Tomas Faresjö

Cortisol in hair measured in young adults - a biomarker of major life stressors?

BackgroundStress as a cause of illness has been firmly established. In public health and stress research a retrospective biomarker of extended stress would be an indispensible aid. The objective of this pilot study was to investigate whether concentrations of cortisol in hair correlate with perceived stress, experiences of serious life events, and perceived health in young adults.MethodsHair samples were cut from the posterior vertex area of (n = 99) university students who also answered a questionnaire covering experiences of serious life events, perceived Stress Scale and perceived health during the last three months. Cortisol was measured using a competitive radioimmunoassay in methanol extracts of hair samples frozen in liquid nitrogen and mechanically pulverised.ResultsMean cortisol levels were significantly related to serious life events (p = 0.045), weakly negatively correlated to perceived stress (p = 0.025, r = -0.061) but nor affected by sex, coloured/permed hair, intake of pharmaceuticals or self-reported health. In a multiple regression model, only the indicator of serious life events had an independent (p = 0.041) explanation of increased levels of cortisol in hair. Out of four outliers with extremely high cortisol levels two could be contacted, both reported serious psychological problems.ConclusionsThese findings suggest that measurement of cortisol in hair could serve as a retrospective biomarker of increased cortisol production reflecting exposure to major life stressors and possibly extended psychological illness with important implications for research, clinical practice and public health. Experience of serious life events seems to be more important in raising cortisol levels in hair than perceived stress.

Impact of the 2008 Economic and Financial Crisis on Child Health : A Systematic Review

The aim of this study was to provide an overview of studies in which the impact of the 2008 economic crisis on child health was reported. Structured searches of PubMed, and ISI Web of Knowledge, were conducted. Quantitative and qualitative studies reporting health outcomes on children, published since 2007 and related to the 2008 economic crisis were included. Two reviewers independently assessed studies for inclusion. Data were synthesised as a narrative review. Five hundred and six titles and abstracts were reviewed, from which 22 studies were included. The risk of bias for quantitative studies was mixed while qualitative studies showed low risk of bias. An excess of 28,000–50,000 infant deaths in 2009 was estimated in sub-Saharan African countries, and increased infant mortality in Greece was reported. Increased price of foods was related to worsening nutrition habits in disadvantaged families worldwide. An increase in violence against children was reported in the U.S., and inequalities in health-related quality of life appeared in some countries. Most studies suggest that the economic crisis has harmed children’s health, and disproportionately affected the most vulnerable groups. There is an urgent need for further studies to monitor the child health effects of the global recession and to inform appropriate public policy responses.

Maternal Influence on Child HPA Axis: A Prospective Study of Cortisol Levels in Hair

OBJECTIVE: To investigate cortisol concentrations in hair as biomarker of prolonged stress in young children and their mothers and the relation to perinatal and sociodemographic factors. METHODS: Prospective cohort study of 100 All Babies In Southeast Sweden study participants with repeated measures at 1, 3, 5, and 8 years and their mothers during pregnancy. Prolonged stress levels were assessed through cortisol in hair. A questionnaire covered perinatal and sociodemographic factors during the child’s first year of life. RESULTS: Maternal hair cortisol during the second and third trimester and child hair cortisol at year 1 and 3 correlated. Child cortisol in hair levels decreased over time and correlated to each succeeding age, between years 1 and 3 (r = 0.30, P = .002), 3 and 5 (r = 0.39, P < .001), and 5 and 8 (r = 0.44, P < .001). Repeated measures gave a significant linear association over time (P < .001). There was an association between high levels of hair cortisol and birth weight (β = .224, P = .020), nonappropriate size for gestational age (β = .231, P = .017), and living in an apartment compared with a house (β = .200, P = .049). In addition, we found high levels of cortisol in hair related to other factors associated with psychosocial stress exposure. CONCLUSIONS: Correlation between hair cortisol levels in mothers and their children suggests a heritable trait or maternal calibration of the child’s hypothalamic–pituitary–adrenocortical axis. Cortisol output gradually stabilizes and seems to have a stable trait. Cortisol concentration in hair has the potential to become a biomarker of prolonged stress, especially applicable as a noninvasive method when studying how stress influences children’s health.

To Match or Not to Match in Epidemiological Studies—Same Outcome but Less Power

This study aimed to analyze the possible resemblance or difference in outcome in a case-control study of quality of life for IBS patients compared to controls free from the disease, when a matching procedure for age and sex was applied for the control group compared to when all participating subjects were included in the control group. The main result was that almost the same and identical results were found irrespective of whether matching or not matching was applied in this epidemiological case-control study. The matching procedure however, slightly diminished the statistical power of the results.

How to think about interprofessional competence: A metacognitive model

Different professions meet and work together in teams every day in health and social care. To identify and deliver the best quality of care for the patient, teamwork should be both professionally and interprofessionally competent. How can enhanced education prepare teamworkers to be both professionally and interprofessionally competent? To achieve interprofessional skills and design effective interprofessional curricula, there is a need for metacognitive frameworks focusing on the relationship between theories and the problem-solving process as well as the structure and content of professional competence. The aim of this article is to discuss the need for shared metacognitive structures/models as a tool for securing successful interprofessional learning and developing personal, professional and interprofessional competence to improve the quality of care. A metacognitive model for interprofessional education and practice is presented in this article. This model has been developed as a tool for analyzing professional competence on three levels: individual, team and organization. The model comprises seven basic components of professional competence and the way they are related and interact. Examples of how this metacognitive model can be used in the early, middle and late stages in interprofessional education are given.

Higher Perceived Stress but Lower Cortisol Levels Found among Young Greek Adults Living in a Stressful Social Environment in Comparison with Swedish Young Adults

The worldwide financial crisis during recent years has raised concerns of negative public health effects. This is notably evident in southern Europe. In Greece, where the financial austerity has been especially pronounced, the prevalence of mental health problems including depression and suicide has increased, and outbreaks of infectious diseases have risen. The main objective in this study was to investigate whether different indicators of health and stress levels measured by a new biomarker based on cortisol in human hair were different amongst comparable Greek and Swedish young adults, considering that Sweden has been much less affected by the recent economic crises. In this cross-sectional comparative study, young adults from the city of Athens in Greece (n = 124) and from the city of Linkoping in Sweden (n = 112) participated. The data collection comprised answering a questionnaire with different health indicators and hair samples being analyzed for the stress hormone cortisol, a biomarker with the ability to retrospectively measure long-term cortisol exposure. The Greek young adults reported significantly higher perceived stress (p<0.0001), had experienced more serious life events (p = 0.002), had lower hope for the future (p<0.0001), and had significantly more widespread symptoms of depression (p<0.0001) and anxiety (p<0.0001) than the Swedes. But, the Greeks were found to have significantly lower cortisol levels (p<0.0001) than the Swedes, and this difference was still significant in a multivariate regression (p<0.0001), after adjustments for potential intervening variables. A variety of factors related to differences in the physical or socio-cultural environment between the two sites, might possibly explain this finding. However, a potential biological mechanism is that long-term stress exposure could lead to a lowering of the cortisol levels. This study points out a possible hypothesis that the cortisol levels of the Greek young adults might have been suppressed and their HPA-axis down-regulated after living in a stressful environment with economic and social pressure.

Health-related quality of life of irritable bowel syndrome patients in different cultural settings

BackgroundPersons with Irritable bowel syndrome (IBS) are seriously affected in their everyday life. The effect across different cultural settings of IBS on their quality of life has been little studied. The aim was to compare health-related quality of life (HRQOL) of individuals suffering from IBS in two different cultural settings; Crete, Greece and Linköping, Sweden.MethodsThis study is a sex and age-matched case-control study, with n = 30 Cretan IBS cases and n = 90 Swedish IBS cases and a Swedish control group (n = 300) randomly selected from the general population. Health-related quality of life, measured by SF-36 and demographics, life style indicators and co-morbidity, was measured.ResultsCretan IBS cases reported lower HRQOL on most dimensions of SF-36 in comparison to the Swedish IBS cases. Significant differences were found for the dimensions mental health (p < 0.0001) and general health (p = 0.05) even after adjustments for educational level and co-morbidity. Women from Crete with IBS scored especially low on the dimensions general health (p = 0.009) and mental health (p < 0.0001) in comparison with Swedish women with IBS. The IBS cases, from both sites, reported significantly lower scores on all HRQOL dimensions in comparison with the Swedish control group.ConclusionThe results from this study tentatively support that the claim that similar individuals having the same disease, e.g. IBS, but living in different cultural environments could perceive their disease differently and that the disease might affect their everyday life and quality of life in a different way. The Cretan population, and especially women, are more seriously affected mentally by their disease than Swedish IBS cases. Coping with IBS in everyday life might be more problematic in the Cretan environment than in the Swedish setting.

Functional dyspepsia affects women more than men in daily life: A case-control study in primary care

BACKGROUND Little is known about possible gender differences among patients with functional dyspepsia (FD). Few studies have measured health-related quality of life (HRQoL) in patients with FD using a population-based control group as a reference. OBJECTIVES This study aimed to determine the degree of HRQoL impairment among patients with FD, to assess the self-reported health impact resulting from the disease, and to analyze any gender differences. METHODS A questionnaire that included the HRQoL Short Form 36 (SF-36) Health Survey, Hospital Anxiety and Depression Scale, and other measurements was mailed to patients with FD identified from medical records. The control group was randomly selected from the general population in the same geographical area. Responses to the SF-36 were transferred to a standard scale ranging from 0 (the worst possible score) to 100 (the best possible score). RESULTS Responders were assigned to 2 gender-specific subgroups, each with 88 patients with FD and 344 randomly matched controls, all aged 18 to 65 years. Compared with the controls, the HRQoL of patients with FD was impaired in all SF-36 dimensions except one -- role limitations caused by emotional problems. Female patients with FD had a significantly lower SF-36 score in the physical functioning dimension than did male patients (82.4 vs 90.5, respectively; P < 0.01). Both groups of patients with FD had impaired HRQoL compared with their respective control group in the dimensions of bodily pain (women: 69.3 vs 80.6, P < 0.001; and men: 75.8 vs 84.8, P < 0.001) and general health (women: 62.0 vs 75.6, P < 0.001; and men: 70.6 vs 78.6, P < 0.001). Additionally, women with FD had significant impairment compared with their respective control group in the dimensions of physical functioning (82.4 vs 89.3; P < 0.01) and physical role limitations (72.1 vs 85.9; P < 0.001). Depression was significantly more common among male patients with FD than among male controls (6.8% vs 2.0%, respectively; P < 0.05). More gastrointestinal comorbidity was reported among patients of both sexes compared with controls. CONCLUSIONS This population-based case-control study reported HRQoL impairment overall among patients with FD. This impairment was more apparent in female patients than in female controls. Females with FD tended to be more negatively affected in their daily life than their male counterparts. These gender differences should be investigated further in future studies.

Early Psychosocial Exposures, Hair Cortisol Levels, and Disease Risk

BACKGROUND: Early psychosocial exposures are increasingly recognized as being crucial to health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker assessing long-term hypothalamic-pituitary-adrenal axis activity. The objective was to investigate whether early-life adverse psychosocial circumstances influence infant cortisol levels in hair and health outcomes in children prospectively until age 10. METHODS: A cohort study in the general community using a questionnaire covering 11 psychosocial items in the family during pregnancy and the cumulative incidence of diagnoses until age 10 years in 1876 children. Cortisol levels in hair were measured by using a radioimmunoassay in those with sufficient hair samples at age 1, yielding a subsample of n = 209. RESULTS: Children with added psychosocial exposures had higher infant cortisol levels in hair (B = 0.40, P < .0001, adjusted for gender and size for gestational age) in a cumulative manner and were significantly more often affected by 12 of the 14 most common childhood diseases, with a general pattern of increasing odds ratios. CONCLUSIONS: The findings support the model of physiologic dysregulation as a plausible mechanism by which the duration and number of early detrimental psychosocial exposures determine health outcomes. The model indicates that the multiplicity of adversities should be targeted in future interventions and could help to identify children who are at high risk of poor health. Furthermore, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair could be of major importance.

Nurses' views of interprofessional education and collaboration: A comparative study of recent graduates from three universities

Today interprofessional education (IPE) is spread throughout the world. In Sweden only one of the existing nursing programs has an IPE curriculum on several levels during the training. The aim of this study was to examine how nurses who recently graduated from universities with IPE or non-IPE curricula perceive the importance of different educational goals and whether they found themselves prepared for their profession, and especially for collaboration with other professions. Three universities with different commitments to IPE were studied. We used a survey with eight different targets: communication skills, cooperation with other professions, problem-solving capability, self-directed learning skills, whether their education has prepared them to work professionally, to perform research, to take care of acutely ill patients, to work preventively and working as a nurse. The participants were asked whether their undergraduate education had prepared them for these targets and whether they perceived that the targets were important goals for their education. A main result in this study was that nurses who had recently graduated from the IPE university perceived to a greater extent that their undergraduate training had prepared them to work together with other professions in comparison with nursing students from non-IPE universities.