Biomarkers of exercise-induced myocardial stress in relation to inflammatory and oxidative stress

Increased concentrations of biomarkers reflecting myocardial stress such as cardiac troponin I and T and brain natriuretic peptide (BNP) have been observed following strenuous, long-lasting endurance exercise. The pathophysiological mechanisms are still not fully elucidated and the interpretations of increased post-exercise concentrations range from (i) evidence for exercise-induced myocardial damage to (ii) non-relevant spurious troponin elevations, presumably caused by assay imprecision or heterophilic antibodies. Several lines of evidence suggest that inflammatory processes or oxidative stress could be involved in the rise of NT-proBNP and Troponin observed in critically ill patients with sepsis or burn injury. We tested the hypothesis that inflammatory or oxidative stress is also responsible for exercise-induced cardiomyocyte strain in a large cohort of triathletes following an Ironman triathlon. However, the post-race increase in cardiac troponin T and NT-proBNP was not associated with several markers of exercise-induced inflammation, oxidative stress or antioxidant vitamins. Therefore, we clearly need more studies with other inflammatory markers and different designs to elucidate the scientific background for increases in myocardial stress markers following strenuous endurance events.

No indications of persistent oxidative stress in response to an ironman triathlon

Introduction: Training for and competing in ultraendurance exercise events is associated with an improvement in endogenous antioxidant defenses as well as increased oxidative stress. However, consequences on health are currently unclear. Purpose: We aimed to examine the impact of training- and acute exercise-induced changes in the antioxidant capacity on the oxidant/antioxidant balance after an ironman triathlon and whether there are indications for sustained oxidative damage. Methods: Blood samples were taken from 42 well-trained male triathletes 2 d before an ironman triathlon, then immediately postrace, 1, 5, and 19 d later. Blood was analyzed for conjugated dienes (CD), malondialdehyde (MDA), oxidized low-density lipoprotein (oxLDL), oxLDL:LDL ratio, advanced oxidation protein products (AOPP), AOPP:total protein (TP) ratio, Trolox equivalent antioxidant capacity (TEAC), uric acid (UA) in plasma, and activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) in erythrocytes. Results: Immediately postrace, there were significant increases in CD, AOPP, TEAC, UA (for all P < 0.001), and AOPP:TP (P < 0.01). MDA rose significantly (P < 0.01) 1 d postrace, whereas CD (P < 0.01), AOPP (P = 0.01), AOPP:TP (P < 0.05), and TEAC (P < 0.001) remained elevated. OxLDL:LDL trended to increase, whereas oxLDL significantly (P < 0.01) decreased 1 d postrace. Except for GSH-Px (P = 0.08), activities of SOD (P < 0.001) and CAT (P < 0.05) significantly decreased postrace. All oxidative stress markers had returned to prerace values 5 d postrace. Furthermore, several relationships between training status and oxidative stress markers, TEAC, and antioxidant enzyme activities were noted. Conclusions: This study indicates that despite a temporary increase in most (but not all) oxidative stress markers, there is no persistent oxidative stress in response to an ironman triathlon, probably due to training- and exercise-induced protective alterations in the antioxidant defense system.

Recovery after an Ironman triathlon: Sustained inflammatory responses and muscular stress

Ultra-endurance exercise, such as an Ironman triathlon, induces muscle damage and a systemic inflammatory response. As the resolution of recovery in these parameters is poorly documented, we investigated indices of muscle damage and systemic inflammation in response to an Ironman triathlon and monitored these parameters 19 days into recovery. Blood was sampled from 42 well-trained male triathletes 2 days before, immediately after, and 1, 5 and 19 days after an Ironman triathlon. Blood samples were analyzed for hematological profile, and plasma values of myeloperoxidase (MPO), polymorphonuclear (PMN) elastase, cortisol, testosterone, creatine kinase (CK) activity, myoglobin, interleukin (IL)-6, IL-10 and high-sensitive C-reactive protein (hs-CRP). Immediately post-race there were significant (P < 0.001) increases in total leukocyte counts, MPO, PMN elastase, cortisol, CK activity, myoglobin, IL-6, IL-10 and hs-CRP, while testosterone significantly (P < 0.001) decreased compared to prerace. With the exception of cortisol, which decreased below prerace values (P < 0.001), these alterations persisted 1 day post-race (P < 0.001; P < 0.01 for IL-10). Five days post-race CK activity, myoglobin, IL-6 and hs-CRP had decreased, but were still significantly (P < 0.001) elevated. Nineteen days post-race most parameters had returned to prerace values, except for MPO and PMN elastase, which had both significantly (P < 0.001) decreased below prerace concentrations, and myoglobin and hs-CRP, which were slightly, but significantly higher than prerace. Furthermore, significant relationships between leukocyte dynamics, cortisol, markers of muscle damage, cytokines and hs-CRP after the Ironman triathlon were noted. This study indicates that the pronounced initial systemic inflammatory response induced by an Ironman triathlon declines rapidly. However, a low-grade systemic inflammation persisted until at least 5 days post-race, possibly reflecting incomplete muscle recovery.

Well-trained, healthy triathletes experience no adverse health risks regarding oxidative stress and DNA damage by participating in an ultra-endurance event

Also physical exercise in general is accepted to be protective, acute and strenuous exercise has been shown to induce oxidative stress. Enhanced formation of free radicals leads to oxidation of macromolecules and to DNA damage. On the other hand ultra-endurance events which require strenuous exercise are very popular and the number of participants is continuously increasing worldwide. Since only few data exists on Ironman triathletes, who are prototypes of ultra-endurance athletes, this study was aimed at assessing the risk of oxidative stress and DNA damage after finishing a triathlon and to predict a possible health risk. Blood samples of 42 male athletes were taken 2 days before, within 20 min after the race, 1, 5 and 19 days post-race. Oxidative stress marker increased only moderately after the race and returned to baseline after 5 days. Marker of DNA damage measured by the SCGE assay with and without restriction enzymes as well as by the sister chromatid exchange assay did either show no change or deceased within the first day after the race. Due to intake during the race and the release by the cells plasma concentrations of vitamin C and α-tocopherol increased after the event and returned to baseline 1 day after. This study indicates that despite a temporary increase in some oxidative stress markers, there is no persistent oxidative stress and no DNA damage in response to an Ironman triathlon in trained athletes, mainly due to an appropriate antioxidant intake and general protective alterations in the antioxidant defence system.

The psychosocial purpose of driving and its relationship with the risky driving behaviour of young novice drivers

Background The overrepresentation of young drivers in road crashes, injuries and fatalities around the world has resulted in a breadth of injury prevention efforts including education, enforcement, engineering, and exposure control. Despite multifaceted intervention, the young driver problem remains a challenge for injury prevention researchers, practitioners and policy-makers. The intractable nature of young driver crash risks suggests that a deeper understanding of their car use – that is, the purpose of their driving – is required to inform the design of more effective young driver countermeasures. Aims This research examined the driving purpose reported by young drivers, including the relationship with self-reported risky driving behaviours including offences. Methods Young drivers with a Learner or Provisional licence participated in three online surveys (N1 = 656, 17–20 years; N2 = 1051, 17–20 years; N3 = 351, 17–21 years) as part of a larger state-wide project in Queensland, Australia. Results A driving purpose scale was developed (the PsychoSocial Purpose Driving Scale, PSPDS), revealing that young drivers drove for psychosocial reasons such as for a sense of freedom and to feel independent. Drivers who reported the greatest psychosocial purpose for driving were more likely to be male and to report more risky driving behaviours such as speeding. Drivers who deliberately avoided on-road police presence and reported a prior driving-related offence had significantly greater PSPDS scores, and higher reporting of psychosocial driving purposes was found over time as drivers transitioned from the supervised Learner licence phase to the independent Provisional (intermediate) licence phase. Discussion and conclusions The psychosocial needs met by driving suggest that effective intervention to prevent young driver injury requires further consideration of their driving purpose. Enforcement, education, and engineering efforts which consider the psychosocial purpose of the driving are likely to be more efficacious than those which presently do not. Road safety countermeasures could reduce the young driver’s exposure to risk through such mechanisms as encouraging the use of public transport.

Relationships between biophysical and psychosocial outcomes following minor stroke

This descriptive correlational study examined relationships between mild stroke functional and psychosocial outcomes over the early post-discharge period among dyads of mild stroke patients (n=38) and their spousal caregivers (n=38). We measured patients' functional scores using the modified Rankin Scale; patients' and caregivers' quality of life (QoL) using Stroke Impact Scale and Short-Form 36 respectively, mood using the Beck Depression Inventory-II, and marital function scores using the Family Assessment Device. Spousal caregivers also completed the Bakas Caregiving Outcomes Scale as a measure of caregiver strain. The average age of stroke patients was 64 years and of spousal caregivers 58 years. All stroke patients were male; all spousal caregivers female. At three months post discharge, patient functional status scores had significantly improved from discharge (p=0.026) with a corresponding increase in QoL scores (p=0.012). Functional status was significantly correlated with patient perceptions of QoL at three months (r=.014, p=0.024) and spousal caregiver perceptions of physical domain QoL (r=.-.397, p=0.014). Spousal caregivers' mood at three months post discharge was strongly correlated with their perceptions of marital satisfaction (r=.578, p=0.000) and caregiver strain (r=-.620, p=0.000). In preparing patients for discharge following mild stroke, nurses must consider the psychological and social implications of the recovery process over time for both the patient with stroke and their spousal caregivers.

Responses to an in-basket activity: The role of work stress, behavioral control, and informational control

This study was undertaken to examine the main and interactive effects of work stress and work control on levels of adjustment. Work stress, behavioral control, and informational control were manipulated in an experimental setting in which participants (N = 192) completed an in-basket activity. Although minimal support was found for the main and interactive effects of objective work stress, behavioral control, and informational control on adjustment, analyses involving the subjective measures of these variables revealed strong support for the proposal that work stress, behavioral control, and informational control would exert main effects on adjustment. There was also evidence that subjective levels of behavioral control buffered the negative effects of subjective work stress on positive mood, subjective task performance, and task satisfaction.

A stress and coping approach to organisational change: Evidence from three field studies

In this paper, a stress and coping perspective is used to outline the processes that determine employee adaptation to organisational change. A theoretical framework that simultaneously considers the effects of event characteristics, situational appraisals, coping strategies, and coping resources is reviewed. Three empirical investigations of organisational change that have tested various components of the model are then presented. In the first study, there was evidence linking event characteristics, situational appraisals, coping strategies and coping resources to levels of employee adjustment in a sample of pilots employed in a newly merged airline company. In a more focused test of the model with a sample of employees experiencing a restructuring process in their organisation it was found that the provision of change-related information enhanced levels of efficacy to deal with the change process which, in turn, predicted psychological wellbeing, client engagement, and job satisfaction. In a study of managers affected by a new remuneration scheme, there was evidence to suggest that managers who received change-specific information and opportunities to participate in the change process reported higher levels of change readiness. Managers who reported higher levels of readiness for change also reported higher levels of psychological wellbeing and job satisfaction. These studies highlight ways in which managers and change agents can help employees to cope during times of organisational change.

Employee reactions to behavioural control under conditions of stress: The moderating role of self-efficacy

Extensive research conducted in the occupational stress literature has failed to provide convincing support for the stress-buffering effects of work control on employee adjustment. Drawing on research conducted in the laboratory context, it was proposed that the stress-buffering effects of work control on employee adjustment would be more marked at high, rather than low, levels of self-efficacy. In a sample of 100 customer service representatives, a significant three-way interaction among role conflict, work control and self-efficacy (measured at Time 1) was observed on (low) depersonalization (measured at Time 2). Consistent with expectations, work control reduced the negative effects of work stress on this outcome measure only for employees who perceived high levels of self-efficacy at work. In addition, there was evidence to suggest that self-efficacy moderated the main effects of work control on job satisfaction and somatic health. These findings are discussed in terms of their theoretical contribution to the job strain model, and also in relation to workplace interventions designed to improve levels of employee adjustment.

An experimental study of the effects of work stress, work control, and task information on adjustment

The present study was designed to examine the main and interactive effects of task demands, work control, and task information on levels of adjustment. Task demands, work control, and task information were manipulated in an experimental setting where participants completed a letter-sorting activity (N= 128). Indicators of adjustment included measures of positive mood, participants' perceptions of task performance, and task satisfaction. Results of the present study provided some support for the main effects of objective task demands, work control, and task information on levels of adjustment. At the subjective level of analysis, there was some evidence to suggest that work control and task information interacted in their effects on levels of adjustment. There was minimal support for the proposal that work control and task information would buffer the negative effects of task demands on adjustment. There was, however, some evidence to suggest that the stress-buffering role of subjective work control was more marked at high, rather than low, levels of subjective task information.

The effects of prediction, understanding, and control: A test of the stress antidote model

A study was undertaken to examine further the effects of perceived work control on employee adjustment. On the basis of the stress antidote model, it was proposed that high levels of prediction, understanding, and control of work-related events would have direct, indirect, and interactive effects on levels of employee adjustment. These hypotheses were tested in a short-term longitudinal study of 137 employees of a large retail organization. The stress antidote measures appeared to be indirectly related to employee adjustment, via their effects on perceptions of work stress. There was weak evidence for the proposal that prediction, understanding, and control would buffer the negative effects of work stress. Additional analyses indicated that the observed effects of prediction, understanding, and control were independent of employees' generalized control beliefs. However, there was no support for the proposal that the effects of the stress antidote measures would be dependent on employees' generalized control beliefs.

Second language social networks and communication-related acculturative stress: The role of interconnectedness

Although a substantial amount of cross-cultural psychology research has investigated acculturative stress in general, little attention has been devoted specifically to communication-related acculturative stress (CRAS). In line with the view that cross-cultural adaptation and second language (L2) learning are social and interpersonal phenomena, the present study examines the hypothesis that migrants’ L2 social network size and interconnectedness predict CRAS. The main idea underlying this hypothesis is that L2 social networks play an important role in fostering social and cultural aspects of communicative competence. Specifically, higher interconnectedness may reflect greater access to unmodified natural cultural representations and L2 communication practices, thus fostering communicative competence through observational learning. As such, structural aspects of migrants’ L2 social networks may be protective against acculturative stress arising from chronic communication difficulties. Results from a study of first generation migrant students (N = 100) support this idea by showing that both inclusiveness and density of the participants’ L2 network account for unique variance in CRAS but not in general acculturative stress. These results support the idea that research on cross-cultural adaptation would benefit from disentangling the various facets of acculturative stress and that the structure of migrants’ L2 network matters for language related outcomes. Finally, this study contributes to an emerging body of work that attempts to integrate cultural/cross-cultural research on acculturation and research on intercultural communication and second language learning.

Understanding the mental health of refugees: Trauma, stress, and the cultural context

Long considered important for professionals working with minority and under-represented populations, cross-cultural competency has become a requisite for all health care providers. As society in the US increasingly diversifies, there is a crucial need to prepare health care professionals to effectively treat this changing population. The Massachusetts General Hospital Textbook on Diversity and Cultural Sensitivity in Mental Health addresses the importance and relevance of cultural sensitivity in US mental health. Prominent researchers and clinicians examine the cultural and cross-cultural mental health issues of Native American, Latino, Asian, African American, Middle Eastern, Refugee and LGBQT communities. The discussion includes understanding the complexities in making mental health diagnoses and the various meanings it has for the socio-cultural group described, as well as biopsychosocial treatment options and challenges. In understanding the specific populations, the analysis delves into overarching concepts that may apply to specific populations and to those at the intersection of multiple cultures. An invaluable resource for mental health professionals, including clinicians, researchers, educators, leaders and advocates in the United States, The Massachusetts General Hospital Textbook on Diversity and Cultural Sensitivity in Mental Health provides the necessary understanding and insights for research and clinical practice in specific cultural and multicultural groups.

Workplace stress and its impact analysis for strategic stress management in construction projects

Workplace stress has been an increasing concern in the construction industry. Workers are working longer hours and construction managers’ responsibilities are becoming more complex and complicated due to reduced resources and widespread stakeholder involvements. These additional pressures potentially trigger workplace stress and impact on project performance. The purpose of this study is to examine and advance understanding of stress and its impact relationships that support holistic and strategic stress management. 17 key stress sources are identified with their impact relationships on different stress types examined. Based on the research findings, this paper concludes with a Stressor-Stress-Performance relationships map.

Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features

Objective National guidelines for management of intermediate risk patients with suspected acute coronary syndrome, in whom AMI has been excluded, advocate provocative testing to final risk stratify these patients into low risk (negative testing) or high risk (positive testing suggestive of unstable angina). Adults less than 40 years have a low pretest probability of acute coronary syndrome. The utility of exercise stress testing in young adults with chest pain suspected of acute coronary syndrome who have National Heart Foundation intermediate risk features was evaluated Methods A retrospective analysis of exercise stress testing performed on patients less than 40 years was evaluated. Patients were enrolled on a chest pain pathway and had negative serial ECGs and cardiac biomarkers before exercise stress testing to rule-out acute coronary syndrome. Chart review was completed on patients with positive stress tests. Results The 3987 patients with suspected intermediate risk acute coronary syndrome underwent exercise stress testing. One thousand and twenty-seven (25.8%) were aged less than 40 years (age 33.3 ± 4.8 years). Four of these 1027 patients had a positive exercise stress test (0.4% incidence of positive exercise stress testing). Of those, three patients had subsequent non-invasive functional testing that yielded a negative result. One patient declined further investigations. Assuming this was a true positive exercise stress test, the incidence of true positive exercise stress testing would have been 0.097% (95% confidence interval: 0.079–0.115%) (one of 1027 patients). Conclusions Routine exercise stress testing has limited value in the risk stratification of adults less than 40 years with suspected intermediate risk of acute coronary syndrome