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Although the literature suggest that alcohol misuse is common in medical students, few studies have investigated it in French medical residents. The present study aims at exploring the prevalence and associated characteristics of alcohol misuse in French medical residents
Medical residents working in one of 3 University Hospital in France (n=292) were invited to fill out an online survey using the mailing lists of the participating centers. Alcohol use was assessed with the 10-item self-report Alcohol Use Disorders Identification Test (AUDIT) (range 0-40) which provides scores for hazardous alcohol use, dependency symptoms and harmful alcohol use. Background variables were also collected.
Mean participants’ age was 27.7 (SD=1.7) and 65.5% (n=190) of them were of female gender. Mean weekly hours of work at the hospital was 57.8 (SD=13.6) and mean number of validated rotations at the time of the assessment was 5.1 (SD=2.4). Mean AUDIT score was 4.5 (SD=3). Forty-four (15.1%) participants scored on the AUDIT above the cut-off (>7) for problem use and 51 of them (17.5%) reported binge drinking at least once a month. AUDIT total score was positively correlated with male gender (r=0.26) and cannabis use (r=0.40) while negatively associated with weekly hours of work (r=-0.12) and number of rotations validated (-0.13). In a regression analysis, only male gender predicted alcohol use.
Alcohol problem use is prevalent in French medical residents, is predicted by male gender and is strongly associated with cannabis use. Future research is needed to confirm these results.
To examine the theory of the mind (TOM) in BPD patients.
Fifteen BPD patients (age>18) meeting criteria for BPD were compared to 16 healthy matched controls on two measures of TOM: mental state decoding (MSD) and mental state reasoning (MSR). MSD is the ability to perceive social cues (faces expression, voices) while MSR is the ability to infer on mental states with experiment, learning, context. MSR was measured by the faux pas recognition task assessing the ability to identify a faux pas in a social situation (range 0-60) and a comic strips task measuring the ability to infer intention (range 0-28). MSD was assessed by a video task reporting the ability to infer false belief and intention of deceit on visual motor action. Depressive symptoms (Beck Depression Inventory) and axis II comorbidity traits (Personality Disorder Questionnaire-4+) were also assessed.
Mean (SD) age was 26.0 (4.1) and two participants were of male gender (6.5%). BPD patients scored significantly lower than controls on the both MSR measures: faux pas task mean (SD) scores of 46.6(14.1) vs 58.0(2.8) (p=0.002) and comic strips mean (SD) scores of 26.1(1.5) vs 27.4(1.3) (p=0.001). No significant differences were found on the video task. Multivariate analyses showed that faux pas score was predicted by BPD diagnosis independently from level of depressive symptoms, history of hypomanic episode, schizotypic and antisocial personality disorder traits (F=4.32, df=6, p< 0.01).
BPD is associated with a TOM deficit on mental state reasoning tasks even after controlling for confounding variables.
Few studies have suggested the efficacy of cognitive-behavioural therapy (CBT) in inpatients suffering from major depressive disorder (MDD). The present study aims at examining the efficacy of Ultra-brief CBT (UCBT) in depressed inpatients.
Twenty-two patients (age>18) admitted to the psychiatric ward of Toulouse University Hospital for MDD were randomised to receive for two weeks either UCBT (n=11) or treatment as usual (TAU) (n=11). UCBT consisted in 6 sessions of CBT while TAU consisted in supportive sessions. Both types of sessions were performed by psychiatric residents. Both groups also received pharmacological and institutional cares. Primary outcome was depressive symptoms assessed by the Beck Depression Inventory (BDI-II) and the Hamilton Depressive Rating Scale (HDRS) before and after treatment (2 weeks).
There were no differences between the groups on any baseline variables. Mean age was 48.4 (SD=12.7) and 36.4% (n=8) were of male gender. Mean baseline HDRS scores were 23.3(SD=6.3) and 19.3(SD=3.9) and BDI scores were 36.7(SD=12) and 36.1(SD=7.5) for the UCBT and TAU groups respectively. At the end of treatment, mean HDRS scores were 12.3(SD=10.1) and 14.4(SD=7.8) and BDI scores were 18.8(SD=16.8) and 20.6(SD=11.4) for the CBT and TAU groups respectively. Both groups displayed a significant decrease on HDRS and BDI scores (all p< 0.05). An analyse of variance showed an interaction time by group in favour of the UCBT group on HDRS score (F=6.66; p=0.018).
Our results suggest that UCBT might be more efficacious than supportive therapy in depressed inpatients.
Although the Peritraumatic Distress Inventory (PDI) and Peritraumatic Dissociative Experiences Questionnaire (PDEQ) are both useful for identifying adults at risk of developing acute and chronic post-traumatic stress disorder (PTSD), they have not been validated in school-aged children. The present study aims at assessing the psychometric properties of the PDI and PDEQ in a sample of French-speaking school children.
One-hundred and thirty-three school-aged victims of road traffic accidents were consecutively enrolled into this study via the emergency room. Mean(SD) age was 11.7(2.2) and 56.4% (n=75) of them were of male gender. The 13-item self-report PDI (range 0-52) and the 10-item self report PDEQ (range 10-50) were assessed within one week of the accident. Symptoms of PTSD were assessed 1 and 6 months later using the 20-item self-report Child Post-Traumatic Stress Reaction Index (CPTS-RI) (range 0-80).
Mean(SD) PDI and PDEQ scores were 19.1(10.1) and 21.1(7.6), respectively, while mean(SD) CPTS-RI scores at 1- and 6-months were 22.6(12.4) and 20.6(13.5), respectively. Cronbach's alpha coefficients were 0.8 and 0.77 for the PDI and PDEQ, respectively. The 1-month test-retest correlation coefficient (n=33) was 0.77 for both measures. The PDI demonstrated a 2-factor structure while the PDEQ displayed a 1-factor structure. As with adults, the two measures were inter-correlated (r=0.52) and correlated with subsequent PTSD symptoms (r=0.21−0.56; p< 0.05).
The PDI and PDEQ are reliable and valid in school-aged children, and predict PTSD symptoms.
It remains unknown whether peritraumatic reactions predict PTSD symptoms in younger populations. To prospectively investigated the power of self-reported peritraumatic distress and dissociation to predict the development of PTSD symptoms at 1-month in school-aged children.
A sample of 103 school-aged children (8-15 years old) admitted to an Emergency Department after a road traffic accident were consecutively enrolled. Peritraumatic distress was assessed using the Peritraumatic Distress Inventory (range 0-52) and peritraumatic dissociation was assessed using the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) (range 10-50). PTSD symptoms were measured at 1-month by both the child version of the clinician-administered PTSD Scale (CAPS-CA) (range: 0-136) and the Child Post-traumatic Stress Reaction Index (CPTS-RI) (range 0-80).
Mean(SD) participants’ age was 11.7(2.2) and 53.4% (n=55) of them were of male gender. At baseline, mean PDI and PDEQ scores were 21.4 (SD=7.8) and 19.2 (SD=10.2), respectively. At 1-month, mean self-reported (CPTS-RI) and interviewer-based (CAPS-CA) PTSD symptom scores were 23.2 (SD=12.1) and 19 (SD=16.9), respectively. According to the CAPS-CA, 5 children (4.9%) suffered from full PTSD. Bivariate analyses demonstrated a significant association between peritraumatic variables (PDI and PDEQ) and both CAPS-CA and CPTS-RI (r=0.22-0.57; all p< 0.05). However, in a multivariate analysis, PDI was the only significant predictor of acute PTSD symptoms (Beta=0.33, p< 0.05).
As has been found in adults, peritraumatic distress is a robust predictor of who will develop PTSD symptoms among school-aged children.
Violent behaviors in psychiatric emergency departments are a common problem. The aim is to study characteristics of patients who need intense preventive care measures and who act violently.
The study was conducted in a locked short term psychiatric inpatient unit and involved 172 patients admitted in a 8 months period. Sociodemographic and clinical data were obtained through a review of the medical records. Secclusion, restraint and agressive behaviors were noted on specific nurse sheets.
Aggressive behaviors or intense preventive measures concerned 34% (n=59) of the 172 patients. Among these 59 patients, 61% (n=36) are men and the mean age is 34,9 years, 28 had seclusion, 51 had restraint and 11 had physical aggression or against object aggression. The diagnosis are schizophrenic disorders for 63% (n=37), dependence or substance abuse for 11% (n=7), mania for 10% (n=6), depression for 3,5% (n=2). For 27% (n=16) of them it was first time in Emergency Department and 30,5% (n=18) were intoxicated at admission. The mean neuroleptic treatments dosis of these patients at admission were 656mg (equivalent chlorpromazine).
Patients concerned by seclusion, restraint and aggressive behavior are more frequently men with schizophrenic disorders, high neuroleptic dosis, and various past admissions in the Emergency Department.
Borderline personality disorder (BPD) is characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This disorder is associated with a significant rate of suicide attempts and completed suicides (4 to 10%), a major impairment in social functioning and an increased healthcare utilization cost. Treatments available include psychotherapy and pharmacotherapy. Research has shown some efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) on post-traumatic stress disorder and mood disorder which both share common biological or clinical features with BPD. It is then likely that rTMS might prove efficient on BPD symptoms.
A review of the literature on neuroimaging and neuropsychology of BPD shows a hypoactivity of the dorsolateral prefrontal cortex which may be a potential target site for rTMS.
We will conduct a pilot randomized sham-controlled trial on 30 BPD patients assessing the efficacy of a 10-day course of daily rTMS on neuropsychological tasks, BPD symptoms severity, risk taking behaviour, depression and general psychopathology.
Little data is available on psychological factors involved in health-related Quality of Life (Qol) after Percutaneous Transluminal Coronary Angioplasty (PTCA). The present study aims at examining the impact of alexithymia on mental and physical QoL 6 months after PTCA.
We continuously enrolled patients admitted to a cardiology ward of Toulouse University Hospital for PTCA. Within 24 hours of the PTCA, each subject was assessed with the 20-item Toronto Alexithymia Scale (TAS) and the 36-item Short Form Health Survey (SF-36) which provides a Physical Component Score (PCS) and a Mental Component Score (MCS). At 6 months, the SF-36 was re-administered by telephone. Correlations analyses were performed, controlling for sex, age, cardio-vascular risk factors and number of dilated arteries.
Fifty-nine subjects (83.9% male) completed the follow-up interview. Mean age was 65.6(SD=11), mean TAS score was 49.1(SD=12.2), mean baseline and 6-month MCS scores were respectively 44.2(SD=11.7) and 48(SD=13.3) and mean baseline and 6-month PCS scores were respectively 41.3(SD=8.8) and 43.8(SD=9.4). At baseline, TAS was correlated with MCS (p<.05) but not with PCS. At 6 months, TAS was no longer associated with MCS, however, after controlling for baseline PCS, increased TAS scores were significantly associated with poorer PCS scores (p<.05).
According to our findings, patients with high levels of alexithymia may be at risk of poorer physical QoL 6 months after PTCA. Therefore the assessment of this psychological construct may prove useful in detecting patients who might benefit from further support.
Existential anxiety (EA) has been described as the anxiety about the meaning of life, death and the necessity to make choices (Tillich, 1953).Although recent research found EA to be associated with trauma and general psychological symptoms in community samples (Weems et al. 2004), to date, no study has investigated its relationship with trauma exposure and posttraumatic stress disorder (PTSD) symptoms in psychiatric outpatients.
To examine the association between EA and self-reported trauma history and PTSD symptoms in psychiatric outpatients.
Seventy-two stable psychiatric outpatients (mean(SD) age=46.1(14), 55% females) were assessed with the Existential Anxiety Questionnaire (EAQ; score ranging 0-39), the Trauma History Questionnaire which reports on criminal experiences, natural disasters, death exposure and questioning about physical and sexual experiences, and the PTSD Checklist (PCL; score ranging 17-85).
Mean(SD) EAQ and PCL scores were 20.0(7.8) and 40.0(15), respectively. A majority of participants (93%) reported at least one lifetime trauma exposure. Results revealed a positive correlation between existential anxiety and lifetime trauma exposure (r=.28, p< .05).Furthermore, in patients with lifetime trauma exposure, increased EA was associated with increased PCL total score (r=.57, p< .001) as well as with all PTSD symptom clusters: re-experiencing (r=0.45, p < 0.001), hyperarousal (r=.51, p< .001) and avoidance (r=.53, p < .01).
Our findings suggest that EA might be an interesting construct to examine further in the assessment and treatment of PTSD and paves the way for empirical investigations of existential therapies.
Suicide is a major public health issue, and a critical step in its prevention is a psychiatric assessment of individuals following suicide attempts (NICE 2008). In cases where patients attempt suicide through substance overdose, the central nervous system and consciousness are altered in significant ways. This is problematic, given that patients must have recovered sufficient cognitive capacity if a psychiatric assessment is to yield a meaningful and suitable care plan that the patient will recall and follow (Lukens 2006). Currently, there is no validated tool to assess whether sufficient cognitive recovery has occurred in such patients to ensure their memory of the assessment. Therefore, our goal was to identify indicators that predict preserved memory of undergoing a psychiatric assessment. We carried out a prospective study with 41 patients recruited from an emergency department. We collected data on cognitive tests (including WAIS coding test), memory self-assessment, plasma benzodiazepine levels, age, gender, and educational level at the time of psychiatric assessment. We then assessed patients’ memory for undergoing a psychiatric interview 24 hours post-assessment, using an episodic memory score. Whereas memory self-assessment did not predict the episodic memory score, age, plasma benzodiazepine level, and cognitive test scores significantly influenced it, predicting 70% of memory score variation. Among these factors, the WAIS coding test predicted 57% of the memory score variation. To improve clinical practice, it may be useful to assess visual scanning, processing speed, and attentional function prior to psychiatric interview to ensure later patient recall.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Serum BDNF levels are decreased in major depressive disorder (MDD) and tend to normalize under antidepressant treatment, serving as a treatment outcome predictor. BDNF is initially synthetized as precursor protein proBDNF and is cleaved to mature BDNF (mBDNF) while only the latter exerts neurotrophic activity.
The aim was to explore if a specific enzyme-linked immunosorbent assay (ELISA) kit for mBDNF in serum would be superior to the unspecific assessment of total serum BDNF in predicting treatment response in MDD.
Twenty-five patients with MDD underwent standardized treatment with duloxetine. Severity of depression was measured by Hamilton Depression Rating Scale (HDRS) at baseline (BL), after one (W1), two (W2) and six weeks (W6) of treatment. Treatment response was defined as a HDRS ≥ 50% reduction of BL score at W6. mBDNF and total BDNF serum levels were determined at BL, W1 and W2.
A high and stable correlation was found between mBDNF and total BDNF serum levels over all measurements. The predictive value of mBDNF BL levels and mBDNFΔW1 to response was similar to that of total BDNF BL and total BDNFΔW1. The assessment of serum mBDNF was not superior to total BDNF in prediction of treatment outcome.
Not only baseline total BDNF but also mBDNF is predictive to treatment outcome. The later might represent the main player in this respect, which supports the idea of a functional link between neuroplasticity and MDD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We present spatially resolved kinematics of ionized gas in the narrow-line region (NLR) and extended narrow-line region (ENLR) in a sample of nearby active galaxies. Utilizing long-slit spectroscopy from Apache Point Observatory (APO)13s ARC 3.5 m Telescope and Hubble Space Telescope (HST) we analyzed the strong λ5007 Å [O III] emission line profiles and mapped the radial velocity distribution of gas at increasing radii from the center. We identified the extents of Active Galactic Nuclei (AGN) driven outflows in our sample and determined the distances at which the observed gas kinematics is being dominated by the rotation of the host galaxy. We also measured the effectiveness of radiative driving of the ionized gas using mass distribution profiles calculated with two-dimensional modeling of surface brightness profiles in our targets. Finally, we compared our kinematic results of the outflow sizes with the maximum distances at which the gas is being radiatively driven to investigate whether these outflows are capable of disrupting or evacuating the star-forming gas at these distances.
We investigate the processes of active galactic nuclei (AGN) feeding and feedback in the narrow line regions (NLRs) and host galaxies of nearby AGN through spatially resolved spectroscopy with the Gemini Near-Infrared Integral Field Spectrograph (NIFS) and the Hubble Space Telescope’s Space Telescope Imaging Spectrograph (STIS). We examine the connection between nuclear and galactic inflows and outflows by adding long-slit spectra of the host galaxies from Apache Point Observatory. We demonstrate that nearby AGN can be fueled by a variety of mechanisms. We find that the NLR kinematics can often be explained by in situ ionization and radiative acceleration of ambient gas, often in the form of dusty molecular spirals that may be the fueling flow to the AGN.
The near-infrared reflectance spectra of Pluto and its satellites are rich with diagnostic absorption bands of ices of CH4, N2, CO, H2O, and an incompletely identified ammonia-bearing molecule. Following years of investigation of the spectra of Pluto and Charon with ground-based telescopes, NASA’s New Horizons spacecraft obtained spectral maps of these bodies and three small satellites on its passage through the system on July 14, 2015, showing the distribution of these ices, as well as a colored, non-ice component. Spectral modeling mapped the distribution of the various ices and showed their abundance and mixing details in relationship to regions of differing surface elevation, albedo, and geologic structure. Additionally, owing to their greatly different degrees of volatility, the ices of Pluto are distributed in patterns responsive to Pluto’s climatic changes on both short and long terms. The surface of Charon is dominated spectrally by H2O ice with one or more ammoniated compounds, and three of the four very small satellites show both H2O ice and the ammonia signature.
Flaviviruses include many viruses causing encephalitis, including West Nile encephalitis, St. Louis encephalitis, tick-borne encephalitis and Japanese encephalitis. Human pegivirus genotype-1 (HPgV-1) is a lesser known member of the Flaviviridae family and has been identified in human serum, cerebrospinal fluid and brain tissue. Here, we describe two adult patients with fatal HPgV-1-associated encephalitis. Neuroimaging revealed multifocal lesions, initially present in the periventricular and brain stem white matter, then one year later throughout the corona radiata bilaterally with marked involvement of the brainstem and cervical spinal cord. Phylogenetic analyses of HPgV-1 showed clustering of brain-derived sequences from both patients with other human pegiviruses. In both patients, a novel 87-nucleotide deletion in the viral NS2 gene was detected. The presence of positive and negative strand HPgV-1 RNA and viral antigens in both patients indicated viral persistence and replication in the CNS. Autopsy showed lymphocyte infiltration and gliosis predominantly in white matter of the brain and brain stem but, to a lesser extent, also in grey matter. Immunofluorescence revealed HPgV-1 NS5A antigen in lymphocytes as well as in astrocytes and oligodendrocytes. Thus, we hypothesize that the novel deletion in the NS2 coding region may have caused HPgV-1 neuroadaptation or might represent a yet unrecognized genotype of human pegivirus.
This presentation will enable the learner to:
1. Describe the clinical and neuropathological features of fatal human pegivirus-associated encephalitis
2. Recognize the importance of molecular analysis in encephalitis cases with unknown etiology
In Germany all keepers of livestock are legally required to record animal welfare indicators as part of their on-farm self-assessment. The Association for Technology and Structures in Agriculture (Kuratorium für Technik und Bauwesen in der Landwirtschaft e.V. (KTBL)) has suggested the use of a particular set of animal welfare indicators in their publication Animal welfare indicators: Practical guide – Pigs. The aim of the present study was to evaluate the inter-observer reliability (Inter-OR) and intra-observer reliability (Intra-OR) of these indicators with respect to the welfare of fattening pigs. For the assessment of Inter-OR, three observers evaluated six KTBL animal welfare indicators. The Inter-OR of the indicators was calculated from the results using intra-class correlation coefficients (ICC). ‘Excellent’ Inter-OR results were found for the indicators tail length (ICC 0.89), skin lesions (ICC 0.77) and ear lesions (ICC 0.80). In contrast, the Inter-OR of the indicators tail lesions (ICC 0.46) and faecal soiling (ICC 0.47) were considered to be only ‘fair’ and that of the indicator lameness (ICC 0.36) as ‘poor’. For the evaluation of the Intra-OR, the same three observers assessed the welfare of 162 to 200 fattening pigs using the same welfare indicators in total eight times. Again ICCs, here per indicator and observer, were used to calculate the Intra-OR. The Intra-OR of the indicators faecal soiling (ICC 0.81) and ear lesions (ICC 0.97) lay in the ‘excellent’ range on average. While the Intra-OR of the indicators skin lesions (ICC 0.67), tail length (ICC 0.74) and lameness (ICC 0.60) could still be considered as being ‘good’, the Intra-OR of the indicator tail lesions (ICC 0.52) could only be assessed as being ‘fair’. From these results the significance of the KTBL indicators could be judged as follows: it is possible to use all the chosen indicators apart from the indicator tail lesions as an internal controlling instrument or as part of an internal weak-point analysis as long as the indicators are evaluated by the same person. A comparison of the indicators tail lesions, lameness and faecal soiling when assessed by different observers should be considered critically because the Inter-OR of these three indicators could only be considered as being ‘poor’ to ‘fair’.
Nurse sow strategies are used to manage large litters on commercial pig farms. However, new-born piglets transferred to nurse sows in late lactation might be compromised in terms of growth and survival. We investigated the effects of two nurse sow strategies on piglet growth, suckling behaviour and sow nursing behaviour. At 1-day post-farrowing, the four heaviest piglets from large litters were transferred to a nurse sow either 21 (1STEP21, n=9 litters) or 7 (2STEP7, n=10 litters) days into lactation. The remainder of the litter remained with their mother and was either kept intact (remain intact (RI), n=10 litters) or had some piglets cross-fostered to equalise birth weights (remain equalised (RE), n=9 litters). The 7-day-old piglets from 2STEP7 were transferred onto a sow 21 days into lactation (2STEP21, n=10 litters). The growth of new-born piglets on 1STEP21 and 2STEP7 nurse sows was initially lower than in RI litters (F3,33.8=4.61; P<0.01), but weaning weights did not significantly differ (F4,32.7=0.78; P>0.5). After the 1st week of lactation, the weights and growth rates did not differ between treatments. Fighting behaviour during nursing bouts decreased over time. The frequency of fights was higher in 1STEP21 and 2STEP21 litters compared with RI litters (t122=3.06 and t123=3.00, respectively, P<0.05). The 2STEP21 litters had shorter nursing bouts than RI and 1STEP21 litters (t107=−2.81 and t81.7=2.8, respectively, P<0.05), which were more frequently terminated by 2STEP21 than RI sows (t595=2.93; P<0.05). Transferring heaviest piglets from RI and RE litters to nurse sows reduced the percentage of teat changes during nursing bouts (RI: F1,275=16.61; RE: F1,308=43.59; P<0.001). In conclusion, nurse sow strategies do not appear to compromise piglet growth. However, new-born piglets transferred onto sows in late lactation experienced more competition at the udder, suggesting that the sows’ stage of lactation is of importance to how achievable nurse sow strategies are. Thus, the two-step nurse sow strategy is likely the best option (in relation to growth and suckling behaviour), as it minimises the difference between piglet age and sow stage of lactation.
Management strategies are needed to optimise the number of piglets weaned from hyper-prolific sows. Nurse sow strategies involve transferring supernumerary new-born piglets onto a sow whose own piglets are either weaned or fostered onto another sow. Such ‘nurse sows’ have extended lactations spent in farrowing crates, which could have negative implications for their welfare. This study used 47 sows, 20 of which farrowed large litters and had their biggest piglets fostered onto nurse sows which were either 1 week (2STEP7, n=9) or 3 weeks into lactation (1STEP21, n=10). Sows from which piglets were removed (R) were either left with the remainder of the litter intact (I) (remain intact (RI) sows, n=10), or had their litters equalised (E) for birth weight using piglets of the same age from non-experimental sows (remain equalised (RE) sows, n=9). Piglets from 2STEP7 were fostered onto another nurse sow which was 3 weeks into lactation (2STEP21, n=9). Back-fat thickness was measured at entry to the farrowing house, at fostering (nurse sows only) and weaning. Sows were scored for ease of locomotion and skin and claw lesions at entry to the farrowing house and weaning. Salivary cortisol samples were collected and tear staining was scored at 0900 h weekly from entry until weaning. Saliva samples were also taken at fostering. Data were analysed using GLMs with appropriate random and repeated factors, or non-parametric tests were applied where appropriate. Back-fat thickness decreased between entry and weaning for all sows (F1,42=26.59, P<0.001) and tended to differ between treatments (F4,16=2.91; P=0.06). At weaning RI sows had lower limb lesion scores than 2STEP7 and RE sows (χ24=10.8, P<0.05). No treatment effects were detected on salivary cortisol concentrations (P>0.05) and all nurse sows had a higher salivary cortisol concentration at fostering, compared with the other days (F10,426=3.47; P<0.05). Acute effects of fostering differed between nurse sow treatments (F2,113=3.45, P<0.05); 2STEP7 sows had a higher salivary cortisol concentration than 1STEP21 and 2STEP21 sows on the day of fostering. 2STEP7 sows had a higher salivary cortisol concentration at fostering, compared with 1STEP21 and 2STEP21 sows. Tear staining scores were not influenced by treatment (P>0.05). In conclusion, no difference was detected between nurse sows and non-nurse sows in body condition or severity of lesions. Although some nurse sows experienced stress at fostering, no long-term effect of the nurse sow strategies was detected on stress levels compared with sows that raised their own litter.