Diurnal patterns of salivary cortisol and DHEA using a novel collection device: electronic monitoring confirms accurate recording of collection time using this device

Saliva biomarkers in oral disease

Saliva is a versatile biofluid that contains a wide variety of biomarkers reflecting both physiologic and pathophysiologic states. Saliva collection is noninvasive and highly applicable for tests requiring serial sampling. Furthermore, advances in test accuracy, sensitivity and precision for saliva has improved diagnostic performance as well as the identification of novel markers especially in oral disease processes. These include dental caries, periodontitis, oral squamous cell carcinoma (OSCC) and Sjögren's syndrome (SS). Numerous growth factors, enzymes, interleukins and cytokines have been identified and are the subject of much research investigation. This review highlights current procedures for successful determination of saliva biomarkers including preanalytical factors associated with sampling, storage and pretreatment as well as subsequent analysis. Moreover, it provides an overview of the diagnostic applications of these salivary biomarkers in common oral diseases.

Changes in cortisol and dehydroepiandrosterone levels immediately after urban park visits

The purpose of this study is to explore physiological and psychological changes immediately after a short-term visit to urban parks in an uncontrolled condition. Sixty park visitors completed a short questionnaire evaluating their subjective well-being (SWB) and donated a saliva sample immediately before and after their park visit. In addition, participants wore a pedometer to track their physical activity level during the park visit. Results indicated the levels of all biomarkers (cortisol, dehydroepiandrosterone [DHEA], and cortisol/DHEA ratio) decreased while SWB scores increased after the park visit. The duration of park visit was identified as a key variable significantly associated with cortisol reduction, and changes in SWB scores after the park visit were significantly associated with changes in cortisol level. A park visit duration of 21.8 min has the predictive ability to discriminate park visitors who exhibit reductions in cortisol levels after the park visit from those who do not.

Measuring stress: a review of the current cortisol and dehydroepiandrosterone (DHEA) measurement techniques and considerations for the future of mental health monitoring

Psychological stress and its inevitable trajectory toward mental health deteriorations such as clinical and major depression has become an unprecedented global burden. The diagnostic procedures involved in the characterization of mental illnesses commonly follow qualitative and subjective measures of stress, often leading to greater socioeconomic burdens due to misdiagnosis and poor understanding of the severity of such illnesses, further fueled by the stigmatization surrounding mental health. In recent years, the application of cortisol and stress hormone measurements has given rise to an alternative, quantifiable approach for the psychological evaluation of stress and depression. This review comprehensively evaluates the current state-of-the-art technology for measuring cortisol and dehydroepiandrosterone (DHEA) and their applications within stress monitoring in humans. Recent advancements in these fields have shown the importance of measuring stress hormones for the characterization of stress manifestation within the human body, and its relevance in mental health decline. Preliminary results from studies considering multimodal approaches toward stress monitoring have showcased promising developments, emphasizing the need for further technological advancement in this field, which consider both neurochemical and physiological biomarkers of stress, for global benefit.

Citalopram Neuroendocrine Challenge Shows Altered Tryptophan and Kynurenine Metabolism in Migraine

Altered tryptophan (TRP) metabolism may have an important role in migraine susceptibility through its main metabolites, serotonin and kynurenine (KYN). Both affect pain processing and stress response by interfering with neural and brain hypersensitivity and by interacting with chemokines and cytokines that control vascular and inflammatory processes. The involvement of these pathways in migraine has been widely studied, but acute citalopram neuroendocrine challenge on TRP metabolism and cytokine profile has not been investigated yet. In our study, females with episodic migraine without aura and healthy controls were studied before and after acute citalopram or placebo in a double-blind setting. At baseline, increased TRP/large neutral amino acid (LNAA) ratio and decreased RANTES chemokine concentration were detected in migraine patients compared to controls. The challenge induced a significant increase in TRP, KYN, and TRP/LNAA in healthy controls, but not in migraine patients. Furthermore, migraine attack frequency negatively correlated with KYN/TRP ratio and positively correlated with the neuroendocrine-challenge-induced KYN concentration increase. Our results support a decreased breakdown of TRP via KYN pathway and a failure to modulate TRP–KYN pathway during citalopram-induced acute stress together with an increased vascular sensitivity in migraine. These mechanisms may provide useful drug targets for future drug development.

Dermatitis during Spaceflight Associated with HSV-1 Reactivation

Human alpha herpesviruses herpes simplex virus (HSV-1) and varicella zoster virus (VZV) establish latency in various cranial nerve ganglia and often reactivate in response to stress-associated immune system dysregulation. Reactivation of Epstein Barr virus (EBV), VZV, HSV-1, and cytomegalovirus (CMV) is typically asymptomatic during spaceflight, though live/infectious virus has been recovered and the shedding rate increases with mission duration. The risk of clinical disease, therefore, may increase for astronauts assigned to extended missions (>180 days). Here, we report, for the first time, a case of HSV-1 skin rash (dermatitis) occurring during long-duration spaceflight. The astronaut reported persistent dermatitis during flight, which was treated onboard with oral antihistamines and topical/oral steroids. No HSV-1 DNA was detected in 6-month pre-mission saliva samples, but on flight day 82, a saliva and rash swab both yielded 4.8 copies/ng DNA and 5.3 × 104 copies/ng DNA, respectively. Post-mission saliva samples continued to have a high infectious HSV-1 load (1.67 × 107 copies/ng DNA). HSV-1 from both rash and saliva samples had 99.9% genotype homology. Additional physiological monitoring, including stress biomarkers (cortisol, dehydroepiandrosterone (DHEA), and salivary amylase), immune markers (adaptive regulatory and inflammatory plasma cytokines), and biochemical profile markers, including vitamin/mineral status and bone metabolism, are also presented for this case. These data highlight an atypical presentation of HSV-1 during spaceflight and underscore the importance of viral screening during clinical evaluations of in-flight dermatitis to determine viral etiology and guide treatment.

Inter-individual differences in pain anticipation and pain perception in migraine: Neural correlates of migraine frequency and cortisol-to-dehydroepiandrosterone sulfate (DHEA-S) ratio

Previous studies targeting inter-individual differences in pain processing in migraine mainly focused on the perception of pain. Our main aim was to disentangle pain anticipation and perception using a classical fear conditioning task, and investigate how migraine frequency and pre-scan cortisol-to-dehydroepiandrosterone sulfate (DHEA-S) ratio as an index of neurobiological stress response would relate to neural activation in these two phases. Functional Magnetic Resonance Imaging (fMRI) data of 23 participants (18 females; mean age: 27.61± 5.36) with episodic migraine without aura were analysed. We found that migraine frequency was significantly associated with pain anticipation in brain regions comprising the midcingulate and caudate, whereas pre-scan cortisol-to DHEA-S ratio was related to pain perception in the pre-supplementary motor area (pre-SMA). Both results suggest exaggerated preparatory responses to pain or more general to stressors, which may contribute to the allostatic load caused by stressors and migraine attacks on the brain.

Stabilization of Salivary Biomarkers

The use of saliva as a diagnostic biofluid has been increasing in recent years, thanks to the identification and validation of new biomarkers and improvements in test accuracy, sensitivity, and precision that enable the development of new noninvasive and cost-effective devices. However, the lack of standardized methods for sample collection, treatment, and storage contribute to the overall variability and lack of reproducibility across analytical evaluations. Furthermore, the instability of salivary biomarkers after sample collection hinders their translation into commercially available technologies for noninvasive monitoring of saliva in home settings. The present review aims to highlight the status of research on the challenges of collecting and using diagnostic salivary samples, emphasizing the methodologies used to preserve relevant proteins, hormones, genomic, and transcriptomic biomarkers during sample handling and analysis.

Studying caregiver-infant co-regulation in dynamic, diverse cultural contexts: A call to action

Caregivers and infants co-regulate their physiology, emotions, and behavior in a way that is dynamically responsive to each other and the contexts in which they live. This paper is an introduction and call to action for researchers interested in understanding how to study caregiver-infant interactions in the home and diverse cultural contexts, including marginalized communities. We argue that research will be more valid, culturally relevant, and tapped-in to the daily lives of caregivers and infants if there is partnership and collaboration with the caregivers in the design of the questions, data collection and analysis, and distribution of the findings. We recommend dynamically assessing emotions, behaviors, and physiology using repeated sampling methods including ecological momentary assessments (EMA), salivary bioscience, and actigraphy. We aim to extend current practices of studying caregiver-infant co-regulation by measuring fluctuations of daily life and considering sociocultural factors that shape naturalistic caregiver-infant interactions. Using methodological advancements and community-based participatory research approaches can enable developmental scientists to measure life as it is actually lived.

Blood and affective markers of stress in Elite Airmen during a preparatory training course: A pilot study

In highly stressful environments, individuals with diverging stress-reactivity can perform differently. Identification of blood markers of stress-reactivity is of major significance to help human performance during stress. Candidate transcripts were identified between stressed and non-stressed strains of rats’ blood and brain, and overlapping significant differentially expressed genes were selected. Serum levels of human orthologues of these proteins, in lieu of blood RNA, in addition to classic stress and general clinical markers, were measured in 33 Battlefield Airmen undergoing a 52 day long preparatory training course before their course of initial entry (COIE). Blood samples and factors of affective state, negative valence “Threat” and positive valence “Challenge”, were obtained five times across different days of training which included either routine physical exercise or prolonged and intense physical and mental training. During training, levels of chloride (Cl), dehydroepiandrosterone-sulfate (DHEA-S), creatinine kinase (CK), and total carbon dioxide (TCO2) differed between airmen who subsequently graduated from their COIE and those who did not. Time dependent changes of serum TCO2 and neuropeptide Y (NPY), as well as the affective factor Challenge differed by future graduation status throughout the training. Serum levels of parvin beta (PARVB) correlated with the affective factor Threat, while those of NPY, testosterone, coactosin like F-actin binding protein 1 (COTL1) and C-reactive protein (CRP) correlated with factor Challenge during the extended, intensive periods of training, consistently. These pilot data suggest that the identified panel of blood markers can measure stress responsiveness, which has the potential to advance individualized stress-management strategies.

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Levels of novel and classical serum markers signal stress severity in men.

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Biomarker levels reflect stress reactivity of Battlefield Airmen in training.

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Affective measures correlate with serum biomarkers after extended stress.

SLOCK (sensor for circadian clock): passive sweat-based chronobiology tracker

SLOCK is a human sweat based platform for circadian relevant biomarkers- cortisol and DHEA. It monitors passively expressed eccrine and apocrine sweat towards measuring and reporting cortisol and DHEA concentrations over multiple time points in humans. The sensor works on the principle of affinity based electrochemical detection. The novelty lies in the usage of a hybrid porosity platform for enhancing multibiomarker detection ability through sweat. The platform is the first demonstration of chronobiology tracking using multiple biomarkers supported by human subject based study. The sensor performance is evaluated on a set of six healthy human subjects, which are varied by age, gender, and ethnicity. Following this, the sensor performance is confirmed using ELISA, a commercially used diagnostic technique. From the results, it can be observed that the sensor is highly sensitive to the target biomarker concentrations in the physiological range of 8-141 ng ml^-1. The platform is also able to capture the biomarker rise and fall (i.e., going from a low concentration of 1 ng ml^-1 to a high concentration of 100 ng ml^-1 and back down to 10 ng ml^-1). This is reflected by a percentage change of cumulative sensor response by 10%, 20%, and 22%, respectively from baseline, for cortisol. Similarly for DHEA, the sensor shows sensitivity to rising and falling changes with percentage changes of 45%, 55%, and 56% for 1, 100, and 10 ng ml^-1 biomarker concentrations. This sensitivity is crucial in order to develop the circadian profile for the user. Thus, the sensor offers a first time demonstration of the potential of a passive self-monitoring approach for managing circadian abnormalities and is a good platform for tracking chronobiology.

Flexible, low volume detection of chronobiology biomarkers from human sweat

The work demonstrates the development of a chronobiology tracking system using an affinity-based electrochemical detection modality. This serpentine electrode based system is non-invasive, label free, and economical enabling passive sweat tracking.

Urban Nature Experiences Reduce Stress in the Context of Daily Life Based on Salivary Biomarkers

Stress reduction through contact with nature is well established, but far less is known about the contribution of contact parameters - duration, frequency, and nature quality. This study describes the relationship between duration of a nature experience (NE), and changes in two physiological biomarkers of stress - salivary cortisol and alpha-amylase. It is the first study to employ long-term, repeated-measure assessment and the first evaluation wherein study participants are free to choose the time of day, duration, and the place of a NE in response to personal preference and changing daily schedules. During an 8-week study period, 36 urban dwellers were asked to have a NE, defined as spending time in an outdoor place that brings a sense of contact with nature, at least three times a week for a duration of 10 min or more. Their goal was compliance within the context of unpredictable opportunity for taking a nature pill. Participants provided saliva samples before and after a NE at four points over the study period. Before-NE samples established the diurnal trajectory of each stress indicator and these were in line with published outcomes of more closely controlled experiments. For salivary cortisol, an NE produced a 21.3%/hour drop beyond that of the hormone's 11.7% diurnal drop. The efficiency of a nature pill per time expended was greatest between 20 and 30 min, after which benefits continued to accrue, but at a reduced rate. For salivary alpha-amylase, there was a 28.1%/h drop after adjusting for its diurnal rise of 3.5%/h, but only for participants that were least active sitting or sitting with some walking. Activity type did not influence cortisol response. The methods for this adaptive management study of nature-based restoration break new ground in addressing some complexities of measuring an effective nature dose in the context of normal daily life, while bypassing the limitations of a clinical pharmacology dose-response study. The results provide a validated starting point for healthcare practitioners prescribing a nature pill to those in their care. This line of inquiry is timely in light of expanding urbanization and rising healthcare costs.

Is cortisol production in response to an acute stressor associated with diurnal cortisol production during adolescence?

The goal of the current study was to examine the extent to which cortisol responding to an acute stressor is related to diurnal cortisol patterns during adolescence. Participants were 105 adolescents (10-17 years of age) who experienced a robust social-evaluative stressor and provided saliva samples (before and immediately after, as well as 10, 20, and 30 min after the stressor) to assess both cortisol reactivity and recovery and also provided saliva samples (at wake-up, 30 min after wake-up, 4 pm, and at bedtime) on two consecutive days to measure diurnal cortisol production. Dual process latent growth curve models, one for cortisol reactivity and one for diurnal cortisol, indicated that dampened cortisol reactivity and prolonged cortisol recovery (i.e., less cortisol produced during reactivity but more cortisol produced during recovery) were associated with dampened decreases in cortisol production across the day, suggesting that adolescents are likely to show attenuation in multiple components of HPA axis functioning.

Adherence to Diurnal Cortisol Sampling Among Mother-Child Dyads From Maltreating and Nonmaltreating Families

There has been increasing interest in evaluating whether interventions for child maltreatment can improve and/or prevent child physiological dysregulation via measurement of diurnal cortisol. The assessment of diurnal cortisol typically involves the home-based collection of saliva multiple times per day, bringing forth important methodological considerations regarding adherence to collection instructions. To date, there has been no data regarding adherence to home collection of diurnal cortisol among maltreating families. The current study provides data on adherence to in-home sampling of salivary cortisol among 166 maltreating and demographically similar nonmaltreating mother-child dyads using electronic monitoring devices (Medication Event Monitoring System caps). Mothers collected saliva samples on themselves and their children 3 times per day (waking, midday, and evening) for 2 consecutive days. Analyses reveal that although maltreating families were more likely to be nonadherent to the collection protocol on their initial attempt, with additional support and resampling, maltreating and nonmaltreating families were comparable on most measures of adherence. Suggestions for best practices, including the use of electronic monitoring devices, for diurnal cortisol collection with maltreating families are provided.

Latent virus reactivation in astronauts on the international space station

Reactivation of latent herpes viruses was measured in 23 astronauts (18 male and 5 female) before, during, and after long-duration (up to 180 days) spaceflight onboard the international space station . Twenty age-matched and sex-matched healthy ground-based subjects were included as a control group. Blood, urine, and saliva samples were collected before, during, and after spaceflight. Saliva was analyzed for Epstein-Barr virus, varicella-zoster virus, and herpes simplex virus type 1. Urine was analyzed for cytomegalovirus. One astronaut did not shed any targeted virus in samples collected during the three mission phases. Shedding of Epstein-Barr virus, varicella-zoster virus, and cytomegalovirus was detected in 8 of the 23 astronauts. These viruses reactivated independently of each other. Reactivation of Epstein-Barr virus, varicella-zoster virus, and cytomegalovirus increased in frequency, duration, and amplitude (viral copy numbers) when compared to short duration (10 to 16 days) space shuttle missions. No evidence of reactivation of herpes simplex virus type 1, herpes simplex virus type 2, or human herpes virus 6 was found. The mean diurnal trajectory of salivary cortisol changed significantly during flight as compared to before flight (P = 0.010). There was no statistically significant difference in levels of plasma cortisol or dehydoepiandosterone concentrations among time points before, during, and after flight for these international space station crew members, although observed cortisol levels were lower at the mid and late-flight time points. The data confirm that astronauts undertaking long-duration spaceflight experience both increased latent viral reactivation and changes in diurnal trajectory of salivary cortisol concentrations.

A novel biomarker associated with distress in humans: calcium-binding protein, spermatid-specific 1 (CABS1)

Calcium-binding protein spermatid-specific 1 (CABS1) is expressed in the human submandibular gland and has an anti-inflammatory motif similar to that in submandibular rat 1 in rats. Here, we investigate CABS1 in human saliva and its association with psychological and physiological distress and inflammation in humans. Volunteers participated across three studies: 1) weekly baseline measures; 2) a psychosocial speech and mental arithmetic stressor under evaluative threat; and 3) during academic exam stress. Salivary samples were analyzed for CABS1 and cortisol. Additional measures included questionnaires of perceived stress and negative affect; exhaled nitric oxide; respiration and cardiac activity; lung function; and salivary and nasal inflammatory markers. We identified a CABS1 immunoreactive band at 27 kDa in all participants and additional molecular mass forms in some participants. One week temporal stability of the 27-kDa band was satisfactory (test-retest reliability estimate = 0.62-0.86). Acute stress increased intensity of 18, 27, and 55 kDa bands; 27-kDa increases were associated with more negative affect and lower heart rate, sympathetic activity, respiration rate, and minute ventilation. In both acute and academic stress, changes in 27 kDa were positively associated with salivary cortisol. The 27-kDa band was also positively associated with VEGF and salivary leukotriene B4 levels. Participants with low molecular weight CABS1 bands showed reduced habitual stress and negative affect in response to acute stress. CABS1 is readily detected in human saliva and is associated with psychological and physiological indicators of stress. The role of CABS1 in inflammatory processes, stress, and stress resilience requires careful study.

Anabolic hormone profiles in elite military men

We recently characterized the awakening responses and daily profiles of the catabolic stress hormone cortisol in elite military men. Anabolic hormones follow a similar daily pattern and may counteract the catabolic effects of cortisol. This companion report is the first to characterize daily profiles of anabolic hormones dehydroepiandrosterone (DHEA) and testosterone in this population. Overall, the men in this study displayed anabolic hormone profiles comparable to that of healthy, athletic populations. Consistent with the cortisol findings in our prior report, summary parameters of magnitude (hormone output) within the first hour after awakening displayed superior stability versus summary parameters of pattern for both DHEA (r range: 0.77-0.82) and testosterone (r range: 0.62-0.69). Summary parameters of evening function were stable for the two hormones (both p<0.001), while the absolute decrease in testosterone across the day was a stable proxy of diurnal function (p<0.001). Removal of noncompliant subjects did not appreciably affect concentration estimates for either hormone at any time point, nor did it alter the repeatability of any summary parameter. The first of its kind, this report enables accurate estimations of anabolic balance and resultant effects upon health and human performance in this highly resilient yet chronically stressed population.

Effect of age, gender and exercise on salivary dehydroepiandrosterone circadian rhythm profile in human volunteers

There has been a lot of effort by scientists to elucidate the multi functions of the naturally occurring hormone, dehydroepiandrosterone (DHEA). However, to plan research experiments optimally, it is important first to characterize the diurnal rhythm in healthy individuals. The aim of this research was to investigate the daily circadian rhythms of DHEA among the 2 genders, and the effect of age and exercise on salivary DHEA circadian rhythms. Volunteers (20-39 and 40-60 years) were recruited for 2 studies investigating the salivary DHEA circadian rhythm. The first study looked at the effect of gender and age on DHEA levels on 2 non-consecutive days, and the second study explored the effect of exercise on DHEA circadian rhythm in males. DHEA levels were estimated by a sensitive and specific ELISA method. The results showed a clear daily circadian rhythm in salivary DHEA in all participants groups, however the profile was flatter in the older female group. There was a significant difference between age and gender groups particularly at 8.00 h. In young males DHEA reduced from 541.1 ± 101.3 (mean ± sd) at 8.00 h to 198.9 ± 90.7 pg/mL at 18.00 h; p<0.0001, and young females from 401.6 ± 149.5 to 215.4 ± 95.3 pg/mL; p<0.001. In older males DHEA reduced from 267.5 ± 32.4 to 132.5 ± 46.7 pg/mL; p<0.001, and older females from 147.7 ± 78.1 to 89.5 ± 29.1 pg/mL; p=0.05. DHEA levels on 2 non-consecutive days showed some variations but this was not significant. Aerobic exercise has significantly increased DHEA levels at 2 time points of the day (p=0.05) in male subjects. In conclusion, our study showed a clear daily circadian rhythm in salivary DHEA in all participants was observed, but the profile was flatter in the older groups.

Intraindividual Cortisol Variability and Psychological Functioning in Caregivers of Hematopoietic Stem Cell Transplant Patients

OBJECTIVE

Caregiving for allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients carries a significant psychological burden, yet it remains unclear whether Allo-HSCT caregivers demonstrate disruptions to stress systems, such as the hypothalamic-pituitary-adrenal axis. Greater intraindividual cortisol variability (ICV) has been observed in psychiatric disorders; however, there is a knowledge gap evaluating ICV in caregivers. We predicted that greater ICV would be related to poorer mental health in Allo-HSCT caregivers.

METHODS

Allo-HSCT caregivers (n = 140) collected saliva for 3 consecutive days at 4 time points/d. Psychological variables included sleep quality and a summary composite score of overall mental health.

RESULTS

Regression analyses demonstrated that greater ICV was significantly related to poorer overall mental health (β = 0.25, p = .009), whereas poorer sleep did not reach significance (β = 0.16, p = .069). No significant relationships emerged for the cortisol area under the curve, diurnal decline, or awakening response.

CONCLUSIONS

Results extend prior work examining ICV as a unique marker that is possibly more sensitive than other widely applied measures of hypothalamic-pituitary-adrenal axis dysregulation to a distressed population of caregivers.

Multiple latent viruses reactivate in astronauts during Space Shuttle missions

Latent virus reactivation and diurnal salivary cortisol and dehydroepiandrosterone were measured prospectively in 17 astronauts (16 male and 1 female) before, during, and after short-duration (12-16 days) Space Shuttle missions. Blood, urine, and saliva samples were collected during each of these phases. Antiviral antibodies and viral load (DNA) were measured for Epstein-Barr virus (EBV), varicella-zoster virus (VZV), and cytomegalovirus (CMV). Three astronauts did not shed any virus in any of their samples collected before, during, or after flight. EBV was shed in the saliva in all of the remaining 14 astronauts during all 3 phases of flight. Seven of the 14 EBV-shedding subjects also shed VZV during and after the flight in their saliva samples, and 8 of 14 EBV-shedders also shed CMV in their urine samples before, during, and after flight. In 6 of 14 crewmembers, all 3 target viruses were shed during one or more flight phases. Both EBV and VZV DNA copies were elevated during the flight phase relative to preflight or post-flight levels. EBV DNA in peripheral blood was increased preflight relative to post-flight. Eighteen healthy controls were also included in the study. Approximately 2-5% of controls shed EBV while none shed VZV or CMV. Salivary cortisol measured preflight and during flight were elevated relative to post-flight. In contrast DHEA decreased during the flight phase relative to both preflight and post-flight. As a consequence, the molar ratio of the area under the diurnal curve of cortisol to DHEA with respect to ground (AUCg) increased significantly during flight. This ratio was unrelated to viral shedding. In summary, three herpes viruses can reactivate individually or in combination during spaceflight.

Anxiety, depression, stress, and cortisol levels in mothers of children undergoing maintenance therapy for childhood acute lymphoblastic leukemia

The purpose of this study was to compare anxiety, depression, and stress between mothers of children during maintenance treatment for acute lymphoblastic leukemia (ALL) and matched controls. Twenty-six mothers were recruited from the hematology unit at a children's hospital, and 26 mothers were recruited from the community. Participants were matched to their child's age and gender. Mothers completed the Hospital Anxiety and Depression Scale, the Perceived Stress Sale, and collected salivary cortisol 4 times a day for 3 consecutive days. Compared with mothers of healthy children, anxiety scores did not differ (P=.10), but depression scores were higher (P=.003) in mothers of children with ALL. More mothers in the ALL group scored above the cutoff of 7 indicating clinical anxiety (46%) and depressive symptoms (27%). A trend toward increased stress was found in mothers in the ALL group. No difference was found in overall daily cortisol (area under the curve), daily decrease in cortisol (slope), and cortisol awakening response. Mothers of children with ALL experienced emotional symptoms many months after the initial diagnosis.

Salivary estradiol and testosterone in Filipino men: Diurnal patterns and relationships with adiposity

OBJECTIVES

We used detailed saliva sampling procedures to test for diurnal changes in men's salivary estradiol (E2) and testosterone (T) and assessed whether greater adiposity predicted higher E2 and T.

METHODS

We drew on a subsample of young adults enrolled in a long-running birth cohort study in Metro Cebu, Philippines. Subjects provided saliva samples at four time points during the day (waking, waking +40 min, early evening, and bedtime), which were assayed for E2 and T. Using these detailed hormonal data, we calculated E2 (n = 29) and T (n = 44) area-under-the-curve values, which provide insights on hormonal production over the study period.

RESULTS

While T declined immediately after waking and reached a nadir in the early evening, E2 did not show significant diurnal change (P ≥ 0.1) but was positively correlated to T at multiple time points (P ≤ 0.05). Subjects with higher adiposity (BMI, waist circumference, skinfolds) had elevated E2 secretion throughout the day (P ≤ 0.01), but adiposity was not related to salivary T.

CONCLUSIONS

Consistent with past research, our results indicate that adipose tissue is a significant site of E2 production in males but differ from a limited number of prior studies of young men in that we did not find lower T with increasing adiposity. Given E2's role in male hypothalamic-pituitary-gonadal function and complex interfaces with the immune system, these results have important implications for models of male life history as rates of overweight and obesity rise in populations around the world.

"Anatomy of an Illness": control from a caregiver's perspective

Caregivers of loved ones with chronic illnesses experience an uncontrollable challenge with potentially negative behavioral and medical consequences. Extensive research has demonstrated immune and endocrine regulation can be significantly disrupted by negative behavioral factors based on both animal models and human studies. However, fewer studies have focused on how psychosocial interventions might reverse the negative consequences of stressors such as caregiving. The distress of caring for individuals with cancer has only recently begun to receive attention. These interventions addressing caregiver distress are rare overall and caregivers of patients receiving hematopoietic stem cell transplants (HSCT) have received even less attention. HSCT caregivers report feelings of loss of control. Animal studies suggest that control over aversive events can mitigate the negative consequences of stressors. Caregivers of allogeneic HSCT patients for blood cancers must be available 24/7 for three months or longer following stem cell infusion to closely monitor the recipients' health and well-being. Does establishing a greater sense of control have positive impacts on caregivers? A randomized control trial of a cognitive behavioral stress management intervention for allogeneic HSCT caregivers is briefly described. A model of caregiver mental health which may potentially impact the patient's quality of life is proposed. These relationships exist in a complex system that includes genetic influences, sex, social environment, and prior experience. This system fits well within recent formulations of a "complexity science" approach to health and well-being.

Benefits of massage therapy for infants with symptoms of gastroesophageal reflux disease

OBJECTIVES

This randomized controlled pilot trial was conducted to evaluate the clinical efficacy of massage therapy (MT) for relief of symptoms of gastroesophageal reflux disease (GERD). The hypothesis was that, when compared to infants who received nonmassage therapy, infants who received MT would display fewer GERD symptoms, greater weight gain, greater amount of sleep, lower cortisol levels before and after treatment, and lower daily (area under the curve [AUC]) cortisol secretion.

METHODS

Participants were 36 infants born at term, 4-10 weeks of age at enrollment, healthy except for a diagnosis of GERD by their pediatrician, and with a score of at least 16 on the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R). Infants were randomized to receive either MT or a nonmassage sham treatment in their homes for 30 min twice a week for 6 weeks. Data collectors and parents were blind to study condition.

RESULTS

GERD symptoms decreased in both groups and weight increased. Pretreatment salivary cortisol levels decreased significantly over time in the massage group while increasing in the nonmassage group. Daily cortisol level also decreased in the massage group and increased in the nonmassage group, but the difference was not significant.

CONCLUSIONS

MT administered by a professional therapist did not affect symptoms of GERD differently than a sham treatment but did decrease infant stress as measured by cortisol. Research focusing on stress reduction in infants with GERD and multimodal treatments addressing GERD symptoms may yield the most effective treatment.

Approaches to salivary cortisol collection and analysis in infants

Salivary cortisol is becoming more commonly utilized as a biologic marker of stress in observational studies and intervention research. However, its use with infants (12 months of age or younger) is less widespread and poses some special challenges to researchers. In order to decide on the most suitable collection procedure for salivary cortisol in infants, a number of criteria should be considered. This article will aid investigators interested in integrating salivary cortisol measurement into their research studies by presenting (1) an overview of the patterns of cortisol secretion in infancy including the development of diurnal rhythm and response to stress; (2) a comparison of the most commonly used approaches for collecting salivary cortisol samples in infants including cotton rope, syringe aspiration technique, filter paper, hydrocellulose microsponge, and the Salimetrics children's swab; (3) a discussion of the factors contributing to heightened cortisol variability in infancy and how these can be limited; (4) analytical issues associated with cortisol measurement; and (5) examples of criteria to consider when choosing a saliva sampling method and lab for conducting assays.