A Randomized Cross-over Exploratory Study of the Effect of Visiting Therapy Dogs on College Student Stress Before Final Exams

This exploratory study investigated the effect of visiting therapy dogs on college-student perceived and physiological stress the week prior to final exams. Students (n = 78) were randomly assigned to order of a therapydog intervention and attention-control condition, each 15 minutes long. Students completed the Perceived Stress Scale (PSS), a stress visual analog scale (SVAS), and provided saliva for measuring nerve growth factor (sNGF) and alpha amylase (sAA), prior to randomization. Saliva samples and SVAS were again collected after each condition. There was no effect of group order on demographics, PSS, or initial SVAS. Repeated measures models were used to analyze the complete data sets of 57 students. There were no significant differences in sAA between or within students completing the intervention and control conditions. sNGF was not subjected to analysis as most levels were undetectable. Significant differences in SVAS scores were found between the intervention and control condition, with large effect sizes. SVAS scores were lower following the intervention, regardless of condition order (intervention first, p = 0.0001, d = 1.87; intervention second, p = 0.0004, d = 1.63). No SVAS differences were found for the control condition. Based on these findings, campus events with visiting therapy dogs represent a costeffective, easily accessible activity to reduce perceived, but not physiological, stress for college students prior to final exams.     

Prevalence of behavioural problems in a group of demented nursing home patients

Behavioural problems in dementia are a burden for patients and caregivers and are often the main reason for admission to a nursing home. Research on the prevalence of behavioural problems is scarce. In this study the prevalence of behavioural problems was estimated in nursing home patients with dementia. In 59 demented patients the Neuropsychiatric Inventory (NPI-NH) and the Cohen-Mansfield Agitation Inventory were used to measure behavioural problems over the last two weeks. Behavioural problems were present in about 85% of the study group. Using the NPI-NH aggression/agitation and apathy were present in almost 40% of the patients. Delusions, hallucinations, depression and anxiety were present in 10-15% of the patients. Using the CMAI cursing/verbal aggression, restlessness, complaining, negativism, and mannerisms were prevalent in 30%-50% of the patients. Larger studies on the prevalence of problem behaviour and possibly influencing factors are necessary.     

穴位按摩疗法对改善经内镜逆行胰胆管造影治疗患者焦虑的临床研究

目的:探讨采用穴位按摩疗法对经内镜下逆行胰胆管造影术(ERCP)患者进行术前护理的临床效应。方法:将124例患者随机分为对照组和实验组,各62例。对照组采用传统的术前准备和心理护理方法,实验组在对照组的基础上采用穴位按摩疗法进行行为干预,观察2组患者生理指标的变化情况,并用焦虑自评量表(SAS)对2组患者术前及术后焦虑情况进行评估。结果:实验组患者生理指标、焦虑改善情况明显优于对照组。结论:穴位按摩疗法有助于消除患者的焦虑情绪,简单易行,患者痛苦小,提高患者配合治疗的积极性,促进患者早日康复。     

Circadian rhythms of agitation in institutionalized patients with Alzheimer's disease

Agitation is a common problem in institutionalized patients with Alzheimer's disease (AD). “Sundowning,” or agitation that occurs primarily in the evening, is estimated to occur in 10—25% of nursing home patients. The current study examined circadian patterns of agitation in 85 patients with AD living in nursing homes in the San Diego, California, area. Agitation was assessed using behavioral ratings collected every 15 minutes over 3 days, and activity and light exposure data were collected continuously using Actillume recorders. A five-parameter extension of the traditional cosine function was used to describe the circadian rhythms. The mean acrophase for agitation was 14:38, although there was considerable variability in the agitation rhythms displayed by the patients. Agitation rhythms were more robust than activity rhythms. Surprisingly, only 2 patients (2.4%) were“sundowners.”In general, patients were exposed to very low levels of illumination, with higher illumination during the night being associated with less robust agitation rhythms with higher rhythm minima (i.e., some agitation present throughout the day and night). Seasonality was examined; however, there were no consistent seasonal patterns found. This is the largest study to date to examine agitation rhythms using behavioral observations over multiple 24h periods. The results suggest that, although sundowning is uncommon, agitation appears to have a strong circadian component in most patients that is related to light exposure, sleep, and medication use. Further research into the understanding of agitation rhythms is needed to examine the potential effects of interventions targeting sleep and circadian rhythms. (Chronobiology International, 17(3), 405-418, 2000)     

Measurements of Salivary Alpha Amylase and Salivary Cortisol in Hominoid Primates Reveal Within-Species Consistency and Between-Species Differences

Salivary alpha amylase (sAA) is the most abundant enzyme in saliva. Studies in humans found variation in enzymatic activity of sAA across populations that could be linked to the copy number of loci for salivary amylase (AMY1), which was seen as an adaptive response to the intake of dietary starch. In addition to diet dependent variation, differences in sAA activity have been related to social stress. In a previous study, we found evidence for stress-induced variation in sAA activity in the bonobos, a hominoid primate that is closely related to humans. In this study, we explored patterns of variation in sAA activity in bonobos and three other hominoid primates, chimpanzee, gorilla, and orangutan to (a) examine if within-species differences in sAA activity found in bonobos are characteristic for hominoids and (b) assess the extent of variation in sAA activity between different species. The results revealed species-differences in sAA activity with gorillas and orangutans having higher basal sAA activity when compared to Pan. To assess the impact of stress, sAA values were related to cortisol levels measured in the same saliva samples. Gorillas and orangutans had low salivary cortisol concentrations and the highest cortisol concentration was found in samples from male bonobos, the group that also showed the highest sAA activity. Considering published information, the differences in sAA activity correspond with differences in AMY1 copy numbers and match with general features of natural diet. Studies on sAA activity have the potential to complement molecular studies and may contribute to research on feeding ecology and nutrition.     

La participación de personas con demencia en las reuniones del plan de atención individualizada: impacto en el bienestar y la calidad del cuidado

Introduction

An individualised intervention plan (IIP) offers a new paradigm in the care of the elderly with dementia, with the aim of increasing their quality of life through personalisation, respect for their freedom, and their participation in the decisions that affect their lives.

Objective

To evaluate the impact of the residential home patient with dementia and their quality of care when they take part in the interdisciplinary meeting in which their care plan is decided.

Material and methods

A total of 52 elderly patients with dementia took part in the study. They were distributed into two groups, one experimental (37 residents) and another control (15 residents). The Dementia Care Mapping (DCM) tool was used to assess the well-being and quality of care of the residents. This tool was used twice, before and after the intervention.

Results

The well-being of the resident, evaluated using the DCM, was similar before and after the intervention in the experimental group. No differences were observed either on comparing the control and experimental groups. However, some indicators of carer behaviour were different before and after the intervention, and when the control and experimental group were compared.

Conclusion

The inclusion of elderly persons with dementia in their IIP meeting had a positive effect in the interaction of the staff with the residents, but not on the well-being of the resident.     

Effect of Chronic Training on Heart Rate Variability,Salivary IgA and Salivary Alpha-Amylase in Elite Swimmers with a Disability

The purpose of this study was to a) determine the heart rate variability (HRV) and saliva markers of immunity (salivary immunoglobulin A; sIgA) and stress (salivary alpha-amylase; sAA) responses to chronic training in elite swimmers with a disability; and b) identify the relationships between HRV, sIgA, sAA and training volume. Eight members of a high performance Paralympic swimming program were monitored for their weekly resting HRV, sIgA and sAA levels in the 14 weeks leading up to a major international competition. The 14 week training program included aerobic, anaerobic, power and speed, and taper training phases, while also incorporating two swimming step tests and two swimming competitions. Specific time (root mean square of the successive differences; RMSSD) and frequency (high frequency normalized units [HFnu]) domain measures, along with non-linear indices (standard deviation of instantaneous RR variability; SD1 and short term fractal scaling exponent; α1) of HRV were used for all analyses with effects examined using magnitude-based inferences. Relationships between HRV and saliva markers were identified by Spearman rank rho (ρ) correlation coefficients. Compared with week 1, SD1 was very likely lower (96/4/0, ES = -2.21), while sAA was very likely elevated (100/0/0, ES = 2.32) at the beginning of week 7 for all athletes. The training program did not alter HRV or saliva whereas competition did. There were also no apparent differences observed for HRV, sIgA and sAA between each of the training phases during the 14 week swimming program. Correlations were observed between sAA and SD1 (ρ = -0.212, p<0.05), along with sAA and mean HR (ρ = 0.309, p<0.05). These results show that high level national competition influences depresses HRV (SD1) and increases saliva biomarkers of stress (sAA). It appears that a well-managed and periodised swimming program can maintain these indices within normal baseline levels. The study also highlighted the parasympathetic nervous system influence on sAA.     

心内科住院患者睡眠质量分析与护理干预

目的:了解心内科住院患者睡眠质量,分析睡眠障碍的原因,探讨改善患者睡眠障碍的有效护理对策。方法:对我院2010年5月-2010年12月心内科109例住院睡眠障碍患者采取问卷调查及深入访谈相结合的方法进行调查,找出心内科患者睡眠障碍的原因;随后,将109例患者随机分为两组,对照组实行组常规护理,干预组实行有针对性的护理,7d后对对两组患者睡眠障碍进行测评。结果:心内科患者睡眠障碍症状为:入眠时间长,早醒,觉醒次数多,醒后再入眠难;睡眠障碍原因为:患者自身疾病、心理、环境、其他及综合因素所致。通过有针对性的护理干预后,两组有较大差距(P<0.05),干预组患者睡眠障碍改善明显,干预组好于对照组,表明护理干预可有效改善患者的睡眠质量。结论:疾病因素、心理因素以及生活习惯是影响心内科住院患者睡眠质量的主要因素,通过科学有效的护理干预措施,可以改善心内科患者的睡眠质量,提高患者的身心健康。     

心理干预对肿瘤内科患者心理状态和生活质量的影响

摘要目的：调查了解肿瘤内科住院患者的常见心理问题,探讨心理干预对肿瘤内科住院患者心理状态和生存质量的改善作用。方法：对我院2011年3月-2012年4月肿瘤内科86例住院患者随机分为常规治疗组和心理干预组,采取问卷调查及访谈相结合的方式对患者心理问题和生活质量进行调查。结果：对86例目标患者进行数据分析,两组患者在治疗前心理状态没有显著性差别,生存质量测定量表各个项目的评分无显著性差别;经治疗后,心理干预组的心理问题明显改善（p〈0．05）,生存质量评分显著高于常规治疗组（P〈0．05）。结论：多数肿瘤内科住院患者都存在不同程度的心理问题,实施针对性的心理干预措施,可以有效缓解其心理问题并提高生存质量。     

Effectiveness of family meetings for family caregivers on delaying time to nursing home placement of dementia patients: a randomized trial

Background

Interventions relieving the burden of caregiving may postpone or prevent patient institutionalization. The objective of this study was to determine whether a family meetings intervention was superior to usual care in postponing nursing home placement of patients with dementia.

Methods

A randomized multicenter trial was conducted among 192 patients with a clinical diagnosis of dementia living at home at enrolment and their primary family caregiver. Dyads of caregivers and patients were randomized to the family meetings intervention (n = 96) or usual care (n = 96) condition. The intervention consisted of two individual sessions with the primary caregiver and four family counseling sessions that included family members and friends. The primary outcome measure was the time until institutionalization of the patient. Intention-to-treat as well as per protocol analyses were performed. Survival analyses were carried out to evaluate the effectiveness of the intervention.

Results

During 18 months follow-up 23 of 96 relatives with dementia of caregivers in the intervention group and 18 of 96 relatives with dementia of caregivers in the usual care group were institutionalized. No significant difference between the intervention and the usual care group was found in time until institutionalization (adjusted hazard ratio (HR) 1.46, 95% confidence interval (CI) 0.78 to 2.74). The per-protocol analysis revealed no significant effect either (adjusted HR 0.57, 95% CI 0.21 to 1.57), although the number of placements among the adherers was relatively low (9.4%). A subgroup effect was found for patients’ age, with a significantly higher risk of institutionalization for ‘younger’ patients in the intervention group compared with the usual care group (adjusted HR = 4.94, 95% CI 1.10 to 22.13).

Conclusion

This family meetings intervention for primary caregivers of patients with dementia did not postpone patient institutionalization more than usual care.

Trial Registration: Controlled-Trials.com ISRCTN90163486

     

CIRCADIAN RHYTHMS OF AGITATION IN INSTITUTIONALIZED PATIENTS WITH ALZHEIMER'S DISEASE

Agitation is a common problem in institutionalized patientswith Alzheimer's disease (AD). “Sundowning,” or agitationthat occurs primarily in the evening, is estimated to occur in 10—25%of nursing home patients. The current study examined circadian patterns ofagitation in 85 patients with AD living in nursing homes in the San Diego,California, area. Agitation was assessed using behavioral ratings collectedevery 15 minutes over 3 days, and activity and light exposure data were collectedcontinuously using Actillume recorders. A five-parameter extension of thetraditional cosine function was used to describe the circadian rhythms. Themean acrophase for agitation was 14:38, although there was considerable variabilityin the agitation rhythms displayed by the patients. Agitation rhythms weremore robust than activity rhythms. Surprisingly, only 2 patients (2.4%) were“sundowners.”In general, patients were exposed to very low levelsof illumination, with higher illumination during the night being associatedwith less robust agitation rhythms with higher rhythm minima (i.e., some agitationpresent throughout the day and night). Seasonality was examined; however,there were no consistent seasonal patterns found. This is the largest studyto date to examine agitation rhythms using behavioral observations over multiple24h periods. The results suggest that, although sundowning is uncommon, agitationappears to have a strong circadian component in most patients that is relatedto light exposure, sleep, and medication use. Further research into the understandingof agitation rhythms is needed to examine the potential effects of interventionstargeting sleep and circadian rhythms. (ChronobiologyInternational, 17(3), 405–418, 2000)     

捏脊与按摩促进腹部术后胃瘫病人康复效果观察

目的：探讨促进腹部术后胃瘫病人康复的有效方法。方法：将152例术后胃瘫病人按入院的先后顺序分为观察组和对照组各76例。对照组采用一般疗法即肠内营养,饮依调理、血糖和电解质监测。观察组在一般治疗的基础上采用捏脊与按摩疗法。两周为一疗程,均治疗两个疗程后对两组治疗效果进行统计学处理（x2检验）。结果：观察组于治疗四周内胃肠功能全部恢复,整体疗效优于对照组（P〈0.01）具有非常显著性差异。结论：捏脊与按摩是促进腹部术后胃瘫病人康复的有效方法。     

Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial

ABSTRACT: BACKGROUND: After diagnosis of a dementing illness patients and their spouses have many concerns related to the disease and their future. This often leads to poor psychological well-being and reduced health related quality of life (HRQoL) of the family. Support for self-management skills has been proven to be an effective method to improve prognosis of asthma, heart failure and osteoarthritis. However, self-management interventions have not been studied in dementia. Therefore, our aim was to examine in an objective-oriented group intervention the efficacy of self-management support program (SMP) on the HRQoL of dementia patients and their spousal caregivers as well as on the sense of competence and psychological well-being of care-givers. METHODS: During the years 2011-12, 160 dementia patients and their spouses will be recruited from memory clinics and randomized into two arms: 80 patients for group-based SMP sessions including topics selected by the participants, 80 patients will serve as controls in for usual community care. Sessions may include topics on dementia, community services, active lifestyle and prevention for cognitive decline, spousal relationship, future planning and emotional well-being. The patients and spouses will have their separate group sessions (10 participants/group) once a week for 8 weeks. Main outcome measures will be patients' HRQoL (15D) and spousal caregivers' HRQoL (RAND-36), and sense of competence (SCQ). Secondary measures will be caregivers' psychological well-being (GHQ-12) and coping resources, patients' depression, cognition and signs of frailty. Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two year follow-up. DISCUSSION: This is a "proof -of-concept" study to explore the efficacy of group support for self-management skills among dementia families. It will also provide data on cost-effectiveness of the intervention.     

Effects of Heart Rate Variability Biofeedback in Subjects with Stress-Related Chronic Neck Pain: A Pilot Study

Recent studies focusing on autonomic nervous system (ANS) dysfunctions, together with theoretical pathophysiological models of musculoskeletal disorders, indicate the involvement of ANS regulation in development and maintenance of chronic muscle pain. Research has demonstrated the effectiveness of heart rate variability (HRV) biofeedback (BF) in increasing HRV and reducing the symptoms of different disorders characterized by ANS aberration. The study investigated the effects of resonance frequency HRV BF on autonomic regulation and perceived health, pain, stress and disability in 24 subjects with stress-related chronic neck-shoulder pain. Twelve subjects participated in 10 weekly sessions of resonant HRV BF and were compared to a control group. Subjective reports and HRV measures during relaxation and in response to a standardized stress protocol were assessed for both groups pre- and post-intervention. Group × time interactions revealed a significantly stronger increase over time in perceived health (SF-36) for the treatment group, including vitality, bodily pain and social functioning. Interactions were also seen for HRV during relaxation and reactivity to stress. The present pilot study indicates improvement in perceived health over a 10 week intervention with HRV-biofeedback in subjects with chronic neck-pain. Increased resting HRV as well as enhanced reactivity to hand grip and cold pressor tests might reflect beneficial effects on ANS regulation, and suggest that this intervention protocol is suitable for a larger controlled trial.     

Evaluation of new biomarkers of stress in saliva of sheep

Some routine handling procedures can produce stress in farm animals, and an adequate control of these stressors is important to avoid the negative effects on animal health and production. The measurement of biomarkers in saliva can be a suitable tool for the evaluation and control of stress. In this report, lipase, butyrylcholinesterase (BChE), total esterase (TEA) and adenosine deaminase (ADA) activities in the saliva of sheep were evaluated as biomarkers of stress. For this purpose, they were measured after inducing stress by facing a dog (experiment 1) and shearing (experiment 2), and comparing them to other stress salivary biomarkers such as α-amylase (sAA) and cortisol, as well as heart rate (HR). Each analyte was measured at the basal time, and during and just after the end of the stressful stimulus, and at various times for the first hour after the period of stress induction. Values were compared with those obtained from a control group. Lipase was the only analyte that showed significant changes between the stress and the control group in both experiments. Although TEA and ADA increased after stress, no significant differences were seen compared with the control group. Lipase was correlated highly with sAA and HR, in experiment 1; and correlated moderately with cortisol and HR in experiment 2. Lipase showed the greatest percentage increase after the stressful stimuli and less overlap with the control group in the two experiments. From the results of this study it can be concluded that lipase, TEA, BChE and ADA are enzymes present in the saliva of sheep and that they can be measured by using simple and fast colorimetric methods. Further studies should be undertaken with regard to the possible application of lipase as a biomarker of stress in sheep.     

Effects of Dementia-Care Mapping on Residents and Staff of Care Homes: A Pragmatic Cluster-Randomised Controlled Trial

Background

The effectiveness of dementia-care mapping (DCM) for institutionalised people with dementia has been demonstrated in an explanatory cluster-randomised controlled trial (cRCT) with two DCM researchers carrying out the DCM intervention. In order to be able to inform daily practice, we studied DCM effectiveness in a pragmatic cRCT involving a wide range of care homes with trained nursing staff carrying out the intervention.

Methods

Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training and conducted the 4-months DCM-intervention twice during the study. The primary outcome was agitation, measured with the Cohen-Mansfield agitation inventory (CMAI). The secondary outcomes included residents’ neuropsychiatric symptoms (NPSs) and quality of life, and staff stress and job satisfaction. The nursing staff made all measurements at baseline and two follow-ups at 4-month intervals. We used linear mixed-effect models to test treatment and time effects.

Results

34 units from 11 care homes, including 434 residents and 382 nursing staff members, were randomly assigned. Ten nurses from the intervention units completed the basic and advanced DCM training. Intention-to-treat analysis showed no statistically significant effect on the CMAI (mean difference between groups 2·4, 95% CI −2·7 to 7·6; p = 0·34). More NPSs were reported in the intervention group than in usual care (p = 0·02). Intervention staff reported fewer negative and more positive emotional reactions during work (p = 0·02). There were no other significant effects.

Conclusions

Our pragmatic findings did not confirm the effect on the primary outcome of agitation in the explanatory study. Perhaps the variability of the extent of implementation of DCM may explain the lack of effect.

Trial Registration

Dutch Trials Registry NTR2314.     

Life- and person-centred help in Mecklenburg-Western Pomerania, Germany (DelpHi): study protocol for a randomised controlled trial

ABSTRACT: BACKGROUND: The provision of appropriate medical and nursing care for people with dementia is a major challenge for the healthcare system in Germany. New models of healthcare provision need to be developed, tested and implemented on the population level. Trials in which collaborative care for dementia in the primary care setting were studied have demonstrated its effectiveness. These studies have been conducted in different healthcare systems, however, so it is unclear whether these results extend to the specific context of the German healthcare system. The objective of this population-based intervention trial in the primary care setting is to test the efficacy and efficiency of implementing a subsidiary support system on a population level for persons with dementia who live at home. Methods and study design The study was designed to assemble a general physician-based epidemiological cohort of people above the age of 70 who live at home (DelpHi cohort). These people are screened for eligibility to participate in a trial of dementia care management (DelpHi trial). The trial is a cluster-randomised, controlled intervention trial with two arms (intervention and control) designed to test the efficacy and efficiency of implementing a subsidiary support system for persons with dementia who live at home. This subsidiary support system is initiated and coordinated by a dementia care manager: a nurse with dementia-specific qualifications who delivers the intervention according to a systematic, detailed protocol. The primary outcome is quality of life and healthcare for patients with dementia and their caregivers. This is a multidimensional outcome with a focus on four dimensions: (1) quality of life, (2) caregiver burden, (3) behavioural and psychological symptoms of dementia and (4) pharmacotherapy with an antidementia drug and prevention or suspension of potentially inappropriate medication. Secondary outcomes include the assessment of dementia syndromes, activities of daily living, social support health status, utilisation of health care resources and medication. DISCUSSION: The results will provide evidence for specific needs in ambulatory care for persons with dementia and will show effective ways to meet those needs. Qualification requirements will be evaluated, and the results will help to modify existing guidelines and treatment paths. Trial registration NCT01401582.     

Effect of a High-Intensity Exercise Program on Physical Function and Mental Health in Nursing Home Residents with Dementia: An Assessor Blinded Randomized Controlled Trial

Background

Dementia is among the leading causes of functional loss and disability in older adults. Research has demonstrated that nursing home patients without dementia can improve their function in activities of daily living, strength, balance and mental well being by physical exercise. The evidence on effect of physical exercise among nursing home patients with dementia is scarce and ambiguous. Thus, the primary objective of this study was to investigate the effect of a high intensity functional exercise program on the performance of balance in nursing home residents with dementia. The secondary objective was to examine the effect of this exercise on muscle strength, mobility, activities of daily living, quality of life and neuropsychiatric symptoms.

Design and Methods

This single blinded randomized controlled trial was conducted among 170 persons with dementia living in nursing homes. Mean age was 86.7 years (SD = 7.4) and 74% were women. The participants were randomly allocated to an intervention (n = 87) or a control group (n = 83). The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks. The control condition was leisure activities.

Results

The intervention group improved the score on Bergs Balance Scale by 2.9 points, which was significantly more than the control group who improved by 1.2 points (p = 0.02). Having exercised 12 times or more was significantly associated with improved strength after intervention (p<0.05). The level of apathy was lower in the exercise group after the intervention, compared to the control group (p = 0.048).

Conclusion

The results from our study indicate that a high intensity functional exercise program improved balance and muscle strength as well as reduced apathy in nursing home patients with dementia.

Trial Registration

ClinicalTrials.gov NCT02262104     

Effect of agitation on violacein production in Pseudoalteromonas luteoviolacea isolated from a marine sponge

AIMS: Experiments were designed to investigate the effect of agitation on the production of violacein by a marine bacterium Pseudoalteromonas luteoviolacea. METHODS AND RESULTS: A marine sponge-associated bacterium, P. luteoviolacea, was grown at different agitation speeds. Agitation did not have a significant effect on bacterial growth, but had a profound effect on the size of bacterial aggregate. The production of violacein was the highest under stagnant conditions and decreased with the increase of the agitation speed. CONCLUSIONS: Agitation affected the aggregation of bacterial cells, which, in turn, affected violacein production by P. luteoviolacea. SIGNIFICANCE AND IMPACT OF THE STUDY: This study suggests that P. luteoviolacea produced the highest amount of violacein when it was cultured under stagnant conditions.     

Differences in saliva collection location and disparities in baseline and diurnal rhythms of alpha-amylase: A preliminary note of caution

Identified in the early 1980s as a surrogate marker of the sympathetic nervous system component of the stress response, there has been renewed interest in measuring salivary alpha-amylase (sAA) to test biosocial models of stress vulnerability. This brief report presents studies that document that oral fluids from the parotid and submandibular gland areas had higher sAA values than did whole saliva specimens, and sAA values in whole saliva were higher than levels measured in oral fluids from the sublingual gland area. sAA in oral fluids from the parotid and submandibular gland areas showed the highest and more pronounced diurnal variation than levels in whole saliva, and sAA in sublingual saliva showed the lowest and shallowest diurnal variation. When this source of inherent variability in sAA activity levels is not controlled for by collecting oral fluids consistently from specific gland areas, the detection of individual differences, associations between sAA and “behavioral” variables, and intra-individual change in sAA levels may be compromised. Awareness, and management, of this ubiquitous source of measurement error in sAA are essential to ensure the success of future research on the correlates and concomitants of sAA levels, stress-related reactivity and recovery, and diurnal variation.