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Salivary Cortisol (salivary + cortisol)
Terms modified by Salivary Cortisol Selected AbstractsThe Associations Between Basal Salivary Cortisol and Illness Symptomatology in Chronic Fatigue SyndromeJOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 3 2008Susan Torres-Harding Hypocortisolism has been reported in chronic fatigue syndrome (CFS), with the significance of this finding to disease etiology unclear. This study examined cortisol levels and their relationships with symptoms in a group of 108 individuals with CFS. CFS symptoms examined included fatigue, pain, sleep difficulties, neurocognitive functioning, and psychiatric status. Alterations in cortisol levels were examined by calculation of mean daily cortisol, and temporal variation in cortisol function was examined by means of a regression slope. Additionally, deviation from expected cortisol diurnal pattern was determined via clinical judgment. Results indicated that fatigue and pain were associated with salivary cortisol levels. In particular, variance from the expected pattern of cortisol was associated with increased levels of fatigue. The implications of these findings are discussed. [source] Gender- and Age-Related Differences in the Association Between Social Relationship Quality and Trait Levels of Salivary CortisolJOURNAL OF RESEARCH ON ADOLESCENCE, Issue 2 2008Alan Booth The majority of studies linking individual differences in the quality of social relationships and activity of the hypothalamic-pituitary-adrenal (HPA) axis have focused on the early development of attachment between infants and their caregivers. Later in development, during middle childhood and adolescence, the parallel HPA links to age-appropriate social relationships with peers, parents, and siblings remain largely unspecified. This study addressed this knowledge gap. Early morning saliva samples were obtained from 367 children in middle childhood (ages 6,10) and 357 adolescents (M age=11,16 years) on two successive days 1 year apart and assayed for cortisol. Latent state,trait modeling was employed to separate variance in cortisol levels attributable to "stable trait-like" versus "state or situational specific" sources to minimize the high moment-to-moment variation in basal adrenocortical activity. During adolescence but not middle childhood, and for girls but not boys, lower levels of "trait cortisol" were associated with poor quality social relationships. The pattern was robust, extending to the quality of relationships with parents, siblings, and peers. Importantly, the relationship was independent of the rates of internalizing or externalizing problem behavior. We found that isolating the variance in cortisol levels attributable to stable intrinsic sources revealed an interpretable pattern that linked individual differences in basal HPA activity to social relationships during adolescence. Studies are needed to reveal the biosocial mechanisms involved in the establishment of this gender- and age-specific phenomenon and to decipher whether or not individual differences in this hormone-behavior link are adaptive. [source] Salivary cortisol and psychosocial hazards at workAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 3 2009Giovanni Maina MD Abstract Background Experimental and clinical evidence suggest that stress can lead to ill-health through the disregulation of the hypothalamic,pituitary,adrenal (HPA) axis. Studies to date have produced equivocal results likely due to different methodologies and failure to account for confounding factors. This investigation aimed to assess the relation between self-reported work-related stressors and salivary cortisol and to clarify the role of the potential confounders. Methods Thirty-six call-handlers completed a self-administered job content questionnaire and collected seven daily salivary samples on two workdays and a weekend. The diurnal salivary cortisol output was expressed as cortisol awakening response (CAR), and cortisol output in the rest of the day. Salivary cortisol data were normalized by means of square root transformation. The generalized estimating equations method was used to assess the relation between job strain and cortisol levels after adjusting for gender, weekdays and adherence to the sampling schedule. Results Job strain significantly influenced the total amount of cortisol response to waking (high strain vs. low strain: 1.1 (0.3,2.0) nmol/L). The cortisol response to waking showed gender-specific differences [women excreting greater cortisol than men: 1.1 (0.3,1.9) nmol/L], and weekday differences [workdays vs. weekend: 1.0 (0.3,1.6) nmol/L]. Non-compliance with the sampling protocol was associated with lower salivary cortisol than in adherent subjects. Conclusions Our results provide further evidence for the HPA axis involvement in the physiological response to work stress. The measure of the CAR showed to be the sensitive index to assess the physiological response to psychosocial factors. Gender, weekday, and protocol compliance were confounding factors. Am. J. Ind. Med. 52:251,260, 2009. © 2008 Wiley-Liss, Inc. [source] Sex differences in negative affective response during nicotine withdrawalPSYCHOPHYSIOLOGY, Issue 4 2006Joanne M. Hogle Abstract This study examined physiological indicants of the neurobiological mediators of negative affect during acute nicotine withdrawal. Eighty subjects (41 male) were assigned to one of four groups (24-h deprived or nondeprived dependent smokers, occasional smokers, and nonsmokers) and participated in an instructed fear conditioning paradigm involving cued administration of electric shock. Negative affective response was measured with fear-potentiated startle during cues that signaled electric shock and during the postcue offset recovery period. Salivary cortisol and self-report measures were also collected. Fear-potentiated startle results indicated that affective recovery postcue offset was delayed in nicotine-deprived women. Nicotine-deprived women also displayed elevated cortisol levels throughout the fear conditioning procedure. [source] Variability in pain response to a non-pharmacological intervention across repeated routine pain exposure in preterm infants: a feasibility studyACTA PAEDIATRICA, Issue 5 2009E Cignacco Abstract Aim: To explore the variability in pain response in preterm infants across time who received sucrose during routine heel stick. Method: Single group, exploratory repeated measures design. Setting: Two tertiary level neonatal intensive care units (NICU) in Switzerland. Subjects: Nine preterm infants born between 28 2/7 and 31 4/7 weeks of gestation during their first 14 days of life. Measurements: Pain was assessed by the Bernese Pain Scale for Neonates (BPSN), the Premature Infant Pain Profile (PIPP) and the Visual Analogue Scale (VAS). Salivary cortisol was analysed. Results: 72,94% of the variability was within-subject variability, indicating inconsistency of pain responses across the 5 heel sticks. Interrater agreement was highest during heel sticks 1,3 and decreased during heel stick 4 and 5, indicating a possible alteration of pain patterns. No significant differences in the amount of cortisol could be detected before and after the heel sticks (p = 0.55), indicating no stress-induced peak after the painful intervention. However, a general gradual decrease of cortisol levels across time could be detected. Conclusion: A high variability in pain response among preterm neonates across time could be described. Consistency of cortisol levels before and after the heel sticks could indicate the effectiveness of sucrose across time. [source] A dose,response study of salivary cortisol after dexamethasone suppression test in Cushing's disease and its potential use in the differential diagnosis of Cushing's syndromeCLINICAL ENDOCRINOLOGY, Issue 6 2003Margaret Castro Summary objective, A dose,response study with different doses of dexamethasone (dex) to assess the corticotrophic resistance in Cushing's disease (CD) using salivary cortisol as an end point has not yet been evaluated. We also reported our experience with salivary cortisol compared to plasma cortisol determination during dex suppression test (DST) and after ovine corticotrophin release hormone (oCRH) test in the differential diagnosis of Cushing's syndrome (CS). design, We studied 46 patients with CS, including 28 patients with CD, 16 with adrenal disease and two with occult ectopic adrenocorticotropic hormone (ACTH) tumours. Salivary cortisol was compared to plasma cortisol and ACTH during a DST 2 mg for 2 days, 8 mg for 2 days and 24 mg for 1 day, and after oCRH test. results, We observed a dose-dependent suppression of salivary cortisol, plasma cortisol and ACTH in CD patients. Salivary cortisol presented a higher percentage of suppression than plasma cortisol: 42%vs. 15% (P < 0·002), 82%vs. 67% (P < 0·002) and 90%vs. 83% (P < 0·03) after 2, 8 and 24 mg/day dex, respectively. The lowest percentage of suppression was observed for plasma ACTH. The parallelism of these lines identified that the criterion of 65% suppression of salivary cortisol corresponding to 50% suppression of plasma cortisol after 8 mg/day for 2 days is consistent with CD. The sensitivity and specificity using 50% suppression for plasma cortisol were 81% and 83%, respectively, for 8 mg DST. Using the criterion of 65% suppression of salivary cortisol, the sensitivity and specificity were 86% and 100%, respectively, for 8 mg DST. After oCRH test the sensitivity and specificity were 86% and 91%, respectively, for ACTH, 100% and 64%, respectively, for plasma cortisol and 93% and 91%, respectively, (20% of increment) or 86% and 100%, respectively, (35% increment) for salivary cortisol. conclusion, In conclusion, salivary cortisol presents more profound suppression than plasma cortisol or ACTH in a dose,response pattern after different doses of dex in patients with CD. In addition, our data suggest that measurement of salivary cortisol might improve the DST as compared to plasma cortisol in the differential diagnosis of CS. [source] Sex Differences in Salivary Cortisol Levels Following Naltrexone Administration,JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 2 2000Laura Cousino Klein Effects of endogenous opioid peptide blockade by naltrexone on salivary Cortisol levels were examined in healthy men (n= 8) and women (n= 6). Participants received naltrexone (100 mg) during one laboratory session and a placebo pill during another session. Drug order was counterbalanced across participants. Saliva samples were collected 24 hr after each pill was administered. Among women, salivary Cortisol levels significantly increased following naltrexone administration compared with a placebo pill. Naltrexone administration did not alter salivary Cortisol levels in men. Results suggest sex differences in neuroendocrine sensitivity to opioid blockade, a finding that may hold significance with regard to the treatment of alcohol addiction with naltrexone. [source] Maternal prenatal anxiety, postnatal caregiving and infants' cortisol responses to the still-face procedureDEVELOPMENTAL PSYCHOBIOLOGY, Issue 8 2009Kerry-Ann Grant Abstract This study prospectively examined the separate and combined influences of maternal prenatal anxiety disorder and postnatal caregiving sensitivity on infants' salivary cortisol responses to the still-face procedure. Effects were assessed by measuring infant salivary cortisol upon arrival at the laboratory, and at 15-, 25-, and 40-min following the still-face procedure. Maternal symptoms of anxiety during the last 6 months of pregnancy were assessed using clinical diagnostic interview. Data analyses using linear mixed models were based on 88 women and their 7-month-old infants. Prenatal anxiety and maternal sensitivity emerged as independent, additive moderators of infant cortisol reactivity, F (3, 180),=,3.29, p,=,.02, F (3, 179),=,2.68, p,=,.05 respectively. Results were independent of maternal prenatal depression symptoms, and postnatal symptoms of anxiety and depression. Infants' stress-induced cortisol secretion patterns appear to relate not only to exposure to maternal prenatal anxiety, but also to maternal caregiving sensitivity, irrespective of prenatal psychological state. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 625,637, 2009 [source] Physiological and neuropsychological correlates of approach/withdrawal tendencies in preschool: Further examination of the behavioral inhibition system/behavioral activation system scales for young childrenDEVELOPMENTAL PSYCHOBIOLOGY, Issue 3 2004Clancy Blair Abstract This study examined a parent-report version of the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales, a measure of approach,withdrawal motivation, in 170 children between the ages of 3 to 5 years attending Head Start programs. Physiological measures included assessments of baseline salivary cortisol and change in cortisol in response to the assessment session, and resting and suppression estimates of cardiac vagal tone. Cognitive self-regulation was assessed with a peg-tapping measure of inhibitory control and an item-selection measure of cognitive set-shifting ability. Results indicated that higher level of parent-reported withdrawal motivation was associated with cortisol increase and that parent-reported approach motivation tended to be associated with cortisol decrease across the assessment session. Higher level of parent-reported withdrawal also was positively related to cognitive self-regulation while parent-reported approach was negatively related to cognitive self-regulation. Person-oriented analysis indicated that children characterized by both high level of approach and high level of withdrawal tended to exhibit lower resting vagal tone, higher initial cortisol, and minimal cortisol and vagal change. Overall, findings suggest that the parent-report version of the BIS/BAS scales works well as an indicator of children's reactivity to appetitive and aversive motivational stimuli. Directions for future research and implications of findings for the longitudinal study of temperament and personality are discussed. © 2004 Wiley Periodicals, Inc. Dev Psychobiol 45: 113-124, 2004. [source] A controlled rapid-sequence induction technique for infants may reduce unsafe actions and stressACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009C. EICH Background: Classic rapid-sequence induction of anaesthesia (RSI-classic) in infants and small children presents a time-critical procedure, regularly associated with hypoxia. This results in high stress levels for the provider and may trigger unsafe actions. Hence, a controlled induction technique (RSI-controlled) that involves gentle mask ventilation until full non-depolarizing muscular blockade has become increasingly popular. Clinical observation suggests that RSI-controlled may reduce the adverse effects noted above. We aimed to evaluate both techniques with respect to unsafe actions and stress. Methods: In this controlled, randomized simulator-based study, 30 male trainees and specialists in anaesthesiology performed a simulated anaesthesia induction in a 4-week-old infant with pyloric stenosis. Two different RSI techniques, classic and controlled, were applied to 15 candidates each. We recorded the incidence of hypoxaemia, forced mask ventilation, and intubation difficulties. In addition, we measured individual stress levels by ergospirometry, salivary cortisol, and ,-amylase, as well as a post-trial questionnaire. Results: Hypoxaemia always occurred in RSI-classic but not in RSI-controlled, repeatedly resulting in unsafe actions. Subjective stress perception and some objective stress levels were lower in the volunteers performing RSI-controlled. Conclusions: Our data suggest that RSI-controlled, as compared with RSI-classic, leads to fewer unsafe actions and may reduce individual stress levels. [source] The Effects of Mindfulness-Based Yoga During Pregnancy on Maternal Psychological and Physical DistressJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2009Amy E. Beddoe ABSTRACT Objective: To examine the feasibility and level of acceptability of a mindful yoga intervention provided during pregnancy and to gather preliminary data on the efficacy of the intervention in reducing distress. Design: Baseline and post-treatment measures examined state and trait anxiety, perceived stress, pain, and morning salivary cortisol in a single treatment group. Postintervention data also included participant evaluation of the intervention. Setting: The 7 weeks mindfulness-based yoga group intervention combined elements of Iyengar yoga and mindfulness-based stress reduction. Participants: Sixteen healthy pregnant nulliparous women with singleton pregnancies between 12 and 32 weeks gestation at the time of enrollment. Methods: Outcomes were evaluated from pre- to postintervention and between second and third trimesters with repeated measures analysis of variance and post hoc nonparametric tests. Results: Women practicing mindful yoga in their second trimester reported significant reductions in physical pain from baseline to postintervention compared with women in the third trimester whose pain increased. Women in their third trimester showed greater reductions in perceived stress and trait anxiety. Conclusions: Preliminary evidence supports yoga's potential efficacy in these areas, particularly if started early in the pregnancy. [source] Prenatal Alcohol Exposure Alters Biobehavioral Reactivity to Pain in NewbornsALCOHOLISM, Issue 4 2010Tim F. Oberlander Objectives:, To examine biobehavioral responses to an acute pain event in a Cape Town, South Africa, cohort consisting of 28 Cape Colored (mixed ancestry) newborns (n = 14) heavily exposed to alcohol during pregnancy (exposed), and born to abstainers (n = 14) or light (,0.5 oz absolute alcohol/d) drinkers (controls). Methods:, Mothers were recruited during the third trimester of pregnancy. Newborn data were collected on postpartum day 3 in the maternity obstetrical unit where the infant had been delivered. Heavy prenatal alcohol exposure was defined as maternal consumption of at least 14 drinks/wk or at least 1 incident of binge drinking/mo. Acute stress-related biobehavioral markers [salivary cortisol, heart rate (HR), respiratory sinus arrhythmia (RSA), spectral measures of heart rate variability (HRV), and videotaped facial actions] were collected thrice during a heel lance blood collection (baseline, lance, and recovery). After a feeding and nap, newborns were administered an abbreviated Brazelton Neonatal Behavioral Assessment Scale. Results:, There were no between-group differences in maternal age, marital status, parity, gravidity, depression, anxiety, pregnancy smoking, maternal education, or infant gestational age at birth (all ps > 0.15). In both groups, HR increased with the heel lance and decreased during the postlance period. The alcohol-exposed group had lower mean HR than controls throughout, and showed no change in RSA over time. Cortisol levels showed no change over time in controls but decreased over time in exposed infants. Although facial action analyses revealed no group differences in response to the heel lance, behavioral responses assessed on the Brazelton Neonatal Scale showed less arousal in the exposed group. Conclusions:, Both cardiac autonomic and hypothalamic,pituitary,adrenal stress reactivity measures suggest a blunted response to an acute noxious event in alcohol-exposed newborns. This is supported by results on the Brazelton Neonatal Scale indicating reduced behavioral arousal in the exposed group. To our knowledge, these data provide the first biobehavioral examination of early pain reactivity in alcohol-exposed newborns and have important implications for understanding neuro-/biobehavioral effects of prenatal alcohol exposure in the newborn period. [source] The association between PTSD symptoms and salivary cortisol in youth: The role of time since the traumaJOURNAL OF TRAUMATIC STRESS, Issue 5 2007Carl F. Weems This study examined the direction of association between symptoms of posttraumatic stress disorder (PTSD) and cortisol levels among youth with recent and distal traumas (N = 50; mean age = 10.7 years). Each had a clinical interview for PTSD symptoms, a cortisol assessment, and the time since the child's most recent trauma was assessed. Results indicated that the time since the most recent trauma moderated the association between cortisol and PTSD symptoms and comparisons indicated that there were significant differences in the size of the correlations across the recent and distal trauma groups. The results point to a potentially important role of the time since trauma in understanding the relationship between PTSD symptoms and cortisol. [source] Salivary cortisol and psychosocial hazards at workAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 3 2009Giovanni Maina MD Abstract Background Experimental and clinical evidence suggest that stress can lead to ill-health through the disregulation of the hypothalamic,pituitary,adrenal (HPA) axis. Studies to date have produced equivocal results likely due to different methodologies and failure to account for confounding factors. This investigation aimed to assess the relation between self-reported work-related stressors and salivary cortisol and to clarify the role of the potential confounders. Methods Thirty-six call-handlers completed a self-administered job content questionnaire and collected seven daily salivary samples on two workdays and a weekend. The diurnal salivary cortisol output was expressed as cortisol awakening response (CAR), and cortisol output in the rest of the day. Salivary cortisol data were normalized by means of square root transformation. The generalized estimating equations method was used to assess the relation between job strain and cortisol levels after adjusting for gender, weekdays and adherence to the sampling schedule. Results Job strain significantly influenced the total amount of cortisol response to waking (high strain vs. low strain: 1.1 (0.3,2.0) nmol/L). The cortisol response to waking showed gender-specific differences [women excreting greater cortisol than men: 1.1 (0.3,1.9) nmol/L], and weekday differences [workdays vs. weekend: 1.0 (0.3,1.6) nmol/L]. Non-compliance with the sampling protocol was associated with lower salivary cortisol than in adherent subjects. Conclusions Our results provide further evidence for the HPA axis involvement in the physiological response to work stress. The measure of the CAR showed to be the sensitive index to assess the physiological response to psychosocial factors. Gender, weekday, and protocol compliance were confounding factors. Am. J. Ind. Med. 52:251,260, 2009. © 2008 Wiley-Liss, Inc. [source] Physiological stress responses in defensive individuals: Age and sex matterPSYCHOPHYSIOLOGY, Issue 2 2010Karine Lévesque Abstract The association between defensiveness and physiological responses to stress were evaluated in 81 healthy working men and 118 women, aged 20 to 64 years (M=41; SD=11.45). Participants underwent laboratory testing during which they were exposed to interpersonal stressors. Heart rate (HR), heart rate variability (HRV), blood pressure (BP), and salivary cortisol were measured. Defensiveness was evaluated using the Marlowe-Crowne Social Desirability Scale. In women, higher defensiveness was associated with greater BP and HR reactivity to stress (p<.05). In older men, lower defensiveness was associated with increased systolic BP reactivity to stress (p<.02), delayed HRV recovery (p<.02), and greater salivary cortisol levels (p<.02). In conclusion, greater defensiveness was associated with increased reactivity to stress in women whereas in older men, lower defensiveness was associated with elevated cardiovascular, autonomic, and endocrine responses to stress. [source] Oxytocin and cortisol in romantically unattached young adults: Associations with bonding and psychological distressPSYCHOPHYSIOLOGY, Issue 3 2008Ilanit Gordon Abstract Despite extensive research on the involvement of oxytocin (OT) in mammalian bonding, less is known about its role in human social affiliation across the life cycle. Forty-five romantically unattached young adults participated. Plasma oxytocin and salivary cortisol were assessed using enzyme immuno-assay, and self-report measures of bonding, attachment, anxiety, and depression were collected. Oxytocin was associated with bonding to own parents and inversely related to psychological distress, particularly depressive symptoms. Cortisol was related to attachment anxiety. Regression analysis indicated that the adult's representations of bonding to parents predicted OT levels above and beyond cortisol, psychological distress, and attachment. Findings are consistent with antistress models of oxytocin and suggest that oxytocin may play a role in bonding-related cognitions across the life span. [source] Validation of salivary cortisol and testosterone assays in chimpanzees by liquid chromatography-tandem mass spectrometryAMERICAN JOURNAL OF PRIMATOLOGY, Issue 8 2009Nobuyuki Kutsukake Abstract Owing to its high temporal sensitivity, saliva has distinct advantages for measuring steroids, compared with other noninvasive samples such as urine and feces. Here, we report the validity of assaying salivary cortisol (C) and testosterone (T) using liquid chromatography-tandem mass spectrometry (LC-MS/MS) in captive male chimpanzees, Pan troglodytes. For both the C and T concentrations, we found positive relationships between saliva and plasma. The concentrations of C and T in saliva showed clear patterns of diurnal fluctuation, whereas those in urine and feces did not. These results suggest that the salivary steroid concentrations can be regarded as good indicators of circulating steroid levels. We also developed and validated an efficient method for collecting saliva samples from cotton rope. Although rope includes inherent steroid-like compounds and may affect the accuracy of steroid measurements, our rope-washing procedures effectively removed intrinsic steroidal materials. There was a significant association between the C and T concentrations measured from saliva collected from rope licked by the chimpanzees and those measured from saliva collected directly from the mouth. Salivary T values estimated by LC/MS-MS were similar to those measured by radioimmunoassay. The results indicate the usefulness of saliva as a noninvasive steroid measure and that steroids in the saliva of chimpanzees can be accurately measured by LC-MS/MS. Am. J. Primatol. 71:696,706, 2009. © 2009 Wiley-Liss, Inc. [source] The relationship between socio-sexual behavior and salivary cortisol in bonobos: tests of the tension regulation hypothesisAMERICAN JOURNAL OF PRIMATOLOGY, Issue 3 2009Gottfried Hohmann Abstract Bonobos are known for their pacifistic behavior and their large repertoire of behaviors that are thought to serve conflict resolution. One is an unusual form of ventro-ventral mounting that facilitates genital contacts (GC). Various hypotheses have been proposed to explain its function. In this study we tested predictions of the tension regulation hypothesis using salivary cortisol as a marker for social stress. The results indicate a temporal relationship between GC and cortisol levels. Compared with baseline data and matched samples of unrestricted food access, rates of GC increased when access to food sources was restricted. Cortisol levels were highest when access to food was constrained. However, because the behavioral and hormonal responses occurred when viewing the stimulus at a distance and preceded the physical presence of the stimulus, we conclude that the anticipation of a competitive situation was sufficient to induce social stress. Contrary to our prediction, targets of aggression did not have higher rates of GC nor did they solicit GC more often than others. Furthermore, higher GC rates did not correlate with a more pronounced decrease in cortisol levels. Not all results obtained in this study supported the predictions concerning the regulatory function of GC on social tension and further research is needed to explore this question. However, the results indicate that the anticipation of competition may be sufficient to induce a costly physiological response, and that high levels of resource competition may have lasting effects on physical stress and stress management. Am. J. Primatol. 71:223,232, 2009. © 2008 Wiley-Liss, Inc. [source] Pain management during eye examinations for retinopathy of prematurity in preterm infants: a systematic reviewACTA PAEDIATRICA, Issue 3 2010X. Sun Abstract Aim:, To assess whether non-pharmacological and/or pharmacological measures lead to decreased pain during an eye examination in preterm infants. Methods:, . Design:, Systematic review. Subjects:, Premature infants meeting the criteria for screening eye examination for retinopathy. Intervention:, Databases were searched through the Ovid interface. Randomized and quasi-randomized controlled trials were included. Data were assessed independently by three reviewers. Main outcome measures:, Pain assessed by Premature Infant Pain Profile (PIPP) or physiological changes. Results:, Eight studies were included and grouped according to intervention: oral sucrose (group 1), anaesthetic eye drops (group 2) and non-pharmacological measures (group 3). For group 1, the mean PIPP score with sucrose was 1.38 (WMD) (95% CI: 0.41,2.35) lower than that of placebo (p = 0.005). For group 2, one study showed a reduction of two points on the PIPP score with topical proparacaine, whereas another showed no benefit. For group 3, developmental care improved developmental scores and salivary cortisol in one study. Conclusion:, Sucrose reduced pain during the eye examination, whereas the efficacy of proparacaine was not consistent in the studies included. However, PIPP scores remained relatively high in all the studies; thus further research is required to delineate better pain reduction strategies. [source] A dose,response study of salivary cortisol after dexamethasone suppression test in Cushing's disease and its potential use in the differential diagnosis of Cushing's syndromeCLINICAL ENDOCRINOLOGY, Issue 6 2003Margaret Castro Summary objective, A dose,response study with different doses of dexamethasone (dex) to assess the corticotrophic resistance in Cushing's disease (CD) using salivary cortisol as an end point has not yet been evaluated. We also reported our experience with salivary cortisol compared to plasma cortisol determination during dex suppression test (DST) and after ovine corticotrophin release hormone (oCRH) test in the differential diagnosis of Cushing's syndrome (CS). design, We studied 46 patients with CS, including 28 patients with CD, 16 with adrenal disease and two with occult ectopic adrenocorticotropic hormone (ACTH) tumours. Salivary cortisol was compared to plasma cortisol and ACTH during a DST 2 mg for 2 days, 8 mg for 2 days and 24 mg for 1 day, and after oCRH test. results, We observed a dose-dependent suppression of salivary cortisol, plasma cortisol and ACTH in CD patients. Salivary cortisol presented a higher percentage of suppression than plasma cortisol: 42%vs. 15% (P < 0·002), 82%vs. 67% (P < 0·002) and 90%vs. 83% (P < 0·03) after 2, 8 and 24 mg/day dex, respectively. The lowest percentage of suppression was observed for plasma ACTH. The parallelism of these lines identified that the criterion of 65% suppression of salivary cortisol corresponding to 50% suppression of plasma cortisol after 8 mg/day for 2 days is consistent with CD. The sensitivity and specificity using 50% suppression for plasma cortisol were 81% and 83%, respectively, for 8 mg DST. Using the criterion of 65% suppression of salivary cortisol, the sensitivity and specificity were 86% and 100%, respectively, for 8 mg DST. After oCRH test the sensitivity and specificity were 86% and 91%, respectively, for ACTH, 100% and 64%, respectively, for plasma cortisol and 93% and 91%, respectively, (20% of increment) or 86% and 100%, respectively, (35% increment) for salivary cortisol. conclusion, In conclusion, salivary cortisol presents more profound suppression than plasma cortisol or ACTH in a dose,response pattern after different doses of dex in patients with CD. In addition, our data suggest that measurement of salivary cortisol might improve the DST as compared to plasma cortisol in the differential diagnosis of CS. [source] | |||||||||||||