The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

Purpose: Over half the HIV-infected persons in the Caribbean, the second most HIV-impacted region in the world, live in Haiti. Using secondary data from a parent study, this research assessed the effects of psychological and social factors on antiretroviral therapy (ART) adherence among Haitian, HIV-positive, female alcohol users. Theoretical Foundation and Research Questions: Using the Theory of Planned Behavior/Reasoned Action and the Information, Motivation, Behavior skills model as guiding theoretical frameworks, the study examined the effectiveness of an adapted cognitive behavioral stress management (CBSM-A) intervention in improving ART adherence. The effect of psychological factors (depression, anxiety, beliefs about medicine, and social support), social factors (stigma, relationship status, and educational attainment), and alcohol on adherence to ART was assessed. Methods: The sample consisted of 116 female ART patients who were randomly assigned to the CBSM-A intervention or the wait-list control group. Participants completed intervention sessions as well as pre- and post-test assessments. Analyses of variance, t-tests, and point biserial correlations were used to test hypotheses. Results: Surprisingly, ART adherence rates significantly decreased for both groups combined [F (1, 108) = 8.79, p = .004]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post assessment. On average, depression decreased significantly among participants in the CBSM-A group only [(t (62) = 5.54, p < .001)]. For both groups combined, alcohol use significantly decreased between baseline and post-assessment [(F (1, 78) = 34.70, p < .001)]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post-assessment. None of the variables were significantly correlated with ART adherence. Discussion: Adherence to ART did not improve in this sample, nor were any of the variables significantly associated with adherence. The findings suggest that additional supportive and psychological services may be needed in order to promote higher adherence to ART among HIV-positive females. More research may be needed on this sample; a focus on mental health issues, partner conflict, family and sexual history may allow for better targeting and more successful interventions.

Randomized controlled trial of physiotherapy for postpartum stress incontinence : 7-year follow-up

Objective To estimate the long-term effect of intensive, 6-week physiotherapy programs, with and without deep abdominal muscle (TrA) training, on persistent postpartum stress urinary incontinence (SUI). Methods The study was a single-blind randomized controlled trial. Fifty-seven postnatal women with clinically demonstrated persistent SUI 3 months after delivery participated in 8 weeks of either pelvic floor muscle training (PFMT) (28) or PFMT with deep abdominal muscle training (PFMT + TrA) (29). Seven years post-treatment, 35 (61.4%) participants agreed to the follow-up; they were asked to complete a 20-min pad test and three incontinence-specific questionnaires with an assessor blinded to each participant's group assignment. Results: Of the 35 (61.4%) who agreed to the follow-up: 26 (45.6%) took the 20-min pad test (12 PFMT and 14 PFMT + TrA) and 35 (61.4%) completed the questionnaires (18 PFMT and 17 PFMT + TrA). The baseline clinical characteristics of the follow-up and non-follow-up participants were not significantly different; nor did they differ between PFMT and PFMT + TrA participants enrolled in the follow-up study. At 7 years, the pad test scores for the PFMT group did not differ statistically from those of the PFMT + TrA group. When combining both treatment groups, a total of 14/26 (53%) follow-up participants were still continent according to the pad test. Conclusion The addition of deep abdominal training does not appear to further improve the outcome of PFM training in the long term. However, benefits of physiotherapy for postpartum SUI, although not as pronounced as immediately after the initial intervention, is still present 7 years post-treatment.

Are stress and mixed urinary incontinence associated with impaired executive control in community-dwelling older women?

Objectives: To assess whether stress or mixed urinary incontinence (UI) is associated with deficits in executive functioning among community-dwelling women. Design: An observational study comparing the performance, using multivariate analyses of variance (MANOVAs) and Bonferroni post hoc test, of continent women and women with stress or mixed UI during executive control tasks. Setting: The research center of the Institut universitaire de gériatrie de Montréal. Participants: One hundred and fifty-five community-dwelling women aged 60 and older participated in the study. Measurements: Based on the Urogenital Distress Inventory (UDI), participants were split into three groups: 35 continent women, 43 women with stress UI, and 78 women with mixed UI. Participants completed a battery of neuropsychological tests and a computerized dual-task test. Results: Women with mixed UI showed poorer performances than continent and stress UI women in executive control functions. Deficits were specific to tests involving switching and sharing/dividing attention between two tasks. Conclusion: Results of this study suggest that mixed UI can be associated with executive control deficits in community-dwelling older women. Future intervention studies in the treatment of UI should take the higher risk of an executive control deficit in women with UI under consideration.

Randomized controlled trial of physiotherapy for postpartum stress incontinence : 7-year follow-up

Objective To estimate the long-term effect of intensive, 6-week physiotherapy programs, with and without deep abdominal muscle (TrA) training, on persistent postpartum stress urinary incontinence (SUI). Methods The study was a single-blind randomized controlled trial. Fifty-seven postnatal women with clinically demonstrated persistent SUI 3 months after delivery participated in 8 weeks of either pelvic floor muscle training (PFMT) (28) or PFMT with deep abdominal muscle training (PFMT + TrA) (29). Seven years post-treatment, 35 (61.4%) participants agreed to the follow-up; they were asked to complete a 20-min pad test and three incontinence-specific questionnaires with an assessor blinded to each participant's group assignment. Results: Of the 35 (61.4%) who agreed to the follow-up: 26 (45.6%) took the 20-min pad test (12 PFMT and 14 PFMT + TrA) and 35 (61.4%) completed the questionnaires (18 PFMT and 17 PFMT + TrA). The baseline clinical characteristics of the follow-up and non-follow-up participants were not significantly different; nor did they differ between PFMT and PFMT + TrA participants enrolled in the follow-up study. At 7 years, the pad test scores for the PFMT group did not differ statistically from those of the PFMT + TrA group. When combining both treatment groups, a total of 14/26 (53%) follow-up participants were still continent according to the pad test. Conclusion The addition of deep abdominal training does not appear to further improve the outcome of PFM training in the long term. However, benefits of physiotherapy for postpartum SUI, although not as pronounced as immediately after the initial intervention, is still present 7 years post-treatment.

Are stress and mixed urinary incontinence associated with impaired executive control in community-dwelling older women?

Objectives: To assess whether stress or mixed urinary incontinence (UI) is associated with deficits in executive functioning among community-dwelling women. Design: An observational study comparing the performance, using multivariate analyses of variance (MANOVAs) and Bonferroni post hoc test, of continent women and women with stress or mixed UI during executive control tasks. Setting: The research center of the Institut universitaire de gériatrie de Montréal. Participants: One hundred and fifty-five community-dwelling women aged 60 and older participated in the study. Measurements: Based on the Urogenital Distress Inventory (UDI), participants were split into three groups: 35 continent women, 43 women with stress UI, and 78 women with mixed UI. Participants completed a battery of neuropsychological tests and a computerized dual-task test. Results: Women with mixed UI showed poorer performances than continent and stress UI women in executive control functions. Deficits were specific to tests involving switching and sharing/dividing attention between two tasks. Conclusion: Results of this study suggest that mixed UI can be associated with executive control deficits in community-dwelling older women. Future intervention studies in the treatment of UI should take the higher risk of an executive control deficit in women with UI under consideration.

Thirty minutes of handgrip exercise enhances brachial artery flow-mediated dilation in response to two different shear stress profiles.

The walls of blood vessels are lined with a single-cell layer of endothelial cells. As blood flows through the arteries, a frictional force known as shear stress is sensed by mechanosensitive structures on the endothelium. Short and long term changes in shear stress can have a significant influence on the regulation of endothelial function. Acutely, shear stress triggers a pathway that culminates in the release of vasodilatory molecules from the endothelium and subsequent vasodilation of the artery. This endothelial response is known as flow mediated dilation (FMD). FMD is used as an index of endothelial function and is commonly assessed using reactive hyperemia (RH)-FMD, a method which elicits a large, short lived increase in shear stress following the release of a brief (5 min) forearm occlusion. A recent study found that a short term exposure (30 min) to a sustained elevation in shear stress potentiates subsequent RH-FMD. FMD can also result from a more prolonged, sustained increase in shear stress elicited by handgrip exercise (HGEX-FMD). There is evidence to suggest that interventions and conditions impact FMD resulting from sustained and transient shear stress stimuli differently, indicating that HGEX-FMD and RH-FMD provide different information about endothelial function. It is unknown whether HGEX-FMD is improved by short term exposure to shear stress. Understanding how exercise induced FMD is regulated is important because it contributes to blood flow responses during exercise. The study purpose was therefore to assess the impact of a handgrip exercise (intervention) induced sustained elevation in shear stress on subsequent brachial artery (BA) HGEX-FMD. Twenty healthy male participants (22±3yrs) preformed a 30-minute HGEX intervention on two experimental days. BA-FMD was assessed using either an RH or HGEX shear stress stimulus at 3 time points: pre-intervention, 10 min post and 60 min post. FMD and shear stress magnitude were determined via ultrasound. Both HGEX and RH-FMD increased significantly from pre-intervention to 10 min-post (p<0.01). These findings indicate that FMD stimulated by exercise induced increases in shear stress is potentiated by short term shear stress exposure. These findings advance our understanding regarding the regulation of endothelial function by shear stress.

Förekomst av sekundär traumatisk stress hos sjuksköterskor och dess påverkan på personcentrerad vård : - En litteraturstudie

Bakgrund: Sjuksköterskan har stor del i den nära patientvården och förväntas vara en god lyssnare genom sitt personcentrerade vårdgivande. Händelser som är traumatiska drabbar förutom den direkt berörda patienten även sjuksköterskan genom sekundär exponering. Syfte: Syftet med studien var att belysa förekomst av STS hos sjuksköterskor samt beskriva hur det påverkar vårdkvalitet och personcentrerad vård. Metod: Litteraturstudie med en översikt av relevanta artiklar i databaserna PubMed och CINAHL. Resultatet baseras på 14 artiklar som uppfyllde inklusionsoch kvalitetskrav. Resultat: Sjuksköterskan påverkas av STS på flera plan, både professionellt och personligt. Vårdkvaliteten blir lidande om STS påvisas. Den personcentrerade vården utgör grunden i sjuksköterskans yrkesutövande men om medvetenhet saknas för STS finns risken att sjuksköterskan påverkas så till den grad att hen väljer att sjukskriva sig och/eller byta arbetsplats. Slutsats: STS är ett relativt okänt begrepp och det kan vara svårt att se tecken på begynnande symtom. Sjuksköterskan kan utsättas för STS oberoende arbetsplats. Detta kan sänka effekten i yrkesutövandet genom personliga symtom som; irritabilitet, trötthet, minskad empati, depression, återupplevelser av tidigare upplevda traumatiska händelser med flera. Arbetsplatsens ledarskap inverkar på identifieringen av sjuksköterskans utveckling/hanterande av STS.

Relação entre Vulnerabilidade ao Stress e Estratégias de Coping: estudo de caso numa empresa de venda a retalho da Região Centro do País

As situações indutoras de stress são uma constante imutável no dia-a-dia do ser humano e quando esta perturbação não é gerida de forma adequada, acarreta graves prejuízos na saúde dos indivíduos refletindo-se em diversas áreas das suas vidas nomeadamente no trabalho. O presente estudo tem como finalidade identificar a relação entre o stress e as estratégias de coping e perceber se os indivíduos com vulnerabilidade ao stress diferem dos indivíduos sem stress no que concerne às estratégias de coping utilizadas. A vulnerabilidade ao stress foi medida pela escala 23QVS, enquanto as estratégias de coping foram avaliadas pelo Inventário de Resolução de Problemas (IRP), tendo sido, ainda, utilizado um questionário sociodemográfico. A amostra foi composta por 62 trabalhadores de uma empresa de venda a retalho com idades compreendidas entre os 20 e os 44 anos (M=32,02 DP=5,770). Os resultados obtidos revelaram que a vulnerabilidade ao stress se correlaciona de forma negativa e altamente significativa com as estratégias de coping e que indivíduos com e sem vulnerabilidade ao stress não diferem quanto ao uso destas estratégias. / The stress-induction situations are a constant unchanging in human being life, and if this disturbance is not managed adequately can be harmful to the health of individuals and reflected in many areas of their lives including their work. The present study aims to analyze the relationship between stress and coping strategies, and understand if individuals with stress vulnerability differs from individuals without stress in respect to the use of coping strategies. Stress vulnerability was measured by the 23QVS scale and coping strategies by the Inventário de Resolução de Problemas – IRP (Inventory of Problem Solving), and we also used a sociodemographic questionnaire. The sample consisted of 62 workers of a retailing company with ages between 20 and 40 years old (M = 32,02; DP = 5,770). Our research studies reveal that stress vulnerability correlates negatively and highly with coping strategies, and individuals with and without stress vulnerability not differ in the use of these strategies.

The Effects of Systematic Self-Monitoring, Feedback, and Collaborative Assessment on Stress Reduction

Thesis (Ph.D.)--University of Washington, 2016-08

Evaluation of the protective effects of kolaviron on Kolanut-induced oxidative stress in developing rat brain

The brain is exposed throughout life to oxidative stress, and certain diseases of the brain and nervous system are thought to involve free radical processes and oxidative damage. This study is aimed at evaluating the effect of kolaviron on kolanut-induced oxidative stress in developing rat brain. Twenty-five adult pregnant Wistar rats weighing between 160 and 180g were used for the experiment. They were randomly divided into five groups of five animals each. The animals were fed with standard diets of mice cubes and water provided ad libitum. The control rats received water and cornoil, while the experimental animals received 200 mg/kg body weight of kolanut (kn), 200 mg/kg of kolaviron (kv), and 200 mg/kg body weight of vitamin E which served as a standard antioxidant with cornoil as vehicle orally in pre- and post-natal life. After birth, gross morphometry and behavioural changes of the pups of days 1, 7, 14, 21 and 28 postpartum were evaluated. Blood samples were collected from pups of day 21 for hematological, liver and renal function analyses, while the brains of pups of day 21 postpartum were preserved in phosphate buffer at a temperature of 4oC and pH 7.4 for biochemical analysis. There were significant alterations in the gross morphometry and behavioural parameters studied in the treated animals compared with the control at p< 0.05. There were elevated levels of RBC, WBC and platelets in the treated group compared with the control at p< 0.05. However, no significant change was observed in the PCV, Hb, liver and renal function parameters studied at p>0.05. A non-significant increase in levels of malondialdehyde, MDA, a bye-product of lipid peroxidation in the kolanut group was observed. However, administration of kolaviron and vitamin E non-significantly (p>0.05) reversed these changes. In conclusion, maternal consumption of kolanut induced mild oxidative stress and the administration of kolaviron and vitamin E decreased the rate at which kolanut induced oxidative stress in developing rat brain.

Hair cortisol levels, perceived stress and body mass index in women and children living in socioeconomically disadvantaged neighborhoods: the READI study

Disadvantaged communities provide adverse psychosocial exposures that have been linked to high levels of stress, and this may provide one explanatory pathway linking socioeconomic disadvantage to obesity. This study used hair cortisol analysis to quantify associations between stress and body mass index (BMI), and between hair cortisol and perceived psychological stress levels, in women and children living in socioeconomically disadvantaged neighborhoods. Participants were a volunteer sample of 70 women from the Resilience for Eating and Activity Despite Inequality study, including 30 maternal-child pairs. Women self-reported body weight, height and perceived psychological stress using the Perceived Stress Scale (PSS), and provided hair samples for themselves and their child. Children's body weight and height were measured. Following extraction, hair cortisol levels were measured using enzyme-linked immunosorbent assay. Multiple linear regression models examined associations between stress and BMI, and between hair cortisol and perceived stress levels in women and children. Women's hair cortisol levels were not associated with their BMI or PSS scores. Women's PSS scores were positively associated with their BMI (p = 0.015). Within maternal-child pairs, mothers and children's hair cortisol levels were strongly positively associated (p = 0.006). Maternal hair cortisol levels and PSS scores were unrelated to their child's zBMI. Children's hair cortisol levels were not associated with their zBMI or with their mother's PSS score. Findings suggest that cortisol-based and perceived psychological measures of stress may be distinct among women and children living in disadvantaged neighborhoods. Perceived psychological measures may be more important predictors of weight-related risk.

Health service use and costs for infant behaviour problems and maternal stress

AIM: We aim to describe health service (HS) use in the first 6 months post-partum and to examine the associations between service costs, infant behaviour and maternal depressive symptoms. METHODS: Participants were 781 infants and mothers in Melbourne, Australia. Mothers reported infant feeding, sleeping and crying problems, depressive symptoms and health service use. Costs were valued in 2012 Australian dollars. RESULTS: The most common services used were maternal child health nurses, general practitioners (GP) and allied health. Infant feeding problems were associated with increased costs for services relevant to infant behaviour including maternal child health nurses (P = 0.007), GP (P = 0.008) and paediatricians (P = 0.03). Maternal depressive symptoms were associated with increased costs for services relevant to depressive symptoms including parenting centres (P = 0.04), GP (P = 0.004), psychiatrists (P = 0.02) and psychologists (P = 0.001). Mothers who completed high school had higher service costs for infant problems than those with lower education (P = 0.02). Single mothers had higher costs for services used for their depressive symptoms than partnered mothers (P < 0.001). Mothers with English as a second language had lower service costs for their depressive symptoms (P = 0.02). CONCLUSIONS: Infant feeding problems and maternal depressive symptoms are associated with higher costs for health services relevant to these conditions. Cost-effective strategies to manage these conditions are needed with accessibility being ensured for mothers who are experiencing social adversity.

An inverse routine to predict residual stress in sheet material

A method is presented to determine residual stress distribution in sheet material from data collected in a free bending test. It may be used where the residual stress distribution is symmetrical about the mid-surface as it is usually the case for frequently-used sheet metal post-processing techniques such as skin-pass or temper rolling, tension- and roller leveling. An existing inverse technique is used to obtain a residual stress profile and material constants that provide the best fit in a finite element analysis of bending with the experimentally derived moment-curvature relation. The method is verified for bending of a low-carbon stainless steel using measurement of residual stress by X-ray diffraction. The residual stresses were induced in the sheet by cold rolling. The technique described here can be used industrially as a rapid method of investigating residual stresses in incoming sheet. In processes where the deformation is principally one of bending, such as cold roll forming, it is known that residual stresses have an influence on shape defects and springback and the method presented here can be used to determine whether incoming sheet is suitable for further processing and also as a means of obtaining improved material data input for numerical simulation.

Intergranular Corrosion and Stress Corrosion Cracking of Extruded AA6005A

A research program focused on understanding the intergranular corrosion (IGC) and stress corrosion cracking (SCC) behavior of AA6005A aluminum extrusions is presented in this dissertation. The relationship between IGC and SCC susceptibility and the mechanisms of SCC in AA6005A extrusions were studied by examining two primary hypotheses. IGC susceptibility of the elongated grain structure in AA6005A exposed to low pH saltwater was found to depend primarily on the morphology of Cu-containing precipitates adjacent to the grain boundaries in the elongated grain structure. IGC susceptibility was observed when a continuous (or semi-continuous) film of Cu-containing phase was present along the grain boundaries. When this film coarsened to form discrete Cu-rich precipitates, no IGC was observed. The morphology of the Cu-rich phase depended on post-extrusion heat treatment. The rate of IGC penetration in the elongated grain structure of AA6005A-T4 and AA6005A-T6 extrusions was found to be anisotropic with IGC propagating most rapidly along the extrusion direction, and least rapidly along the through thickness direction. A simple 3-dimensional geometric model of the elongated grain structure was accurately described the observed IGC anisotropy, therefore it was concluded that the anisotropic IGC susceptibility in the elongated grain structure was primarily due to geometric elongation of the grains. The velocity of IGC penetration along all directions in AA6005A-T6 decreased with exposure time. Characterization of the local environment within simulated corrosion paths revealed that a pH gradient existed between the tip of the IGC path and the external environment. Knowledge of the local environment within an IGC path allowed development of a simple model based on Fick's first law that considered diffusion of Al3+ away from the tip of the IGC path. The predicted IGC velocity agreed well with the observed IGC velocity, therefore it was determined that diffusion of Al3+ was the primary factor in determining the velocity of IGC penetration. The velocity of crack growth in compact tensile (CT) specimens of AA6005A-T6 extrusion exposed to 3.5% NaCl at pH = 1.5 was nearly constant over a range of applied stress intensities, exposure times, and crack lengths. The crack growth behavior of CT specimens of AA6005A-T6 extrusion exposed to a solution of 3.5% NaCl at pH = 2.0 exhibited similar behavior, but the crack velocity was ~10.5X smaller than that those exposed to a solution at pH =1.5. Analysis of the local stress state and polarization behavior at the crack tip predicted that increasing the pH of the bulk solution from 1.5 to 2.0 would decrease the corrosion current density at the crack tip by approximately 11.8X. This predicted decrease in corrosion current density was in reasonable agreement with the observed decrease in SCC velocity associated with increasing the solution pH from 1.5 to 2.0. The agreement between the predicted and observed SCC velocities suggested that the electrochemical reactions controlling SCC in AA6005A-T6 extrusions are ultimately controlled by the pH gradient that exists between the crack tip and external environment.

Heat and water stress induce unique transcriptional signatures of heat-shock proteins and transcription factors in grapevine

Grapevine is an extremely important crop worldwide.In southern Europe, post-flowering phases of the growth cycle can occur under high temperatures, excessive light, and drought conditions at soil and/or atmospheric level. In this study, we subjected greenhouse grown grapevine, variety Aragonez, to two individual abiotic stresses, water deficit stress(WDS), and heat stress (HS). The adaptation of plants to stress is a complex response triggered by cascades of molecular net works involved in stress perception, signal transduction, and the expression of specific stress-related genes and metabolites. Approaches such as array-based transcript profiling allow assessing the expression of thousands of genes in control and stress tissues. Using microarrays, we analyzed the leaf transcriptomic profile of the grapevine plants. Photosynthesis measurements verified that the plants were significantly affected by the stresses applied. Leaf gene expression was obtained using a high-throughput transcriptomic grapevine array, the 23K custom-made Affymetrix Vitis GeneChip. We identified 1,594 genes as differentially expressed between control and treatments and grouped them into ten major functional categories using MapMan software. The transcriptome of Aragonez was more significantly affected by HS when compared with WDS. The number of genes coding for heat-shock proteins and transcription factors expressed solely in response to HS suggesting their expression as unique signatures of HS. However, across-talk between the response pathways to both stresses was observed at the level of AP2/ERF transcription factors.