Publications

Cortisol levels, observed distress behavior, behavior problems, and symptoms of anxiety and depression are examined in young adolescents. The longitudinal design consists of three times of measurement, at 6-month intervals. We (1) examine covariations among cortisol level and extent of distress behavior in adolescents experiencing a challenging situation, (2) identify intraindividual patterns of change in cortisol level (cortisol reactivity) during the novel and challenging situation at the first time of measurement, (3) examine longitudinal changes in cortisol reactivity and distress behavior, and (4) examine relations between patterns of cortisol reactivity and behavior and psychological problems 1 year later. Significant decreases in distress behavior are found across the l-year period, whereas changes in cortisol level vary by gender. Cortisol level and extent of distress behavior are related under the most novel and challenging circumstance. Intraindividual differences in cortisol reactivity in the c...

Little or no research has determined the effect of vitamin D3 supplementation in conjunction with pharmacological and non-pharmacological approaches in the diabetes mellitus type 2 (DMT2) patients. The objective of this study was to determine the effect of vitamin D3 supplementation in a cohort of Saudi DMT2 population on diet, insulin and/or different oral hypoglycemic agents and compare them with a non-DMT2 control cohort. A total of 499 randomly selected Saudi subjects divided into 8 groups [Non-DMT2 Control = 151; Rosiglitazone alone = 49; Diet = 15; Insulin alone = 55; Insulin + Orals = 12; Metformin alone = 121; Oral agents combination = 37; Sulphonylurea alone = 59] were included in this 12-month interventional study. All DMT2 patients were given 2000 IU vitamin D3 daily, while the control group received none but were advised to increase sun exposure. Anthropometrics, glucose, lipid profile and 25-hydroxyvitamin D (25-OHVitD) were measured at baseline, 6 and 12 months. Circulating 25-OHVitD concentrations improved in all patient groups. The metformin group showed the highest change in circulating vitamin D levels both at 6 months (62.6%) and 12 months (50.6%) as compared to baseline (p < 0.001). No significant changes were observed in the BMI and glucose in any of the DMT2 groups. In contrast, the insulin + oral agents group showed more significant improvements in the metabolic profile, which included triglycerides and total cholesterol, as well as systolic blood pressure and HDL-cholesterol in males. Also, significant decreases in triglycerides were observed in the rosiglitazone and insulin + oral hypoglycemic agent groups both at 6 and 12 months of supplementation (both p-values <0.001). While in all DMT2 groups circulating levels of 25-OHVitD increased after supplementation, in DMT2 patients on insulin in combination with other drugs benefitted the most in improving cardiovascular risk. Metformin improves 25-hydroxyvitamin D levels but did not seem to confer other added cardiometabolic benefits.

Specific in vivo neutralization was used in an attempt to explore the roles of corticotropin-releasing hormone (CRH), ACTH, and beta-endorphin during surgical stress in Sprague-Dawley rats. Rats were randomly assigned to groups (n = 20-30/group) that received iv injections of rabbit antirat/human CRH (anti-r/hCRH), antihuman ACTH (anti-hACTH), antihuman beta-endorphin (anti-h beta-endorphin), or normal rabbit serum. Three hours later all animals were subjected to a uniform stress consisting of ether anesthesia, surgical laparotomy, and phlebotomy of 7 ml via the inferior vena cava. Survival rates were recorded, and RIAs were performed for ACTH, beta-endorphin, and corticosterone. Rats treated with anti-h beta-endorphin had a survival rate of 64%, which was significantly higher than that of the control group (33%; P less than 0.025, by analysis of variance). Anti-r/hCRH or anti-hACTH treatment was not associated with a change in survival rate. Plasma immunoreactive beta-endorphin levels were markedly decreased in the group treated with anti-h beta-endorphin (P less than 0.0001). Anti-r/hCRH had no effect on plasma immunoreactive ACTH or beta-endorphin. Plasma immunoreactive ACTH and corticosterone levels were decreased in the group treated with anti-hACTH (P less than 0.0001 and P less than 0.01, respectively). We conclude that 1) beta-endorphin immune neutralization is associated with a survival advantage during severe surgical stress, suggesting that circulating beta-endorphin might have deleterious effects during stress; 2) In severe stress, acute immune neutralization of CRH is not sufficient to inhibit ACTH, beta-endorphin, and corticosterone secretion, suggesting significant involvement of other secretagogues of the pituitary-adrenal axis; and 3) moderate decreases in corticosterone cannot affect survival, presumably because glucocorticoids play only a permissive role in maintaining cardiovascular stability during surgical stress.

Many children and adolescents are exposed to traumatic experiences every year. Over 30% of these children develop a clinical syndrome with emotional, behavioural, cognitive, social, and physical symptoms called post-traumatic stress disorder (PTSD). Road traffic accidents (RTAs) are the main cause of morbidity and mortality in ages 0–19 in industrialized countries. In Greece, 30,000 individuals are injured and 2000 die in RTAs every year, 40% of them between 15 and 34 years old. Findings from previous research exhibit that each fatal motor vehicle accident is related to 50 severe injuries. Although distress after the accident can persist for several months and the need of early assessment and treatment has been highlighted, the emotional needs of children involved in RTAs are rarely recognized and children have received hardly any planned intervention (Kramer & Landolt, 2014 Kramer, D. N., & Landolt, M. A. (2014). Early psychological intervention in accidentally injured children ages 2–16: A randomized controlled trial. European Journal of Psychotraumatology, 5. doi:10.3402/ejpt.v5.24402[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). In addition, studies on the extent to which the degree of physical injury predicts PTSD development show mixed results (Delahanty, Raimonde, Spoonster, and Cullado, 2003 Delahanty, D. L., Raimonde, A. J., Spoonster, E., & Cullado, M. (2003). Injury severity, prior trauma history, urinary cortisol levels, and acute PTSD in motor vehicle accident victims. Journal of Anxiety Disorders, 17, 1–2.[Crossref], [Web of Science ®] , [Google Scholar]). In these relatively limited studies, contradicting results concerning the relationship between demographic, accident and trauma factors and the psychological symptoms are shown.In a previous study (Pervanidou et al., 2007 Pervanidou, P., Kolaitis, G., Charitaki, S., Lazaropoulou, C., Papassotiriou, I., Hindmarsh, P., … Chrousos, G. P. (2007). The natural history of neuroendocrine changes in pediatric posttraumatic stress disorder (PTSD) after motor vehicle accidents: progressive divergence of noradrenaline and cortisol concentrations over time. Biological Psychiatry, 62(10), 1095–1102. doi:10.1016/j.biopsych.2007.02.008[Crossref], [Web of Science ®] , [Google Scholar]), which was conducted over a two-year period, the main aim was to identify and evaluate the severity of PTSD symptoms after a RTA. Furthermore, epidemiological, psychosocial and clinical characteristics related to the disorder were reviewed. The sample consisted of 57 children (39 male, 18 female), aged 7–18, who were admitted to ‘Aghia Sophia’ Children’s General Hospital and other hospitals. Self-reported questionnaires and a semi-structured psychiatric diagnostic interview (K-SADS-PL) were administered. Stress-related hormones were also measured. Assessment took place during the admission to the general hospital, in one month, and six months later. There was a community control group of 30 children/adolescents.Concerning the type of the accident, 36 (59%) of the young victims were traumatized as pedestrians, while 25 (41%) were passengers. The severity of body injury was mild in 21 (34.4%), moderate in 24 (39.3%) and severe in 16 (26.2%) victims. Results showed that 38.3% of children/adolescents who were involved in a RTA suffered from PTSD one month afterwards, while the percentage is significantly lower (15%) six months after the RTA. PTSD symptoms were experienced by children of all ages, although boys were most likely to be affected, especially those who were severely injured during the accident. The only predictor variable that had a significant positive effect on the development of PTSD (one month after the accident) was current maternal PTSD symptoms. Important findings regarding the consequent short- and/or long-term alterations on the circulating concentrations of stress hormones and adipo-cytokines were established as well (Pervanidou et al., 2007 Pervanidou, P., Kolaitis, G., Charitaki, S., Lazaropoulou, C., Papassotiriou, I., Hindmarsh, P., … Chrousos, G. P. (2007). The natural history of neuroendocrine changes in pediatric posttraumatic stress disorder (PTSD) after motor vehicle accidents: progressive divergence of noradrenaline and cortisol concentrations over time. Biological Psychiatry, 62(10), 1095–1102. doi:10.1016/j.biopsych.2007.02.008[Crossref], [Web of Science ®] , [Google Scholar]).Despite increasing attention over the past 20 years, PTSD is a significant public health issue that has not been properly addressed. It is well documented that highly stressful events affect the normal activity of the neurotransmitter norepinephrine and elevate levels of the hormone cortisol. Furthermore, continuous arousal during the course of time may produce difficulty in the hippocampus’s ability to manage in the future highly stressful events. Children and adolescents may respond to a traumatic event differently, depending on the degree of exposure, the age or developmental stage, the effect of the personal impact and the proximity to the actual traumatizing event. In our study, almost one out of three young victims of RTAs was found to suffer from PTSD a month later, confirming previous findings. The child’s perception of the accident was important, with badly injured children being more likely to develop PTSD. Further research could contribute to improved treatment approaches to reduce the devastating personal and societal impact of PTSD.

Fetal programming of the hypothalamic-pituitary-adrenal (HPA) axis has been proposed as an intermediary in the association between reduced fetal growth and adult cardiovascular and metabolic diseases. Previous studies have shown that small size at birth is associated with increased fasting plasma cortisol and adrenal responsiveness to ACTH stimulation. We have extended these studies by evaluating the salivary cortisol response to awakening and plasma ACTH and cortisol responses to CRH stimulation and a dexamethasone-suppressed CRH (DEX/CRH) test in a group of low birth weight [LBW; <3.18 kg (7 lb), n = 58] and high birth weight [>3.86 kg (8.5 lb), n = 65] men aged 60–69 yr. Despite no difference in basal pituitary-adrenal activity or in their ACTH and cortisol responses to CRH, LBW men had significantly lower pituitary-adrenal responses in the DEX/CRH test. Although these findings do not explain the HPA abnormalities associated with LBW in previous studies, they provide further evidence of dysregulation of the HPA axis in people who were small at birth.

A methodology is introduced for applying the FUSEIS beam-link steel lateral-load-resisting system for strengthening existing reinforced-concrete buildings. The purpose is to take advantage of the easy replaceability and architectural versatility of the FUSEIS systems to strengthen a deficient structure, while minimizing the economic impact of the rehabilitation works due to suspension of the operation of the building. Additionally, a case study is presented, where an existing building is upgraded by introducing FUSEIS beam-link systems, first by performing response spectra analysis using an initial behaviour factor, then refining the results via the INNOSEIS performance-based methodology. This necessitates the use of nonlinear dynamic analyses to quantify a risk-consistent behaviour factor that incorporates the effect of aleatory and epistemic uncertainty on the actual systems’ performance. Finally, a pre-normative assessment for the q-factor of FUSEIS-beam link systems is achieved, for use in existing reinforced concrete buildings within Eurocode 8.

The aim of the present study is the validation of the “Job Stress Measure” in the Greek population. “Job Stress Measure” along with ASSET scale was finally distributed to 238 individuals, working in public and private organizations. The Cronbach’s alpha coefficient of the “Job Stress Measure scale” was found to be 0.868. Three main circumstantial factors explain the 55% of the variance of the phenomenon: a) characteristics of work, b) clarity of objectives and c) without specific concept. The study showed positive correlation between stress and workload, job insecurity and difficulties in working relationships, physical and mental condition, communication and beliefs about work. Conclusively the “Job Stress Measure” can be used as a reliable validated tool for measuring job stress in the Greek population.

To study the pathophysiology of hypercortisolism in anorexia nervosa, we measured the cerebrospinal fluid (CSF) levels of corticotropin-releasing hormone (CRH) in patients when they were underweight and at intervals after weight restoration. CSF CRH levels were significantly elevated in hypercortisolemic underweight patients. Both CSF CRH levels and pituitary-adrenal function normalized after weight recovery. A significant positive correlation was found between CSF CRH levels and depression ratings in weight-corrected patients. We conclude that the hypercortisolism of anorexia nervosa reflects a defect at or above the hypothalamus which results in the hypersecretion of endogenous CRH. The positive correlation between CSF CRH and depression in the weight-restored patients is compatible with previous data indicating increased CRH secretion in the depressed phase of primary affective disorder and supports the notion of a relationship between CRH and depressive symptomatology. Moreover, these data are compatible with observations that depression is part of the anorexia nervosa syndrome.