Little is known about the dynamic characteristics of stress system activity during “life as it is lived”. Using as representative a study design as possible, this investigation sought to gain insights into this area. A healthy 25-year-old woman collected her entire urine over a period of 63 days in 12-h intervals (126 measurements) to determine cortisol and neopterin (immune activation marker) levels. In addition, she filled out questionnaires on emotional state and daily routine in 12-h intervals, and was interviewed weekly to identify emotionally negative and positive everyday incidents. Adjusted cross-correlational analyses revealed that stressful incidents were associated with cyclic response patterns in both urinary cortisol and urinary neopterin concentrations. Urinary cortisol levels first decreased 12–24 h after stressful incidents occurred (lag 1: −.178; p = 0.048) and then increased a total of 72–84 h later (lag 6: +.224; p = 0.013). Urinary neopterin levels first increased 0–12 h before the occurrence of stressful incidents (−lag 1: +.185; p = 0.040) and then decreased a total of 48–60 h following such stressors (lag 4: −.181; p = 0.044). Decreases in urinary neopterin levels were also found 24–36 and 48–60 h after increases in pensiveness (lag 2: −.215; p = 0.017) and depressiveness (lag 4: −.221; p = 0.014), respectively. Findings on emotionally positive incidents sharply contrasted with those dealing with negative experiences. Positive incidents were followed first by urinary cortisol concentration increases within 12 h (lag 0: +.290; p = 0.001) and then by decreases after a total of 60–72 h (lag 5: −.186; p = 0.039). Urinary neopterin levels first decreased 12–24 h before positive incidents occurred (−lag 2: −.233; p = 0.010) and then increased a total of 12–24 h following these incidents (lag 1: +.222; p = 0.014). As with previous investigations on patients with systemic lupus erythematosus (SLE), this study showed that stress system response can be considerably longer and more complex and differentiated than findings from conventional group studies have suggested. Further integrative single-case studies will need to be conducted in order to draw firm conclusions about stress system dynamics under real-life conditions.

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This study on a patient with systemic lupus erythematosus (SLE) investigated the impact of positive emotionally pleasing incidents on hypothalamus‐pituitary‐adrenal (HPA) axis and cellular immune system activity under complex everyday conditions. A 52 year‐old woman collected her entire urine for 56 days in 12‐h intervals for the determination of cortisol and neopterin, a cellular immune parameter. Psychological variables were based on daily questionnaires and weekly interviews. Time series analysis consisted of ARIMA modeling and cross‐correlational analysis. Positive everyday incidents were associated with three distinct emotional reactions: short‐term positive reactions, anticipatory negative reactions, and long‐term negative reactions. Short‐term positive reactions were associated with a decrease in urine cortisol after 36 h and an increase after a total of 48 h, while urine neopterin increased 24 h after the incidents and decreased after a total of 84 h. Anticipatory negative reactions were associated with an initial increase in urine cortisol 24 h before the incident occurred and with a subsequent decrease a total of 12 h following the incident. Long‐term negative reactions were associated with an ultimate increase in urine neopterin 144 h after the incidents. These findings empirically demonstrate that one specific category of positive everyday incidents can be associated with multiple emotional reactions that differ in valence (positive/negative) and duration (short‐term/long‐term), and also depend on whether an incident was expected (anticipated/not anticipated). This calls for a careful categorization of positive incidents when testing stress system functioning under complex everyday life conditions. Copyright © 2006 John Wiley & Sons, Ltd.

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Background: Medical students gain a particular perspective on health problems during their medical education. This article describes how medical students value 10 hypothetical health states using the EQ-5D compared to the general population.