APA format, based on PICOT TOPIC STRESS, Follow the rubric and use the articles also provided. 

Review Article
Effect of Stress on Autonomic and Cardiovascular Systems in
Military Population: A Systematic Review

Álvaro Bustamante-Sánchez,1 José Francisco Tornero-Aguilera,1,2

Valentı́n E. Fernández-Elı́as,1 Alberto J. Hormeño-Holgado,1,2 Athanasios A. Dalamitros,3

and Vicente Javier Clemente-Suárez 1,2,4

1Universidad Europea de Madrid, Faculty of Sport Sciences, Madrid, Spain
2Studies Centre in Applied Combat (CESCA), Toledo, Spain
3Laboratory of Evaluation of Human Biological Performance, School of Physical Education and Sport Sciences,
Aristotle University of )essaloniki, )essaloniki, Greece
4Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla, Colombia

Correspondence should be addressed to Vicente Javier Clemente-Suárez; [email protected]

Received 14 December 2019; Accepted 24 July 2020; Published 11 August 2020

Academic Editor: Anne Knowlton

Copyright © 2020 Álvaro Bustamante-Sánchez et al. -is is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Stress is regulated by the autonomous nervous system, increasing the sympathetic modulation when a threat is perceived. A
multifactorial response usually leads to significant behavioural modifications and alterations on homeostasis and physical and
psychological status. Moreover, stress is an emotional response that can lead to psychosocial and psychophysiological adversity.
Regarding military population, military operations and combat exposure are important stressors that influence acute and chronic
stress response in soldiers, affecting their performance and health. A bibliographic search was carried out between April and May
2019, focusing on recent studies (2013–2019) that analysed psychophysiological response, stress, stress regulation, heart rate, heart
rate variability, and posttraumatic stress disorder in military population. Autonomic and cardiovascular chronic stress seems to be
modulated by experience and previous specific training of each military unit. Physical exercise, music embedded with binaural
beat technology, bidirectional sensory motor rhythm training, heart rate variability biofeedback, and transcutaneous vagal nerve
stimulation are the main techniques applied to balance stress and to recover body homeostasis. Since military population are
usually exposed to multiple stressors, knowing previous training and experience, together with developing techniques to balance
stress, is the main practical application in this field of study to balance autonomic and cardiovascular systems.

1. Introduction

Stress is a multifactorial respons

Contents lists available at ScienceDirect

Food Research International

journal homepage: www.elsevier.com/locate/foodres

Quantitative assessment of tolerance response to stress after exposure to
oregano and rosemary essential oils, carvacrol and 1,8-cineole in Salmonella
Enteritidis 86 and its isogenic deletion mutants Δdps, ΔrpoS and ΔompR

Myrella Lira Cariria, Adma Nadja Ferreira de Meloa, Luke Mizzib, Ana Carolina Ritterc,
Eduardo Tondoc, Evandro Leite de Souzad, Vasilis Valdramidisb, Marciane Magnania,⁎

a Laboratory of Microbial Process in Foods, Department of Food Engineering, Center of Technology, Federal University of Paraíba, João Pessoa, Brazil
b Department of Food Sciences and Nutrition, Faculty of Health Sciences, Msida MSD 2080, University of Malta, Malta
c Laboratory of Food Microbiology, Food Science and Technology Institute, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
d Laboratory of Food Microbiology, Department of Nutrition, Health Sciences Center, Federal University of Paraíba, João Pessoa, Brazil


Salmonella enterica
Stress response
Essential oils


This study assessed the influence of rpoS, dps and ompR genes on the tolerance response of Salmonella Enteritidis
86 (SE86) to homologous and heterologous stressing agents after exposure to essential oils (EOs) from Origanum
vulgare L. (oregano; OVEO) and Rosmarinus officinalis L. (rosemary; ROEO) and their major constituents (ICs),
carvacrol (CAR) and 1,8-cineole (CIN), respectively, by modelling the log reduction over time. Minimum in-
hibitory concentration values of OVEO (1.25 μL/mL), CAR (0.62 μL/mL), ROEO (20 μL/mL) and CIN (10 μL/mL)
against SE86 were always one-fold higher than those against Δdps, ΔrpoS and ΔompR mutants. Exposure to the
same concentration of OVEO, CAR, ROEO or CIN caused higher reductions (up to 2.5 log CFU/mL) in Δdps,
ΔrpoS and ΔompR mutants than in SE86 in chicken broth. In assays with homologous stressing agents, ompR, dps
and rpoS influenced the tolerance to OEs or ICs. After adaptation to OVEO, CAR, ROEO and CIN, osmotolerance
and acid tolerance of SE86 were influenced by rpoS gene, while thermotolerance of SE86 was influenced by
ompR. Tolerance of SE86 to sodium hypochlorite after adaptation to OEs or ICs was influenced by rpoS and dps.
These findings quantitatively describe for the first time the influence of rpoS, dps and ompR genes on the tol-
erance of Salmonella Enteritidis to OVEO, CAR, ROEO and CIN.

1. Introduction

Among approximately 2600 serotype subspecies of Salmonella en-
terica subsp. enterica, S. Enterititis is reported as one of the major
etiological agents of salmonellosis outbreaks worldwide (Center for
Disease Control and Prevention, 2018; Yadav, Saxena, Saxena, &
Kataria, 2016). Epidemic strains of S. Enteritidis present a d


Mixed feelings: general practitioners’
attitudes towards eHealth for stress urinary
incontinence – a qualitative study
Lotte Firet* , Chrissy de Bree, Carmen M. Verhoeks, Doreth A. M. Teunissen and Antoine L. M. Lagro-Janssen


Background: Stress urinary incontinence (SUI) is the most prevalent subtype of urinary incontinence and is a bothering
condition in women. Only a minority of those with SUI consult a general practitioner (GP). EHealth with pelvic
floor muscle training (PFMT) is effective in reducing incontinence symptoms and might increase access to care.
The role of the GP regarding such an eHealth intervention is unknown. The aim of the study is to gain insight
into the attitudes towards a PFMT internet-based, eHealth, intervention for SUI.

Methods: A qualitative study was conducted. Data were collected through semi-structured interviews among
purposively sampled GPs. Audio records were fully transcribed, and analysed thematically.

Results: Thirteen GPs were interviewed, nine females and four males. Three themes emerged: appraisal of eHealth as a
welcome new tool, mixed feelings about a supportive role, and eHealth is no cure-all. GPs welcomed eHealth for SUI
as matching their preferences for PFMT and having advantages for patients. With eHealth as stand-alone therapy GPs
were concerned about the lack of feedback, and the loss of motivation to adhere to the intervention. Therefore, GPs
considered personal support important. The GP’s decision to recommend eHealth was strongly influenced by
a woman’s motivation and her age. GPs’ treatment preferences for elderly are different from those for young
women with SUI; both PFMT and eHealth are perceived less suitable for older women.

Conclusion: EHealth with PFMT fits into the GPs’ routine practice of SUI and adds value to it. Although there
is evidence that eHealth as a stand-alone intervention is effective, GPs consider personal support important to
supplement the perceived shortcomings. Probably GPs are not aware of, or convinced of the existing evidence. Training
should address this issue and should also focus on common misunderstandings about regular care for women with SUI,
such as the idea that PFMT is not suitable for the elderly. Improving GPs’ knowledge that eHealth can be a stand-alone
therapy for SUI facilitates the implementation in daily care.

Keywords: eHealth, Stress urinary incontinence, General practitioners, Attitude of health personnel, Qualitative research,

Urinary incontinence is a common condition in women
and has a major impact on quality of life. Stress urinary
incontinence (SUI) is the most prevalent subtype of
incontinence and is defined as the complaint of involun-
tary urinary leakage on effort or exertion, or on sneezing
or coughing [1–3]. The overall prevalence rate of urinary


· For this assignment you will use the Quantitative and the Qualitative article that you submitted for week 4 assignment that were related to your week 2 picot question.

· Only articles you uploaded and used in week 4 (Quantitative or Qualitative) are to be submitted. Articles must be current (within the last 5 years). All articles must be related to the field of nursing and related to the topic list from week 2.

· Write a summary (one to two pages)

· In the summary identify differences in article designs and research methods. Describe the differences in your articles designs and methods. Carefully review the rubric before you submit. This summary is using your own words to examine the differences specifically between the articles.

· Use current APA style for your summary paper and to cite your sources.

· Submit the Articles and the summary, APA Format

Week 4 assignment articles used are attached separately

Week 2 Assignment PICOT Questions:

Question 1: In nurses with acute stress, how does mindfulness plan compared to relaxing to music reduce an individual’s stress symptoms?

Question 2: how do first-time mothers of premature babies in NICU overcome postnatal stress during the first two months after birth?

Question 3: How does the use of exercises compare to medication in reducing stress among elderly people?