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Background: Children living with HIV are reaching adulthood and transitioning to adult clinics. This study aimed to describe clinical and immunovirological status after transition in patients with perinatal HIV. Methods: Patients participating in the Spanish multicenter pediatric HIV cohort (CoRISpe) transferred to adult care (FARO cohort) from 1997 to 2016 were included. Clinical and immunovirological data were collected from 12 years old to the last follow-up moment after transition (up to December 2017). We used mixed-effect models to analyze changes in CD4 counts or viral suppression and multivariate analysis for risk factors for virological failure (VF) and immune status after transition. Transition years were classified into 5-year periods. Results: Three hundred thirty-two youths were included. The median age at transition was 18 years (interquartile range: 16.3–18.9) and 58.1% women. The median follow-up time after transition was 6.6 years (interquartile range: 4.6–9.8), and 11 patients (3.3%) died. The immunovirological status at transition improved over the last periods. Globally, VF decreased from 27.7% at transition to 14.4% at 3 years post-transition (P < 0.001), but no changes were observed in the last 2 transition periods. There were no significant differences in CD4 over the transition period. Risk factors for VF after transition were female sex, being born abroad and VF at transition, and for lower CD4 after transition were Romani heritage, younger age at transition, lower CD4 nadir, and CD4 at transition. Conclusions: After transition, virological suppression improved in the early transition periods, and immunological status remained stable. Nevertheless, some patients had higher risk of worse outcomes. Identifying these patients may aid during transition. Supported by the Instituto de Salud Carlos III—Spanish Ministry of Science an Innovation [The Spanish National Cohort of HIV-infected Children (CoRISpe), included in the Spanish National AIDS Research Network (RIS-EPICLIN 06/2013) [Grant no RD06/0025]. D.A.A. is funded by the Spanish Ministry of Health—Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union (FEDER) [Contrato Río Hortega CM18/00100].

The coronavirus disease 2019 (COVID-19) outbreak emerged at the end of 2019 and quickly spread around the world. Measures to counter COVID-19, including social distancing and lockdowns, created an unusual situation that had the potential to impact a variety of behaviours, including sleep, which is crucial for health and well-being. Data were obtained through an online survey. The total sample comprised 19,482 participants from the UK. Participants were asked several questions regarding sleep quality and quantity. Each participant completed the questionnaires once during a data collection period spanning January 20 to March 31, 2020. Data provided by different participants during different weeks (spanning time-periods just before COVID-19 was identified in the UK and during the early weeks following its arrival) were compared using analysis of variance tests and regressions. Regression analyses controlling for age, sex and ethnicity revealed significant associations of small magnitude between date of survey completion and sleep quality, sleep latency, number of awakenings and composite score of poor sleep quality. These analyses also indicated small increases in eveningness tendency as the study progressed. There was no change in sleep duration or time spent awake at night. The COVID-19 outbreak did not appear to impact negatively sleep in a substantial manner during the early stages in the UK. The small increases in sleep quality variables (except for time spent awake at night and sleep duration) and eveningness are nonetheless of interest. Further research is needed to understand how best to provide support to those most in need of a good night’s sleep during this unprecedented time. Wellcome Collection (The Touch Test) to MJB (Principal Investigator) and AMG (Co-Investigator).

Chemsex, a new risky sexual behavior involving participation in sexual relations under the influence of drugs, has shown a significantly increased prevalence in recent years. This fact entails a serious public health issue, especially when Chemsex is practiced by individuals with an HIV (Human Immunodeficiency Virus) diagnosis. Hence, analyzing the characteristics of Chemsex practices, associated sexual practices and the health outcomes of individuals who participate in Chemsex, is extremely important. The main aim of the present study is to analyze the prevalence and characteristics of the practice of Chemsex in a sample of 101 men with HIV who have sex with men who attended the Department of Infectious Diseases of the General University Hospital of Alicante (Spain). Furthermore, the association between Chemsex and Health-Related Quality of Life (HRQoL) was also assessed. Chemsex and sexual practices were evaluated by employing a questionnaire applied on an ad hoc basis. HRQoL was assessed by employing the Medical Outcomes Study HIV Health Survey (MOS-HIV). In total, 40.6% of the participants had practiced Chemsex during the last year. When sexual practices were compared between those individuals who practiced Chemsex and those who did not, the former presented a higher level of risky sexual behaviors, especially with occasional and multiple sexual partners. Regarding HRQoL, those individuals who practiced Chemsex exhibited a poorer HRQoL in the majority of domains, especially those participants who practiced it with a higher intensity. The present study points out the high prevalence of Chemsex practice between men with HIV who have sex with men in Spain. Moreover, this study highlights the negative effects of Chemsex on HRQoL, probably due to the mixed effects of higher levels of risky sexual practices and the consequences of drug consumption. This research was funded by the Office of the Vice President of Research and Knowledge Transfer of the University of Alicante, Grant Number: GRE-18-17B.

Currently, AIDS or severe immunodeficiency remains as a challenge for people with HIV (PWHIV) and healthcare providers. Our purpose was to analyze the impact of advanced HIV disease (AHD) on mortality, life expectancy and health-related quality of life (HRQoL). We reviewed cohort studies and meta-analyses conducted in middle- and high-income countries. To analyze HRQoL, we selected studies that reported overall health and/or physical/mental health scores on a validated HRQoL instrument. AIDS diagnosis supposes a higher risk of mortality during the first six months, remaining higher for 48 months. It has been reported that cancer and cardiovascular disease persist as frequent causes of mortality in PWHIV, especially those with previous or current AHD. PWHIV who initiate combination antiretroviral therapy (cART) with CD4 < 200 cells/µL have significantly lower estimated life expectancy than those with higher counts. AHD is associated with lower HRQoL, and a worse physical health or mental health status. AIDS and non-AIDS defining events are significant predictors of a lower HRQoL, especially physical health status. AHD survivors are in risk of mortality and serious comorbidities, needing special clinical attention and preventive programs for associated comorbidities. Their specific needs should be reflected in HIV guidelines.

Study Objectives Twin studies have provided data about the relative weight of genetic and environmental factors on sleep variables over the last few decades. However, heritability is a non-intuitive concept and it is often misunderstood even amongst the scientific community. This study aimed to analyze: (1) understanding of the meaning of heritability of insomnia; (2) the accuracy of estimations of heritability in the general population regarding three sleep traits (sleep duration, sleep quality and insomnia); (3) perceptions of the effectiveness of different treatments for insomnia depending on how the disorder is presented (i.e. having an environmental or genetic etiology) and whether the subject’s estimate of genetic influence on sleep traits impacted beliefs about the effectiveness of different treatments. Methods Participants (N = 3658) completed a survey which included: questions about general genetic knowledge; a specific question about the meaning of heritability; estimates of heritability of three different sleep traits; and the effectiveness of different treatments for insomnia depending on how the etiology of this condition was presented. Results Fewer than 25% of the participants selected the correct description of the heritability of insomnia. Almost half of the sample incorrectly believed that heritability refers to the chance of passing a disorder onto their children. We also found that participants provided different estimates for the effectiveness of different treatments depending on the presumed etiology of the disorder. Conclusion Most people do not have accurate knowledge about the concept of heritability. People’s assumptions about the etiology of a disorder may influence which treatments they consider most effective. J.J.M-V. was supported by predoctoral scholarship (19814/FPI/15) of the Fundación Seneca. This work was supported by Russian Foundation for Basic Research Grant No. 18-29-14071.

The last decades have witnessed a sudden increase in myopia incidence among youngsters that have been related to modern lifestyle along with the use of emerging technologies affecting visual exposure. Increasing exposures to known risk factors for myopia, such as time spent indoors, close-distance work, or low-light conditions are thought to be responsible for this public health issue. In most cases, development of myopia is secondary to a vitreous chamber enlargement, although the related mechanisms and the potential interaction between central and peripheral retinal area remain unclear. For a better understanding, we performed a classical twin study where objective refractive error along 70° of horizontal retinal arc was measured in 100 twin pairs of university students, 78% of which showed manifest myopia. We found the variance of shared environmental origin (range 0.34 to 0.67) explained most of the objective refractive error variance within central 42° of the retina (22° temporal to 19° nasal), whereas additive genetic variance (range 0.34 to 0.76) was predominant in the peripheral retinal areas measured. In this sample of millennial university students, with a large prevalence of myopia, environmental exposures were mostly responsible for inter-individual variation in the retinal horizontal area surrounding the macula, while their relative weight on phenotypic variance was gradually descending, and replaced by the variance of genetic origin, towards the retinal periphery. This study was supported by MyFUN (Myopia Fundamental Understanding Needed): European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 675137.

Objectives: To determine the satisfaction of relatives of deceased patients with the care received in a palliative care unit (PCU) and compare it with cases in which a team with specific psychological care were not involved. Material and methods: An anonymous survey (n = 202) was administered to the relatives (response rate, 42.1%), which evaluated 9 issues related to the process of dying and the overall assessment of the care. Results: The overall satisfaction was high (mean score of 9.22); the score for the full team was 9.40, while that of the team without the psychologist was 8.40 (P=.005). The items that scored highest were “team availability”, “information received” and “assistance for facing the disease”, followed by “pain control”, “peaceful death”, “assistance for patient-family communication”, “grief support” and “quality of life”. Conclusions: Based on the relatives’ assessment, the hospital PCU teams help increase the quality of care at the end of life. Objetivo: Conocer la satisfacción de familiares de pacientes fallecidos con la atención recibida en una unidad de cuidados paliativos (UCP) y comparar con los casos donde no intervino el equipo con atención psicológica específica. Material y métodos: Administración de encuesta anónima (n = 202) a familiares (tasa de respuesta = 42,1%). Se evaluaron 9 cuestiones relacionadas con el proceso de morir y la valoración global de la atención. Resultados: La satisfacción global fue alta (9,22). La valoración del equipo completo fue 9,40 y sin la psicóloga, 8,40 (p = 0,005). Los ítems mejor valorados fueron «disponibilidad del equipo», «información recibida» y «ayuda para enfrentar la enfermedad», seguidos de «control del dolor», «muerte en paz», «ayuda para la comunicación entre paciente-familia», «apoyo en el duelo» y «calidad de vida». Conclusiones: Según la valoración de los familiares, los equipos de las UCP hospitalarias contribuyen a incrementar la calidad de la atención al final de la vida. This study was funded by the Biomedical and Healthcare Research Institute of Alicante (ISABIAL). Research project: ‘‘Quality of life and the efficacy of the intervention of the palliative care team in a general hospital’’ (‘‘Calidad de vida y eficacia de la intervención del equipo de Cuidados Paliativos en un Hospital General’’), approved in the Second Round of Research Project Bids of ISABIAL-2015, modality of Predoctoral Grants, reference UGP-15-295.

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.

Twin studies have consistently found that genetic factors explain a substantial proportion of the variance for insomnia. However, studies vary widely in their heritability estimates. Therefore, this meta-analysis aimed to: 1) Estimate the mean heritability of insomnia; 2) Assess heterogeneity among twin studies of insomnia; and 3) Search and analyse characteristics of the studies (moderator variables) that may explain heterogeneity among estimates. For this purpose, separate meta-analyses were carried out for MZ and DZ correlations and for heritability estimates by assuming random-effects models. Thirteen independent samples were included in this meta-analysis. The heterogeneity index for heritability estimates was significant in both best fitting models (I2 = 98.77, P < .0001) and full models (I2 = 97.80, P < .0001). MZ correlations were higher (0.37; 95%CI: 0.31,.43) than DZ correlations (0.15; 95%CI: 0.12,.18). A mean heritability of 0.39 (95%CI: 0.32,.44) was found for insomnia. These results highlight the role of genetic factors in explaining differences among the population on insomnia and Emphasize heterogeneity among studies. Further research is needed to identify variables that could explain this heterogeneity.

Research has emphasized the genetic basis of individual differences in body mass index (BMI); however, genetic factors cannot explain the rapid rise of obesity. Eating behaviors have been stipulated to be the behavioral expression of genetic risk in an obesogenic environment. In this study, we decompose variation and covariation between three key eating behaviors and BMI in a sample of 698 participants, consisting of 167 monozygotic, 150 dizygotic complete same-sex female twins and 64 incomplete pairs from a population-based twin registry in the southeast of Spain, The Murcia Twin Registry. Phenotypes were emotional eating, uncontrolled eating and cognitive restraint, measured by the Three Factor Eating Questionnaire and objectively measured BMI. Variation in eating behaviors was driven by nonshared environmental factors (range: 56%−65%), whereas shared environmental and genetic factors were secondary. All three eating behaviors were correlated with BMI (r = .19–.25). Nonshared environmental factors explained the covariations (Emotional eating–Uncontrolled eating: rE = .54, 95% CI [.43, .64]; BMI–Cognitive restraint: rE = .15, 95% CI [.01, .28]). In contrast to BMI, individual differences in eating behaviors are mostly explained by nonshared environmental factors, which also accounted for the phenotypic correlation between eating behaviors and BMI. Due to the sample size, analyses were underpowered to detect contributions of additive genetic or shared environmental factors to variation and covariation of the phenotypes. Although more research is granted, these results support that eating behaviors could be viable intervention targets to help individuals maintain a healthy weight. The Murcia Twin Registry is being funded by Seneca Foundation — Regional Agency for Science and Technology, Murcia, Spain (grants 03082/PHCS/05, 08633/PHCS/08, 15302/PHCS/10 and 19479/PI/14) and the Spanish Ministry of Science and Innovation (PSI2009–11560 and PSI2014-56680-R). Dr Herle is funded by fellowship from the Medical Research Council UK (MR/T027843/1). A/Prof Colodro-Conde is supported by a QIMR Berghofer fellowship.

The dramatic increase in the number of older people with Mild Cognitive Impairment (MCI) entails a serious public health problem. MCI involves different degrees of dependence that has been previously related to a decrease in Health-Related Quality of Life (HRQoL), due to impairment in the performance of activities of daily living. Resilient coping, as an adaptive coping style, could reduce the associated limitations derived by the characteristic deficits of MCI, and hence improve HRQoL. The principal objective of this work was to compare the level of autonomy (measured in terms of independence in the performance of basic (ADL) and instrumental (IADL) activities of daily living), and HRQoL between resilient and non-resilient individuals with MCI. The results showed a positive relationship between resilience, autonomy, and HRQoL. Hence, resilient participants exhibited higher independence in daily living activities and better HRQoL than non-resilient individuals. Mediation analyses confirmed an indirect influence of resilience on HRQoL through the mediation effect of better performance in IADLs. These findings underline the relevance of resilience as a coping style to compensate deficits in daily living in people with MCI. The inclusion of intervention programs, oriented to the promotion of resilience coping for older adults, might increase the autonomy levels in this population, improving their HRQoL. This research was supported by the Program of Networks-I3CE of Investigation in University Teaching (Program Networks) from the Vice-Rectorate of Quality and Educational Innovation and Education Sciences Institute of the University of Alicante (2017–2018). Ref.: (4253).

The reported prevalence of HIV-associated neurocognitive disorders in HIV people depends on the population studied and the methodology used. We analyze the prevalence of neurocognitive impairment (NCI) and associated factors in patients on successful antiretroviral therapy (ART), without comorbidities. Cross-sectional observational study in HIV subjects, =18 years old, on stable ART, and HIV viral load of

This study examined the predictive validity of the Spanish version of the Suicide Risk Assessment Manual (S-RAMM) and the Historical-Clinical-Risk Management-20 (HCR-20) in a sample of violent offenders with schizophrenia and other psychosis, who had committed violent crimes and had been sentenced to compulsory psychiatric treatment by the criminal justice system. Patients were prospectively monitored within the institution for 18 months. During the follow-up period, 25% of offenders were involved in any suicidal behavior including acts of self-harm, suicidal ideation and suicide attempts and 34% were physically or verbally violent. The S-RAMM and HCR-20 risk assessment tools were strongly correlated and were able to predict suicidal behavior and violence with a moderate-large effect size (AUCs = 0.81–0.85; AUCs = 0.78–0.80 respectively). Patients scoring above the mean on the S-RAMM (>20-point cut-off) had a five times increased risk of suicide related events (OR = 5.05, 95% CI = 2.6–9.7) and sevenfold risk of violence in the HCR-20 (>21-point cut-off) (OR = 7.13, 95% CI = 2.0–21.2) than those scoring below the mean. Offenders at high risk for suicide and violence had significantly more suicide attempts (p < 0.001) and more prior sentences for violent crimes (p < 0.001). These results support the use of the S-RAMM and HCR-20 for clinical practice by providing evidence of the utility of these measures for predicting risk for suicidal and violent behavior in mentally disordered offenders.

Objective: There is a lack of data on the association between body self-perception and eating patterns in Brazil. Thus, this study aimed to explore the relationship between body image dissatisfaction and eating patterns by the anthropometric status in adolescents. Methods: A cross-sectional study of 1496 adolescents was conducted. The participants completed the Body Shape Questionnaire. Demographic, anthropometric, and socioeconomic data were collected, as well as information regarding the pubertal development and dietary intake. Logistic regression was performed to evaluate the associations of interest. Results: Body image dissatisfaction was identified in 19.5% of the adolescents. Three dietary patterns were identified: (1) the Western pattern was composed of sweets and sugars, soft drinks, typical dishes, pastries, fast food, beef, milk, and dairy products; (2) the Traditional pattern was composed of oils, chicken, fish, eggs, processed meat products, cereals (rice, cassava flour, pasta, etc.), baked beans, and bread; and (3) the Restrictive pattern was composed of granola, roots, vegetables, and fruit. Among overweight/obese adolescents, the data indicated a negative association of slight body image dissatisfaction (OR: 0.240 [0.100; 0.576]) and moderate body image dissatisfaction (OR: 0.235 [0.086; 0.645]) with the Western dietary pattern. Additionally, in this group, there was a positive association between high body image dissatisfaction and the Restrictive pattern (OR: 2.794 [1.178; 6.630]). Conclusion: Amongst overweight/obese adolescents, those with slight and moderate body image dissatisfaction were less likely to follow a Western-like dietary pattern when compared with those satisfied with their body image. Additionally, in this group, adolescents with high body image dissatisfaction was more likely to follow a restrictive pattern. Resumo: Objetivo: Há poucos dados sobre a associação entre autopercepção corporal e padrões alimentares no Brasil. Assim, este estudo teve como objetivo explorar a relação entre insatisfação com a imagem corporal (IIC) e padrões alimentares de acordo com o estado antropométrico em adolescentes. Métodos: Um estudo transversal com 1.496 adolescentes foi conduzido. Os participantes preencheram o Questionário de Imagem Corporal. Dados demográficos, antropométricos e socioeconômicos foram coletados, bem como informações relacionadas ao desenvolvimento puberal e ao consumo alimentar. Foi realizada uma regressão logística para avaliar as associações de interesse. Resultados: A IIC foi identificada em 19,5% dos adolescentes. Três padrões alimentares foram identificados: (1) O padrão Ocidental, composto de doces e açúcares, refrigerantes, pratos típicos, artigos de pastelaria, fast food, carne bovina, leite e laticínios, (2) o padrão Tradicional, composto de óleos, frango, peixe, ovos, produtos de carne processada, cereais (arroz, farinha de mandioca, massas, etc.), feijão cozido e pão e (3) o padrão Restritivo, composto de granola, raízes, verduras e frutas. Entre adolescentes acima do peso/obesos, os dados indicaram uma associação negativa entre IIC leve [RC = 0,240 (0,100; 0,576)] e IIC moderada [RC = 0,235 (0,086; 0,645)] e padrões alimentares Ocidentais. Além disso, nesse grupo, houve uma associação positiva entre a IIC grave e o padrão Restritivo [RC = 2,794 (1,178; 6,630)]. Conclusão: Entre adolescentes acima do peso/obesos, aqueles com IIC (leve e moderada) apresentaram menor probabilidade de seguir um padrão alimentar Ocidental em comparação aos satisfeitos com sua imagem corporal. Além disso, nesse grupo, adolescentes com IIC grave apresentaram maior probabilidade de seguir um padrão Restritivo. Keywords: Dietary patterns, Body image dissatisfaction, Adolescents, Body mass index, Palavras-chave: Padrões alimentares, Insatisfação com a imagem corporal, Adolescentes, Índice de massa corporal

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.

Conduct disorder (CD) prior to age 15 identifies a subgroup of men with severe mental illness (SMI) who present a high risk for violence that persists across the life span. The present study examined male violent offenders with SMI in a forensic hospital in Spain, comparing those with SMI+CD and those without SMI-CD on the HCR-20 and PCL:SV. Violent offenders with SMI+CD obtained higher HCR-20 and PCL: SV total scores, and much higher H and factor 2 scores as compared to those without prior CD. Men with SMI+CD present a challenge to forensic psychiatric services.

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.

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.