The Cortisol Awakening Response and Depressive Symptomatology: The Moderating Role of Sleep and Gender

The association between depression and the cortisol awakening response (CAR) has been widely examined, yet the results are mixed and factors responsible for such inconsistencies are poorly understood. The current study investigated whether the link between depressive symptomatology and CAR varied as a function of two such factors: sleep and gender. The sample included 58 young adults (30 females; Mageâ =â 18.7; SDageâ =â 0.91). Participants completed the Beck Depression Inventory as well as the Consensus Sleep Diary to assess depressive symptomatology and daily sleep patterns, respectively. Participants also provided four salivary cortisol samples (0, 30, 45 and 60â min after awakening) during two consecutive weekdays. Results demonstrated that greater depressive symptoms were associated with a greater CAR but only when depressive symptoms were linked to a shorter sleep time. In addition, gender significantly moderated the association between depressive symptoms and CAR. While greater depressive symptoms were associated with an elevated CAR among females, they were associated with a blunted CAR among males. These findings provide some insight into potential mechanisms linking depressive symptomatology and CAR, and suggest that future studies examining CAR as a biomarker of depression should account for differences in sleep and gender. Copyright © 2016 John Wiley & Sons, Ltd.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138213/1/smi2691_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138213/2/smi2691.pd

Physiological Correlates of Choice‐Induced Dissonance: An Exploration of HPA‐Axis Responses

Choice can produce a negatively arousing cognitive conflict (called dissonance), which is thought to motivate the chooser to spread their preferences for the relevant options (called Spreading of Alternatives, or SA). The current work aimed to determine the relationship between HPA‐axis activity and both choice‐induced dissonance and its reduction (i.e. SA) among individuals with varying cultural backgrounds. European–Americans and Asians made a choice between two equally attractive CDs either in the presence of a cue indicative of social eyes (i.e. public‐choice condition) or in the absence thereof (i.e. private‐choice condition). As predicted, European–Americans and Asians showed a reliable SA primarily in the private and public choice conditions, respectively. Importantly, a sharp decline of salivary cortisol was observed over the span of 30 min, and, moreover, this decline was reliably predicted by the magnitude of SA regardless of either culture or the choice being private vs. public. These results suggest that although choice‐induced dissonance is too weak to elicit an HPA‐axis stress response, SA is associated with variability in the decline of salivary cortisol during the laboratory task. Copyright © 2015 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113729/1/bdm1845.pd

Dimorfismo sexual en el comportamiento altruista de jóvenes colombianos: correlatos electrofisiológicos y endocrinos

La especie humana se caracteriza por un alto nivel de complejidad en sus interacciones y estructuras sociales. Para Dunbar (1998), esta fue la principal razón que podría explicar el crecimiento relativo del cerebro, principalmente el lóbulo frontal, en nuestra especie y otros primates no humanos afines filogenéticamente. Las explicaciones de este autor parten de que un entorno social complejo generaría una mayor exigencia cognitiva para los individuos, dado que, para lograr eficacia en sus interacciones, deben aumentar su capacidad para recordar y manipular información social, reconocer las jerarquías y roles, reconocer estados emocionales y anticipar intenciones de otros individuos, así como realizar comportamientos estratégicos como el engaño táctico y el establecimiento de alianzas.1a edició

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Facial emotion expression recognition by children at familial risk for depression: high‐risk boys are oversensitive to sadness

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97466/1/jcpp12005.pd

Understanding the role of early life trauma in the neuroendocrine dysregulation of youth depression

Background : To date there are inconsistent empirical findings regarding the nature of hypothalamic–pituitary–adrenal (HPA)-axis dysregulation in depressed youth. Some of these inconsistencies may be explained in part by exposure to different types of trauma. The purpose of this study is to clarify the interplay between trauma exposure and neuroendocrine reactivity in depressed youth. We hypothesized that exposure to specific subtypes of trauma will moderate the effect of depression on dysregulation of the stress response system. Methods : Participants were 51 depressed and non-depressed youth (22 males; mean age = 12.9, SD = 2.8). Participants completed a semi-structured clinical interview, an Early Trauma Inventory (ETI), and a 90-minute stress task which included saliva samples upon arrival, after a 30 minute baseline, 25, 35, 45, 55, and 65 minutes following the SE-Current Procedural Terminology (CPT). Results : There were no differences between depressed and non-depressed participants in reported exposure to trauma of any type. However, depressed participants had higher cortisol levels during the regulation phase, 45 [F(15,35) = 2.65, p < 0.05], 55 [F(15,35) = 2.64, p < 0.05], and 65 [F(15,35) = 3.11, p < 0.01] minutes after the stressor. We also found that there was a main effect of depression symptoms [F(11,35) = 296.18, p<0.05] on cortisol reactivity (AUCi). In addition, we found that there was a significant interaction of depression and trauma history [F(2,30) = 523.29, p<0.05], in that exposure to abuse, but not general trauma, increased AUCi in the depressed sample only. Conclusions : Depressed youth with a history of abuse are more likely to have a specific dysregulation of the HPA-axis related to an inability to “shut down” the stress response as evidenced by later peak times. This suggests that abuse may have an impact specifically on HPA regulatory capacity. We did not find this effect for general trauma highlighting the potential differential role of various types of trauma on HPA functioning