Search

Study Design: A retrospective chart review., Objective: The authors aim to investigate the role of clinical and radiographic parameters in patients who underwent posterior cervical surgery, and their association with C5 palsy severity and time to recovery., Background: Postoperative C5 palsy affects 1%-30% of patients undergoing posterior decompression, with or without fusion. Causation and avoidance of this complication remain widely debated., Materials and Methods: A single institution review of patients who underwent posterior cervical spine surgery was focused on using specific Common Procedural Technology codes associated with the patient population of interest. Patients were excluded if they had inadequate pre and postoperative imaging, as well as a history of prior cervical spine surgery, concurrent anterior surgery, intradural pathology, spinal tumor, or spinal trauma. Radiographic measurements of the pre and postoperative images were completed with subsequent intraclass correlation coefficient analysis to confirm the precision of measurements., Results: Out of 105 total patients, 35 (33%) patients developed a C5 palsy. Twenty-four (69%) of those palsies completely resolved, with a median time to recovery of 8 months. Preoperative demographics and radiographic parameters demonstrated heterogeneity among those patients who did and did not have a resolution of palsy. Patients with increased change in C2-C7 lordosis (P = 0.011) after surgery were associated with decreased likelihood of recovery. Patients without a smoking history (P = 0.009) had an increased likelihood of recovering from C5 palsy., Conclusions: The degree of increased lordosis in the treatment of degenerative cervical disease plays a role in the rate of recovery from C5 palsy. This should be considered during preoperative planning in determining the amount of lordosis desired. In addition, patients without a smoking history were associated with a higher rate of recovery., Level of Evidence: Level IV., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Demonstration of competency is an essential component of nursing orientation in the practice environment. Standardization of the assessment with a validated instrument supports high-quality care and patient safety. This study engaged six nurse experts to establish content validation for a newly developed competency-based assessment framed by the domains of the national standard for nursing education. Two rounds of rigorous review resulted in a scale content validity index universal agreement calculation of .891, indicating that all items were evaluated as relevant for inclusion in this comprehensive measure of registered nurse clinical competency in the medical-surgical specialty., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Vaccination is the most effective strategy for preventing infectious diseases and related complications, and proving its efficacy is crucial for its success and adherence, especially for newly introduced vaccines, such as adjuvanted recombinant herpes zoster virus vaccination (RZV). In this observational real-life study, we recorded adverse effects following immunization (AEFIs) after RZV administration in frail populations., Methods: A total of 271 subjects underwent RZV at Vaccination Center, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy. Most subjects were solid organ transplant recipients (kidney, 77.1%; liver, 4.8%). Demographics, clinical data, and AEFIs (type, duration, and medications used) were recorded., Results: Overall, 37% of participants reported at least one AEFI following the first dose, predominantly pain at the injection site (60%), while 41% did so after the second dose (pain at the injection site in 62% of cases). Medications were more frequently used for AEFI treatment after the second dose (28%) rather than after the first dose (13%) ( p = 0.01). After stratification by sex, females experienced AEFIs more frequently than males, particularly local skin reactions., Conclusions: Our study added evidence of safety and tolerability of the adjuvanted recombinant RZV in frail adults.

Background: A nudge intervention against Herpes Zoster, created and implemented in Italy, is presented in order to administer the Shingrix vaccine on a sample of frail patients, as required by the National Prevention Plan. Individual and contextual factors associated with vaccine adherence were investigated., Method: 300 frail adult subjects underwent a full vaccine cycle with recombinant-Shingrix vaccine (RZV vaccine). Hospital Presidia of the Salerno University Hospital Authority, a Hospital Presidium of the Salerno Local Health Authority, and the Public Health Laboratory of the University of Salerno (Campania) participated in the intervention. An ad hoc questionnaire was administered with the following scales: EQ-5D, PSS-10, MSPSS, and representations of HZ and its consequences., Results: Some variables, such as peer support, doctor-patient relationship, level of education, and perception of health, are important in vaccine adherence and information processing. The following factors emerged from the factor analysis: Trust in collective knowledge and collective responsibility (F1); beliefs about virus risk and vaccine function (F2); information about virus and symptomatology (F3); and vaccine distrust (F4). Factor 4 correlates negatively with social support indices (R = -0.363; p < 0.001). There is a significant relationship between factor 3 and satisfaction with national information campaigns (F = 3.376; gdl = 5; p -value = 0.006)., Conclusions: Future vaccination campaigns should be built with the aim of personalizing information and developing contextualized strategies, starting from understanding the stakeholders involved, cultural contexts, and organizational settings.

Introduction: The University of Salerno has implemented a nudge intervention with the aim of promoting vaccine adherence among employees of academia and identifying individual and contextual determinants that influence adherence., Method: A purpose-built questionnaire was used during the reference period of October-December 2022 in order to assess levels of state anxiety (STAI-Y1), perceived stress (PSS-10), and public sentiments, which influence vaccination behavior, with consequences for the whole population (VCI)., Results: Analysis of the results revealed a difference in mean scores on the PSS: those who have always adhered to the vaccination campaign compared to those who have never been vaccinated perceived higher levels of stress (12.01 vs. 11.33; F = 4.744, p = 0.031); furthermore, there was a relationship between the presence/absence of pathologies and VCI (F = 3,93; df = 1; p = 0.04)., Conclusions: The University of Salerno's nudge intervention made its employees more responsible for protecting the health of the academic community and encouraged good adherence to the flu vaccination campaign. University employees, equipped with high cultural tools, sought information primarily from institutional sources indicated by the university during the free vaccination campaign at the university's vaccine center.

Background: The use of stents with various porosities for treating cerebral aneurysms requires dual antiplatelet therapy (DAPT) without clear guidelines on the utility of platelet function tests (PFTs) and the duration of DAPT. We sought to determine the effects of stent porosity, PFT usage, and DAPT duration on the radiographic and clinical outcomes after stenting of cerebral aneurysms., Methods: PubMed was searched on March 29, 2021 for studies of cerebral aneurysm stenting that had specified the stent type and DAPT duration. A random effects meta-analysis was used to measure the prevalence of nonprocedural thrombotic and hemorrhagic events, clinical outcomes, aneurysm occlusion, and in-stent stenosis stratified by stent porosity, PFT usage, and DAPT duration., Results: The review yielded 105 studies (89 retrospective and 16 prospective) with 117 stenting cohorts (50 high porosity, 17 intermediate porosity, and 50 low porosity). In the high-, intermediate-, and low-porosity stenting cohorts, PFT usage was 26.0%, 47.1%, and 62.0% and the mean DAPT duration was 3.51 ± 2.33, 3.97 ± 1.92, and 5.18 ± 2.27 months, respectively. The intermediate-porosity stents showed a reduced incidence of hemorrhagic events (π = 0.32%) compared with low-porosity stents (π = 1.36%; P = 0.01) and improved aneurysm occlusion (π = 6.18%) compared with high-porosity stents (π = 14.42%; P = 0.001) and low-porosity stents (π = 11.71%; P = 0.04). The prevalence of in-stent stenosis was lower for the intermediate-porosity (π = 0.57%) and high-porosity (π = 1.51%) stents than for the low-porosity stents (π = 3.30%; P < 0.05). PFT use had resulted in fewer poor clinical outcomes (π = 3.54%) compared with those without PFT use (π = 5.94%; P = 0.04). The DAPT duration had no effect on the outcomes., Conclusions: In the present meta-analysis, which had selected for studies of cerebral aneurysm stenting that had reported the DAPT duration, intermediate-porosity stents and PFT use had resulted significantly improved outcomes. No effect of DAPT duration could be detected., (Published by Elsevier Inc.)

This study analyses the digital marketing tools that companies producing Pecorino Siciliano with a protected designation of origin (PDO) are implementing on the web through their corporate website and their brand page on Facebook. It aims to verify whether companies are adapting (or not) to new trends in web marketing and e-commerce. The quality of corporate websites was assessed during the COVID-19 pandemic in terms of usability and amount of activity on Facebook brand pages by Pecorino Siciliano PDO-producing companies. Analysed data show that the companies producing Pecorino Siciliano PDO fell short in developing their web-marketing tools, demonstrating their poor adaptation to the new digitalisation trends driven by the COVID-19 pandemic., Competing Interests: None., (© 2022 Society of Dairy Technology.)

Objective  Research productivity impacts an individual's academic credentials and serves to advance the field of neurosurgery at large. Poster presentations allow researchers to share preliminary results with respected colleagues; however, more critical is the ability to publish peer-reviewed articles. Key factors that lead posters to journal publication are not well understood and difficult to quantify. This study investigates the association between bibliometrics of authors who presented posters at the North American Skull Base Society (NASBS) meeting and odds of journal publication. Methods  Posters from the 2016 to 2018 NASBS archive were reviewed. Hirsch-index (h-index) of first (FH) and senior (SH) authors, research type, research topic, and number of poster authors (nAuthPost) were collected. For posters published as journal articles, number of days from poster presentation to publication (nDays), number of authors in published articles (nAuthArt), and journal impact factor (JIF) were recorded. Results  One-hundred sixty-nine of 481 posters (35.1%) were published as articles. Median FH and SH for published versus unpublished posters were 7 versus 5 ( p  = 0.01) and 29 versus 19 ( p  < 0.001), respectively. When adjusted with multivariate regression, only SH ( p  < 0.001) and nAuthPost ( p  = 0.001) were significantly associated with odds of publication. Median (interquartile range [IQR]) nDays was 361 (394). Increased authors from poster to article ( p  = 0.017) and lower FH ( p  = 0.08) were correlated with increased time to publication. Median (IQR) JIF for all publications was 1.723 (1.068). Conclusions  Bibliometrics such as h-index and number of authors from posters can help objectively characterize and predict future success in research productivity., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)

Introduction: With the advent of Covid-19, Italian university students were overwhelmed by fear of the pandemic and the social restrictions of the lockdown phase, with all didactic activity provided online. These stress factors caused people to experience psychological problems and/or the aggravation of pre-existing mental symptomatology. Psychological support is, therefore, important for the university-student population. Aims: (1) Analyzing the psychological difficulties and mental problems relative to lockdown from Covid-19 of students who asked for help from the Center of Psychological Counseling of the University of Salerno. (2) Describing the online services of the university's psychological counseling treatment. Participants: 266 university students, but only 49 were undergoing psychological treatment during the Covid-19 lockdown at the center. Methods: (1) Semistructured interview; (2) Questionnaire consisting of sociodemographic information and ad hoc questions; and (3) Scl-90-r test. Results and Conclusions: Aim 1: The main results highlight high levels of anxiety and stress, concentration disorders, and psychosomatization. In several cases, there was a reactivation of previous traumas and sleep was found qualitatively compromised. Aim 2: Counseling services included telephone listening activities, online psychological interviews, psychoeducational groups for interventions of anxiety management, and workshops on study methods conducted in small groups. The online counseling intervention, in times of emergency, increased the resilience and identified any psychological problems in order to implement timely management.

Background and Purpose: The modified TICI score is the benchmark for quantifying reperfusion after mechanical thrombectomy. There has been limited investigation into the reliability of this score. We aim to identify intra-rater and inter-rater reliability of the mTICI score among endovascular neurosurgeons., Materials and Methods: Four independent endovascular neurosurgeons (raters) reviewed angiograms of 67 patients at 2 time points. κ statistics assessed inter- and intrarater reliability and compared raters'-versus-proceduralists' scores. Reliability was also assessed for occlusion location and by dichotomizing modified TICI scores (0-2a versus 2b-3)., Results: Interrater reliability was moderate-to-substantial, weighted κ = 0.417-0.703, overall κ = 0.374 ( P  < .001). The dichotomized modified TICI score had moderate-to-substantial interrater agreement, κ statistics = 0.468-0.715, overall κ = 0.582 ( P  < .001). Intrarater reliability was moderate-to-almost perfect, weighted κ = 0.594-0.81. The dichotomized modified TICI score had substantial-to-almost perfect reliability, κ = 0.632-0.82. Proceduralists had fair-to-moderate agreement with raters, weighted κ = 0.348-0.574, and the dichotomized modified TICI score had fair-to-moderate agreement, κ = 0.365-0.544. When proceduralists and raters disagreed, proceduralists' scores were higher in 79.6% of cases. M1 followed by ICA occlusions had the highest agreement., Conclusions: The modified TICI score is a practical metric for assessing reperfusion after mechanical thrombectomy, though not without limitations. Agreement improved when scores were dichotomized around the clinically relevant threshold of successful revascularization. Interrater reliability improved with time, suggesting that formal training of interventionalists may improve reporting reliability. Agreement of the modified TICI scale is best with M1 and ICA occlusion and becomes less reliable with more distal or posterior circulation occlusions. These findings should be considered when developing research trials., (© 2020 by American Journal of Neuroradiology.)

Background: Atlantoaxial instability (AAI) is a common cause of neurologic dysfunction and pain in patients with Down syndrome (DS), frequently requiring instrumented fusion of the upper cervical spine. Despite this, optimal treatment strategy is controversial., Methods: A systematic review of the literature was performed according to the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement to identify patients with AAI and DS were treated with upper cervical spine fusion. Patient demographics, preoperative symptoms, fixation type, and outcome measures including complications, neurologic outcomes, and bony fusion status were gathered for patients in the included publications. Meta-analysis was performed to compare outcomes of different types of fixation constructs., Results: Of the 1191 publications retrieved, 51 met inclusion criteria, yielding 137 patients. Six fixation strategies were identified: noninstrumented (n = 6), wiring (n = 77), wiring with rods (n = 14), screw fixation (n = 33), hook and rod fixation (n = 2), and screw and wire fixation (n = 5). Constructs with screws and rods had greater bony union (P = 0.003) and a lower rate of revision surgery (P = 0.047), loss of reduction or pseudoarthrosis (P = 0.009), halo utilization (P < 0.001), and early neurologic decline (P = 0.004) compared with wiring alone. Constructs with wires and rods had greater bony union (P = 0.036) than wiring alone., Conclusions: Numerous fixation strategies exist for AAI in patients with DS. Using a combination of screws, rods, and wiring in appropriately selected patients may help reduce the high rate of surgical complications in these patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Previous studies have shown that the successive negative contrast procedure, in which food-restricted rats entrained to once daily, brief presentations of 32% sucrose are unexpectedly shifted to a 4% solution, results in an adrenocortical response on the second, but not the first postshift day. We attempted to generalize that finding in our own procedure. In Experiment 1, two groups of rats were given a 32% sucrose solution once daily in their home cages for 14 days before being shifted to a 4% solution. One group was killed 10 min after the first 4% solution and one was killed after the second 4% solution. In addition, two groups receiving either 32% or 4% sucrose throughout the experiment served as unshifted controls. In contrast to previous findings, both shifted groups exhibited prominent adrenocorticotropin hormone (ACTH) and adrenocortical (B) responses on both postshift days compared to unshifted controls, which did not differ from one another. Experiment 2a employed distinctive contexts to test if the lack of generality of the delayed HPA axis response was due to suppressive effects of S(+) on the first postshift day. Rats were given once daily 32% sucrose in S(+) and equal exposure time in S(-). Half of these rats were shifted to 4% sucrose in S(+) and half were shifted in S(-). These two groups were compared to home cage controls. Half of each group was killed after their first 4% sucrose, and half after the second 4% sucrose. All rats showed ACTH and B responses comparable to shifted rats in Experiment 1. S(+) failed to suppress the HPA axis, and the stress response was higher on the first compared to the second day of the shift. Experiment 2b established that distinctive contexts predicting sucrose, S(+), or not predicting sucrose, S(-), controlled behavioral choice and contextual discrimination. Thus, there was no evidence that issues of stimulus control could explain the lack of generality of previous findings. The data indicate that thwarting sucrose expectancies is stressful, and that this stress response habituates across days.

Previous findings (N. Pecoraro, J. Chou-Green, & M. F. Dallman, 2003; N. Pecoraro & M. F. Dallman, 2005) indicated that unexpected reductions in sucrose concentration in once daily meals result in a febrile response on the 1st, but not the 2nd day of a concentration shift. This study shows that this day-specific fever is blocked by adrenalectomy accompanied by constant low corticosterone replacement. Rats implanted with telemetry probes were adrenalectomized and given low-corticosterone pellets or were sham operated. Food-restricted rats were given 2 rounds of sucrose concentration downshifts, as follows: 32% sucrose (14 days), 4% sucrose (6 days), 32% sucrose (4 days), and 4% sucrose (4 days). Intact rats showed more pronounced anticipation of the sucrose than did rats having low, clamped corticosterone. Only intact rats showed a 4-hr, postshift temperature burst on the 1st, but not the 2nd day of the shift to 4% sucrose, during both rounds of shifting. Increased activity accompanied the fever. These data confirm previous findings, show them to be dependent on high corticosterone, and appear to be related to a host of day-specific alterations in other motor outflows following unexpected downward shifts in palatable sucrose concentrations., (((c) 2007 APA, all rights reserved).)

Based on observed phenotypic differences in growth and ACTH responses to stress in Sprague Dawley rats obtained from different vendors, we ran head-to-head comparisons on rats obtained from three different vendors, Harlan, Charles River, and Simonsen, with respect to baseline phenotypic differences and a metabolic feedback hypothesis of hypothalamo-pituitary-adrenal (HPA) regulation. Charles River and Harlan rats gained weight faster than Simonsen rats, but chow intake standardized for body weight was not increased, consistent with their greater caloric efficiency. Weight gain was inversely related with mean daily temperatures, without differences in activity levels. Half of the animals given lard and 32% sucrose solutions in addition to chow increased caloric intake and core temperature, decreased caloric efficiency, and increased fat depots, leptin, and in Simonsen rats, insulin. A 5-day regimen of once-daily 2-h restraint decreased feeding and caloric efficiency. Rats from two vendors with the availability of sucrose and lard, Charles River and Simonsen, showed blunted HPA responses to restraint compared to chow controls, whereas the Harlans exhibited no adrenocorticotropin (ACTH) response and an amplified adrenocortical response on the high-energy diet compared to chow controls. Substantial phenotypic differences exist between Sprague Dawley rats from different vendors with respect to metabolism and HPA function. The metabolic feedback hypothesis was supported in two of the three vendors' rats.

The hypothalamo-pituitary-adrenal (HPA) axis is the critical mediator of the vertebrate stress response system, responding to environmental stressors by maintaining internal homeostasis and coupling the needs of the body to the wants of the mind. The HPA axis has numerous complex drivers and highly flexible operating characterisitics. Major drivers include two circadian drivers, two extra-hypothalamic networks controlling top-down (psychogenic) and bottom-up (systemic) threats, and two intra-hypothalamic networks coordinating behavioral, autonomic, and neuroendocrine outflows. These various networks jointly and flexibly control HPA axis output of periodic (oscillatory) functions and a range of adventitious systemic or psychological threats, including predictable daily cycles of energy flow, actual metabolic deficits over many time scales, predicted metabolic deficits, and the state-dependent management of post-prandial responses to feeding. Evidence is provided that reparation of metabolic derangement by either food or glucocorticoids results in a metabolic signal that inhibits HPA activity. In short, the HPA axis is intimately involved in managing and remodeling peripheral energy fluxes, which appear to provide an unidentified metabolic inhibitory feedback signal to the HPA axis via glucocorticoids. In a complementary and perhaps a less appreciated role, adrenocortical hormones also act on brain to provide not only feedback, but feedforward control over the HPA axis itself and its various drivers, as well as coordinating behavioral and autonomic outflows, and mounting central incentive and memorial networks that are adaptive in both appetitive and aversive motivational modes. By centrally remodeling the phenotype, the HPA axis provides ballistic and predictive control over motor outflows relevant to the type of stressor. Evidence is examined concerning the global hypothesis that the HPA axis comprehensively induces integrative phenotypic plasticity, thus remodeling the body and its governor, the brain, to yoke the needs of the body to the wants of the mind. Adverse side effects of this yoking under conditions of glucocorticoid excess are discussed.

To test whether glucocorticoids amplify incentive motivation, three groups of rats were adrenalectomized and replaced subcutaneously with pellets of corticosterone (B), containing 0, 30, or 80% B and cholesterol. A fourth group of sham adrenalectomized rats received cholesterol pellets. Animals were placed on a four-arm maze baited with 32% sucrose for 5-min daily sessions. After 7 days of minimal drinking on the maze at free-feeding weights, their body weights were gradually reduced to 90% of their free-feeding weights for the next 12 days (pre-shift phase). The sucrose concentration was reduced to 4% for the next 2 days (post-shift phase). B dose-dependently increased 32% sucrose intake, insulin secretion, and relative fat depots. Intake was reduced similarly in all groups following the shift to 4%, resulting in a relative B-dependent intake suppression following the shift to 4%. Videoscoring of locomotor activity indicated that search behaviors were not different between groups prior to the shift to 4%, whereas the increase in search behavior following the shift to 4% sucrose was entirely B-dependent. These data were predicted by a new model of chronic stress positing two regulatory axes on brain by glucocorticoids: one indirect axis by which glucocorticoids remodel energy stores to provide metabolic feedback and a direct axis whereby glucocorticoids act directly on brain to remodel appetitive structure.

This study tested whether pre-training pairings of ingestion of a 32% sucrose solution and injection(s) of corticosterone (B) would enhance later ingestion in the absence of B, and whether these effects would carry over into later contrast-like effects when animals were subsequently shifted to 4% sucrose. Frequency-dependence of these pairings was also examined. Three groups of male Sprague-Dawley rats were adrenalectomized (ADX). A fourth group was sham ADX. Each ADX group received three presentations of sucrose and B (666 microg/kg, s.c.). One received unpaired presentations (separated by days), one received two unpaired presentations and one paired (i.e., simultaneous) presentation, and one received three paired presentations. Shams received three sucrose presentations paired with saline. Single, but not multiple pairings of B with ingestion of a 32% sucrose solution enhanced later sucrose ingestion, a memorial-like effect that carried over into later, opposite contrast-like effects upon presentation of a less-preferred 4% sucrose solution. These effects could not be easily ascribed to differences in training, other than the pairing regimen itself, nor to motivational differences at the time of testing, and were presumed to be memorial. The pairing and frequency-dependence of these appetitive phenomena are analogous to what is frequently observed during acute or chronic exposure to aversive situations and/or neuromodulatory stress hormones, in terms of their bidirectional effects on memory. Through effects on memory, stress hormones may modulate reward and reward relativity.

Rats were used in a successive negative contrast procedure to determine which brain structures were activated by sucrose concentration downshifts, and on what day this occurred. Subjects were given preshift solutions for 12 days before being shifted to their postshift concentrations. Groups included 2 unshifted controls (32%-32% and 4%-4%) and 1 shifted group (32%-4%). Half of each group was killed 1 hr after the first exposure to the shifted solution (Shift 1), and half after the second exposure (Shift 2). Brains were processed for c-Fos-like immunoreactivity (FLI). Two major patterns emerged. Terminal drinking of 32% sucrose activated minimal brainstem regions involved in palatable taste, visceral feedback, and fluid homeostasis. In contrast, shifted subjects showed extensive cortical activation with selective activation in cerebral nuclei and brainstem. Robust FLI on Shift 1 was absent on Shift 2, consistent with evidence for rapid (1-trial) changes in all major motor outputs mediated by expectancy., (Copyright (c) 2005 APA, all rights reserved.)

We suggested a new model of the effects of glucocorticoids (GCs) exerted during chronic stress, in which GCs directly stimulate activities in the brain while indirectly inhibiting activity in the hypothalamo-pituitary-adrenal (HPA) axis through their metabolic shifts in energy stores in the periphery. This study is an initial test of our model. In a 2 x 2 design, we provided ad lib access to calorically dense lard and sucrose (comfort food) + chow or chow alone, and repeatedly restrained half of the rats in each group for 5 d (3 h/d). We measured caloric intake, body weight, caloric efficiency, ACTH, corticosterone (B), and testosterone during the period of restraint and leptin, insulin, and fat depot weights, as well as hypothalamic corticotropin-releasing factor mRNA at the end of the period. We hypothesized that chronically restrained rats would exhibit a relative increase in comfort food ingestion and that these rats would have reduced HPA responses to repeated restraint. Although total caloric intake was reduced in both groups of restrained rats, compared with controls, the proportion of comfort food ingested increased in the restrained rats compared with their nonrestrained controls. Moreover, caloric efficiency was rescued in the stressed, comfort food group. Furthermore, ACTH and B responses to the repeated restraint bouts were reduced in the rats with access to comfort food. Corticotropin-releasing factor mRNA was reduced in control rats eating comfort food compared with those eating chow, but there were no differences between the stressed groups. The results of this experiment tend to support our model of chronic effects of stress and GCs, showing a stressor-induced preference for comfort food, and a comfort-food reduction in activity of the HPA axis.