Alakidi Adolf, Dimitrov Iliyan, Bivolarska Anelia Vesselinova, Mihaylova Vanina
Department of Epidemiology and Hygiene, Faculty of Medicine, Medical University of Sofia, Sofia 1000, Bulgaria
Department of Medical Biochemistry, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
Rural Remote Health. 2023 Jan;23(1):7318. doi: 10.22605/RRH7318. Epub 2023 Jan 30.
Stress is a phenomenon accompanying everyday life. Various reactions of the body are activated during stress, including activation of the hypothalamo-pituitary-adrenal endocrine axis and the autonomous nervous system. Their activity could be assessed by the measurement of biological stress marker molecules - salivary α-amylase and cortisol - on one side and heart rate, and blood pressure monitoring, on the other. The aim of the present study is to determine whether the daily professional routines cause stress development among general practitioners (GPs) who work in rural, distant areas in the territory of the Republic of Bulgaria.
One hundred and twenty-eight GPs were asked to answer a questionnaire to assess their health conditions, habits, priority objectives and interests, as well as their moral and ethical relationships with the patients. On this basis 40 participants were selected and outlined for the present survey (n=40, mean age 55.92±8.8). Four salivary samples were collected from each participant during 1 week: two on Monday (one in the morning and one after work) and two on Friday, by the same mechanism. The salivary samples collection was followed by measurement of blood pressure and pulse. This non-invasive survey was based on an ELISA method for quantitative determination of the marker molecules in saliva. The blood pressure and pulse were measured by blood pressure monitor.
The levels of the salivary α-amylase were significantly higher at the end of the working day, especially on Friday (142.28±23.34 U/mL, p=0.018), but not between the beginning and the end of the week. The normal cortisol awakening response, characterized by a peak in the levels of cortisol after wake-up, followed by a slow decrease during the day, was detected only at the beginning of the week. The data show a significant impairment of this regularity at the end of the week. Moreover, the levels of cortisol, measured for the morning samples, show a decrease at the end of the week (25.73±10.51 ng/mL) in comparison to the beginning of the week (30.1±10.84, p=0.033). The analyses on the effect of smoking (p=0.002) and alcohol consumption (p=0.036) on stress development show a significant increase in the levels of the salivary α-amylase, but not on the levels of salivary cortisol. The changes in the blood pressure indicate stress development at the end of the week (p=0.04), while the pulse showed changes within a day rather than during the week. The values of the pulse were higher at the end of the day.
The professional lives of the GPs who work in distant and rural places are associated with stress development. Different habits from the daily routine, such as alcohol consumption, smoking and physical activity, could be considered as modulators of stress development.
压力是伴随日常生活的一种现象。压力期间身体会激活各种反应，包括下丘脑 - 垂体 - 肾上腺内分泌轴和自主神经系统的激活。一方面，可以通过测量生物应激标记分子——唾液α - 淀粉酶和皮质醇，另一方面通过监测心率和血压来评估它们的活动。本研究的目的是确定日常工作流程是否会在保加利亚共和国偏远农村地区工作的全科医生（GP）中导致压力的产生。
128名全科医生被要求回答一份问卷，以评估他们的健康状况、习惯、优先目标和兴趣，以及他们与患者的道德伦理关系。在此基础上，选择40名参与者进行本次调查（n = 40，平均年龄55.92±8.8）。在1周内从每位参与者收集4份唾液样本：周一两份（一份早上，一份下班后），周五两份，采用相同的方法。收集唾液样本后测量血压和脉搏。这项非侵入性调查基于酶联免疫吸附测定法（ELISA）对唾液中的标记分子进行定量测定。血压和脉搏通过血压监测仪测量。
工作日结束时，尤其是周五，唾液α - 淀粉酶水平显著升高（142.28±23.34 U/mL，p = 0.018），但一周开始和结束之间没有差异。正常的皮质醇觉醒反应，其特征是醒来后皮质醇水平达到峰值，随后在一天中缓慢下降，仅在一周开始时检测到。数据显示在周末这种规律性受到显著损害。此外，与一周开始时（30.1±10.84，p = 0.033）相比，早上样本测量的皮质醇水平在周末有所下降（25.73±10.51 ng/mL）。关于吸烟（p = 0.002）和饮酒（p = 0.036）对压力产生影响的分析表明，唾液α - 淀粉酶水平显著升高，但唾液皮质醇水平没有升高。血压变化表明周末压力增加（p = 0.04），而脉搏变化在一天内而非一周内出现。一天结束时脉搏值较高。
在偏远农村地区工作的全科医生的职业生活与压力的产生有关。日常不同的习惯，如饮酒、吸烟和体育活动，可被视为压力产生的调节因素。
