Risk of autism spectrum disorder in children born to mothers with systemic lupus erythematosus and rheumatoid arthritis in Taiwan

Objectives

To determine whether offspring of Taiwanese mothers with systemic lupus erythematosus or rheumatoid arthritis have a higher risk of autism spectrum disorder.

孤独症谱系障碍患儿照顾者家庭坚韧力状况及影响因素研究

目的探讨孤独症谱系障碍患儿照顾者家庭坚韧力状况及其影响因素。方法采用一般人口学资料问卷、儿童孤独症评定量表、家庭坚韧性量表和亲职压力简表对189例孤独症谱系障碍患儿照顾者进行问卷调查。结果孤独症谱系障碍患儿照顾者家庭坚韧力量表总分为(39.28±6.03)分。家庭坚韧力量表得分与亲职压力简表总分及各维度得分呈负相关(P0.05,P0.01);多元逐步线性回归分析结果显示,亲子愁苦、困难儿童、疾病程度和亲子互动关系失调因子可预测家庭坚韧力54.8%的变异量。结论孤独症谱系障碍患儿照顾者家庭坚韧力量表得分处于较低水平,医护人员应在关注患儿疾病的同时,通过心理咨询和提供亲子互动空间缓解患儿照顾者的亲职压力水平,积极发挥其主观能动性,提高家庭应激能力和坚韧力。     

Chronic parenting stress and mood reactivity: The role of sleep quality

Sleep is a basic biological process supporting emotion regulation. The emotion regulation function of sleep may be particularly important in the context of chronic stress. To better understand how chronic stress and sleep interact to predict mood, 66 parents of children with autism completed daily diaries assessing parenting stress, negative mood, and sleep quality for 6 consecutive days. Hierarchical linear modelling revealed that daily negative mood was predicted by between‐person differences in parenting stress and between‐person differences in sleep efficiency. Further, between‐person differences in sleep efficiency and within‐person differences in sleep satisfaction moderated the impact of stress on mood. These data suggest that sleep disturbances may exacerbate the association between stress and mood in the context of chronic parenting stress. Further, high parenting stress appears to heighten the impact of transient sleep disturbances on mood.     

Cardiovascular reactivity to simulated social stress

This study tested the hypotheses that blood pressure reactivity to simulated social stress would be positively correlated with resting pCO₂ and with increased variability of blood pressure in the natural environment. Sixty white and black men and women participated in a role‐playing task involving scenarios describing common infringements of their rights. Blood pressure was higher during the role playing task than during a preceding structured interview and an intervening rest period, and decreased after role playing. Heart rate changes were small by comparison, though heart rate reactivity of women was greater than that of men. Blood pressure reactivity was not correlated with resting pCO₂ and was inversely correlated with ambulatory systolic blood pressure variability. Resting pCO₂ was, however, correlated with mean 24‐h ambulatory systolic and diastolic blood pressure. This study confirms that social stress elevated blood pressure acutely via a vascular mechanism, is consistent with the view that hyperresponsive individuals tend to avoid arousing situations, and further implicates pCO₂ in long‐term blood pressure regulation. Copyright © 1999 John Wiley & Sons, Ltd.     

学龄前孤独症患儿照顾者连带病耻感及影响因素分析

目的 探讨学龄前孤独症谱系障碍患儿照顾者连带病耻感现状及其与疾病获益感、心理弹性的相关性。 方法 采用一般资料问卷、连带病耻感量表、疾病获益感量表、心理弹性量表对258名学龄前孤独症谱系障碍患儿照顾者进行调查。 结果 学龄前孤独症谱系障碍患儿照顾者连带病耻感条目均分2.44±0.46,情感维度病耻感最高,且得分最高的5个条目均归属于情感维度。疾病获益感、心理弹性与连带病耻感呈显著负相关（均P＜0.05）。分层回归分析结果显示,学龄前孤独症谱系障碍患儿照顾者连带病耻感主要受就业状态、夫妻关系、疾病严重程度和心理弹性因素影响,在控制照顾者及患儿一般资料后,疾病获益感未影响连带病耻感,而心理弹性能解释连带病耻感总变异的8%（P＜0.05）。 结论 孤独症谱系障碍患儿照顾者连带病耻感处于较高水平,情感维度病耻感最为严重。医护人员应重视照顾者的心理感受,采取措施提高其心理弹性,引导其以积极的心态面对困难,从而降低连带病耻感。     

Acute stress and performance in police recruits

Emergency personnel consistently work under high‐stress situations, and thus, the question about whether this stress affects performance is critical to the safety of both themselves and the public. However, considerable controversy exists about the influence of stress on performance. This study investigates the association between both biological and psychological manifestations of stress and performance. The study was conducted with 84 police recruits using a high‐fidelity simulation of a policing event in order to try to determine performance in a life‐like workplace environment. Measures included both biological (heart rate and salivary cortisol levels) and psychological (subjective anxiety) indicators of stress. Performance was videotaped and was later evaluated by three expert raters. The results of this study are promising in that neither physiological nor psychological responses impaired performance in a simulated acutely stressful policing situation. On the other hand, those individuals with greater cortisol release showed higher levels of performance, supporting the notion that cortisol can enhance ability in high‐stress situations. Recruits were also asked to subjectively evaluate their performance. A small group of individuals ranked themselves as poor performers while evaluators ranked them highly. These individuals experienced significantly higher increase in subjective distress and significantly higher cortisol levels at baseline and peak. Copyright © 2008 John Wiley & Sons, Ltd.     

Anti‐stress effect of yoga‐type breathing: modification of salivary cortisol,heart rate and blood pressure following a step‐climbing exercise

This paper reports salivary cortisol levels and cardiovascular adjustments monitored after the performance of physical exercise in a subject (healthy man, 58 years old) who had practised and taught yoga techniques for a number of years. The subject performed two different step‐climbing trials which were varied according to the different breathing recovery techniques used. Immediately after the step‐climbing, the subject was asked either to get his breath back spontaneously (as reference) or by 3 min breathing using the ‘Istity Method’, based on the prolongation or amplification of the steps of the breath (breathing in–out) with short regular rest intervals. The measurements of the basal heart rate, blood pressure and cortisol concentration in the saliva were made just before starting, and 5, 15 and 30 min after the end of step‐climbing. Results suggest that the Istity breathing method can induce rapid modification of the cardiovascular function and attenuation of the cortisol level after exposure to physical stress. It might be of interest to pursue further studies of this effect, perhaps not confined to yoga experts, since the ‘Istity Method’ can be implemented by anyone after a short and simple training period. Copyright © 2002 John Wiley & Sons, Ltd.     

Differences in hormonal responses to preoperative emotional stress between preschool and school children

Background: The behavior of children under emotional stress differs according to whether they are of preschool or school age.
Methods: To examine the effect of age on hormonal responses to preoperative emotional stress, we measured the concentrations of catecholamines (adrenaline and noradrenaline) and cortisol in 56 healthy boys before surgery.
Results: Among preschool boys (3–5 years old), those showing anxious behavior showed significantly higher cortisol, adrenaline, and noradrenaline concentrations in the blood circulation than those not showing such behavior ( P <0.0001, P <0.0001 and P <0.005, respectively). However, among the schoolboys (6–11 years old), anxiety was associated only with the cortisol concentration ( P <0.01)
Conclusions: Hormonal responses to preoperative emotional stress in preschool boys differ from those in schoolboys.     

Stress system dysregulation in pediatric generalized anxiety disorder associated with comorbid depression

Because chronic stress is an important risk factor for anxiety states and depressive disorders, we studied hypothalamus–pituitary–adrenal (HPA) axis and sympathetic system activity via changes in cortisol and alpha amylase activity levels in pediatric generalized anxiety disorder (GAD) patients (n = 26) with comorbid depression and a healthy comparison group (n = 26). Morning plasma cortisol and diurnal profiles of salivary cortisol and salivary alpha amylase (sAA) activity were assessed, also reactivity of HPA‐axis, sAA activity, and heart rate following a psychosocial stressor (Trier Social Stress Test for children). GAD patients with comorbid depression showed increased morning plasma and salivary cortisol levels, ameliorating throughout in‐patient treatment, and higher sAA activity in their diurnal profile. Both HPA and sympathetic activity positively correlated with the severity of anxiety and depression. We also demonstrated a blunted HPA and sympathetic response to acute stress in patients. This pattern of neuroendocrine and sympathetic changes seems to be distinct from the one previously reported in pediatric patients with only social anxiety or depressive disorders. We propose morning plasma and saliva cortisol levels as potential physiological indicators for supporting the evaluation of symptoms' severity and treatment progress in children with GAD and comorbid depressive disorder.     

The role of dehydroepiandrosterone on functional innate immune responses to acute stress

The androgen dehydroepiandrosterone (DHEA) responds to stress activation, exhibits anti‐glucocorticoid properties, and modulates immunity in diverse ways, yet little is known of its role in acute stress responses. In this study, the effects of DHEA and its sulfate ester DHEA‐S on human male immune function during exposure to an acute stressor is explored. Variation in DHEA, DHEA‐S, testosterone, and cortisol, along with bacterial killing assays, was measured in response to a modified Trier Social Stress test in 27 young adult males. Cortisol was positively related to salivary innate immunity but only for participants who also exhibited high DHEA responses. Additionally, DHEA positively and DHEA‐S negatively predicted salivary immunity, but the opposite was observed for serum‐based innate immunity. The DHEA response to acute stress appears to be an important factor in stress‐mediated immunological responses, with differential effects on immunity dependent upon the presence of other hormones, primarily cortisol and DHEA‐S. These results suggest that DHEA plays an important role, alongside other hormones, in modulating immunological shifts during acute stress.     

Lower cortisol response in high‐resilient caregivers of people with autism: the role of anger

Caring for an offspring with an autism spectrum disorder (ASD) has been related to high stress levels and health disturbances. However, a protective effect against these negative health outcomes has been described in high‐resilient caregivers. In this context, the main aim of the present study was to assess the association between resilient coping and cortisol response to acute stress in caregivers of people with ASD. Furthermore, the study aimed to explore the mediating role of anger in this association. We exposed 40 caregivers of people with ASD to an acute psychosocial stressor in the laboratory. Salivary cortisol samples were obtained before, during, and after the stressor. Resilient coping, anger, and socio‐demographic variables were also assessed. Resilient coping was negatively correlated with cortisol response. Specifically, cortisol release was lower in high‐resilient than low‐resilient caregivers. Anger was positively correlated with cortisol response, mediating the association with resilient coping. The observed associations of resilient coping and anger with cortisol response indicate that these variables may affect health outcomes, resilience being protective and anger harmful. Psychotherapeutic interventions focused on strengthening resilience and anger management could benefit caregivers, improving their health status and quality of life.     

Psychological and physical abuse in the schools: A paradigm for understanding post-traumatic stress disorder in children and youth

The literature on Post-Traumatic Stress Disorder (PTSD) in children is rather sparse. Most accounts describe only the aftereffects of horrendous traumas. Yet there is evidence that children are also vulnerable to a wider range of stressor than adults. Since the nosology for PTSD is based upon adult psychopathology, there is a need to examine the syndrome in light of current knowledge about development, psychopathology, and ecological factors in children's lives. The purpose of this paper is to present evidence that the pattern of symptoms of PTSD in children is different from those in adults. The paradigm presented was generated by work with children and youth who were the victims of excessively punitive disciplinary practices in schools. An updated overview of the literature on PTSD in children is presented. Case studies and retrospective data are offered in support of the need to differentiate child/adolescent PTSD from adult nosology and to understand the nature of PTSD when it occurs as a result of school related abuse.     

孤独症儿童无移位肱骨髁上骨折的功能锻炼策略

目的探讨孤独症谱系障碍(ASD)儿童罹患无移位肱骨髁上骨折后的功能锻炼方法。 方法回顾2015年1月至2018年12月在中山大学附属第三医院儿童发育行为中心诊断为ASD的患儿。纳入标准：采用石膏托外固定治疗的3～7岁患儿,随访时间不少于6个月。排除标准：有其他部位骨折、保守治疗失败、既往已有患侧上肢活动受限、症状性ASD、其它先天性发育异常疾病。共纳入22名患儿,根据患儿是否采用针对性骨折功能锻炼方案,分为ASD功能锻炼组(15例)、ASD未功能锻炼组(7例),并以发生同样骨折的正常发育儿童44名为非ASD儿童组。采用卡方检验比较3组患儿伤后2个月、6个月肘关节、尺桡关节的被动关节活动度(PROM)。并采用秩和检验比较ASD患儿生活自理能力变化。 结果ASD未功能锻炼组受伤后2个月的肘关节屈曲(F＝5.974,P<0.05)、伸展(F＝26.968,P<0.05)、尺桡关节旋转(旋前F＝5.162,P<0.05;旋后(F＝30.432,P<0.05)PROM均比另外2组儿童差;其伤后6个月在肘关节伸展(F＝12.318,P<0.05)和尺桡关节旋后(F＝24.504,P<0.05)功能仍明显比另2组儿童差。伤后6个月,ASD未功能锻炼组患儿的生活自理能力明显倒退(Z＝－2.225,P<0.05)。 结论保守治疗的无移位肱骨髁上骨折ASD儿童,宜进行骨折功能锻炼,有助于改善关节活动度,避免生活自理能力倒退。     

Daily sleep in relation to subjective and physiological stress in an occupational context: Daily vigour as a mediator

Studies on the stress-sleep relationship consistently demonstrate negative effects of stress on sleep. The reversed relation, however, has received less research attention. Also, field studies on physiological stress are scarce. The aim of this day-level diary study was to examine daily relationships between sleep quality and quantity, and subjective and physiological stress in an occupational context. Moreover, we examined daily vigour as an underlying mechanism of the sleep-stress relationship. Participants were 167 knowledge workers who filled in daily questionnaires measuring sleep quality and quantity, morning vigour and subjective afternoon stress on Tuesdays and Thursdays for 5 weeks. Physiological stress was assessed with cortisol decline from morning peak to evening, and with blood pressure in the afternoon. Multilevel path analysis results showed that better sleep quality and longer sleep hours predicted increased vigour the following morning, which in turn predicted lower subjective stress in the afternoon. Sleep quality and quantity were not related to physiological stress neither directly nor indirectly via morning vigour. On the basis of our results, sleep should be considered as a factor affecting vigour which in turn seems to lower stress.     

Dynamic changes in salivary cortisol and secretory immunoglobulin A response to acute stress

Psychological stress leads to the secretion of cortisol. While this psychoneuroendocrine response helps to maintain physiological as well as psychological homeostasis under stress, exaggerated release of cortisol can suppress aspects of immune function and have negative effects on health. The present study set out to investigate the dynamic changes in salivary secretory immunoglobulin A (sIgA) and cortisol before and after acute stress, and to analyse the relationship between sIgA and cortisol trend. Thirty‐five healthy subjects took part in this study. All subjects underwent an acute stress test (mental arithmetic task). Salivary cortisol and sIgA responses were assessed repeatedly before the stress test, immediately after the stress test and 20 min after the stress test. The levels of salivary cortisol and sIgA both significantly increased after the acute mental arithmetic challenge. However, the increase of sIgA is transient; the sIgA fall was significantly correlated with the cortisol rise during the 20 min after stress (r = 0.569, p < 0.001). These results may help determine the timing of effective intervention in order to reduce the hypersecretion of cortisol and improve mucosal immune function. Copyright © 2008 John Wiley & Sons, Ltd.