Assessment of the cortisol awakening response: expert consensus guidelines

The cortisol awakening response (CAR), the marked increase in cortisol secretion over the first 30–45 min after morning awakening, has been related to a wide range of psychosocial, physical and mental health parameters, making it a key variable for psychoneuroendocrinological research. The CAR is typically assessed from self-collection of saliva samples within the domestic setting. While this confers ecological validity, it lacks direct researcher oversight which can be problematic as the validity of CAR measurement critically relies on participants closely following a timed sampling schedule, beginning with the moment of awakening. Researchers assessing the CAR thus need to take important steps to maximize and monitor saliva sampling accuracy as well as consider a range of other relevant methodological factors. To promote best practice of future research in this field, the International Society of Psychoneuroendocrinology initiated an expert panel charged with (i) summarizing relevant evidence and collective experience on methodological factors affecting CAR assessment and (ii) formulating clear consensus guidelines for future research. The present report summarizes the results of this undertaking. Consensus guidelines are presented on central aspects of CAR assessment, including objective control of sampling accuracy/adherence, participant instructions, covariate accounting, sampling protocols, quantification strategies as well as reporting and interpreting of CAR data. Meeting these methodological standards in future research will create more powerful research designs, thus yielding more reliable and reproducible results and helping to further advance understanding in this evolving field of research

Variation in the proportion of adults in need of BP-lowering medications by hypertension care guideline in low- and middle-income countries:a cross-sectional study of 1,037,215 individuals from 50 nationally representative surveys

BACKGROUND:Current hypertension guidelines vary substantially in their definition of who should be offered blood pressure–lowering medications. Understanding the effect of guideline choice on the proportion of adults who require treatment is crucial for planning and scaling up hypertension care in low- and middle-income countries. METHODS:We extracted cross-sectional data on age, sex, blood pressure, hypertension treatment and diagnosis status, smoking, and body mass index for adults 30 to 70 years of age from nationally representative surveys in 50 low- and middle-income countries (N = 1 037 215). We aimed to determine the effect of hypertension guideline choice on the proportion of adults in need of blood pressure–lowering medications. We considered 4 hypertension guidelines: the 2017 American College of Cardiology/American Heart Association guideline, the commonly used 140/90 mm Hg threshold, the 2016 World Health Organization HEARTS guideline, and the 2019 UK National Institute for Health and Care Excellence guideline. RESULTS:The proportion of adults in need of blood pressure–lowering medications was highest under the American College of Cardiology/American Heart Association, followed by the 140/90 mm Hg, National Institute for Health and Care Excellence, and World Health Organization guidelines (American College of Cardiology/American Heart Association: women, 27.7% [95% CI, 27.2–28.2], men, 35.0% [95% CI, 34.4–35.7]; 140/90 mm Hg: women, 26.1% [95% CI, 25.5–26.6], men, 31.2% [95% CI, 30.6–31.9]; National Institute for Health and Care Excellence: women, 11.8% [95% CI, 11.4–12.1], men, 15.7% [95% CI, 15.3–16.2]; World Health Organization: women, 9.2% [95% CI, 8.9–9.5], men, 11.0% [95% CI, 10.6–11.4]). Individuals who were unaware that they have hypertension were the primary contributor to differences in the proportion needing treatment under different guideline criteria. Differences in the proportion needing blood pressure–lowering medications were largest in the oldest (65–69 years) age group (American College of Cardiology/American Heart Association: women, 60.2% [95% CI, 58.8–61.6], men, 70.1% [95% CI, 68.8–71.3]; World Health Organization: women, 20.1% [95% CI, 18.8–21.3], men, 24.1.0% [95% CI, 22.3–25.9]). For both women and men and across all guidelines, countries in the European and Eastern Mediterranean regions had the highest proportion of adults in need of blood pressure–lowering medicines, whereas the South and Central Americas had the lowest. CONCLUSIONS:There was substantial variation in the proportion of adults in need of blood pressure–lowering medications depending on which hypertension guideline was used. Given the great implications of this choice for health system capacity, policy makers will need to carefully consider which guideline they should adopt when scaling up hypertension care in their country

Wearable Biomonitoring Platform for the Assessment of Stress and its Impact on Cognitive Performance of Firefighters: An Experimental Study

Background: Stress is a complex process with an impact on health and performance. The use of wearable sensor-based monitoring systems offers interesting opportunities for advanced health care solutions for stress analysis. Considering the stressful nature of firefighting and its importance for the community’s safety, this study was conducted for firefighters. Objectives: A biomonitoring platform was designed, integrating different biomedical systems to enable the acquisition of real time Electrocardiogram (ECG), computation of linear Heart Rate Variability (HRV) features and collection of perceived stress levels. This platform was tested using an experimental protocol, designed to understand the effect of stress on firefighter’s cognitive performance, and whether this effect is related to the autonomic response to stress. Method: The Trier Social Stress Test (TSST) was used as a testing platform along with a 2-Choice Reaction Time Task. Linear HRV features from the participants were acquired using an wearable ECG. Self-reports were used to assess perceived stress levels. Results: The TSST produced significant changes in some HRV parameters (AVNN, SDNN and LF/HF) and subjective measures of stress, which recovered after the stress task. Although these short-term changes in HRV showed a tendency to normalize, an impairment on cognitive performance was found after performing the stress event. Conclusion: Current findings suggested that stress compromised cognitive performance and caused a measurable change in autonomic balance. Our wearable biomonitoring platform proved to be a useful tool for stress assessment and quantification. Future studies will implement this biomonitoring platform for the analysis of stress in ecological settings

Effects of temperature at constant air dew point on leaf carboxylation efficiency and CO 2 compensation point of different leaf types

The effect of temperature on photosynthesis at constant water-vapor pressure in the air was investigated using two sclerophyll species, Arbutus unedo and Quercus suber , and one mesophytic species, Spinacia oleracea . Photosynthesis and transpiration were measured over a range of temperatures, 20–39° C. The external concentration of CO 2 was varied from 340 μbar to near CO 2 compensation. The initial slope (carboxylation efficiency, CE) of the photosynthetic response to intercellular CO 2 concentration, the CO 2 compensation point (Γ), and the extrapolated rate of CO 2 released into CO 2 -free air ( R i ) were calculated. At an external CO 2 concentration of 320–340 μbar CO 2 , photosynthesis decreased with temperature in all species. The effect of temperature on Γ was similar in all species. While CE in S. oleracea changed little with temperature, CE decreased by 50% in Q. suber as temperature increased from 25 to 34° C. Arbutus unedo also exhibited a decrease in CE at higher temperatures but not as marked as Q. suber . The absolut value of R i increased with temperature in S. oleracea , while changing little or decreasing in the sclerophylls. Variations in Γ and R i of the sclerophyll species are not consistent with greater increase of respiration with temperature in the light in these species compared with S. oleracea .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47470/1/425_2004_Article_BF00397389.pd

Graduate Nursing Teaching At Unicamp: Policies And Practices [ensino De Graduação Em Enfermagem Da Unicamp: Políticas E Práticas.]

The authors analyse teaching at the graduate nursing program from Unicamp (SP), starting from the introduction of a new curriculum in 1997, in accordance to the curricular standards taken from Federal Law concerning education. In theory, the changes implemented subvert the established order. It has been a hard task to operate curricular reform in a public university that is experiencing a financial and management crisis--reflections of a neoliberal ideology in public education policies, which increasingly values scientific production to the detriment of initiatives toward quality teaching. The difficulties found demanded some considerations and the proposition of seven fundamental thesis in order to subsidize problem analysis and guide necessary interventions. Among them, the theme Policies and Practice in nursing teaching is focused in this text.56668368

Strawberry in South America: from the Caribbean to Patagonia

Across a vast continent, strawberries (Fragaria × ananassa Duch.) are produced and consumed in virtually all the South American (SA) countries, from the Caribbean (Venezuela) to the Patagonia region (Argentina and Chile). Except for the Guyanas, in all SA countries the strawberry industry has strong links with cultural, economic and social aspects. As a whole, South America grows approximately 13200 ha and produces about 350400 t of strawberry, which in some countries are available year round (Argentina, Colombia, Ecuador, Uruguay and Venezuela) due to climatic diversity. In other countries, strawberry production occurs predominantly from spring to autumn (Chile and Peru) or from winter to spring (Brazil, Bolivia and Paraguay). Production volumes vary considerably among countries. Brazil and Chile are the major strawberry producers, with 120000 and 56300 t, respectively. Argentina, Colombia, Ecuador, Peru and Venezuela are within the same range of cultivated area as Chile, but their productions are lower: 45500, 42500, 15000, 22000 and 27600 t, respectively, due to technological issues. Smaller productions can be found in Uruguay (6250 t), Bolivia (4250 t) and Paraguay (3500 t). Most of the fruit are marketed in domestic or regional markets, with a variable portion going for processing (locally or exported). Regarding to the genetic of the planting material used in South America, University of California (UC) cultivars dominate the varietal spectrum.EEA FamailláFil: Kirschbaum, Daniel Santiago. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Famaillá; ArgentinaFil: Vicente, C.E. Instituto Nacional de Investigación Agropecuaria (INIA) Salto Grande; UruguayFil: Cano-Torres, M.A. Universidad de Ciencias Aplicadas y Ambientales. Facultad de Ingenierı́a Agronómica; ColombiaFil: Gambardella, M. Pontificia Universidad Católica de Chile. Facultad de Agronomı́a e Ingeniería Forestal; ChileFiL .Veizaga-Pinto, F.K. Gobierno Autónomo Municipal de Comarapa, Provincia Manuel Caballero, BoliviaFil: Antunes, L.E.C. EMBRAPA Clima Temperado; Brasi