Decreased Interleukin-4 Release from the Neurons of the Locus Coeruleus in Response to Immobilization Stress

It has been demonstrated that immobilization (IMO) stress affects neuroimmune systems followed by alterations of physiology and behavior. Interleukin-4 (IL-4), an anti-inflammatory cytokine, is known to regulate inflammation caused by immune challenge but the effect of IMO on modulation of IL-4 expression in the brain has not been assessed yet. Here, it was demonstrated that IL-4 was produced by noradrenergic neurons in the locus coeruleus (LC) of the brain and release of IL-4 was reduced in response to IMO. It was observed that IMO groups were more anxious than nontreated groups. Acute IMO (2 h/day, once) stimulated secretion of plasma corticosterone and tyrosine hydroxylase (TH) in the LC whereas these increments were diminished in exposure to chronic stress (2 h/day, 21 consecutive days). Glucocorticoid receptor (GR), TH, and IL-4-expressing cells were localized in identical neurons of the LC, indicating that hypothalamic-pituitary-adrenal- (HPA-) axis and sympathetic-adrenal-medullary- (SAM-) axis might be involved in IL-4 secretion in the stress response. Accordingly, it was concluded that stress-induced decline of IL-4 concentration from LC neurons may be related to anxiety-like behavior and an inverse relationship exists between IL-4 secretion and HPA/SAM-axes activation

IL-4 Inhibits IL-1β-Induced Depressive-Like Behavior and Central Neurotransmitter Alterations

It has been known that activation of the central innate immune system or exposure to stress can disrupt balance of anti-/proinflammatory cytokines. The aim of the present study was to investigate the role of pro- and anti-inflammatory cytokines in the modulation of depressive-like behaviors, the hormonal and neurotransmitter systems in rats. We investigated whether centrally administered IL-1β is associated with activation of CNS inflammatory pathways and behavioral changes and whether treatment with IL-4 could modulate IL-1β-induced depressive-like behaviors and central neurotransmitter systems. Infusion of IL-4 significantly decreased IL-1β-induced anhedonic responses and increased social exploration and total activity. Treatment with IL-4 markedly blocked IL-1β-induced increase in PGE2 and CORT levels. Also, IL-4 reduced IL-1β-induced 5-HT levels by inhibiting tryptophan hydroxylase (TPH) mRNA and activating serotonin transporter (SERT) in the hippocampus, and levels of NE were increased by activating tyrosine hydroxylase (TH) mRNA expression. These results demonstrate that IL-4 may locally contribute to the regulation of noradrenergic and serotonergic neurotransmission and may inhibit IL-1β-induced behavioral and immunological changes. The present results suggest that IL-4 modulates IL-1β-induced depressive behavior by inhibiting IL-1β-induced central glial activation and neurotransmitter alterations. IL-4 reduced central and systemic mediatory inflammatory activation, as well as reversing the IL-1β-induced alterations in neurotransmitter levels. The present findings contribute a biochemical pathway regulated by IL-4 that may have therapeutic utility for treatment of IL-1β-induced depressive behavior and neuroinflammation which warrants further study

Depression and anxiety one month after stroke

Depression and anxiety after stroke negatively affect patient outcomes; however, health care professionals may overlook poststroke depression and anxiety while they focus on the physical disabilities of patients soon after a stroke. The purpose of this study was to investigate the prevalence and predictors of depression, anxiety, or both concurrently at one month after stroke. We conducted a cross-sectional, descriptive study in a sample of 231 hospitalized patients with ischemic stroke in Korea. Data were collected by interviews using a series of structured questionnaires in addition to clinical data retrieved from patients’ medical records. More than 70% were identified as depressed, 45.9% experienced anxiety, and 43.7% had concurrent depression and anxiety. Using a multiple logistic regression analysis, we identified anxiety as a predictor of depression; depression as a predictor of anxiety; and female sex, headaches, and swallowing difficulty as predictors of the comorbidity of depression and anxiety. Periodical screenings for poststroke depression and anxiety from an early stage in a hospital to years after stroke in a community are recommended to provide better chances for early identification of patients at risk because depression and anxiety may manifest at any stage of recovery. Special attention should be given to individuals with culture-bound somatic symptoms in addition to female patients and those who have difficulty swallowing among Korean stroke patients

Critical Care Nurses\u27 Beliefs About and Reported Management of Anxiety

Background: Anxiety is associated with increased morbidity and mortality. Critical care nurses are uniquely positioned to reduce anxiety in their patients. Critical care nurses\u27 beliefs about and frequency of use of strategies to reduce anxiety have not been studied. Objectives: To explore critical care nurses\u27 beliefs about the importance of anxiety management and to describe nurses\u27 reported use of strategies to manage anxiety in their patients. Methods: A random sample (N = 2500) of members of the American Association of Critical-Care Nurses was asked to complete the Critical Care Nurse Anxiety Identification and Management Survey. Results: Respondents (n = 783) were primarily female (92%), white (88.5%) staff nurses (74.1%) who thought that anxiety is potentially harmful (mean, 4.1; SD, 0.8; range, 1 = no harm to 5 = life-threatening harm), that anxiety management is important (mean, 4.8; SD 0.6; range, 1 = no benefit to 5 = profound benefit). A majority commonly used pharmacological management; most also used information and communication interventions. Fewer subjects used the presence of patients\u27 family members to alleviate patients\u27 anxiety; few reported using stress-reduction techniques. Conclusion: Most respondents thought that treating anxiety is important and beneficial. Commonly used strategies included pharmacological relief of anxiety and pain and information and communication interventions. Although these strategies are useful, they may not effectively reduce anxiety in all patients

Critical Care Nurses\u27 Assessment of Patients\u27 Anxiety: Reliance on Physiological and Behavioral Parameters

Background: Anxiety activates the sympathetic nervous system and hypothalamic-pituitary-adrenal axis and may increase morbidity and mortality in vulnerable critical care patients. Despite the adverse effects of anxiety, little is known about critical care nurses\u27 practices for assessing anxiety. Objective: To determine the importance that critical care nurses place on evaluating anxiety and to describe clinical indicators used to assess anxiety. Methods: Twenty-five hundred members of the American Association of Critical-Care Nurses received the Critical Care Nurse Anxiety Identification and Management Survey and were asked to rate the importance of anxiety assessment, to rate the importance of 61 anxiety indicators, and to select and rank the 5 most important anxiety indicators. Results: Seven hundred eighty-three completed surveys (31.6%) were returned by female (92.0%), white (88.6%) staff nurses (74.2%) who practiced critical care nursing 32.5 hours (SD, 12.3 hours) weekly. Nearly three quarters (71.3%) of respondents thought that anxiety assessment is very important. Only 2 indicators, agitation and patients\u27 verbalization of anxiety, were rated as very important to anxiety assessment. Thirty-nine indicators rated as important primarily included measurable physiological changes and observable behaviors. The top 5 anxiety indicators were agitation, increased blood pressure, increased heart rate, patients\u27 verbalization of anxiety, and restlessness. Conclusion: Important indicators of anxiety included observable behaviors and measurable physiological changes. Reliance on these criteria may produce an inaccurate and incomplete anxiety evaluation in vulnerable patients and lead to poorer outcomes. A comprehensive, systematic anxiety assessment tool for valid and reproducible evaluation of patients\u27 anxiety is needed

State of the Science: Salivary Biomarker Utilization for Stress Research

The use of salivary biomarkers for stress research is increasing based on the convenience of collection, affordability and scientific merit. This short review provides an overview of the state of the science of salivary biomarkers utilized in research related to stress. Methods: An integrative review was conducted. Results: The trend of utilizing salivary biomarkers in stress research was reviewed, specifically, focusing on the use of endocrine and inflammatory biomarkers incorporated in previous stress research. Then, a review of sampling procedures for salivary biomarkers and the analytic methods is provided. Finally, a discussion on the strengths and areas for improvement in the use of salivary biomarkers in stress research is included. Conclusion: Salivary biomarkers as an alternative to blood biomarkers are increasingly being recognized as a legitimate source for analyzing the stress response in humans

Turo (Qi Dance) Training Attenuates Psychological Symptoms and Sympathetic Activation Induced by Mental Stress in Healthy Women

Vagal withdrawal and sympathetic overactivity accompany various types of stress. Qi training is reported to reduce sympathetic hyper-reactivity in a stressful situation. Turo, which is a type of dance that uses the Meridian Qi System, may reduce the psychological symptoms induced by an imbalance of the autonomic nervous system (ANS). We observed whether Turo training alters psychopathological and psychological symptoms using the Symptom Checklist 90-Revision (SCL-90-R) and examined whether it attenuates the stress response to mental stress in healthy adolescent females using the power spectrum analysis of heart rate variability (HRV). Twenty-one subjects received Turo training and 27 subjects were trained with mimicking movements. The SCL-90-R was measured before and after the 2-month training period. Heart rate (HR), total power (TP) and the LF/HF ratio of HRV were compared between the Turo and control groups during and after mental stress. The somatization and hostility subscales of the SCL-90-R of the Turo group were significantly lower than those of the control group after 2 months. The increases in HR and the LF/HF ratio of HRV induced by the stress test were significantly lower in the Turo group than in the control group. The TP of the Turo group was significantly higher than that of the control group. The psychological symptoms and sympathetic activation induced by the artificial stress were significantly reduced by the Turo training. These findings suggest that Turo training can play a critical role in attenuating psychological symptoms and stress-induced sympathetic activation

Effect of Acculturation and Mutuality on Family Loyalty Among Mexican American Caregivers of Elders

Purpose: Informal family care for elders is conventional in Mexican American communities despite increasing intergenerational gaps in filial values. In our study, we explored whether acculturation and dyadic mutuality, as perceived by Mexican American family caregivers, explain the caregivers’ expectations of family loyalty toward elderly relatives. Design: A nonexperimental, correlational design with convenience sampling was used in El Paso, Texas, from October 2007 to January 2008. Methods: Three bilingual promotoras collected data from 193 Mexican American adult caregivers of community‐dwelling elders using three scales designed for Mexican Americans: the Acculturation Rating Scale for Mexican Americans II‐Short Form, the Mutuality Scale, and the Expectations of Family Loyalty of Children Toward Elderly Relatives Scale. Confirmatory factor analysis was used to analyze the data. Findings: Acculturation had a marginal effect (r= .21, p \u3c .05), but mutuality presented a strong correlation (r= .45, p \u3c .001) with the expectations of family loyalty toward elderly relatives. There was no significant correlation between acculturation and mutuality (r= .05). Conclusions: Although Mexican American caregivers with strong Mexican orientation may have high expectations of family loyalty toward elderly relatives, mutuality exhibits more significant effects on expectations. Among Mexican Americans, mutuality between the caregiving dyad, as perceived by caregivers, may be a better predictor of filial values than caregivers’ acculturation alone. Clinical Relevance: It may be useful to incorporate the dual paradigm of acculturation and mutuality into immigrant family care for elderly relatives

Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey

Objective: The objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea. Methods: This paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records. Among 233 acute ischemic stroke patients enrolled in a large-scale study, 160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis. Results: Users of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs. 625 min., p = 0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs. 31.5%, p = 0.013). For those who first contacted emergency medical service, the facilitators of emergency medical service use were the presence of hemiparesis (p = 0.003), bilateral paralysis (p = 0.040), and loss of balance (p = 0.021). The predominant barrier was the failure to recognize the urgency of symptoms (p = 0.006). Conclusions: The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h. Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier, public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services. Keywords: Barrier, Emergency medical services, Facilitator, Social norms, Strok