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The covid-19 pandemic calls for adherence to multiple health behaviours. While authorities mostly use health information to deal with these issues, such an approach may be insufficient. This study examined the effects of a cognitive method, namely psychological inoculation (PI) + health information (experimental) versus health information alone (control) on anxiety, resilience and adherence.A randomized controlled trial was used. Participants were assigned to the experimental or control conditions, all provided on an automatized computerized system.These included anxiety, adherence to the Covid-19 Israeli health ministry's recommendations, and mental resilience. Participants were assessed before, immediately after and a week after the interventions.Controls increased only in adherence at 1 week compared to baseline. In contrast, those in the PI increased in resilience and adherence and reported lower anxiety immediately after treatment compared to baseline levels. In the PI condition, degree of refuting challenging sentences correlated with less anxiety.Results showed better immediate improvements in anxiety, resilience and intention to adhere in the experimental condition compare to the controls. Authorities may wish to add PI to help the public deal with the effects of such a pandemic and to increase adherence to health recommendations.

Background Patients with COVID-19 present with a variety of clinical manifestations, ranging from mild or asymptomatic disease to severe illness and death. Whilst previous studies have clarified these and several other aspects of COVID-19, one of the ongoing challenges regarding COVID-19 is to determine which patients are at risk of adverse outcomes of COVID-19 infection. It is hypothesized that this is the result of insufficient inhibition of the immune response, with the vagus nerve being an important neuro-immuno-modulator of inflammation. Vagus nerve activity can be non-invasively indexed by heart-rate-variability (HRV). Therefore, we aimed to assess the prognostic value of HRV, as a surrogate marker for vagus nerve activity, in predicting mortality and intensive care unit (ICU) referral, in patients hospitalized with COVID-19. Methods A retrospective cohort study including all consecutive patients (n = 271) diagnosed and hospitalized with COVID-19 between March 2020 and May 2020, without a history of cardiac arrhythmias (including atrial and ventricular premature contractions), pacemaker, or current bradycardia (heart rate 110 bpm). HRV was based on one 10s ECG recorded at admission. 3-week survival and ICU referral were examined. Results HRV indexed as standard deviation of normal to normal heartbeat intervals (SDNN) predicted survival (H.R. = 0.53 95%CI: 0.31–0.92). This protective role was observed only in patients aged 70 years and older, not in younger patients. HRV below median value also predicted ICU referral within the first week of hospitalization (H.R = 0.51, 95%CI: 0.29–0.90, P = 0.021). Conclusion Higher HRV predicts greater chances of survival, especially in patients aged 70 years and older with COVID-19, independent of major prognostic factors. Low HRV predicts ICU indication and admission in the first week after hospitalization.

The combination of radiotherapy (RT) with immunotherapy represents a promising treatment modality for non-small cell lung cancer (NSCLC) patients. As only a minority of patients shows a persistent response today, a spacious optimization window remains to be explored. Previously we showed that fractionated RT can induce a local immunosuppressive profile. Based on the evolving concept of an immunomodulatory role for vagal nerve stimulation (VNS), we tested its therapeutic and immunological effects alone and in combination with fractionated RT in a preclinical-translational study. Lewis lung carcinoma-bearing C57Bl/6 mice were treated with VNS, fractionated RT or the combination while a patient cohort with locally advanced NSCLC receiving concurrent radiochemotherapy (ccRTCT) was enrolled in a clinical trial to receive either sham or effective VNS daily during their 6 weeks of ccRTCT treatment. Preclinically, VNS alone or with RT showed no therapeutic effect yet VNS alone significantly enhanced the activation profile of intratumoral CD8+ T cells by upregulating their IFN-γ and CD137 expression. In the periphery, VNS reduced the RT-mediated rise of splenic, but not blood-derived, regulatory T cells (Treg) and monocytes. In accordance, the serological levels of protumoral CXCL5 next to two Treg-attracting chemokines CCL1 and CCL22 were reduced upon VNS monotherapy. In line with our preclinical findings on the lack of immunological changes in blood circulating immune cells upon VNS, immune monitoring of the peripheral blood of VNS treated NSCLC patients (n=7) did not show any significant changes compared to ccRTCT alone. As our preclinical data do suggest that VNS intensifies the stimulatory profile of the tumor infiltrated CD8+ T cells, this favors further research into non-invasive VNS to optimize current response rates to RT-immunotherapy in lung cancer patients.

In response to adverse social-environmental conditions, leukocytes gene expression profile is altered in a pattern recognized as the conserved transcriptional response to adversity (CTRA). This entails the up-regulated expression of pro-inflammatory genes and down-regulated expression of genes involved in type-I interferon (IFN) related anti-viral immunity. In contrast, vagal nerve activity is recognized as a significant anti-inflammatory modulator. In this work, we investigated the association between CTRA and vagal activity indicated by the standard deviation of all NN interval (SDNN), a measure of heart-rate variability, in breast cancer patients awaiting surgery (n = 16). This association was tested both at the molecular leukocyte transcription factor activity level, as well as at the cytokines serum levels. We found an association between higher SDNN and increased interferon (IFN) related anti-viral pathways, both on the leukocyte transcription factor level and serum protein level. Unexpectedly, we also found a positive correlation between higher SDNN and pro-inflammatory transcription factor activity and cytokine serum level, potentially suggesting that increased vagal activity was induced by increased inflammation, in the context of pre-surgical stress and the presence of malignant tissue. Transcription origin analysis (TOA) suggests a role for monocyte and B-cells in the anti-inflammatory and anti-metastatic effects induced by vagal nerve signaling. Larger prospective studies are needed to verify and elaborate on the results from this small cross-sectional study.

Objective: An effective method for preventing the Human Immunodeficiency Virus (HIV) is condom use. Yet, research shows limited effects of education on increasing condom use. This research examined the effects of psychological inoculation (PI) versus education on condom use -barriers and –tendencies, using a fully automatized online system. Design: Two randomized controlled trials. In Study 1, 59 Sub-Saharan students were included while Study 2 20 European students were included. In both studies, participants were randomly assigned to PI or control conditions. In Study 2, we additionally matched pairs on gender and condom barriers. In the PI, participants received challenging sentences they had to refute. Main outcome measures: An indirect condom use test (I-CUTE) and a condom use barriers questionnaire, assessed at baseline and a month later. Results: In Study 1, a significant increase in I-CUTE scores and no change in barriers was found in the PI condition. Controls did not change on either outcome. In Study 2, two sub-scales of condom barriers (concerning partner and satisfaction) were significantly decreased in the PI group, while in controls, barriers significantly increased over time. In both groups, I-CUTE scores tended to increase. Conclusions: These results replicate previous studies and extend them to a fully automatized system without counselors.

Post-operative pain is a common clinical problem after surgery, yet its predictors are inconsistent and unclear. This study examined whether pre-surgical vagal cardiac efferent nerve activity, indirectly indexed by heart rate variability (HRV), predicts patients' pain after epileptic surgery.Using a prospective design, HRV was measured at rest during 5 min in n = 30 patients, prior to undergoing epileptic surgery. Post-operative pain was assessed every 8 h during the first 2 days after surgery, and our analyses focused on the worse pain level. We used multiple regression analyses and statistically considered several confounders (age, surgical duration, and analgesics during various surgical phases).Multiple HRV indexes strongly and inversely predicted post-operative pain, with high-frequency HRV (HF-HRV) being the strongest predictor (r = -0.81, p 0.001). In a hierarchical multiple regression, HF-HRV accounted for an additional and significant 18% of the variance in post-operative pain, after statistically considering effects of age, surgical duration and effects of two anaesthetics.Pre-surgical HF-HRV independently, strongly and inversely predicts post-operative pain. These results are in line with a neuromodulatory role of the vagus nerve in pain and have clinical implications for predicting and managing post-operative pain.

This chapter discusses the clinical and empirical perspectives concerning adherence to treatment in hypertension (HT) and coronary heart disease (CHD). The correlates of adherence may be divided into treatment-related, disease-related, physician-related, patient background and patient trait/state or psychosocial variables. While the main challenge of adherence in HT is ensuring that prescribed medication is taken, this is only one of several challenges for CHD patients. The comprehensiveness of assessing adherence in CHD follows the complexity of its medical treatment. The Medical Outcomes Study assessed adherence to specific behaviours recommended to patients with heart disease in the same way they did for patients with HT. The Minnesota Heart Health Program aimed at increasing awareness and adherence to smoking cessation, preventing HT, reducing salt, fat and alcohol consumption, and increasing physical exercise for preventing CHD at the community of Mankato, Minnesota and USA.

Objective Condom use prevents the contraction of the HIV. Research shows limited effects of education on increasing condom use. Psychological inoculation (PI) has been found to be more effective in this domain, however, its mechanism is unknown. This study examined effects of PI versus education on condom use barriers and tendencies, and its relations with cognitive dissonance, using a fully automatized online system. Design The study was a randomized controlled trial (RCT) and included 149 students from a German University randomly assigned to PI or a control condition. Main outcome measures An indirect condom use test (I-CUTE), a condom use barriers questionnaire, self-reported condom use, and cognitive dissonance estimations were all assessed at baseline and one-month post-intervention. Results PI significantly increased I-CUTE scores when participants had sexual relations. Control participants increased in self-reported condom use and on I-CUTE scores in people without sexual relations. No changes in barriers were seen in either group. The cognitive dissonance tended to be higher in PI participants as compared to control participants. Conclusions PI increases I-CUTE scores compared to controls (based on effect sizes), and significantly in those with sexual relations. The role of relationship status and the mechanisms of PI should be further examined.

BackgroundHeart Rate Variability (HRV) represents efferent vagus nerve activity which is suggested to be inversely related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various types of cancer. HRV is also believed to predict the occurrence and severity of post-operative complications. We aimed to determine the role of pre-operative HRV as a prognostic factor in overall and cancer free survival in patients with colorectal cancer.MethodsRetrospective analysis was performed in a detailed dataset of patients diagnosed with primary colorectal cancer between January 2010 and December 2016, who underwent curative surgical treatment. HRV was measured as time-domain parameters (SDNN (Standard Deviation of NN-intervals) and RMSSD (Root Mean Square of Successive Differences)) based on pre-operative 10 second ECGs. Groups were created by baseline HRV: Low HRV (SDNN ResultsA total of 428 patients were included in this study. HRV was not significantly associated with overall survival (SDNN ConclusionsHeart rate variability was not associated with overall or cancer free survival in patients with primary colorectal cancer who underwent curative surgical treatment. These results do not align with results found in studies including only patients with advanced cancer, which suggests that there is only an association in the other direction, cancer causing low HRV.

Little is known about the interplay between the autonomic nervous system and disease activity in multiple sclerosis (MS). We examined the relationship between heart rate variability (HRV), a reliable measure of vagal nerve function, and disease characteristics in a prospective MS cohort. Standard deviation of each normal-to-normal inter-beat interval (SDNN) and root mean square of successive differences (RMSSD), global indices of HRV, were measured in 114 MS patients, which included four predefined subgroups, and 30 age and sex-matched healthy controls (HC). We assessed group differences at baseline, HRV reproducibility at month 3, and used logistic regression modeling to relate baseline HRV with relapse occurrence. No significant HRV differences were found between MS and HC and between MS subgroups. In MS patients, both HRV indices correlated with age (r = &minus, 0.278, p = 0.018 and r = &minus, 0.319, p &lt, 0.001, respectively) and with month 3 assessments (r = 0.695 and r = 0.760, p &lt, 0.001). Higher SDNN and RMSSD at baseline were associated with self-reported relapses at month 3 (OR = 1.053, 95% CI (1.013&ndash, 1.095), p = 0.009 and OR = 1.065, 95% CI (1.016&ndash, 1.117), p = 0.009), and SDNN at baseline with relapses at month 12 (OR = 1.034, 95% CI (1.009&ndash, 1.059), p = 0.008, ROC, AUC = 0.733, p = 0.002). There were no baseline HRV differences between MS and HC or between subgroups. Post-hoc analysis showed an association with an increased relapse risk.

Accumulating evidence points to a beneficial effect ofvagus nerve activity in tumor development. The vagus nerve is proposed to slow tumorigenesis because of its anti-inflammatory properties mediated through ACh and the α7nAChR. Since α7nAChRs are widely expressed by many types of immune cells we hypothesized that the vagus nerve affects the tumor microenvironment and anticancer immunity. We found direct evidence in studies using animal cancer models that vagus nerve stimulation alters immunological responses relevant to the tumor microenvironment. Also studies in pathologies other than cancer suggest a role for the vagus nerve in altering immunological responses relevant to anticancer immunity. These results provide a rationale to expect that vagus nerve stimulation, in combination with conventional cancer treatments, may improve the prognosis of cancer patients by promoting anticancer immunity.

‘Mind–body’ debates assume that better brain–body associations are healthy. This study examined whether degree of associations between a neurophysiological vagal nerve index and peripheral disease biomarkers predict prognosis in pancreatic cancer (PC) and multiple sclerosis (MS). Sample 1 included 272 patients with advanced PC. Sample 2 included 118 patients with MS. We measured the vagal nerve index heart rate variability (HRV) derived from electrocardiograms. We examined associations between HRV and patients’ peripheral disease biomarkers: CA19-9 in PC and neurofilament light chain (NFL) in MS. Associations between HRV and each biomarker were examined separately in patients who survived or died (PC), and in those with and without relapse during 12 months (MS). In PC, HRV was significantly inversely related to the tumor marker CA19-9 in patients who later survived (r = −0.44, p < 0.05) but not in those who died (r = 0.10, NS). In MS, HRV was significantly and inversely related to NFL only in those who did not relapse (r = −0.25, p < 0.05), but not in those who relapsed (r = −0.05, NS). The degree of association between a neurophysiological vagal marker and peripheral disease biomarkers has prognostic value in two distinct diseases.

BACKGROUND: Effects of health education (HE) on physical activity (PA) are limited. Also, HE fails to address people's personal barriers and social pressures. In contrast, "psychological inoculation" (PI) targets both topics. This research examined the effects of PI versus HE on PA-related barriers and on self-reported PA in 2 studies. METHODS: Randomized controlled trials were employed. Study 1 (N = 20) took place in Britain, while study 2 (N = 40) in Belgium, with nonphysically active participants. PI exposed people to challenging sentences reflecting barriers concerning PA, which they had to refute. In study 1, PA barriers and self-reported PA levels were assessed before and a week after interventions. In study 2, the degree of refuting challenging sentences was estimated and the level of PA was assessed before and 2 months after interventions. RESULTS: In study 1, in the PI condition alone, PA barriers significantly decreased and self-reported PA increased. Change in barriers correlated with posttreatment PA. In study 2, PA increased only in the PI group. Level of rejecting challenging sentences predicted PA later. Most group differences remained when controlling for baseline measures. CONCLUSIONS: PI is more effective than HE for increasing PA, and reducing its barriers is essential for this.

Thousands of migrants arrived in Europe via the Balkan route, many with various health conditions. The camp of Preševo, Serbia, close to the Macedonian border, was established by the Serbian government and run by the United Nations High Commissioner. The camp was wstablished for Refugees (UNHCR) late in 2015 as a registration and a transfer camp for refugees traveling through the Balkans on their way from the Near East to Western Europe. Refugees stayed at the camp for several hours or a day. NATAN, an Israeli non-governmental volunteer organization, in collaboration with HUMEDICA, a German organization, established a clinic at the camp, staffed by Israeli and German personnel. The Israeli team consisted of a doctor, nurse, and social worker, at least one of whom spoke Arabic. The language barrier was bridged through the fact that Arabic is commonly spoken in Israel, and more than half of the volunteers were Palestinian-Israelis. As for the Farsi language, we were helped by interpreters from the Department of Languages in the University of Belgrade. This report contains data on 2136 consecutive clients visiting the clinic between December 2015 and February 2016. The report focuses on the three most frequent major countries of origin, Syria (51%), Iraq (18%), and Afghanistan (31%). Analysis of the age distribution revealed that 36% were under 18 years of age, while only 5% were above the age of 60. Male gender was predominant. Infections were the most common diagnosis (61%) followed by pain in various body parts (13%). Antibiotics were prescribed in 47.6% of the infections. Most of the visits were for minor illnesses, with very few cases of chronic diseases such as diabetes (28 visits) or hypertension (17 visits). We provide the demographic correlates of migrants’ health conditions and discuss the findings in light of past studies and the context of the present sample of migrants.

One of the challenges facing researchers in the domain of human immunodeficiency virus prevention is the assessment of condom use in an unbiased self-reported manner. The current study presents the development and preliminary validation of an indirect condom use test (I-CUTE), designed to assess condom use tendencies and to overcome self-report biases. Two samples were included using correlational designs. In sample 1, 88 students from European university completed the I-CUTE with questionnaires of condom use barriers, social desirability, and condom use negotiation self-efficacy. In sample 2, 212 students from sub-Saharan universities completed the I-CUTE with questionnaires of condom use barriers and knowledge. The I-CUTE included 17 pictures of human figures in relation to condom use, where participants had to choose one of the four a-priori given sentences reflecting the figures’ thoughts. This represented a semi-projective, yet standardized test. In sample 1, I-CUTE scores were inversely related to barriers, positively correlated with condom use negotiation self-efficacy and unrelated to social desirability. In sample 2, I-CUTE scores were inversely related to barriers and unrelated to knowledge scores. In a multiple regression, condom use barriers had a unique contribution to explaining variance in I-CUTE scores, beyond the contribution of background variables and knowledge. These results support the preliminary reliability and validity of the I-CUTE tool in a variety of cultures, and reveal its lack of bias by social desirability and the importance of condom use barriers in condom use tendencies.Keywords: condom use, barriers, social desirability, assessment, measure

International audience; Deep slow breathing can increase vagal nerve activity, indexed by heart rate variability (HRV). HRV is also associated with better decision-making. This research examined the effects of two breathing patterns on HRV (Study 1) and on stress and decision-making performance (Study 2). In Study 1, 30 healthy people performed either a symmetric breathing pattern (equal ratio of inhaling/exhalation timing), a skewed pattern (exhalation longer than inhalation), or watched an emotionally neutral film (sham), following a baseline period. Both types of breathing patterns significantly increased time and frequency domain HRV parameters, while viewing the film did not. In Study 2, 56 students were randomized to perform 2 min of the skewed vagal breathing (experimental group) or to wait for 2 min (controls), before performing a 30-minute business challenging decision-making task with multiple choice answers. Stress levels were self-reported before and after the task. While controls reported elevations in stress levels, those in the experimental group did not. Importantly, participants in the experimental group provided a significantly higher percentage of correct answers than controls. These studies show that brief vagal breathing patterns reliably increase HRV and improve decision-making. Limitations, possible mechanisms and implications for business decision-making are discussed.

This is a very applied, though scientifically based, chapter, involving a very common clinical issue in medicine. After presenting the chapter’s “case,” we learn briefly the biology of wound healing and surgical recovery. This sets the ground to review evidence on whether psychological factors predict recovery from surgery. We then review studies related to the PNI of surgery. The last topic concerns empirical evidence on the effects of pre-surgical psychological interventions on recovery from surgery. The chapter ends by returning to its hypothetical case. The topic of predicting recovery from surgery and improving recovery by psychological means has vast implications, where behavioral medicine can make a real impact with brief interventions, in such highly stressful moments in health care.

International audience; No abstract available

The chapter begins by a hypothetical case and an introduction to biomedical risk factors and the etiology of coronary heart disease (CHD). We then review psychosocial etiological risk factors and psychosocial prognostic factors of CHD (e.g., hostility, depression, Type-D personality). The chapter then presents in depth the PNI of the acute coronary syndrome with an emphasis on the vagal nerve and inflammation. We then discuss behavioral mediators between psychological factors and CHD prognosis and the evidence for the effects of various psychological interventions on CHD prognosis. These are done via meta-analyses and specific studies. The chapter ends with returning to the hypothetical case, vis-a-vis the presented studies.

This chapter forms the basis of any clinical encounter and is crucial for appreciating the humane interaction in clinical settings. After introducing a hypothetical case (as will all remaining chapters), it introduces the basic theory in doctor-patient communication. It then provides empirical examples of the effects of doctor-patient communication on patient outcomes. We then shift to the topic of patients’ adherence in medical care. We review methods for assessing adherence and then systematically review the factors affecting patients’ adherence from the perspective of disease, the patient, the clinician, and the treatment. After we learn about evidence for the effects of psychological interventions on patients’ adherence and lifestyle, we return to the hypothetical case and “treat” it better.

This chapter presents one of the topics which involves behavioral medicine, clinical psychology, and psychiatry, namely, emergency mental health. The chapter also reveals the heavy psychological and societal price we pay when not performing evidence-based interventions. After presenting the chapter’s “case,” theoretical models, explaining responses to traumatic events, are presented. Risk factors for developing PTSD after traumatic events are described, based on scientific literature. I then review evidence concerning past interventions for preventing PTSD, with particular emphasis on the failure of debriefing. This is followed by a voyage into the neuropsychology of trauma leading to an alternative intervention, the memory structuring intervention (MSI), which is a neuroscience-based and evidence-based intervention. Additional methods in emergency mental health are mentioned, and the chapter ends by “treating” better our hypothetical case.

This is the second chapter on a specific population, namely, the elderly. After presenting the hypothetical “case,” the chapter briefly reviews basic biological processes in aging. Psychological models in gerontology are mentioned, including the less known model of gerotranscendence. Stress and the importance of control and perceived control in the elderly are reviewed in depth as a central psychological aspect of aging with pivotal health implications. Psychological aspects of dementia are then discussed, followed by psychological aspects of falling in the elderly. Here, a psychobiological model of this issue is proposed, which includes environmental, psychosocial, and biological components. We then learn several PNI aspects of psychogeriatrics and examine effects of psychological interventions in the elderly. The chapter ends by returning to its case and “treating” it better, vis-a-vis the reviewed empirical evidence. This chapter is of high relevance to the current aging population, worldwide.

Background: Myofascial trigger points (MTrPs) are common in people with musculoskeletal pain and may play a role in chronic nonspecific low back pain (CLBP). One of the potential treatments of MTrPs is the Nervomatrix Soleve® auto-targeted neurostimulation device, providing targeted transcutaneous electrical nerve stimulation (TENS) to MTrPs in the lower back muscles. To date, no controlled studies have evaluated the effectiveness of this device for the pain management of this population. Objective: To examine whether the Nervomatrix Soleve® auto-targeted neurostimulation device is superior over placebo for the treatment of CLBP. Study Design: A fourfold-blind randomized controlled trial was conducted. Setting: Brussels University Hospital, health care centers and pharmacies around Belgium. Methods: Participants with CLBP for at least 3 months were randomly assigned to the experimental (the Nervomatrix Soleve® auto-targeted neurostimulation device providing TENS-stimulation and mechanical pressure) or placebo group (the Nervomatrix Soleve® autotargeted neurostimulation device providing mechanical pressure alone without current). The treatment protocol in both groups consisted of 6 treatment sessions per patient. Participants were evaluated at baseline prior to the intervention, immediately following treatment, and at one month follow-up. Pain and pain behavior (steps climbed) were assessed as primary outcome measures. Secondary outcome measures were pain functioning, health beliefs, symptoms of central sensitization, pain catastrophizing, and kinesiophobia. Results: In total, 39 participants were included in the study. Participants in both groups improved significantly for pain and functioning, but no significant differences were observed between groups. These improvements were not clinically meaningful for any of the reported measures. The health beliefs changed significantly in both groups (P < 0.05), with superior results at follow-up in the placebo group. Limitations: The follow-up period is limited to one month. Conclusions: Treatment of MTrPs with the Nervomatrix Soleve® auto-targeted neurostimulation device in patients with CLBP does not result in a better outcome than placebo-treatment in terms of pain, pain behavior, functioning, central sensitization, pain catastrophizing, and health beliefs. Key words: Low back pain, chronic pain, randomized controlled trial, electric stimulation therapy, trigger points

Psychosocial factors have been linked to cardiovascular diseases independently of traditional risk factors. The impact of psychosocial factors on plaque destabilizing factors, such as matrix metalloproteinases (MMPs) has been proposed although scarcely studied. Objective: To evaluate the relationships between hostility, perceived stress and social support with MMPs activity in patients after an Acute Myocardial Infarction (AMI). Methods: Blood samples were obtained from 76 patients on admission, post-angioplasty, 24. h, 7 days and 3 months after AMI. Hostility, perceived stress and social support were evaluated by validated questionnaires. Results: Social support was positively correlated with patientś ejection fraction (r = 0.453, p = 0.009). Patients with higher infarct size presented increased MMP-2 activity at admission (p = 0.04). Patients with one diseased vessel had more social support than those with three diseased vessels (p = 0.05). The highest values of MMP-2 and MMP-9 activity were observed at the acute event, decreasing, with the lowest activity at 3 months post-AMI (p < 0.001). Only in patients with low social support, hostility correlated with MMP-2 activity, from AMI onset (r = 0.645, p = 0.013), to 7 days post AMI (r = 0.557, p = 0.038). Hostility explained up to 28% of the variance in MMP-2 activity (R2=0.28, p = 0.005). Finally, in patients with high hostility, MMP-9 was positively correlated with IL-1β (r = 0.468, p = 0.02). Conclusions: This study adds weight to the idea that two psychosocial factors, namely hostility and social support, acting jointly, may affect MMP-2 activity. Moreover, in hostile patients, there is a link between IL-1β and MMP-9. These findings support the role of psychosocial factors in plaque destabilization and in the inflammatory process in AMI. Fil: Fernandez Machulsky, Nahuel Hernan. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina Fil: Fabre, Bibiana. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina Fil: Miksztowicz, Verónica Julieta. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Lombardo, Micaela. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina Fil: García Escudero, Alejandro. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina Fil: Gigena, Gerardo. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina Fil: Blanco, Federico Carlos. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina Fil: Gelpi, Ricardo Jorge. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiopatología Cardiovascular; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Schreier, Laura Ester. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina Fil: Gidron, Yori. Vrije Unviversiteit Brussel; Bélgica Fil: Berg, Gabriela Alicia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina

Made available in DSpace on 2022-04-29T08:45:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-10-01 Aim: To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients before any type of cancer treatment and investigate associated factors. Methods and results: This cross-sectional study included women (30–69 years old) with primary diagnosis of breast cancer and women with benign breast tumors. We evaluated cardiac modulation by heart rate variability and assessed factors of anxiety, depression, physical activity, and other relevant medical variables. Patients were divided into three groups based on TNM staging of cancer severity: early-stage cancer (n = 42), advanced-stage cancer (n = 37), or benign breast tumors to serve as a control (n = 37). We analyzed heart rate variability in time and frequency domains. The advanced-stage cancer group had lower vagal modulation than early-stage and benign groups; also, the advance-stage group had lower overall heart rate variability when compared to benign conditions. Heart rate variability was influenced by age, menopausal status, and BMI. Conclusions: Heart rate variability seems to be a promising, non-invasive tool for early diagnosis of autonomic dysfunction in breast cancer and detection of cardiovascular impairments at cancer diagnosis. Cardiac autonomic modulation is inversely associated with breast cancer staging. Departamento de Medicina Disciplina de Cardiologia Hospital São Paulo Escola Paulista de Medicina Universidade Federal de São Paulo, 715 Napoleão de Barros St Departamento de Fisioterapia Faculdade de Ciência e Tecnologia Universidade do Estado de São Paulo, 305 Roberto Símonsen St Faculdade de Medicina do ABC Laboratório de Epidemiologia e Análise de Dados, 2000 Lauro Gomes Av Department of Physiology and Institute of Molecular Cardiology School of Medicine University of Louisville, Baxter Biomedical Research Building II, 590 S Preston St Instituto do Câncer Doutor Arnaldo Vieira de Carvalho, 66 Largo do Arouche Departamento de Ginecologia Hospital São Paulo Escola Paulista de Medicina Universidade Federal de São Paulo Centro de Referência da Saúde da Mulher Hospital Pérola Byington, 683 Brigadeiro Luís Antônio Ave Departamento de Medicina Disciplina de Clínica Médica Hospital São Paulo Escola Paulista de Medicina Universidade Federal de São Paulo Free University of Brussels (VUB), Boulevard de la Plaine 2

Method: We retroactively derived markers of vagal nerve activity indexed by heart rate variability (HRV), specifically the root mean square of successive differences (RMSSD), from patients' electrocardiograms near diagnosis. The NIM index was the ratio of RMSSD to C-reactive protein levels (RMSSD/CRP). Sample 1 included 202 Belgian patients with advanced pancreatic cancer (PC), while sample 2 included 71 Belgian patients with non-small cell lung cancer (NSCLC). In both samples, we examined the overall survival, while in sample 2, we additionally examined the survival time in deceased patients., SCOPUS: ar.j, info:eu-repo/semantics/published

// Dimple Y. Chudasama 1, 2 , Zeynep Aladag 2 , Mayla I. Felicien 2 , Marcia Hall 2 , Julie Beeson 1 , Nizar Asadi 1 , Yori Gidron 3 , Emmanouil Karteris 2 and Vladimir B. Anikin 1 1 Division of Thoracic Surgery, The Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK 2 Division of Biosciences, Brunel University London, London, UK 3 Scalab, Lille University, Oncolille, Lille, France Correspondence to: Vladimir B. Anikin, email: V.Anikin@rbht.nhs.uk Keywords: circulating tumour DNA; Alu repeats; DNA integrity index; malignant lung tumours; liquid biopsy Received: August 12, 2017 Accepted: March 06, 2018 Published: April 20, 2018 ABSTRACT Introduction: Lung cancer survival remains poor in the western world due to late presentation in most cases, leading to difficulty of treatment in these advanced and metastatic patients. Therefore, the development of a robust biomarker for prognosis and to monitor treatment response and relapse would be of great benefit. The use of Alu repeats and DNA Integrity Index has been shown to hold both diagnostic and prognostic value, and as it is obtained from the plasma of patients, it can serve as a non-invasive tool for routine monitoring. This study evaluates the efficiency of this technique in malignant lung cancer patients. Methods: Plasma samples were collected from 48 patients, consisting of 29 lung cancer patients and 19 non-cancer controls. Alu repeat ratio and confounders were measured. Results: Observations showed a higher Alu repeat ratio amongst the cancer group compared to controls ( p=0.035) , mean Alu ratio 0.38 (range 0.01-0.93) and 0.22 (0.007-0.44) respectively, ROC curve analysis AUC 0.61 (p=0.22) . Analysis by staging was more promising, whereby a higher DNA Integrity Index was seen in advanced cases compared to both early stage and controls, p 0.5 to be associated with poorer overall survival p=0.03 . Conclusion: The results of this study show a potential use of Alu repeats ratios for prognostic purposes in the advanced setting for lung cancer patients.

Objective The objective of this cross-sectional study was to analyze the relationship between symptoms of central sensitization (CS) and important cognitive behavioral and psychosocial factors in a sample of patients with chronic nonspecific low back pain. Methods Participants with chronic nonspecific low back pain for at least 3 months were included in the study. They completed several questionnaires and a functional test. Pearson’s correlation was used to analyze associations between symptoms of CS and pain behavior, functioning, pain, pain catastrophizing, kinesiophobia, and illness perceptions. Additionally, a between-group analysis was performed to compare patients with and without clinically relevant symptoms of CS. Results Data from 38 participants were analyzed. Significant associations were found between symptoms of CS and all other outcomes, especially current pain (r = 0.510, P = .001), mean pain during the past 7 days (r = 0.505, P = .001), and pain catastrophizing (r = 0.518, P = .001). Patients with clinically relevant symptoms of CS scored significantly worse on all outcomes compared with persons without relevant symptoms of CS, except on functioning (P = .128). Conclusions Symptoms of CS were significantly associated with psychosocial and cognitive behavioral factors. Patients exhibiting a clinically relevant degree of symptoms of CS scored significantly worse on most outcomes, compared with the subgroup of the sample with fewer symptoms of CS.

Acute stress reactions immediately after exposure to trauma or crisis have received growing attention in recent years and are gaining momentum in light of recent mass traumatic events worldwide including conflicts, terrorist attacks and natural disasters. Unlike routine life, traumatic or emergency situations are unexpected and unstructured events. Early helping responses in these situations is of utmost importance: immediate, focused and efficient interventions are beneficial for the reduction of acute stress reactions and a return to normal functioning as well as decreasing the risk for future onset of post-traumatic stress disorder symptoms. However, many early efforts were either found to be ineffective or are based on narrative expression and empathy alone. The aim of this paper is to present the SIX Cs model - a new psychological first aid approach - immediate cognitive-functional psychological first aid - for the global nonprofessional community as well as for first responders. The model addresses the need to standardize interventions during an Acute Stress Reaction and intends to help shift the person from helplessness & passiveness into active effective functioning, within minutes, in the immediate aftermath of a perceived traumatic event. The model is based on four theoretical and empirically tested concepts: (1) Hardiness, (2) Sense of Coherence, (3) Self-Efficacy, and (4) on the Neuro-psychology of the stress response, focusing on shifting people from a limbic system hyperactivity to a prefrontal cortex activation during stressful events. Preliminary results on the effectiveness of the SIX Cs model in terms of increasing resiliency, reducing anxiety and improving perceived self-efficacy are presented. To date, this approach has been recognized by the Israeli Ministry of Health as the Israeli national model for psychological first aid.

While the parasympathetic nervous system appears to be involved in the regulation of tumor progression, its exact role is still unclear. Therefore, using a rat BP6-TU2 fibrosarcoma tumor model, we investigated the effect of (1) reduction of vagal activity produced by subdiaphragmatic vagotomy; and (2) enhancement of vagal activity produced by continuous delivery of electric impulses to the cervical part of the vagus nerve on tumor development and survival of tumor-bearing rats. We also evaluated the expression of cholinergic receptors within in vitro cultivated BP6-TU2 cells. Interestingly, we found that both, vagal stimulation and subdiaphragmatic vagotomy slightly reduced tumor incidence. However, survival of tumor-bearing rats was not affected by any of the experimental approaches. Additionally, we detected mRNA expression of the α1, α2, α5, α7, and α10 subunits of nicotinic receptors and the M1, M3, M4, and M5 subtypes of muscarinic receptors within in vitro cultivated BP6-TU2 cells. Our data indicate that the role of the vagus nerve in modulation of fibrosarcoma development is ambiguous and uncertain and requires further investigation.

Traffic accidents (TA) are a leading cause of morbidity and mortality worldwide. Psychological risk factors, whether traits or states, are important predictors of dangerous driving and of TA. However, educational and awareness campaigns often have little impact on such factors since they do not provide social resistance skills or cognitive restructuring, to change cognitive distortions which may underlie such factors. This research tested the effects of psychological inoculation (PI), a cognitive method that challenges and modifies cognitive distortions and teaches social resistance skills, on road hostility tendencies, using an indirect measure (Studies 1 and 2), and on simulated driving (Study 3). We preliminarily validated an indirect measure of road hostility tendencies, using a semi-projective test, not relying on interpretation or self-report. In Study 1, 59 Belgian students were assessed for indirect road hostility tendencies, before and immediately after PI or an awareness control. Indirect road hostility tendencies significantly decreased only in the PI group. In Study 2, 59 Israeli police cadets received PI or driving safety education (control) in groups. Levels of road hostility tendencies were significantly lower in the PI group than in controls, only immediately after the intervention, but not two weeks later. In Study 3, 40 male students were observed for brief PC-based simulated driving with social pressure, before and after PI or safety education (control). Only PI led to reduced accidents and touching/passing sidewalks from pre- to post-intervention. These relatively consistent results support the effectiveness of PI for reducing road hostility tendencies and accidents in simulated driving. Future studies need to test the long-term impact of PI on actual driving behavior. The ease of administering PI en-masse and its effects on road hostility tendencies and on simulated driving behavior may have important implications for accident prevention.

OBJECTIVES: Pain is a complex common health problem, with important implications for quality of life and with huge economic consequences. Pain can be elicited due to tissue damage, as well as other multiple factors such as inflammation and oxidative stress. Can there be 1 therapeutic pathway that may target multiple etiologic factors in pain? METHODS: In the present article, we review evidence for the relationships between vagal nerve activity and pain, and between vagal nerve activity and 5 factors that are etiologic to or protective in pain. RESULTS: Vagal nerve activity inhibits inflammation, oxidative stress, and sympathetic activity, activates brain regions that can oppose the brain "pain matrix," and finally it might influence the analgesic effects of opioids. Together, these can explain the antinociceptive effects of vagal nerve activation or of acetylcholine, the principal vagal nerve neurotransmitter. These findings form an evidence-based neurobiological rationale for testing and possibly implementing different vagal nerve-activating treatments in pain conditions. DISCUSSION: In this article, we show evidence for the relationships between vagal nerve activity and pain, and between vagal nerve activity and 5 factors that are etiologic to pain. Given the evidence and effects of the vagus nerve activation in pain, people involved in pain therapy may need to seriously consider activation of this nerve.

Recent research proposes that left hemispheric lateralization (HL) may protect against the effects of life events on mental distress. This study extends these findings by examining the protective role of left HL in the relationship between war threat (missile exposure) and PTSD symptoms. A sample of 186 Israelis, exposed to missile attacks, completed brief scales of self-reported missile exposure, a subjective and a neuropsychological HL measure, and of PTSD symptoms. The sample was split into right HL and left HL individuals on both HL measures. Self-reported missile exposure was positively associated with PTSD symptoms in right HL, but not in left HL individuals on both HL measures. These results replicate, extend our previous results and suggest that left HL may even protect against the effects of severe life threatening events. Results are discussed in relation to neuropsychological and neurophysiological differences between the hemispheres.

The vagus nerve is strategically located in the body, and has multiple homeostatic and health-promoting effects. Low vagal activity predicts onset and progression of diseases. These are the reasons to activate this nerve. This study examined the effects of transcutaneous vagus nerve stimulation (t-VNS) on a main index of vagal activity, namely heart rate variability (HRV). In Study 1, we compared short (10 min) left versus right ear t-VNS versus sham (no stimulation) in a within-subjects experimental design. Results revealed significant increases in only one HRV parameter (standard deviation of the RR intervals (SDNN)) following right-ear t-VNS. Study 2 examined the prolonged effects of t-VNS (1 h) in the right ear. Compared to baseline, right-t-VNS significantly increased the LF and LF/HF components of HRV, and SDNN in women, but not in men. These results show limited effects of t-VNS on HRV, and are discussed in light of neuroanatomical and statistical considerations and future directions are proposed.

Past studies show that life events (LE) predict mental distress. This research tested whether hemispheric lateralization (HL) moderated the relationship between LE and mental distress. In studies 1 and 2, different instruments for assessing HL were used (questionnaire and neuropsychological test). In both studies, LE or daily hassles were positively correlated with distress (study 1) and with anxiety and depression (study 2), only in people with right but not left HL, controlling for effects of gender. In study 3, experimentally induced stress led to increased perceived stress, again only in participants with right but not left HL. These results show consistently that left HL may protect against adverse effects of LE, hassles or acute stress on well-being. We propose possible mechanisms and future research directions.

Injured students-athletes took part in a randomized controlled trial to test whether written disclosure could reduce psychological distress and improve injury mobility. Writing took place alongside prescribed physical rehabilitation and consisted of three 20-minute writing sessions, once a week for three consecutive weeks. Participants in the experimental injury-writing group followed a structured form of written disclosure, called the guided disclosure protocol (GDP). They firstly, wrote about the onset of their injury in a chronological manner, secondly, they explicitly labelled their emotions and described the impact of the injury, finally they wrote about future coping and psychological growth. Controls wrote about nonemotional and noninjury related topics. In addition to self-report measures, a physiotherapist, blind to experimental condition, assessed mobility at the injury site. Although self-report indices remained unchanged, the GDP group evidenced a significant improvement in injury mobility compared to controls.

Objective: written emotional disclosure for 15–20?min a day over 3 to 4?days improves physical and psychological health and may benefit cancer patients. However, no studies have tested the effectiveness of guided writing in cancer patients and their partners. A randomised controlled trial tested whether writing about the patient's diagnosis and treatment of ovarian cancer using the Guided Disclosure Protocol (GDP) is effective in reducing perceived stress and improving quality of life (QoL) in ovarian cancer couples. The study also tested two theories that may account for beneficial effects of written emotional disclosure, the cognitive processing hypothesis and the social interaction hypothesis. Methods: patients and their partners (N?=?102 couples) were randomised to write at home for 15?min a day over 3?days about the patient's diagnosis and treatment using the GDP or what the patient did the previous day (control). Couples were assessed at baseline, 3- and 6-month follow-ups on the primary outcomes of perceived stress and QoL and secondary outcomes of intrusive thoughts (testing the cognitive processing hypothesis) and illness-related couple communication (testing the social interaction hypothesis). Results: there were no main effects for any outcomes. However, in patients, the GDP improved QoL if illness-related couple communication improved and buffered the effect of intrusive thoughts on perceived stress. Conclusions: the GDP might benefit patients in certain circumstances, through changes in communication (in line with the social interaction hypothesis). Further research is needed to determine whether patients benefit from interventions to improve illness-related couple communication and under which conditions

This article is made available through the Brunel Open Access Publishing Fund. Pregnancy is associated with major physiological and future psychosocial changes, and maternal adaptation to these changes is crucial for normal foetal development. Psychological stress in pregnancy predicts an earlier birth and lower birth weight. Pregnancy-specific stress contributes directly to preterm delivery. The importance of nutrition and exercise during pregnancy with regard to pregnancy outcome has long been acknowledged. This importance has only been further emphasized by the recent changes in food quality and availability, lifestyle changes and a new understanding of foetal programming's effects on adult outcomes. We hypothesised that for a successful pregnancy certain events at a nutritional, immune, psycho-emotional and genetic level should be tightly linked. Therefore, in this study we followed an ‘integrative’ approach to investigate how maternal stress, nutrition, pregnancy planning and exercise influence pregnancy outcome. A key finding of our study is that there was a significant reduction in the intake of alcohol, caffeine-containing and sugary drinks during pregnancy. However, passive smoking in the household remained unchanged. In terms of immune profile, a significant inverse correlation was noted between difficulty to ‘fight’ an infection and number of colds (r=-0.289, P=0.003) as well as the number of infections (r=-0.446, P