionsThe results demonstrate the feasibility of using smartphone-based imaging for instant stress detection. Given that this approach does not need long-term measurements requiring attention and reduced mobility, we believe it is more suitable for mobile mental health care solutions in the wild.

Bifidobacterium bifidum R0071 decreases stress-associated diarrhoea-related symptoms and self-reported stress: a secondary analysis of a randomised trial

Psychological stress is associated with gastrointestinal (GI) distress. This secondary analysis from a randomised, double-blind, placebo-controlled study examined whether three different probiotics could normalise self-reported stress-associated GI discomfort and reduce overall self-reported stress. Undergraduate students (n=581) received Lactobacillus helveticus R0052, Bifidobacterium longum ssp. infantis R0033, Bifidobacterium bifidum R0071, or placebo. Participants self-reported 2 outcomes for a 6-week period, which included final academic exams: daily level of stress (0=no stress to 10=extremely stressed) and weekly three diarrhoea-related symptoms (DS, 1=no discomfort to 7=severe discomfort) using the GI Symptom Rating Scale. Self-reported stress was positively related to DS (P=0.0068). Mean DS scores were lower with B. bifidum versus placebo at week 2 at the average level of stress and the average body mass index (BMI). DS scores were lower with B. bifidum at week 5 versus week 0 and 1 and with B. infantis R0033 at week 6 versus week 0. DS scores were higher when antibiotics were used in the prior week with placebo (P=0.0092). DS were not different with or without antibiotic use with the probiotics. Only B. bifidum had an effect on self-reported stress scores (P=0.0086). The self-reported stress score was also dependent on hours of sleep per day where it decreased by 0.13 for each additional hour of sleep. During a stressful period, B. bifidum R0071 decreases DS and self-reported stress scores. This trial was registered at clinicaltrials.gov as NCT01709825.

Psychological stress and testicular function: a cross-sectional study of 1,215 Danish men

To study the associations between self-reported psychological stress, semen quality, and serum reproductive hormones among young Danish men. Cross-sectional study. University hospital-based research center. Danish men (median age 19 years) from the general population were investigated from 2008 to 2012. Participants completed a questionnaire on health and lifestyle, including a four-item questionnaire about self-rated stress, had a physical examination performed, delivered a semen sample, and had a blood sample drawn. Semen parameters (semen volume, sperm concentration, and percentages of motile and morphologically normal spermatozoa) and serum levels of reproductive hormones (LH, FSH, T, calculated free T, sex hormone-binding globulin, and inhibin B). Poorer semen quality was detected among men with self-reported stress scores above an intermediate stress level, in a dose-response manner. For example, men with the highest stress levels had 38% (95% confidence interval [CI] 3%; 61%) lower sperm concentration, 34% (95% CI 59%; 106%) lower total sperm count, and 15% (95% CI 1%; 27%) lower semen volume than men with intermediate stress levels. No significant associations between self-reported stress and levels of reproductive hormones were detected. A negative association between self-reported stress and semen quality was detected. If causal, stress may be a contributing factor for suboptimal semen quality among otherwise healthy men.

Salivary cortisol and self-reported stress among persons with environmental annoyance

Increased vulnerability to stress has been suggested as a possible mechanism behind medically unexplained conditions such as sensitivity to electricity and common smells. This study examined whether subjective environmental annoyance among the general population is associated with increased physiological reactivity or subjective stress scores. Four groups were studied (N=141): an electrically annoyed (N=17), a smell-annoyed (N=29), and a generally annoyed group (N=39) and a reference group matched for age, gender, and socioeconomic status (N=56). Over 5 days, the participants collected saliva for cortisol determination at awakening, 30 minutes after awakening, 8 hours after awakening, and at 9 o'clock in the evening. On the evening preceding the fifth day, the participants ingested a 0.5-mg dexamethasone tablet so that possible differential suppression of the hypothalamic-pituitary-adrenal (HPA) axis could be assessed. Each day, the participants also rated their subjective stress and health complaints. No significant differences were found between the groups regarding cortisol secretion over 5 days. The dexamethasone suppression test showed inhibited cortisol secretion in all four groups. No associations were found between the cortisol concentrations and the self-reported stress scores or subjective health complaints. Although the environmentally annoyed groups showed no signs of increased HPA-axis activation, being annoyed by both electrical devices and smells seems to be related to increased psychological activation in terms of self-reported stress. Because the participants were otherwise healthy and recruited from the general population, the results imply that subtle psychological stress processes may be important in the early development of environmental annoyance.

Students' tactics of resistance and teachers' stress.

In a study of 134 college teachers, teachers' self-reported stress scores were significantly and positively related with their perceptions of students' use of reluctant compliance and deception tactics in resistance to on-task learning.