These data suggest a relative independence in the regulation of the HPA axis and the autonomic nervous system in response to everyday stressors but synchrony of both systems in highly stressful situations.

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Background: The characterization of an individual’s hypothalamic-pituitary-adrenal axis stress response is a main research topic in neuropsychobiology since alterations have been causally linked to several disease states. Over the last years, several studies focused on the identification of sources of inter- and intraindividual variability, but there is still a paucity of experimental data on the effect of different pharmaceuticals on cortisol responses to acute psychological stress. Therefore, in this randomized double-blind placebo-controlled study, we investigated the effect of treatment with two popular and clinically used pharmaceuticals on stress-related cortisol responses, namely acetylsalicylic acid (aspirin), a known prostaglandin synthesis inhibitor, and the beta-blocker propranolol (Inderal), a nonselective beta-receptor antagonist. Methods: For 5 days, 73 healthy subjects (50 men, 23 women; mean age 47.3 ± 7.7 years) received either a daily oral dose of 100 mg aspirin, 80 mg propranolol (Inderal), aspirin + propranolol, or placebo. After treatment, subjects were confronted with the Trier Social Stress Test, a widely-used standardized psychosocial stress protocol. Cortisol responses were measured by six saliva samples taken before and after the stress exposure. Results: Subjects showed a significant cortisol increase after stress (p < 0.0001). The four treatment groups did not differ in their cortisol responses (group effect p > 0.44; interaction p > 0.97). Additionally, controlling for gender, age, smoking status, body mass index, mean arterial blood pressure or pre-stress cortisol levels yielded similar results in the total sample as well as in the male or female subgroups, respectively. Conclusion: Neither short-term treatment with aspirin nor propranolol altered the acute free cortisol response to psychological stress in healthy adults.

We hypothesized that the 2 cardiovascular drugs aspirin and propranolol attenuate the prothrombotic response to acute psychosocial stress relative to placebo medication. We randomized 56 healthy subjects, double-blind, to 5-day treatment with an oral dose of either 100 mg of aspirin plus 80 mg of propranolol combined, single aspirin, single propranolol, or placebo medication. Thereafter, subjects underwent a 13-minute psychosocial stressor. Plasma levels of von Willebrand factor antigen (VWF:Ag), fibrinogen, coagulation factor VII (FVII:C) and XII (FXII:C) activity, and D-dimer were determined in blood samples collected immediately pre- and post-stress and 45 minutes post-stress. The stress-induced changes in prothrombotic measures were adjusted for gender, age, body mass index, mean arterial blood pressure, smoking status, and sleep quality. There was an increase in VWF:Ag levels from immediately pre-stress to 45 minutes post-stress in the placebo group relative to the 3 subject groups with verum medication (P's

Activity of clotting factor VIII has been shown to acutely increase with sympathetic nervous system stimulation. We investigated whether aspirin and propranolol affect the responsiveness of plasma clotting factor VIII activity levels to acute psychosocial stress. We randomized 54 healthy subjects double-blind to 5-day treatment with a single daily oral dosage of either 100 mg aspirin plus 80 mg propranolol combined, 100 mg of aspirin, 80 mg of propranolol, or placebo medication. Thereafter, subjects underwent a 13-min standardized psychosocial stressor. Plasma levels of clotting factor VIII activity were determined immediately before, immediately after, 45 min and 105 min after stress. Controlling for demographic, metabolic, and life style factors repeated measures analysis of covariance showed that the change in clotting factor VIII activity from prestress to 105 min poststress differed between medication groups (P = 0.023; partial eta = 0.132). The clotting factor VIII activity level decreased from prestress to immediately poststress in the aspirin/propranolol group relative to the placebo group (P = 0.048) and the aspirin group (P < 0.06). Between 45 min and 105 min poststress, clotting factor VIII levels increased in the aspirin/propranolol group relative to the placebo group (P = 0.007) and the aspirin group (P = 0.039). The stress response in clotting factor VIII activity levels was not significantly different between the aspirin/propranolol group and the propranolol group. Propranolol in combination with aspirin diminished the acute response in clotting factor VIII activity to psychosocial stress compared with placebo medication and aspirin alone. The effect of single aspirin on the acute clotting factor VIII stress response was indistinguishable from a placebo effect.

Middle-aged nursing aides who worked to 80-90 % are particularly at risk to resign from the position prematurely. Measures need to be mainly implemented in the social and organizational areas. It can be assumed that a targeted individual support, recognition and promotion of nursing aides may decrease the level of job strain.

Zusammenfassung. Hintergrund: Patientinnen und Patienten mit einer Krebstherapie sind mit krebs- und therapiebedingten Symptomen konfrontiert und fühlen sich im Umgang damit oft unsicher. Zur Förderung des Symptom-Selbstmanagements wurde das sogenannte Symptom-Navi-Programm (SNP) entwickelt. Es beinhaltet individualisierte Abgabe schriftlicher Kurzinformationen, genannt Symptom-Navi-Flyer (SNF), im Rahmen von halb-strukturierten pflegerischen Edukationsgesprächen. Ziel: Die Studie untersuchte, ob Betroffene das SNP (SNF und ihre individualisierte Abgabe im Rahmen strukturierter Gespräche) als unterstützend für ihr Symptom-Selbstmanagement erfahren. Methode: In einer qualitativen Studie wurden zehn halbstrukturierte Interviews im onkologisch ambulanten Setting durchgeführt. Die Interviews wurden anhand der thematischen Analyse nach 1-1Braun und Clarke (2006) ausgewertet. Ergebnisse: Insgesamt beschrieben die Befragten das SNP als sehr unterstützend für ihr Symptom-Selbstmanagement, dies in einer Situation, in der sie stark emotional herausgefordert waren. Die individualisierte Abgabe der SNF und Beratung schilderten sie als förderlich für ihr Symptom-Selbstmanagement. Sie beobachteten eine Erweiterung ihres Handlungsspielraums im Umgang mit den Symptomen. Die Befragten nutzten SNF auch um ihre Angehörigen zu informieren. Schlussfolgerungen: Das SNP ist aus der Patientinnen- und Patientenperspektive vielversprechend, um das Symptom-Selbstmanagement zu fördern. Es wird nun systematisch in die Versorgungspraxis implementiert und weiter evaluiert.