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Physiological and Neurobiological Aspects of Stress and Their Relevance for Residency Training

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References

  1. Landrigan CP, Rothschild JM, Cronin JW, et al: Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med 2004; 351:1838–1848

    Article  CAS  PubMed  Google Scholar 

  2. Haas JS, Cook EF, Puopolo AL, et al: Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med 2000; 15:122–128

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Greenup RA: The other side of the stethoscope. Acad Psychiatry 2008; 32:1–2

    Article  PubMed  Google Scholar 

  4. Roberts LW, Warner TD, Rogers M; Collaborative Research Group on Medical Student Health Care: Medical student illness and impairment: a vignette-based survey study involving 955 students at 9 medical schools. Compr Psychiatry 2005; 46:229–237

    Article  PubMed  Google Scholar 

  5. Hampton T: Experts address risk of physician suicide. JAMA 2005; 294:1189–1191

    Article  CAS  PubMed  Google Scholar 

  6. Steinbrook R: Medical student debt: is there a limit? N Engl J Med 2008; 359:2629–2632

    Article  CAS  PubMed  Google Scholar 

  7. American College of Physicians: The impending collapse of primary care medicine and its implications for the state of the nation’s health care: a public policy report of the American College of Physicians; January 30, 2006

  8. Cohen JJ: Heeding the plea to deal with resident stress. Ann Intern Med 2002; 136:394–395

    Article  PubMed  Google Scholar 

  9. Van Allen EM: One day later: continuing psychological stress after a cardiac intensive care rotation. J Gen Intern Med 2010; 25:882–883

    Article  PubMed Central  PubMed  Google Scholar 

  10. Cohen JS, Patten S: Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ 2005; 5:21

    Article  PubMed Central  PubMed  Google Scholar 

  11. Iglehart JK: Revisiting duty-hour limits: IOM recommendations for patient safety and resident education. N Engl J Med 2008; 359:2633–2635

    Article  CAS  PubMed  Google Scholar 

  12. Barger LK, Cade BE, Ayas NT,et al: Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med 2005; 352:354:125–134

    Article  CAS  PubMed  Google Scholar 

  13. Goodrick GK, Kneuper S, Steinbauer JR: Stress perceptions in community clinic: a pilot survey of patients and physicians. J Community Health 2005; 30:75–88

    Article  PubMed  Google Scholar 

  14. Boerjan M, Bluyssen SJM, Bleichrodt RP, et al: Work-related health complaints in surgical residents and the influence of social support and job-related autonomy. Med Educ 2010; 44: 835–844

    Article  PubMed  Google Scholar 

  15. Sakata Y, Wada K, Tsutsumi A, et al: Effort—reward imbalance and depression in Japanese medical residents. J Occup Health 2008; 50:498–504

    Article  PubMed  Google Scholar 

  16. Kahn-Greene ET, Killgore DB, Kamimori GH, et al: The effects of sleep deprivation on symptoms of psychopathology in healthy adults. Sleep Med 2007; 8:215–221

    Article  PubMed  Google Scholar 

  17. Killgore WDS, Kahn-Greene ET, Lipizzi EL, et al: Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills. Sleep Med 2008; 9:517–526

    Article  PubMed  Google Scholar 

  18. Franzen PL, Siegle GJ, Buysse DJ: Relationships between affect, vigilance, and sleepiness following sleep deprivation. J Sleep Res 2008; 17:34–41

    Article  PubMed Central  PubMed  Google Scholar 

  19. Halbach MM, Spann CO, Egan G: Effect of sleep deprivation on medical resident and student cognitive function: a prospective study. Am J Obstet Gynecol 2003; 188:1198–1201

    Article  PubMed  Google Scholar 

  20. Orton DI, Gruzelier JH: Adverse changes in mood and cognitive performance of house officers after night duty. BMJ 1989; 298:21–23

    Article  CAS  PubMed  Google Scholar 

  21. Papp KK, Stoller EP, Sage P, et al: The effects of sleep loss and fatigue on resident-physicians: a multi-institutional, mixed-method study. Acad Med 2004; 79:394–406

    Article  PubMed  Google Scholar 

  22. Goldman LI, McDonough MT, Rosemond GP: Stresses affecting surgical performance and learning. I. Correlation of heart rate, electrocardiogram, and operation simultaneously recorded on videotapes. J Surg Res 1972; 12:83–86

    Article  CAS  PubMed  Google Scholar 

  23. Haynes DF, Schwedler M, Dyslin DC, et al: Are postoperative complications related to resident sleep deprivation? South Med J 1995; 88:283–289

    Article  CAS  PubMed  Google Scholar 

  24. Friedman RC, Bigger JT, Kornfeld DS: The intern and sleep loss. N Engl J Med 1971; 285:201–203

    Article  CAS  PubMed  Google Scholar 

  25. Poulton EC, Hunt GM, Carpenter A, et al: The performance of junior hospital doctors following reduced sleep and long hours of work. Ergonomics 1978; 21:279–295

    Article  CAS  PubMed  Google Scholar 

  26. Heiser P, Dickhaus B, Schreiber W, et al: White blood cells and cortisol after sleep deprivation and recovery sleep in humans. Eur Arch Psychiatry Clin Neurosci 2000; 250:16–23

    Article  CAS  PubMed  Google Scholar 

  27. Shakhar K, Valdimarsdottir HB, Guevarra JS, et al: Sleep, fatigue, and NK cell activity in healthy volunteers: significant relationships revealed by within subject analyses. Brain Behav Immun2007; 21:180–184

  28. Irwin M: Effects of sleep and sleep loss on immunity and cytokines. Brain Behav Immun 2002; 16:503–512

    Article  CAS  PubMed  Google Scholar 

  29. Everson CA: Clinical assessment of blood leukocytes, serum cytokines, and serum immunoglobulins as responses to sleep deprivation in laboratory rats. Am J Physiol Regul Integr Comp Physiol 2005; 289:R1054–R1063

    Article  CAS  PubMed  Google Scholar 

  30. Rosen IM, Gimotty PA, Shea JA, et al: Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med 2006; 81:82–85

    Article  PubMed  Google Scholar 

  31. Cohen S, Tyrrell DA, Smith AP: Psychological stress and susceptibility to the common cold. N Engl J Med 1991; 325:606–612

    Article  CAS  PubMed  Google Scholar 

  32. Herbert TB, Cohen S: Stress and immunity in humans: ameta-analytic review. Psychosom Med 1993; 55:364–379

    CAS  PubMed  Google Scholar 

  33. Marshall GD Jr, Agarwal SK, Lloyd C, et al: Cytokine dys-regulation associated with exam stress in healthy medical students. Brain Behav Immun 1998; 12:297–307

    Article  CAS  PubMed  Google Scholar 

  34. Cohen S, Herbert TB: Health psychology: psychological factors and physical disease from the perspective of human psychoneuroimmunology. Annu Rev Psychol 1996; 47:113–142

    Article  CAS  PubMed  Google Scholar 

  35. Chrousos GP, Gold PW: The concepts of stress and stress system disorders: overview of physical and behavioral homeostasis. JAMA 1992; 267:1244–1252

    Article  CAS  PubMed  Google Scholar 

  36. Kudielka BM, Wüst S: Human models in acute and chronic stress: assessing determinants of individual hypothalamus-pituitary-adrenal axis activity and reactivity. Stress 2010; 13:1–14

    Article  PubMed  Google Scholar 

  37. Moynihan JA: Mechanisms of stress-induced modulation of immunity. Brain Behav Immun 2003; 17(Suppl 1):S11–S16

    Article  PubMed  Google Scholar 

  38. Irwin MR, Miller AH: Depressive disorders and immunity: 20 years of progress and discovery. Brain Behav Immun 2007; 21:374–383

    Article  CAS  PubMed  Google Scholar 

  39. Knight JM, Avery EF, Janssen I, et al: Cortisol and depressive symptoms in a population-based cohort of midlife women. Psychosom Med 2010; 72:855–861

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Webster Marketon JI, Glaser R: Stress hormones and immune function. Cell Immunol 2008; 252:16–26

    Article  CAS  PubMed  Google Scholar 

  41. Chatterton RT Jr, Dooley SL: Reversal of diurnal cortisol rhythm and suppression of plasma testosterone in obstetric residents on call. J Soc Gynecol Investig 1999; 6:50–54

    Article  PubMed  Google Scholar 

  42. Coeck C, Jorens PG, Vandevivere J, et al: ACTH and cortisol levels during residency training. N Engl J Med 1991; 325:738

    CAS  PubMed  Google Scholar 

  43. Tendulkar AP, Victorino GP, Chong TJ, et al: Quantification of surgical resident stress “on call”. J Am Coll Surg 2005; 201:560–564

    Article  PubMed  Google Scholar 

  44. Brant H, Wetherell MA, Lightman S, et al: An exploration into physiological and self-report measures of stress in pre-registration doctors at the beginning and end of a clinical rotation. Stress 2010; 13:155–162

    Article  PubMed  Google Scholar 

  45. Papp KK, Miller CM, Strohl KP: Graduate medical training, learning, relationships, and sleep loss. Sleep Med Rev 2006; 10:339–345

    Article  PubMed  Google Scholar 

  46. Cacioppo JT, Hawkley LC: Social isolation and health, with an emphasis on underlying mechanisms. Perspect Biol Med 2003; 46(Suppl):S39–S52

    PubMed  Google Scholar 

  47. Hawkley LC, Cacioppo JT: Loneliness and pathways to disease. Brain Behav Immun 2003; 17(Suppl 1):S98–S105

    Article  PubMed  Google Scholar 

  48. Cappuccio FP, Cooper D, D’Elia L, et al: Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J 2011; 32: 1484–1492

    Article  PubMed  Google Scholar 

  49. Spiegel K, Tasali E, Penev P, et al: Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004; 141:846–850

    Article  PubMed  Google Scholar 

  50. Taheri S, Lin L, Austin D, et al: Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 2004; 1:e62

    Article  PubMed Central  PubMed  Google Scholar 

  51. Spiegel K, Knutson K, Leproult R, et al: Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes. J Appl Physiol 2005; 99:2008–2019

    Article  CAS  PubMed  Google Scholar 

  52. Copinschi G: Metabolic and endocrine effects of sleep deprivation. Essent Psychopharmacol 2005; 6:341–347

    PubMed  Google Scholar 

  53. Miller MA, Cappuccio FP: Inflammation, sleep, obesity and cardiovascular disease. Curr Vasc Pharmacol 2007; 5:93–102

    Article  CAS  PubMed  Google Scholar 

  54. Melamed S, Ugarten U, Shirom A, et al: Chronic burnout, somatic arousal and elevated salivary cortisol levels. J Psychosom Res 1999; 46:591–598

    Article  CAS  PubMed  Google Scholar 

  55. Dimsdale JE: Psychological stress and cardiovascular disease. J Am Coll Cardiol 2008; 51:1237–1246

    Article  PubMed Central  PubMed  Google Scholar 

  56. Bosch JA, Fischer JE, Fischer JC: Psychologically adverse work conditions are associated with CD8+ T cell differentiation indicative of immunesenescence. Brain Behav Immun 2009; 23:527–534

    Article  CAS  PubMed  Google Scholar 

  57. Surani S, Subramanian S, Aguillar R, et al: Sleepiness in medical residents: impact of mandated reduction in work hours. Sleep Med 2007; 8:90–93

    Article  PubMed  Google Scholar 

  58. Arora VM, Georgitis E, Siddique J, et al: Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities. JAMA 2008; 300:1146–1153

    Article  CAS  PubMed  Google Scholar 

  59. Fletcher KE, Underwood W 3rd, Davis SQ, et al: Effects of work hour reduction on residents’ lives: a systematic review. JAMA 2005; 294:1088–1100

    Article  CAS  PubMed  Google Scholar 

  60. Lockley SW, Cronin JW, Evans EE; Harvard Work Hours, Health and Safety Group: Effect of reducing interns’ weekly work hours on sleep and attentional failures. N Engl J Med 2004; 351:1829–1837

    Article  CAS  PubMed  Google Scholar 

  61. Fondell E, Axelsson J, Franck K, et al: Short natural sleep is associated with higher T cell and lower NK cell activities. Brain Behav Immun 2011; 25:1367–1375

    Article  CAS  PubMed  Google Scholar 

  62. Vgontzas AN, Zoumakis E, Bixler EO, et al: Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab 2004; 89: 2119–2126

    Article  CAS  PubMed  Google Scholar 

  63. Luskin F, Newell K: Mind-body approaches to successful aging. Mind-Body Medicine: A clinician’s Guide to Psychoneuroimmunology 1997;:251-68

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Correspondence to Jennifer M. Knight M.D..

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Knight, J.M. Physiological and Neurobiological Aspects of Stress and Their Relevance for Residency Training. Acad Psychiatry 37, 6–10 (2013). https://doi.org/10.1176/appi.ap.11100187

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