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      Music therapy-induced changes in salivary cortisol level are predictive of cardiovascular mortality in patients under maintenance hemodialysis

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          Music therapy has been applied in hemodialysis (HD) patients for relieving mental stress. Whether the stress-relieving effect by music therapy is predictive of clinical outcome in HD patients is still unclear.


          We recruited a convenience sample of 99 patients on maintenance HD and randomly assigned them to the experimental (n=49) or control (n=50) group. The experimental group received relaxing music therapy for 1 week, whereas the control group received no music therapy. In the experimental group, we compared cardiovascular mortality in the patients with and without cortisol changes.


          The salivary cortisol level was lowered after 1 week of music therapy in the experimental group (−2.41±3.08 vs 1.66±2.11 pg/mL, P<0.05), as well as the frequency of the adverse reaction score (−3.35±5.76 vs −0.81±4.59, P<0.05), the severity of adverse reactions score (−1.93±2.73 vs 0.33±2.71, P<0.05), and hemodialysis stressor scale (HSS) score (−6.00±4.68 vs −0.877±7.08, P<0.05). The difference in salivary cortisol correlated positively with HD stress score scales ( r=0.231, P<0.05), systolic blood pressure ( r=0.264, P<0.05), and respiratory rates ( r=0.369, P<0.05) and negatively with finger temperature ( r=−0.235, P<0.05) in the total study population. The 5-year cardiovascular survival in the experimental group was higher in patients whose salivary cortisol lowered by <0.6 pg/mL than that in patients whose salivary cortisol lowered by >0.6 pg/mL (83.8% vs 63.6%, P<0.05).


          Providing music during HD is an effective complementary therapy to relieve the frequency and severity of adverse reactions, as well as to lower salivary cortisol levels. Differences in salivary cortisol after music therapy may predict cardiovascular mortality in patients under maintenance HD.

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          Most cited references 34

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          Salivary cortisol as a biomarker in stress research.

          Salivary cortisol is frequently used as a biomarker of psychological stress. However, psychobiological mechanisms, which trigger the hypothalamus-pituitary-adrenal axis (HPAA) can only indirectly be assessed by salivary cortisol measures. The different instances that control HPAA reactivity (hippocampus, hypothalamus, pituitary, adrenals) and their respective modulators, receptors, or binding proteins, may all affect salivary cortisol measures. Thus, a linear relationship with measures of plasma ACTH and cortisol in blood or urine does not necessarily exist. This is particularly true under response conditions. The present paper addresses several psychological and biological variables, which may account for such dissociations, and aims to help researchers to rate the validity and psychobiological significance of salivary cortisol as an HPAA biomarker of stress in their experiments.
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            Salivary cortisol: a better measure of adrenal cortical function than serum cortisol.

            Salivary cortisol concentration was found to be directly proportional to the serum unbound cortisol concentration both in normal men and women and in women with elevated cortisol-binding globulin (CBG). The correlation was excellent in dynamic tests of adrenal function (dexamethasone suppression, ACTH stimulation), in normals and patients with adrenal insufficiency, in tests of circadian variation and randomly collected samples. Women in the third trimester of normal pregnancy exhibited elevated salivary cortisol throughout the day. The relationship between salivary and serum total cortisol concentration was markedly non-linear with a more rapid increase in salivary concentration once the serum CBG was saturated. The rate of equilibrium of cortisol between blood and saliva was very fast, being much less than 5 minutes. These data, combined with a simple, stress-free, non-invasive collection procedure, lead us to suggest that salivary cortisol is a more appropriate measure for the clinical assessment of adrenocortical function than is serum cortisol.
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              Music, language and meaning: brain signatures of semantic processing.

              Semantics is a key feature of language, but whether or not music can activate brain mechanisms related to the processing of semantic meaning is not known. We compared processing of semantic meaning in language and music, investigating the semantic priming effect as indexed by behavioral measures and by the N400 component of the event-related brain potential (ERP) measured by electroencephalography (EEG). Human subjects were presented visually with target words after hearing either a spoken sentence or a musical excerpt. Target words that were semantically unrelated to prime sentences elicited a larger N400 than did target words that were preceded by semantically related sentences. In addition, target words that were preceded by semantically unrelated musical primes showed a similar N400 effect, as compared to target words preceded by related musical primes. The N400 priming effect did not differ between language and music with respect to time course, strength or neural generators. Our results indicate that both music and language can prime the meaning of a word, and that music can, as language, determine physiological indices of semantic processing.

                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                23 February 2017
                : 13
                : 263-272
                [1 ]Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University
                [2 ]Department of Nursing, Taipei Medical University
                [3 ]Graduate Institute of Basic Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City
                [4 ]School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China
                Author notes
                Correspondence: Chia-Chi Chang, School of Gerontology Health Management, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, Taipei 110, Taiwan, Republic of China, Tel/fax +886 2 2736 1661 6336, Email cchang@ 123456tmu.edu.tw
                Li-King Yang, Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, 362 Chung-Cheng Road, Hsin-Tien District, New Taipei City 23148, Taiwan, Republic of China, Tel +886 2 2219 3391 65343, Fax +886 2 2218 5579, Email margaretlaiking@ 123456yahoo.com
                © 2017 Hou et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research


                music therapy, maintenance hemodialysis, salivary cortisol


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