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Signs of burnout can be detected in sweat

When we’re in a stressful situation, whether life-threatening or mundane, cortisol is the hormone that takes over. It instructs our bodies to direct the required energy to our brain, muscles and heart.

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We’ve all felt stressed at some point, whether in our personal or professional lives or in response to exceptional circumstances like the COVID-19 pandemic. But until now there has been no way to quantify stress levels in an objective manner.

That could soon change thanks to a small wearable sensor developed by engineers at EPFL’s Nanoelectronic Devices Laboratory (Nanolab) and Xsensio. The device can be placed directly on a patient’s skin and can continually measure the concentration of cortisol, the main stress biomarker, in the patient’s sweat.

Cortisol: A double-edged sword

Cortisol is a steroid hormone made by our adrenal glands out of cholesterol. Its secretion is controlled by the adrenocorticotropic hormone (ACTH), which is produced by the pituitary gland. Cortisol carries out essential functions in our bodies, such as regulating metabolism, blood sugar levels and blood pressure; it also affects the immune system and cardiovascular functions.

When we’re in a stressful situation, whether life-threatening or mundane, cortisol is the hormone that takes over. It instructs our bodies to direct the required energy to our brain, muscles and heart.

“Cortisol can be secreted on impulse – you feel fine and suddenly something happens that puts you under stress, and your body starts producing more of the hormone,” says Adrian Ionescu, head of Nanolab.

While cortisol helps our bodies respond to stressful situations, it’s actually a double-edged sword. It’s usually secreted throughout the day according to a circadian rhythm, peaking between 6am and 8am and then gradually decreasing into the afternoon and evening. “But in people who suffer from stress-related diseases, this circadian rhythm is completely thrown off,” says Ionescu. “And if the body makes too much or not enough cortisol, that can seriously damage an individual’s health, potentially leading to obesity, cardiovascular disease, depression or burnout.”

Capturing the hormone to measure it

Blood tests can be used to take snapshot measurements of patients’ cortisol levels. However, detectable amounts of cortisol can also be found in saliva, urine and sweat. Ionescu’s team at Nanolab decided to focus on sweat as the detection fluid and developed a wearable smart patch with a miniaturized sensor.

The patch contains a transistor and an electrode made from graphene which, due to its unique proprieties, offers high sensitivity and very low detection limits. The graphene is functionalized through aptamers, which are short fragments of single-stranded DNA or RNA that can bind to specific compounds. The aptamer in the EPFL patch carries a negative charge; when it comes into contact with cortisol, it immediately captures the hormone, causing the strands to fold onto themselves and bringing the charge closer to the electrode surface. The device then detects the charge, and is consequently able to measure the cortisol concentration in the wearer’s sweat.

So far, no other system has been developed for monitoring cortisol concentrations continuously throughout the circadian cycle. “That’s the key advantage and innovative feature of our device. Because it can be worn, scientists can collect quantitative, objective data on certain stress-related diseases. And they can do so in a non-invasive, precise and instantaneous manner over the full range of cortisol concentrations in human sweat,” says Ionescu.

Engineering improved healthcare

The engineers tested their device on Xsensio’s proprietary Lab-on-SkinTM platform; the next step will be to place it in the hands of healthcare workers. Esmeralda Megally, CEO of Xsensio, says: “The joint R&D team at EPFL and Xsensio reached an important R&D milestone in the detection of the cortisol hormone. We look forward to testing this new sensor in a hospital setting and unlocking new insight into how our body works.” The team has set up a bridge project with Prof. Nelly Pitteloud, chief of endocrinology, diabetes and metabolism at the Lausanne University Hospital (CHUV), for her staff to try out the continuous cortisol-monitoring system on human patients. These trials will involve healthy individuals as well as people suffering from Cushing’s syndrome (when the body produces too much cortisol), Addison’s disease (when the body doesn’t produce enough) and stress-related obesity. The engineers believe their sensor can make a major contribution to the study of the physiological and pathological rhythms of cortisol secretion.

So what about psychological diseases caused by too much stress? “For now, they are assessed based only on patients’ perceptions and states of mind, which are often subjective,” says Ionescu. “So having a reliable, wearable system can help doctors objectively quantify whether a patient is suffering from depression or burnout, for example, and whether their treatment is effective. What’s more, doctors would have that information in real time. That would mark a major step forward in the understanding of these diseases.” And who knows, maybe one day this technology will be incorporated into smart bracelets. “The next phase will focus on product development to turn this exciting invention into a key part of our Lab-on-SkinTM sensing platform, and bring stress monitoring to next-generation wearables,” says Megally.

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Happiness really does come for free

Majority of people reported remarkably high levels of happiness. This was especially true in the communities with the lowest levels of monetization, where citizens reported a degree of happiness comparable to that found in Scandinavian countries which typically rate highest in the world.

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Economic growth is often prescribed as a sure way of increasing the well-being of people in low-income countries, but a study led by McGill and the Institute of Environmental Sciences and Technologies at the Universitat Autònoma de Barcelona (ICTA-UAB) suggests that there may be good reason to question this assumption.

The researchers set out to find out how people rate their subjective well-being in societies where money plays a minimal role, and which are not usually included in global happiness surveys. They found that the majority of people reported remarkably high levels of happiness. This was especially true in the communities with the lowest levels of monetization, where citizens reported a degree of happiness comparable to that found in Scandinavian countries which typically rate highest in the world.

The results suggest that high levels of subjective well-being can be achieved with minimal monetization, challenging the perception that economic growth will automatically raise life satisfaction among low-income populations.

Measuring happiness

To explore how monetization affects people’s sense of well-being, the researchers spent time in several small fishing communities, with varying degrees of monetization, in the Solomon Islands and Bangladesh, two very low-income countries. Over a period of a few months, with the help of local translators, they interviewed citizens in both rural and urban areas a number of times. The interviews, which took place both in person and through phone calls at unexpected moments, were designed to elicit information about what constituted happiness for the study subjects, as well as to get a sense of their passing moods, their lifestyle, fishing activities, household income, and level of market integration.

In all, the researchers interviewed 678 people, ranging in age between their mid-twenties and early fifties, with an average age of about 37. Almost 85 % of the study participants were male. The disproportionate number of men in the study was due to the fact that cultural norms in Bangladesh made it difficult to interview women. In the Solomon Islands, responses to the study questions from men and women were not significantly different. However, this is not necessarily applicable to the situation in Bangladesh, as men and women’s social realities and lifestyles differ so much. Further research will need to address whether gender-related societal norms impact the association found in this study.

Early stages of monetization may be detrimental to happiness

The researchers found that in the communities where money was in greater use, such as in urban Bangladesh, residents reported lower levels of happiness.

“Our study hints at possible ways of achieving happiness that are unrelated to high incomes and material wealth,” says Eric Galbraith, a professor in McGill’s Department of Earth and Planetary Sciences and the senior author on the study, which was recently published in PLOS One. “This is important, because if we replicate these results elsewhere and can pinpoint the factors that contribute to subjective well-being, it may help us circumvent some of the environmental costs associated with achieving social well-being in the least developed nations.”

“In less monetized sites, we found that people reported a greater proportion of time spent with family and contact with nature as being responsible for making them happy,” explains Sara Miñarro, the lead author on the study who is a Postdoctoral Research Fellow at (ICTA-UAB). “But with increasing monetization, we found that the social and economic factors commonly recognized in industrialized countries played a bigger role. Overall, our findings suggest that monetization, especially in its early stages, may actually be detrimental to happiness.”

Interestingly, while other research has found that technology and access to information from faraway cultures with different lifestyles may affect people’s sense of their own well-being by offering standards to which people compare their own lives, this did not appear to be the case in these communities.

“Happy without money: Minimally monetized societies can exhibit high subjective well-being” by Sara Miñarro, et al was published in PLOS One.

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Picture books can boost physical activity for youth with autism

There are numerous health benefits of exercise, such as pumping blood in your body, better sleep and reduced risk of obesity. Also, if we can get kids with autism more physically engaged, they are more likely to run around and play with their peers, so there are other aspects of their life we can improve as well.

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While physical activity is important for everyone, research has shown people with developmental disabilities do not exercise as often as their typically developed peers. In an effort to close this disparity, a researcher at the University of Missouri recently created fitness picture books that help youth with autism exercise more frequently while offering low-income families a simple resource for workout motivation when outdoor fitness equipment might not be accessible.

“There is so much research geared toward helping individuals with autism improve their academic performance, social skills and communication skills, but we also need to remember how important physical activity is for living a healthy lifestyle,” said Lorraine Becerra, an assistant teaching professor at the MU College of Education. “There are numerous health benefits of exercise, such as pumping blood in your body, better sleep and reduced risk of obesity. Also, if we can get kids with autism more physically engaged, they are more likely to run around and play with their peers, so there are other aspects of their life we can improve as well.”

Becerra is also a behavior analyst at the Thompson Center for Autism and Neurodevelopmental Disorders. Since some of her former clients with autism had body mass indexes that had risen to unhealthy levels due to excessive sedentary behavior, their caregivers asked Becerra to develop creative ways to encourage their children to exercise more.

So, in a recent research study, Becerra created fitness picture books that contained step-by-step images of various exercises, such as jumping jacks, bear crawls and lunges. The picture books were successfully utilized to increase the amount of time the individuals with autism engaged in physical activity.

Having previously worked in low-income school districts with limited financial resources, Becerra understands the need to find cost-efficient methods to help kids with autism exercise more frequently.

“It’s important to remember that some schools might not have a jungle gym or many age-appropriate resources for kids to play with,” Becerra said. “The great thing about the picture books is they provide simple, engaging exercises that can be done in a wide variety of settings, like a school playground, backyard or even an empty field at a park. It is also a quick and easy way for caregivers or teachers to provide organized structure during flexible free time, such as during recess.”

With recent advancements in technology and entertainment, youth are increasingly spending more of their time sitting in front of televisions, tablets and personal electronic devices. Becerra is passionate about reminding youth — particularly individuals on the autism spectrum — about the importance of scheduling time for physical activity.

“These lifelong habits start when you are young,” Becerra said. “Making time to run around and establish those exercise routines early in life will help youth maintain those habits in their adolescent and adult years.”

“The effect of photographic activity schedules on moderate-to-vigorous physical activity in children with autism spectrum disorder” was recently published in the Journal of Applied Behavior Analysis.

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Taking the fear out of driver education

Educational programs often use fear-based messaging and films of crash scenes to reduce risky driving behavior among young people. But does this “scary” approach work?

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Photo by Laura Gariglio from Unsplash.com

New drivers between the ages of 15 and 25 account for nearly half of the more than one million road deaths that occur worldwide each year, according to the World Health Organization. Educational programs often use fear-based messaging and films of crash scenes to reduce risky driving behavior among young people. But does this “scary” approach work?

A new study published in the journal Risk Analysis suggests that fear-based messaging fails to reduce risky driving behavior, while fear-based Virtual Reality (VR) films depicting a violent collision may actually lead young drivers to take more chances behind the wheel.

A team of psychologists led by University of Antwerp researcher Clara Alida Cutello, PhD, conducted a study of 146 students who had been legally driving for less than five years. The researchers examined the impact of both content (fear vs. positive) and delivery mode (2D vs. VR) of driver safety intervention programs.

Fear-based driver ed films often show terrible crash scenes in graphic detail. The assumption behind this approach is that arousing a sense of fear by depicting a serious consequence such as death will persuade young people to drive more carefully. Positively framed films take the opposite approach, using humor and empathy and modeling safe driving behaviors that result in positive consequences.

Three tests were used to gauge the risk-taking behavior of the young drivers before and after participating in the intervention program. One was a Driver Behavior Questionnaire. The other was the Vienna Risk-Taking Test on traffic, which asks participants to watch video clips of driving situations from the point of view of the driver and choose whether they view a situation as too risky. For example, choosing whether to pass another car in icy conditions. A third test was a 21-item Emotional Arousal Scale that measured the level of emotional arousal (such as feeling afraid) after watching a film.

The results showed that participants who viewed the fear-based VR film reported riskier driving behaviors afterward, while those who viewed a positively framed VR film exhibited the greatest reduction in risky driving behavior. This finding supports other research that has shown that exposing participants to an extreme and graphic collision tends to activate defensive mechanisms, such as paying attention for a shorter time, disengaging, rejecting a message, and an increase in risky behaviors.

“Fear appeals have been used in many health and environmental campaigns, such as smoking, anti-drug, safe sex, and HIV prevention campaigns,” says Dr. Cutello. “Further experimental research is needed to determine whether the use of fear is effective.”

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