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Background and objectives The appearance of a highly contagious disease forced the confinement of the population in almost all parts of the world, causing an increase in psychological problems, with pregnant women being a particularly vulnerable group to suffer negative consequences. The aim of this research was to check which confinement or psychological stress variables are related to the increase of anxious and depressive symptoms in pregnant women, as a consequence of the pandemic caused by the COVID-19. Materials and methods The sample was composed of 131 pregnant women who experienced the confinement imposed by the Government of Spain on March 14, 2020. Sociodemographic, obstetric, confinement related and psychological variables were collected. Results Perceived stress, pregnancy-specific stress, as well as insomnia are predictive variables in most anxious (obsessions and compulsions, anxiety and phobic anxiety) and depressive symptoms related to COVID-19. Conclusions It is important to focus future psychological interventions in this population on stress control and sleep monitoring, since these variables influence the increase of anxiety and depression.

Due to an absence of maternal stress being measured in routine prenatal care by clinicians, prenatal stress has become a serious problem which is associated with poorer obstetric outcomes, as well as worse maternal and infant health. For that reason, the aim of this study was the translation, validation and adaptation of Prenatal Distress Questionnaire Revised (NuPDQ) in a Spanish sample.Three-hundred and seventy-one pregnant women were assessed using the NuPDQ, the Prenatal Distress Questionnaire, Perceived Stress Scale and the Connor-Davidson Resilience Scale. The NuPDQ was translated into Spanish by the backtranslation method and administered to participants.A confirmatory factor analysis revealed the established unidimensional structure to be a poor fit to data with the Spanish version. An exploratory factor analysis suggested a five-factor structure with 14 items. The instrument had good reliability, convergent and discriminant validity psychometric properties.The five-factor 14-item NuPDQ is useful to assess pregnancy-specific stress in Spanish pregnant women. It may be appropriate to use this instrument in order to identify pregnant women with high pregnancy-specific stress to try to prevent negative consequences derived from those high levels.

Pregnancy is a life process that brings about a series of associated changes, both physical and psychological, in women. The psychopathological changes occurring in pregnant women due to the simple fact of this new vital stage are unknown. Therefore, the objective of this study was to compare the psychopathological symptoms present during pregnancy with those present in non-pregnant women, as well as the perceived stress and hair cortisol levels. For this, a group of non-pregnant women (n = 171) were compared with pregnant women who were in the first trimester (n = 124), second trimester (n = 200) and third trimester (n = 190). Moreover, 77 women were followed up to verify their psychopathological course of pregnancy. Differences were found between pregnant and non-pregnant women relating to a wide range of psychopathological symptoms, perceived stress and hair cortisol levels. The symptoms were greater in the group of pregnant women. By studying different types of psychopathological symptoms associated with pregnancy, it is possible to assign psychological interventions to given characteristics of pregnant women. In addition, we can broaden our knowledge about the psychological aspects of pregnancy and the changes associated with it.

To determine whether psychological variables (perceived stress, pregnancy-specific stress and psychopathology symptoms) and physiological variables (hair cortisol levels) are related to type of delivery (eutocic or instrumental delivery; spontaneous or induced labor).This was a longitudinal study.Spain.A total sample of 88 pregnant women.Perceived stress, pregnancy-specific stress, psychopathology symptoms and hair cortisol level were assessed in pregnant women throughout the third trimester of pregnancy until they gave birth. Participants were grouped by type of delivery (eutocic or instrumental delivery; spontaneous or induced labor). ANOVA tests were performed in order to determine differences between groups. We found differences between the eutocic and instrumental delivery groups in the SCL-90-R subscales somatisation (t = 6.98; p = 0.01), anxiety (t = 3.42; p 0.05), depression (t = 5.20; p 0.02) and psychoticism (t = 5.28; p 0.01), and in the general indices global severity index (t = 5.57; p 0.05) and positive symptoms (t = 5.21; p 0.01). No differences were found between groups for the other variables.Maternal psychological status could have an impact on delivery, since women who had an instrumental delivery presented more psychopathology symptoms in the third trimester.The psychological assessment and treatment of pregnant women could play a key role in enhancing maternal mental health and preventing the processes and outcomes associated with poor psychological status.

Ministry of Economy, Knowledge, Business and University of the Junta de Andalucia, Grant/Award Number: A-CTS-229-UGR18; European Regional Development Fund (ERDF); Spanish Ministry of Science, Innovation and Universities, Grant/Award Number: 18/00617, Objective: To compare the postpartum psychopathological symptoms of women who gave birth before the pandemic with those who gave birth during the pandemic. Methods: A total of 212 women participated in the study, of which 96 gave birth before the pandemic and 116 during the pandemic. Psychopathological symptoms, postpartum depression, perceived stress, and resilience were evaluated. Results: Women who gave birth during the pandemic had higher scores on somatization, obsessions and compulsions, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, and psychoticism. In addition, perceived stress was the common predictor of an increase in these symptoms. Conclusion: Postpartum is a complicated period in a woman's life. Many psychological adaptations take place and women may be subject to psychological alterations during this period. In addition, women who gave birth during the COVID-19 crisis may show greater psychological vulnerability, due to the specific situation experienced during the pandemic. The COVID-19 pandemic may have played a role in the increase in psychopathological symptoms after childbirth. Detecting possible symptoms postpartum plays a crucial role, because it allows intervening and preventing the development of psychopathologies., Ministry of Economy, Knowledge, Business and University of the Junta de Andalucia A-CTS-229-UGR18, European Commission, Spanish Ministry of Science, Innovation and Universities 18/00617

Stress during pregnancy has been widely studied and associated to different variables, usually with negative results for the health of the mother and the newborn, such as having a higher risk of suffering postpartum depression, premature birth, obstetrics complications or low birthweight, among others. However, there are not many lines of research that study the role that the sex of the baby plays on this specific stress and vice versa. Thus, the main objective was to analyse the relationship between the sex of the offspring and the stress of the mothers in the first trimester of pregnancy. In order to achieve this, 108 women had their biological stress measured (trough hair cortisol levels) and psychological stress evaluated (the Prenatal Distress Questionnaire (PSS), the Perceived Stress Scale (PDQ) and the Stress Vulnerability Inventory (IVE)). The results revealed significant differences in maternal hair cortisol levels in the first trimester based on the sex of the baby they had given birth to (t = −2.04; P < 0.05): the concentration of the hormone was higher if the baby was a girl (164.36: 54.45-284.87 pg/mg) than if it was a boy (101.13:37.95-193.56 pg/mg). These findings show that the sex of the future baby could be conditioned, among many other variables, by the mother´s stress levels during conception and first weeks of pregnancy. Further research is needed in this area to support our findings., Frontier Project “A-CTS-229-UGR18” of the Ministry of Economy, Knowledge, Business and University of the Junta de Andalucía, European Regional Development Fund (ERDF), Spanish Ministry of Science, Innovation and Universities, FPU program, reference number 18/00617, (Spanish Ministry of Economy, Industry and Competitiveness, FPI Program, reference number BES-2016-077619

Producción Científica, Background: The global pandemic has affected the psychological health of the population, including pregnant women. Due to the difficulty of offering conventional therapies to reduce stress in this population, studies are needed to show the effect of online therapies. Therefore, the objective was to test the effect of online cognitive behavioural therapy in pregnant women during the pandemic on the main variables of stress and psychopathology. Methods: The sample consisted of 16 pregnant women who participated in a weekly cognitive behavioural intervention for 8 weeks. Prenatal concerns, general stress, stress vulnerability, resilience and psychopathology were assessed. Results: The results show a reduction in prenatal concerns, perceived stress, stress vulnerability and psychopathology, as well as an increase in resilience. Conclusions: Online cognitive behavioural intervention may be effective in pregnant women, so it is important to conduct a randomised controlled trial to certify these findings., Junta de Andalucía y Fondo Europeo de Desarrollo Regional (FEDER) - (Project A-CTS-229-UGR18), Ministerio de Ciencia, Innovación y Universidades - (FPU 18/00617)

This work was supported by the Frontier Project "ACTS229UGR18" of the Ministry of Economy, Knowledge, Business and University of the Junta de Andalucia, cosupported by funds/European Regional Development Fund (ERDF) - a way to build Europe. Beside, Mr. Jose Antonio PuertasGonzalez has been awarded with an individual research grant (Spanish Ministry of Science, Innovation and Universities, FPU program, reference number 18/00617) ., The aim was to examine the psychological effects caused by the COVID-19 pandemic on pregnant women, as well as the factors influencing these effects. The study design was cross-sectional and the participants were 200 pregnant women. The first group called the Pandemic Group (PG) included 100 women who were evaluated with psychological assessment instruments during the COVID-19 pandemic. The second group titled Pre-Pandemic Group (PPG) consisted of 100 women who were evaluated prior to the pandemic. Perceived stress, prenatal concerns and psychopathological symptoms were evaluated and compared. Pandemic Group scored significantly higher than Pre-Pandemic Group in the depression dimension of the SCL-90, in the phobic anxiety dimension, and in the Perceived Stress Scale. In addition, insomnia, along with having recently suffered the loss of a loved one explained 25% of the score variance in the depression dimension of the SCL-90. Insomnia also explained 13% of the variance of the results found in the Perceived Stress Scale. The fear of contagion by COVID-19 increased the scores obtained in the phobic anxiety dimension, explaining 11% of the variance. Thus, the COVID-19 pandemic could produce an increase in psychopathological symptomatology and stress, which can lead to negatively affecting pregnant women's mental health., Ministry of Economy, Knowledge, Business ACTS229UGR18, Junta de Andalucia, European Commission, Spanish Ministry of Science, Innovation and Universities, FPU program 18/00617

Our objective was to examine the feasibility of hair cortisol concentrations (HCC) as a biomarker to predict clinical pregnancy outcomes and investigate its potential associations with perceived anxiety, resilience, and depressive symptoms. A total of 43 participants were assessed using HCC, the state trait anxiety inventory (STAI), resilience scale (RS), and the depression subscale of the symptom checklist 90-R (SCL-90-R). Participants were approached at their second consultation with the reproductive endocrinologist (T1), before scheduling their IVF cycle, and then 12 weeks after (T2), at their post-transfer visit with the study coordinators, before the human chorionic gonadotropin (HCG) pregnancy test. The logistic regression model revealed that HCC at T2 predicted 46% of a positive pregnancy test [R2 = 0.46, (&szlig, = 0.11, p &lt, 0.05)]. Pregnant women had higher levels of resilience at T2 (M = 149.29, SD = 17.56) when compared with non-pregnant women at T2 (M = 119.96, SD = 21.71). Significant differences were found between both groups in depression at T2 (t = 3.13, p = 0.01) and resilience at T2 (t = &minus, 4.89, p = 0.01). HCC might be a promising biomarker to calculate the probability of pregnancy in women using assisted reproductive technologies (ART).

The menstrual cycle involves significant changes in hormone levels, causing physical and psychological changes in women that are further influenced by stress. The aim of this study was to understand the relationship between menstrual cycle phase and salivary cortisol patterns during the day as well as the salivary cortisol response to the Virtual Reality Version of the Trier Social Stress Test (TSST-VR). Forty two women not taking oral contraceptives (24 in follicular phase and 18 in luteal phase) participated in the study. Five samples of salivary cortisol collected during the day and another five samples of cortisol during the TSST-VR were analyzed. Psychological stress measures and psychopathological symptomatology were also evaluated. A 2 × 4 mixed ANCOVA showed an interaction between the two groups on the TSST-RV invoked cortisol response to the [F(3,42) = 3.681; p = 0.023) where women in luteal phase showed higher cortisol post exposure levels (5.96 ± 3.76 nmol/L) than women in follicular phase (4.31 ± 2.23 nmol/L). No other significant differences were found. Our findings provide evidence that menstrual cycle phase tended to influence cortisol response to laboratory-induced mental stress, with more reactivity observed in the luteal phase. This study is a part of a Thesis Doctoral and was supported by the I+D Project “PSI2010-15780”, funded by the Spanish Ministry of Economy and Competitiveness.

Resumen Antecedentes y objetivo El sindrome metabolico (SM) es un conjunto de condiciones metabolicas que incluyen obesidad abdominal, reduccion de las concentraciones de colesterol unido a las high density lipoproteins (c-HDL, «lipoproteinas de alta densidad»), trigliceridos elevados, aumento de la presion arterial e hiperglucemia. Dado que se trata de una enfermedad multicausal, el objetivo de este estudio es identificar las variables psicologicas, emocionales y de estilo de vida que pueden ejercer una influencia sobre los diferentes componentes del SM. Pacientes y metodos Estudio transversal con 103 pacientes diagnosticados de SM (47 varones y 56 mujeres). Se recogieron medidas antropometricas, clinicas y analiticas para valorar las variables asociadas al SM. Tambien se evaluaron las principales variables psicologicas y emocionales. Resultados Se realizaron diferentes pruebas de regresion lineal multiple para identificar que variables eran predictoras del SM. Las variables dependientes fueron el indice de masa corporal (IMC), la circunferencia abdominal, el c-HDL y la calidad de vida, y las variables predictoras fueron el estres psicologico, la ira y la adherencia a la dieta mediterranea. Los resultados mostraron que el estres psicologico era un predictor de la calidad de vida (β = −0,55, p ≤ 0). De igual modo, la ira fue un predictor del IMC (β = 0,23, p = 0,047) y de la circunferencia abdominal (β = 0,27, p = 0,021). Segun lo previsto, la adherencia a la dieta mediterranea fue un predictor del c-HDL (β = 0,2, p = 0,045) y de la calidad de vida (β = −0,18, p = 0,031). Conclusiones Los resultados confirman un vinculo entre la adherencia a ciertos habitos alimentarios y el estilo de vida; sin embargo, se situan un paso por delante y resaltan la importancia de los factores psicologicos y emocionales como el estres y la ira en algunos componentes del SM.

Background Kinesio taping (KT) is a new taping modality frequently used in the clinical setting. However there is contradictory evidence about its effectiveness in patients with neck pain. Objective To determine the effectiveness of KT as a supplementary treatment in addition to conventional rehabilitation in patients with neck pain. Methods Forty-five subjects with neck pain were included in this controlled trial and were assigned to the following groups: Kinesio Taping, placebo (P), and conventional rehabilitation control (CR). A daily self-assessment record of perceived pain, medication intake, quality of life and range of motion was registered at baseline, posttreatment and follow-up. Results Cohen's coefficient showed large effects in terms of reducing pain perception in all three groups. ANOVAs showed that the course of treatment differed across groups only for neck flexion (p= 0.043). We found significant differences in neck flexion when comparing baseline and one-month follow-up values and neck flexion significantly increased in all three groups: KT (p= 0.05); P (p= 0.01); and CR (p= 0.04). Between-group analyses showed no significant differences for any of the measurements. Conclusions A protocol of manual therapy and physical exercises, significantly improved pain and mobility in patients with neck pain. We obtained no evidence of additional benefits from the use of KT in this population.

Background and objective Non-adherence to treatment is usually a clinical problem in patients with systemic lupus erythematosus (SLE). Increasing the knowledge of predictors of treatment adherence can be meaningful in the clinical setting. The main objective of the present study was to analyze the influence of sociodemographic, clinical and psychological variables on the degree of treatment adherence in a sample of Spanish women with SLE. Patients and method This is an observational–transversal study. All participants were evaluated for the degree of treatment adherence, their clinical status, psychopathological manifestations, the level of perceived stress and self-efficacy. The sample was divided into two groups (adherent vs non-adherent). The factors associated with a lack of adherence in this sample were analyzed by means of logistic regression. Results This study comprises 72 women with SLE (average age = 36.72 ± 12.2 years). Almost 64% of patients with SLE were non-adherent to treatment. The results showed that a low educational level, being unemployed, living with a partner and alcohol abuse were associated with low treatment adherence. There were significant mean differences between groups in psychopathological subscales of somatization, obsession–compulsion and general psychopathological indices. There were also mean differences between groups for the level of perceived stress. The use of non-steroidal anti-inflammatory drugs, suffering arthrosis and scoring higher in dimensions of psychopathology were significant predictors of treatment adherence, explaining between 35% and 47% of its variability. Conclusions Including the clinical and psychopathological manifestations as important aspects in the clinical reasoning of health professionals could improve the adherence to treatment of patients with SLE.

Resumen Antecedentes y objetivo El incumplimiento terapeutico constituye un importante problema asistencial en pacientes con lupus eritematoso sistemico (LES). Conocer los factores asociados de este puede ser de gran utilidad en el ambito clinico. El objetivo de esta investigacion fue analizar la influencia de las variables sociodemograficas, clinicas y psicologicas sobre la adherencia al tratamiento en una muestra espanola de mujeres con LES. Pacientes y metodo En este estudio transversal-observacional se evaluo el grado de adherencia al tratamiento, el estado clinico y psicopatologico, el estres psicologico y la autoeficacia en mujeres con LES. La muestra se dividio en 2 grupos: adherentes y no adherentes. Mediante un analisis de regresion logistica se identificaron los factores asociados a la falta de adherencia en esta poblacion. Resultados Se evaluaron 72 pacientes (edad media: 36,7 ± 12,2 anos). El 63,9% no tuvieron adherencia. Un bajo nivel educativo, estar desempleada, vivir en pareja y el consumo de alcohol se asociaron a una baja adhesion al tratamiento. Se encontraron diferencias entre el grupo adherente y el no adherente en las subescalas psicopatologicas de somatizacion, obsesion-compulsion e indices psicopatologicos generales, asi como en el estres percibido, obteniendo puntuaciones mas altas las pacientes adherentes. El uso de antiinflamatorios no esteroideos (AINE), tener artrosis y mayor alteracion psicopatologica fueron predictores significativos de la adherencia al tratamiento, explicando entre el 35 y el 47% de la variabilidad de esta. Conclusiones La falta de adherencia al tratamiento de las pacientes con LES fue alta y parece estar influida por factores clinicos y psicopatologicos.

Objective The goal of this systematic-review and meta-analysis was to assess whether high maternal stress during pregnancy is associated with the development of pediatric pathology. Design Epidemiological peer-reviewed studies published in English or Spanish assessing associations between maternal stress during pregnancy and psychiatric and medical diseases were selected. Participants We retrieved 73,024 citations; 42 studies meeting inclusion criteria were assessed. Overall sample included 65,814,076 women. Findings Overall odds ratio for the development of a medical disease was OR=1.24 (CI95=1.11, 1.39), Z=3.85, p Key conclusions We concluded that exposure to high levels of stress during pregnancy are associated with autism spectrum disorder, obesity, and infantile colic in offspring. Implications for practice Maternal stress during pregnancy should be addressed to tackle its potential impact in health across the life span.

Some recent researches have shown the important role of hair cortisol as a retrospective biomarker of chronic stress. The aim of this research was to investigate the relationship between hair cortisol levels and sociodemographic and psychological variables, such as perceived stress levels and psychopathological symptoms on a Spanish population. The sample consisted of 347 healthy people, 230 women and 117 men, with an average age of 33.39 years (SD= 12.63). Hair cortisol levels were measured by obtaining a hair sample. In addition, a psychological assessment composed by: Analogic-Visual Stress Scale, Perceived Stress Scale (PSS), Symptom Checklist 90 Revised (SCL–90–R) and the assessment of vital stressful events suffered, was carried out. The mean cortisol level was 108.93 pg/mg (SD= 66.43) in men, and 120.38 pg/mg (SD= 87.26) in women. The linear hierarchical regression showed that Analogic-Visual Stress Scale and perceived stress levels were related with higher hair cortisol levels (R2= .032;t= 2.21;p= .029). Due to the relationship between daily stress levels, Analogic-Visual Stress Scale, anxiety sub-scale of SCL 90–R and perceived stress levels with hair cortisol levels, we conclude that there is a relation between perceived yourself stressed and the physiological levels.

Background: Several factors can influence the production of mothers' own milk. Purpose: To assess the influence of maternal psychological stress, maternal cortisol levels, and neonatal hair cortisol levels on timing of secretory activation. Methods: A prospective study was conducted at 2 public health centers in Andalusia, Spain. Participants were 60 pregnant women and their 60 neonates. Hair cortisol levels and psychological stress (pregnancy-specific stress [Prenatal Distress Questionnaire, PDQ] and perceived stress [Perceived Stress Scale, PSS]) were evaluated during the third trimester and the postpartum period. This study was part of the GESTASTRESS cohort study on the effects of stress during pregnancy. Results: Higher PDQ and PSS scores (P < .05) in the third trimester were associated with later onset of secretory activation. Higher postpartum maternal hair cortisol levels were associated with a delayed secretory activation of mother's own milk (P < .05). Implications for Research: Future studies should look at the influence of psychological stress and cortisol levels on hormones involved in mother's own milk production. Implications for Practice: Neonatal nurses and other healthcare providers should be familiar with levels of neonates' exposure to maternal prenatal stress prior to birth. This work was supported by the I + D Project 2PSI2015-63494-P” of the Spanish Ministry of Science and Innovation (http://www.idi.mineco.gob.es/portal/site/MICINN/menuitem.00d7c011ca2a3753222b7d1001432ea0/?vgnextoid =33881f4368aef110VgnVCM1000001034e20aRCRD); cosupported by funds/European Regional Development Fund (ERDF) ± a way to build Europe (MIPR).

Background: Maternal stress during pregnancy can affect fetal development during certain sensitive periods. Objective: To longitudinally assess maternal hair cortisol levels during pregnancy, and the postpartum along with neonatal hair cortisol levels that could be associated with infant neurodevelopment at six months of age. Methods: A sample of 41 pregnant women longitudinally assessed during the first, second, and third trimester and the postpartum, along with their 41 full-term neonates participated in this study. Hair cortisol levels were assessed from participants. Infant neurodevelopment was assessed by means of the Bayley Scale of Infants Development, Third Edition at age six months. Results: Maternal hair cortisol levels in the first and second trimester accounted for 24% and 23%, respectively, of variance of infant gross motor development (p &lt, 0.05). Maternal hair cortisol levels during the postpartum accounted for 31% of variance of infant cognitive development (p &lt, 0.05), and 25% of variance of infant gross motor development (p &lt, 0.05). Neonatal hair cortisol levels accounted for 28% of variance of infant gross motor development (p &lt, 0.05). Conclusions: The preconception and prenatal time are sensitive periods related to infant neurodevelopment along with the cortisol levels surrounding the fetus while in the womb. Pregnant women could be assessed for hair cortisol levels while attending a prenatal appointment.

Hair cortisol concentration (HCC), as a novel promising method to retrospectively measure hypothalamic-pituitary-adrenal (HPA) axis activation, is being increasingly studied. We tested the relationships between HCC and a range of possible confounding variables in a Spanish sample of healthy adults and pregnant women.The number of healthy adults who participated in the study was 529, being 270 males and 259 females, with a combined mean age of 37.88 years (SD = 15.66). Additionally, a separate sample of 62 pregnant women was also recruited with a mean age of 32.95 (SD = 3.67), and in the first trimester of pregnancy. Each participant was interviewed before the study to obtain sociodemographic and lifestyle variables, and a hair sample was taken from the posterior vertex of the head, cut as close to the scalp as possible. Assuming the average growth rate of head hair is 1 cm per month, a 3-cm segment was analysed, in order to measure the cortisol concentrations from a three-month period. For the pregnant women, hair samples for each trimester of pregnancy were analysed.The mean hair cortisol concentration was 127.91 (111.52) pg/mg for the general sample. The variables of age, education, employment status, use of hair dyes, use of oral contraceptives, and physical exercise had a significant relation to HCC. When adjusted for further variables, only education and physical exercise remained statistically significant. When including the use of oral contraceptives and only with respect to females, only physical exercise remains statistically significant. For the subsample of pregnant woman, the mean hair cortisol concentration was 334.51 (409.77) pg/mg for the first trimester, 302.18 (270.24) pg/mg for the second trimester, and 331.31 (295.46) pg/mg for the third trimester of pregnancy. None of the assessed confounding variables (age, body mass index, previous miscarriages, employment status, hair dyes, dependent children and physical exercise), except education level, was related to HCC.In this sample of healthy Spaniards, results suggested an association between HCC and physical exercise and educational level. In pregnant women, the prevalence of HCC was higher than in non-pregnant woman, and was related to educational level. This study emphasises the need to determine the relationship between HCC and confounders such as sociodemographic and lifestyle variables in the general population and specific groups formed by individuals such as pregnant women.

The Prenatal Distress Questionnaire (PDQ) was developed among English-speaking women in the United States to assess specific worries and concerns during pregnancy. Our aim was to analyze the factor structure of the PDQ, using confirmatory factor analysis, and assess its convergent validity in Spanish women. A sample of 233 pregnant women with ages ranging from 19 to 42 years in the south of Spain (Europe) (January 2015 - March 2016) completed the translated PDQ, the Perceived Stress Scale (PSS) and the Symptom Checklist-90-revised (SCL-90-R). Confirmatory factor analysis revealed a three-factor structure supporting the original PDQ factor structure (χ2 (31) = 55.43, p = 0.004; CFI = 0.96; RMSEA = 0.058; WRMR = 0.702). The Spanish PDQ significantly correlated with the PSS and SCL-90-R (r's 0.18-0.49, p's < 0.05), providing evidence of convergent validity. These results illustrate that the stress dimensions investigated by the PDQ adequately represent pregnant women's distress across a different cultural context and corroborate the psychometric properties of this instrument previously demonstrated in English-speaking women. The Spanish version of the PDQ can be used by clinical practitioners to evaluate specific worries and concerns women experience during pregnancy.

Aunque el número de estudios sobre las propiedades psicomé- tricas de la CD-RISC es notablemente amplio, aún hay gran falta de con- senso sobre su estructura interna en población general. Por ello, el objetivo de este estudio ha sido triple, verificar sus propiedades psicométricas, ex- plorar la estructura factorial y calcular baremos de la escala de resiliencia CD-RISC para una muestra de población española. Para ello participaron 1119 personas, 324 hombres y 795 mujeres, cumplimentando las siguientes escalas: CD-RISC, Escala de Estrés Percibido, Escala de Apoyo Social Percibido, Escala de Autoeficacia, Escala de Vulnerabilidad al Estrés, Cuestionario de Personalidad Resistente y subescalas de ansiedad y depre- sión del SCL-90. Las evidencias de validez confirmaron las relaciones teó- ricas esperadas correlacionándose con las medidas descritas. El análisis fac- torial encontró un apoyo razonable a la hipótesis de unidimensionalidad. En cuanto a la fiabilidad se obtuvieron valores aceptables con un alfa de .86 y una omega de .86. Se obtienen resultados satisfactorios que refuerzan la utilidad y precisión de esta escala para su uso en población española, apoyando la hipótesis de unidimensionalidad y aportando baremos que permiten interpretar las puntuaciones para su aplicación tanto en investiga- ción como en la práctica clínica. Although the number of studies in the literature on the psychometric properties of the CD-RISC measures is remarkably high, there is still a great lack of consensus about its internal structure among the general population. Therefore, the aim of this study has been threefold: to analyze the psychometric properties, explore the factorial structure and calculate percentiles of the Connor-Davidson Resilience Scale (CD-RISC) for a sample of the Spanish population. For this purpose, the study sample consisted of 1119 participants consisting of 324 males and 795 females and they completed the following scales: CD-RISC, Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, General Self-Efficacy Scale, Stress Vulnerability Inventory, Personality Hardiness Questionnaire and the anxiety and depression subscales of the SCL-90-R. In terms of reliability, an adequate Cronbach's coefficient alpha value of .86 was obtained. The evidence for the validity of the internal structure supports the unidimen- sionality of the CD-RISC measurements, as well as confirming the expec- ted theoretical relationships and correlating with the described measures in the expected direction. Satisfactory results are obtained in the present study that reinforce the usefulness and precision of this scale for its appli- cation using the Spanish population, presenting percentiles that can provi- de guidance in the interpretation and use of the scores with respect to its application in both research and clinical practice.

Objective: To compare stress levels throughout pregnancy in women who had conceived using assisted reproductive technology (ART) and women who had conceived naturally and somatometric values for infants. Background: Pregnant women who have received ART are exposed to high levels of stress. Methods: Ninety-one women attending a prenatal appointment at a Health Centre (Granada, Spain), and their 91 newborns participated in this study: 69 women conceiving naturally and 22 conceiving using ART. Assessment consisted of measuring hair cortisol levels, the Prenatal Distress Questionnaire, the Perceived Stress Scale and the Symptom Checklist-90-Revised. Results: Women conceiving using ART had higher cortisol levels in the first trimester than women who conceived naturally. In the third trimester, women who used ART reported higher levels of perceived stress than those who had conceived naturally. Maternal cortisol levels in the first trimester explained 32% of the variance in neonatal head circumference in the group of women who had conceived using ART. Conclusions: Women who had conceived using ART showed higher levels of cortisol in the first trimester and higher levels of perceived stress in the third trimester than women who had conceived naturally, rendering them more vulnerable to adverse outcomes. Maternal cortisol predicted the infants' development.

Objective to compare neurodevelopment differences between babies born from low-risk pregnancies and babies born from high-risk pregnancies. Study design Longitudinal design Setting Spain Participants A total of 91 women participated in the study, divided into two groups: 49 women in the low-risk pregnancy group and 42 women in the high-risk group. Measurement and findings The average amount of cortisol in pregnant mothers’ hair was determined in both groups. Following their birth, the babies’ neurodevelopment was evaluated using the Bayley-III instrument at 6 months of age and a new sample of cortisol was obtained from both the baby and the mother. The results showed that pregnancy risk group could predict cognitive, fine motor, gross motor and general motor neurodevelopment. Key Conclusions These results seem to show that an appropriate treatment tailored to the needs of individualised pregnancies may favor babies’ neurodevelopment, including that of babies born from high-risk pregnancies. Implications for research It is essential to take special care of pregnant women no matter their medical condition and offer them the best medical care available.

Cortisol obtained from hair samples represents a retrospective biomarker of chronic stress experienced by the subject in previous months. Although hair cortisol levels have been used to study the relationship between maternal and neonatal stress levels in primates, this has not yet been performed in humans using a longitudinal design and focusing specifically on this association. Therefore, the objective of this study was to determine whether a relationship existed between maternal psychological stress and hair cortisol levels during pregnancy and postpartum, and neonatal hair cortisol levels. The sample consisted of 80 pregnant women and their 80 newborn infants. We conducted a longitudinal assessment of hair cortisol levels, psychological stress, anxiety, and depression in the three trimesters of pregnancy and postpartum. After childbirth, neonatal hair cortisol levels were also measured. We found that maternal hair cortisol levels in the first trimester negatively predicted neonatal hair cortisol levels. Perceived stress in the third trimester of pregnancy also predicted lower neonatal cortisol, whereas pregnancyspecific stress in the same trimester had a positive relation with neonatal cortisol. Cortisol is essential for embryonic and fetal development; consequently, if fetal synthesis of cortisol is affected by high maternal cortisol levels, such development could be impaired., This work was supported by the I+D Project "PSI2015-63494-P" of the Spanish Ministry of Science and Innovation co-supported by funds/ European Regional Development Fund (ERDF) - a way to build Europe (MIPR). Besides, Mr. Borja Romero-Gonzalez has been awarded with an individual research grant (Spanish Ministry of Economy, Industry and Competitiveness, FPI Program, reference number BES-2016-077619)

to describe whether there were differences in sociodemographic, obstetric, perinatal and psychological variables between immigrant women and native-born women in Spain during the first 24 h after delivery.The immediate postpartum period is a critical time when physical and psychological disorders are likely to occur. Immigrant women have, in general, poor perinatal and psychological results during this time.One hundred and three women at the Virgen de las Nieves University Hospital (Granada, Spain) were divided into two groups: 50 Spanish and 53 immigrants. The instruments used were the Life Orientation Test, the Stress Vulnerability Inventory, the Perceived Stress Scale and the Symptom Checklist-90-Revised (SCL-90-R). Sociodemographic and obstetric data were obtained from the healthcare providers reports.During the postpartum period, the immigrant women had higher mean scores on the following subscales: interpersonal sensitivity (F(1,102) = 4.06; p 0.05); depression (F(1,102) = 7.24; p 0.01); phobic anxiety (F(1,102) = 4.83; p 0.05), paranoid ideation (F(1,102) = 7.20; p 0.01); and psychoticism (F(1,102) = 4.04; p 0.05). When considering age, education, profession, job situation, immigrant status of the partner and duration of time in Spain as covariates, differences between groups were significant on obsessive-compulsiveness (F(1,102) = 5.37; p 0.05) and depression (F(1,102) = 6.89; p 0.05).Immigrant women are in need of more psychological and emotional support from their families, midwives and the rest of healthcare providers than are native Spaniards immediately after delivery.

Resumen Introducción: el índice de masa corporal (IMC) pregestacional afecta a la salud de la madre durante y después del embarazo, y se relaciona con un aumento del riesgo a sufrir diabetes gestacional, preeclampsia o muerte fetal. Además, el IMC pregestacional elevado aumenta los niveles de ansiedad, estrés y depresión, lo que conlleva al aumento de riesgo de aborto, bajo peso al nacer y prematuridad. Objetivos: comprobar si existen diferencias en estrés, síntomas psicopatológicos y variables fisiológicas durante el embarazo, entre embarazadas con IMC pregestacional normal e IMC pregestacional elevado. Métodos: han participado 156 mujeres embarazadas evaluadas longitudinalmente durante los tres trimestres de embarazo divididas en dos grupos: grupo con IMC pregestacional normal (n = 115) y grupo con IMC pregestacional elevado (n = 41). Se midieron niveles de estrés, síntomas psicopatológicos, hipertensión y glucosa. Resultados: los resultados mostraron que existían diferencias estadísticamente significativas entre los dos grupos en estrés específico del embarazo y en las subescalas del SCL-90-R: depresión, ideación paranoide y la escala de síntomas generales en el primer trimestre; en el segundo trimestre, en estrés específico del embarazo y subescalas (somatizaciones, obsesión compulsión, sensibilidad interpersonal, depresión, ansiedad, ideación paranoide y en las escalas generales; y en estrés percibido) y las subescalas somatizaciones, ansiedad y en la escala SP en el tercer trimestre. También se encontraron diferencias entre ambos grupos en tensión arterial diastólica en el primer trimestre, y en tensión arterial sistólica y diastólica en el tercer trimestre. Conclusiones: el IMC pregestacional elevado se relaciona con mayor estrés psicológico y con síntomas psicopatológicos y fisiológicos durante el embarazo.

Objective Verify the efficacy of cognitive behavioral therapy (CBT) in adherence to the Mediterranean diet (MedDiet) in metabolic syndrome (MetS) patients. Design, Setting, Participants, and Intervention In the Multimodal Intervention Program for Patients with Metabolic Syndrome clinical trial, 79 MetS patients completed the intervention. Of those, 48 belonged to the experimental group and 31 to the control group. The intervention received by the experimental group was CBT; the control group followed usual care and attended a workshop on healthy lifestyle. Main Outcome Measure(s) and Analysis Anthropometric, biochemical, psychological, and lifestyle measures were taken before and after the intervention at 3 and 6 months. Analyses included paired t tests, ANOVA, and ANCOVA. Results The ANOVA results showed a statistically significant interaction between the 2 groups in waist circumference (P = .009), triglycerides (P = .015), and adherence to the MedDiet (P = .026). The ANCOVA results indicated between-group difference in waist circumference (P = .026 and .062 at 3 and 6months, respectively), in triglycerides (P = .009 and .860 at 3 and 6 months, respectively), and in MedDiet (P = .024 and .273 at 3 and 6 months, respectively). Conclusions and Implications In interventions in which CBT was applied, significant improvements were observed in MetS patients, especially in adherence to the MedDiet.

Background and objective Metabolic syndrome (MetS) is a cluster of metabolic conditions that include abdominal obesity, reduction in cholesterol concentrations linked to high density lipoproteins (HLDc), elevated triglycerides, increased blood pressure and hyperglycaemia. Given that this is a multicausal disease, the aim of this study is to identify the psychological, emotional and lifestyle variables that can have an influence on the different MetS components. Patients and methods A cross-sectional study with 103 patients with diagnostic criteria for MetS (47 male and 56 female). Anthropometric, clinical and analytical measurements were collected to assess the variables associated with MetS. The main psychological and emotional variables were also assessed. Results Different multiple linear regression tests were performed to identify which variables were predictive of MetS. The dependent variables were body mass index (BMI), abdominal circumference, HDLc, and quality of life, and the predictive variables were psychological stress, anger and adherence to a Mediterranean diet. The results showed that psychological stress was a predictor of quality of life (β = −0.55, p ≤ 0). Similarly, anger was a predictor of BMI (β = 0.23, p = .047) and abdominal circumference (β = 0.27, p = .021). As expected, adherence to a Mediterranean diet was a predictor of HDLc (β = 0.2, p = .045) and of quality of life (β = −0.18, p = .031). Conclusions The results confirm a link between adherence to certain dietary habits and lifestyle, however they go one step further and show the importance of psychological and emotional factors like psychological stress and anger in some MetS components.

Study Design A randomized clinical trial. Introduction Rehabilitation treatments for improving fine motor skills (FMS) in hand osteoarthritis (HOA) have not been well explored yet. Purpose of the Study To assess the effectiveness of a rehabilitation program on upper limb disability, independence of activities of daily living (ADLs), fine motor abilities, functional independency, and general self-efficacy in older adults with HOA. Methods About 45 adults (74-86 years) with HOA were assigned to an experimental group for completing an FMS intervention or a control group receiving conventional occupational therapy. Both interventions were performed 3 times/wk, 45 minutes each session, during 8 weeks. Upper limb disability, performance in ADLs, pinch strength, manual dexterity, range of fingers motion, functional independency, and general self-efficacy were assessed at baseline, immediately after treatment, and after 2 months of follow-up. Results FMS group showed significant improvements with a small effect size on manual dexterity ( P ≤ .034; d ≥ 0.48) and a moderate-high effect on range of index ( P ≤ .018; d ≥ 0.58) and thumb ( P ≤ .027; d ≥ 0.39) motion. The control group showed a significant worse range of motion over time in some joints at the index ( P ≤ .037; d ≥ 0.36) finger and thumb ( P ≤ .017; d ≥ 0.55). Conclusions A rehabilitation intervention for FMS may improve manual dexterity and range of fingers motion in HOA, but its effects on upper limb disability, performance in ADLs, pinch strength, functionality, and self-efficacy remain uncertain. Specific interventions of the hand are needed to prevent a worsening in range of finger motion. Level of Evidence 1b.

Objective:A high incidence of burnout has been reported in health professionals working in palliative care units. Our present study aims to determine whether there are differences in the secretion of salivary cortisol between palliative care unit health professionals with and without burnout, and to elucidate whether there is a relationship between burnout syndrome and perceived stress and psychopathological status in this population.Method:A total of 69 health professionals who met the inclusion criteria participated in our study, including physicians, nurses, and nursing assistants. Some 58 were women (M = 29.65 years, SD = 8.64) and 11 men (M = 35.67 years, SD = 11.90). The level of daily cortisol was registered in six measurements taken over the course of a workday. Burnout syndrome was evaluated with the Maslach Burnout Inventory–Human Services Survey (MBI–HSS), the level of perceived stress was measured using the Perceived Stress Scale, and psychopathological status was gauged using the SCL–90–R Symptoms Inventory.Results:There were statistically significant differences in secretion of cortisol in professionals with high scores on a single subscale of the MBI–HSS [F(3.5) = 2.48, p < 0.03]. This effect was observed 15–30 minutes after waking up (p < 0.01) and at bedtime (p < 0.06). Moreover, the professionals with burnout showed higher scores on the psychopathology and stress subscales than professionals without it.Significance of results:A higher score in any dimension of the burnout syndrome in palliative care unit health professionals seems to be related to several physiological and psychological parameters. These findings may be relevant for further development of our understanding of the relationship between levels of burnout and cortisol secretion in the health workers in these units.

This study aims to determine whether it is possible to modify executive function in stressed individuals by means of cognitive-behavioral therapy for stress management. Thirty-one people with high levels of perceived stress were recruited into the study (treatment group = 18; wait-list group = 13). The treatment group received 14 weeks of stress management program. Psychological and executive function variables were evaluated in both groups pre and post-intervention. The treatment group showed improved psychological variables of perceived stress (t = 5.492; p = .001), vulnerability to stress (t = 4.061; p = .001) and superstitious thinking (t = 2.961; p = .009). Likewise, the results showed statistically significant differences in personality variables related to executive function, positive urgency (t = 3.585; p = .002) and sensitivity to reward (t = –2.201; p = .042), which improved after the therapy. These variables showed a moderate to high effect size (oscillates between 1.30 for perceived stress and .566 for sensitivity to reward). The cognitive-behavioral therapy for stress management may be an appropriate strategy for improving personality construct components related to executive function, however effects of the therapy are not showed on performance on the tests of executive function applied, as presented studies previous.

Although many studies have shown that patients with autoimmune disease present a hypoactive hypothalamic–pituitary–adrenal axis (HPA), controversial results have been described. Our objective was to study HPA axis activity in women with autoimmune disease compared to healthy women. Therefore, we analyzed salivary cortisol over the course of a day, and hair cortisol concentrations from the three preceding months, from 65 women divided into two groups: healthy women (n = 30), with a mean age of 44.70 ± 11.65 years; and women with autoimmune disease (n = 35), with a mean age of 48.26 ± 9.04 years. The latter group comprises women with systemic lupus erythematosus (SLE), Sjögren’s syndrome (SS), and systemic sclerosis (SSc). Perceived stress and psychopathological symptomatology were also evaluated. Autoimmune disease group scored higher on the somatization subscale SCL-90-R and lower on the anxiety subscale than the control group. Regarding HPA axis activation, the area under curve for cortisol levels during the day was higher for the autoimmune disease group. In addition, higher cortisol levels in hair were found in the group with autoimmune disease. Our findings show greater short and long-term HPA axis activity in women with autoimmune disease than in healthy women. This study is part of a doctoral thesis and was supported by the I+D Project “PSI2010-15780” of the Spanish Ministry of Economy and Competitiveness.

The aim of this study was to investigate the possible effects of corticosteroids in women with systemic lupus erythematosus (SLE) in two processes of executive function: cognitive flexibility and decision-making. To that end, we evaluated 121 women divided into three groups: 50 healthy women, 38 women with SLE not receiving corticosteroid treatment and 33 women with SLE receiving corticosteroid treatment. Cognitive flexibility was measured with the Trail Making Tests A and B; decision-making was measured with the Iowa Gambling Task. Additionally, demographic (age and education level), clinical (SLE Disease Activity Index (SLEDAI), Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI) and disease duration) and psychological characteristics (stress vulnerability, perceived stress and psychopathic symptomatology) were evaluated. The results showed that both SLE groups displayed poorer decision-making than the healthy women (p = 0.006) and also that the SLE group receiving corticosteroid treatment showed lower cognitive flexibility than the other two groups (p = 0.030). Moreover, SLE patients showed poorer scores than healthy women on the following SCL-90-R subscales: somatisation (p = 0.005), obsessions and compulsions (p = 0.045), depression (p = 0.004), hostility (p = 0.013), phobic anxiety (p = 0.005), psychoticism (p = 0.016) and positive symptom total (p = 0.001). In addition, both SLE groups were more vulnerable to stress (p = 0.000). These findings help to understand the effects of corticosteroid treatment on cognitive flexibility and decision-making, in addition to the disease-specific effects suffered by women with SLE. This study is a part of a doctoral thesis, and was supported by the I+D Project “PSI2010-15780” of the Spanish Ministry of Science and Innovation.

Summary In recent studies showing how stress can affect an individual's decision-making process, the cognitive component of decision-making could also be considered a coping resource available to individuals when faced with a stressful situation. The Iowa Gambling Task (IGT) constitutes the standard test for the assessment of decision-making skills under conditions of uncertainty. Responses of the hypothalamic–pituitary–adrenal (HPA) axis to psychosocial stress, in turn, have been estimated by means of cortisol measurements. Our main objective in this study was to test if good and bad IGT performers show distinct HPA axis responses, when challenged in a classic psychosocial stress test. Because women have been shown to outperform men on the IGT under the influence of psychosocial stress, we chose a sample of 40 women to take the IGT before they were exposed to a public speaking task in a virtual environment. The activation of the HPA axis, involved in the stress response, was assessed by examining the levels of cortisol in the subjects’ saliva at the following four stages: before the challenge, after the challenge, and 10 and 20 min after the task. Participants were divided into two groups according to their level of performance, good or poor, on the IGT. Results showed statistically significant differences between the groups for pre-exposure cortisol levels and for cortisol levels 20 min after exposure. Overall cortisol levels were significantly higher in the group with poor performance on the IGT. It appears that good decision-making, which may be an important resource for coping with stress, is associated with a lower HPA axis response to a psychosocial stressor.

Objective: The aim of the study was to determine the clinical and psychological factors linked to health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE) and test the effectiveness of cognitive behavioural therapy in changing these factors. Methods: We evaluated 34 patients with SLE over a period of 15 months. In order to study the variables related to items of QOL and the physical (PCS) and mental (MCS) component summaries of the SF-36, several multiple linear regression models were constructed. Patients were randomized and distributed into two similar groups; one of them received cognitive behavioural therapy and the other received the usual controlled care. The psychological aspects as well as the related-disease factors were evaluated four times during the study. Results: Self-perceived stress (R2 corrected: 0.314, t: -2.476, p < 0.021), vulnerability to stress (R2 corrected: 0.448, T: -2.166, p < 0.04) and anxiety (R2 corrected: 0.689, T: -7.294, p < 0.00) were predictor variables of MCS. The group of patients who received the therapy improved their level of physical role functioning, vitality, general health perceptions and mental health, compared with the group of patients who only received conventional care. Conclusion: QOL usually depends on multiple factors, some of which are stress and anxiety, which can be modified by a cognitive behavioural therapy, in order to obtain a significant improvement in the HRQOL, irrespective of the activity level of the disease. Frequent evaluations of the quality of life in patients with SLE and psychological treatment should also be considered. Lupus (2010) 19, 1632—1639.

Resumen Fundamento y objetivo El lupus eritematoso sistemico (LES) es una enfermedad autoinmunitaria que afecta la calidad de vida. Hay varios instrumentos especificos que miden la calidad de vida relacionada con la salud (CVRS), pero ninguno se ha adaptado al espanol. El objetivo de este trabajo fue adaptar y validar en la poblacion espanola una medida especifica de la CVRS en los pacientes con LES. Pacientes y metodos La adaptacion se baso en el metodo de traduccion y retrotraduccion de la version inglesa del LupusQoL (Lupus Quality of Life) y su aplicacion en 115 adultos con LES. Resultados El analisis factorial identifico 5 dominios del LupusQoL; la fiabilidad evidencio un alto coeficiente en el alfa de Cronbach de 0,977 y en el metodo de las 2 mitades de Guttman de 0,936; las correlaciones significativas del LupusQoL con el Medical Outcome Survey muestran alta validez convergente del cuestionario, mientras que las correlaciones con el Systemic Lupus Erythematosus Disease Activity Index y el System Lupus International Collaborating Clinics fueron bajas, lo que evidencia su validez discriminante. Conclusion La version espanola del LupusQoL cuenta con estables propiedades psicometricas para medir la CVRS en las personas con LES en ambitos clinicos y de investigacion en la poblacion hispanoparlante.

Objective: The purpose of this study was to test which stressors worsen the symptoms perceived by patients with lupus, thus broadening and corroborating results obtained in a previous study published in Psychosomatic Medicine. Methods: In order to examine this question, we selected 43 patients with lupus whose symp-toms worsened due to the effects of daily stress. These patients were divided into two groups: patients whose increase in clinical lupus symp-tomatology was predicted by an increase in daily stressors on the same day (G1) and pa-tients whose increase in clinical lupus symp-tomatology was predicted by an increase in daily stressors the day before and the same day (G2). Later, three factorial analyses were con-ducted with the items related to stressors and the items related to lupic symptoms. Results: The results showed that in G1 there were three factors that made up a total of 35.08% of the explained variance. The stressors associated with certain symptoms of the illness in this group are feeling ill or being worried about their physical appearance, with the main stressor being the illness itself. However, in G2, two factors were found that made up a total of 40.37% of the explained variance for lag=0 and 38.67% for lag=1. The stressors associated with the majority of the lupus symptoms are of an interpersonal and work-related nature. This as-sociation was maintained when we carried out the factorial analyses with the items of the symptoms from the following day. Conclusions: The interpersonal and work-related stressors are related to a worsening in the majority of the lupic symptoms in the patients whose sympto-matology worsens as a result of daily stress experienced the day before.

Virtual reality adaptations of the Trier Social Stress Test (TSST-VR) constitute useful tools for studying the physiologic axes involved in the stress response. Here, we aimed to determine the most appropriate experimental approach to the TSST-VR when investigating the modulation of the axes involved in the stress response. We compared the use of goggles versus a screen projection in the TSST-VR paradigm. Forty-five healthy participants were divided into two groups: the first one (goggles condition; 13 females, 11 males) wore goggles while performing the TSST-VR; the second (screen condition; 15 females, six males) was exposed to the TSST-VR projected on a screen. Sympathetic reactivity to stress was measured by continuously recording skin conductance (SC), while the hypothalamic-pituitary-adrenal axis (HPA) was evaluated by sampling salivary cortisol throughout the experiment. At the end of the task, there was an increase in SC and cortisol level for both means of delivering the TSST-VR, although the increase in SC was greater in the goggles condition, while salivary cortisol was comparable in both groups. Immersion levels were reportedly higher in the screen presentation than in the goggles group. In terms of sex differences, females experienced greater involvement and spatial presence, though comparatively less experienced realism, than their male counterparts. These findings help us determine which protocol of the TSST-VR is most suitable for the stress response under study. They also emphasize the need to consider the sex of participants, as males and females show distinct responses in each protocol. This study is a part of a Thesis Doctoral and was supported by the I+D Project “PSI2010-15780” of the Spanish Ministry of Science and Innovation.

The goal of this study was to develop a simple, easy, and quick self-report measure, the Lupus Symptom Inventory (LSI), designed to evaluate subjective symptoms of Systemic Lupus Erythematosus (SLE). The internal consistency of the LSI was tested, as well as its concordance with physician reports and serological indicators of disease activity by evaluating the self-reports of 46 patients with SLE who completed the LSI daily for a one-month period. Throughout this one-month period, parameters of serological activity and routine medical check-up were obtained. The results showed a high internal consistency of the LSI, with a Cronbach alpha of .86. Additionally, a contingency analysis showed agreement between medical report and patient self-report on the same day for six of seven lupus symptoms (difficulty breathing (p

Study design Descriptive, cross-sectional. Introduction The impact of upper limb (UL) disability, dexterity and fine motor skill on self-efficacy in older adults with osteoarthritis (OA) is not well known yet. Purposes of the study To evaluate the self-efficacy and its relationship with UL function/disability in institutionalized OA. Methods Institutionalized adults ( n = 45) over the age of 65 years with OA were evaluated in a single session, to determine pinch strength, active range of motion of the hand and UL disability and functionality. They were classified as self-efficacious or not based on their general self-efficacy level. The influence on self-efficacy on upper limb function was statistically analyzed using bivariate and multivariate regression analyses. Results Self-effective older adults showed significantly lower scores in disability and higher scores in pinch strength, dexterity and motion of thumb than those who were classified as non-self-effective. Self-efficacy was associated with pinch strength ( p ≤ 0.038), disability ( p p ≤ 0.048). Multiple regression analyses showed that disability explained almost 40% of the variability of self-efficacy. Conclusions Older adults classified as non-self-effective have higher UL disability and less pinch strength, manual dexterity and thumb motion than those who are self-effective, suggesting a relationship between impairment and perceived ability. Level of evidence 3a.

Postpartum depression affects a huge number of women and has detrimental consequences. Knowing the factors associated with postpartum depression during pregnancy can help its prevention. Although there is evidence surrounding behavioral or psychological predictors of postpartum depression, there is a lack of evidence of biological forecasters. The aim of this study was to analyze the sociodemographic, obstetric, and psychological variables along with hair cortisol levels during the first, second, and third trimesters of pregnancy that could predict postpartum depression symptoms. A sample of 44 pregnant women was assessed during 3 trimesters of pregnancy and the postpartum period using psychological questionnaires and hair cortisol levels. Participants were divided into 2 groups: a group with postpartum depression symptoms and a group with no postpartum depression symptoms. Results showed significant positive differences between groups in the first trimester regarding the Somatization subscale of the SCL-90-R (p < .05). In the second trimester, significant differences were found in the Somatization, Depression, Anxiety, and GSI subscales (p < .05). In the third trimester significant differences between both groups were found regarding pregnancy-specific stress. We found significant positive differences between groups regarding hair cortisol levels in the first and the third trimester. Hair cortisol levels could predict 21.7% of the variance of postpartum depression symptoms. In conclusion, our study provided evidence that psychopathological symptoms, pregnancy-specific stress, and hair cortisol levels can predict postpartum depression symptoms at different time-points during pregnancy. These findings can be applied in future studies and improve maternal care in clinical settings.

ejd.2010.1214 Auteur(s) : Maria Encarnacion AGUILAR-FERRANDIZ1, Carmen MORENO-LORENZO1, Guillermo Adolfo MATARAN-PENARROCHA2, Adelaida Maria CASTRO-SANCHEZ3 adelaid@ual.es, Maria Isabel PERALTA-RAMIREZ4, Ricardo RUIZ-VILLAVERDE5 1 Department of Physical Therapy, University of Granada, Spain 2 Health District Malaga (North), Andalusian Health Service, Malaga, Spain 3 Department of Nursing and Physical Therapy, Carretera de Sacramento s/n. Facultad de Ciencias de la Salud, Universidad de Almeria, [...]

Objective The objectives of this paper are to compare sexual function and distress in women with systemic lupus erythematosus (SLE) and in healthy controls; to determine the association between disease characteristics, quality of life, psychopathology and sexual function; and to compare sexual function and distress of women according to age (reproductive and nonreproductive-age women). Methods We conducted a cross-sectional study of 120 participants; 65 women had SLE (aged 18–65), and 55 were healthy, age-matched controls. The assessment included the Female Sexual Function Index (FSFI), Symptom Checklist-90-Revised (SCL-90-R), Short Form 36 health survey (SF-36), socio-demographic characteristics and the Systemic Lupus International Collaborating Clinics (SLICC) and SLE Disease Activity Index (SLEDAI) in SLE patients only. Results Of 65 eligible patients with SLE, 61 (94%) responded; of 55 control subjects, 53 (96%) responded. The FSFI total score and subscale scores for desire, arousal, lubrication, orgasm and pain were significantly lower in patients with SLE. More somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobia, paranoid ideation, psychoticism, the Positive Symptom Total (PST), Positive Score Discomfort Index (PSDI), the use of psychotropic drugs, general health, vitality, social function, emotional role and mental health were significantly associated with changes in the patient group’s sexuality. Multivariate analysis indicated that depression, PSDI and vitality were the variables significantly associated with low sexual function in patients with SLE. Conclusions Women with SLE reported significantly impaired sexual function compared with healthy controls. Impaired sexual function was associated with somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, hostility, paranoid ideation, psychoticism, PST, higher scores in the PSDI subscale, vitality, social functioning and mental health. These results indicate that, in daily practice, inquiring about sexuality and quality of life and screening for psychopathology are important for every patient with SLE, irrespective of their clinical characteristics.

Objectives: The objective was to determine the effect of myofascial techniques on the modulation of immunological variables. Design: Thirty-nine healthy male volunteers were randomly assigned to an experimental or control group. Interventions: The experimental group underwent three manual therapy modalities: suboccipital muscle release, so-called fourth intracranial ventricle compression, and deep cervical fascia release. The control group remained in a resting position for the same time period under the same environmental conditions.Outcome Measures: Changes in counts of CD3, CD4, CD8, CD19, and Natural Killer cells (as immunological markers) between baseline and 20 minutes post-intervention. Results: Repeated-measures ANOVA revealed a significant time x groups interaction [F (1, 35)=9.33; p= 0.004] for CD19. There were no significant time x group interaction effects on CD3, CD4, CD8, or Natural Killer cell counts. Intra-subject analyses showed a higher CD19 count in the experimental group post-intervention versus baseline (t=-4.02; p=0.001)], with no changes in the control group (t=0.526; p=0.608). Conclusion: A major immunological modulation, with an increased B lymphocyte count, was observed at 20 minutes after the application of craniocervical myofascial induction techniques.

The objective was to determine the effect of myofascial techniques on the modulation of physiologic and psychologic variables.Forty-one (41) healthy male volunteers were randomly assigned to an experimental or control group.The experimental group underwent 3 manual therapy modalities: suboccipital muscle technique, compression of fourth intracranial ventricle, and deep cervical fascia technique. The control group remained in a resting position for the same time period under the same environmental conditions.Temperature, heart rate, and systolic and diastolic blood pressure (BP) were measured before, during, and after the intervention. State and trait anxiety levels and depression level were evaluated before and after the intervention.Repeated-measures analysis of variance revealed a significant time x groups interaction [F = 4.7(1,40); p = 0.036] for state anxiety. There were no significant time x group interaction effects for depression [F = 0.33(1,40); p = 0.57] or trait anxiety [F = 3.76(1,40), p = 0.060]. Among physiologic parameters, a significant time x group interaction was found for systolic BP [F = 2.86(6,240); p = 0.033] and heart rate [F = 2.89(6,240); p = 0.036].Psychologic modulation is observed after application of manual therapy techniques, with a decrease in state anxiety in the experimental group. Heart rate and systolic BP were modulated during the course of myofascial induction techniques. All of these effects were observed up to 20 minutes after the therapy.

The purpose of this paper was to examine memory performance in patients with SLE by studying the overall deterioration in memory, analyzing the differences and frequency of impairment in the variables from the visual and verbal memory tests, and studying the alterations in the memory. This study included 59 patients with a diagnosis of systemic lupus erythematosus (SLE) and 18 with a diagnosis of chronic discoid lupus (CDL), who were administered the Spanish complutense verbal learning test (TAVEC) and the Rey complex figure test (RCFT). Statistically significant differences were detected between the two groups on the immediate visual recall and delayed visual recall variables, with the mean of the SLE group being lower than that of the CDL group. The difference between the frequency of verbal and visual impairment could be explained by various factors, one of which would be a lateralization of memory impairment.

Background: Chronic stress worsens the quality of life (QOL) of lupus patients by affecting their physical and psychological status. The effectiveness of a cognitive-behavioural intervention in a group of patients with lupus and high levels of daily stress was investigated. Methods: Forty-five patients with lupus and high levels of daily stress were randomly assigned to a control group (CG) or a therapy group (TG); they received cognitive behavioural therapy (CBT) which consisted of ten consecutive weekly sessions. The following variables were evaluated at baseline and at 3, 9 and 15 months: (1) stress, anxiety, depression, (2) Systemic Lupus Erythematosus Disease Activity Index, somatic symptoms, number of flares, (3) anti-nDNA antibodies, complement fractions C3 and C4 and (4) QOL. A multivariate analysis of repeated measures and various analyses of variance were carried out. Results: We found a significant reduction in the level of depression, anxiety and daily stress in the TG compared to the CG and a significant improvement in QOL and somatic symptoms in the TG throughout the entire follow-up period. We did not find any significant changes in the immunological parameters. Conclusions: CBT is effective in dealing with patients suffering from lupus and high levels of daily stress as it significantly reduces the incidence of psychological disorders associated with lupus and improves and maintains patients’ QOL, despite there being no significant reduction in the disease activity index.

The objective of this study was to investigate the possible effects of the daily stress experienced during a six-month period on the cognitive functioning of patients with systemic lupus erythematosus (SLE). For this purpose, we evaluated the daily stress of 21 patients with lupus every day for six months. Later, we carried out a neuropsychological exam that included an evaluation of attention and memory. At the same time, scores on depression and anxiety were recorded with the objective of controlling other emotional variables that might be influencing these cognitive processes. The results show that daily stress was able to predict the scores on the neuropsychological variables studied. Specifically, the daily stress experienced in the previous six months is the variable with the greatest explanatory-predictive power on the scores for delayed recall visual memory, visual fluency and attention speed. This relationship proved to be negative in all three cases ( R2 corr = 0.290; t = −2.712, P < 0.014); ( R2 corr = 0.318; t = −2.818, P < 0.012); ( R2 corr = 0.319; t −2.906, P < 0.009), which means that the greater the daily stress, the lower the score on visual memory, fluency and total attention speed. We can state that daily stress is related to impairments in visual memory, fluency and attention in patients with SLE. This effect was not found with other emotional variables, such as depression and anxiety.

Objective The purpose of this study was to verify whether stress worsens the clinical symptomatology perceived by patients with lupus erythematosus. Toward this end, we considered two types of stressors-daily stress and high-intensity stressful life events. Methods In 46 patients with systemic lupus erythematosus and 12 patients with chronic lupus discoid, we studied the stress they experienced daily for 6 months and their disease symptoms. During this period, we also analyzed the levels of C3 and C4 complements and anti-DNAn antibodies. The systemic lupus erythematosus activity (assessed by the Systemic Lupus Activity Measures) and cumulative organ damage (assessed by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) were also analyzed. Results We did not find that high-intensity stressful life events produced a worsening of the symptomatology of the disease. However, using a time-series analysis (Box-Jenkins), we found that a high percentage of lupus patients (74.1%) perceived a worsening in their clinical symptomatology due to the effects of daily stress. Of this 74.1%, 53.4% worsened the same day they suffered the perceived daily stress, and the remaining 20.7% experienced an increase in symptoms both the same day and the following day. Subsequent Mann-Whitney analyses showed that the patients who worsened for 2 days because of the effects of stress had greater lupus activity, as evaluated by their levels of C3, C4, and anti-DNAn. Conclusion Daily stress, and not stressful life events, worsened the clinical symptomatology perceived by lupus erythematosus patients. This increase extended at times to 2 days, and was associated with greater lupic activity.

There is emerging evidence that suggests emotional processes may be involved in the development of addiction, and that emotional alterations may compromise the effectiveness of treatment approaches in substance abuse. Nonetheless, there is a dearth of studies that have examined the experience of emotions in substance abusers, especially with regard to natural affective stimuli that are motivationally relevant for the normal population. The main aims of this study are: (a) to examine possible differences in the experience of emotions of drug-free substance abusers exposed to images containing motivationally relevant stimuli, with regard to a normal population and (b) to examine possible differences in the experience of emotions of substance abusers depending on their drug of choice. We used 25 images from the International Affective Picture System (IAPS) to elicit different emotional states, and the Self Assessment Manikin (SAM) to record participants' subjective experience on three emotional dimensions: valence, arousal, and dominance. We used bifactorial MANOVA to examine subjective emotional ratings as a function of group, and as a function of the kind of image shown. Results showed a differential emotional profile of substance abusers with regard to healthy controls; and different emotional profiles between abusers of a number of substances. These results suggest the experience of emotions may be significantly altered in substance abusers, and that these alterations may play an important role in drug abuse treatment course and results.