Factors affecting cortisol secretion [39].
\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"Milestone",originalUrl:"/media/original/124"}},components:[{type:"htmlEditorComponent",content:'
Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\n'}],latestNews:[{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"},{slug:"intechopen-identified-as-one-of-the-most-significant-contributor-to-oa-book-growth-in-doab-20210809",title:"IntechOpen Identified as One of the Most Significant Contributors to OA Book Growth in DOAB"}]},book:{item:{type:"book",id:"3735",leadTitle:null,fullTitle:"Face Recognition",title:"Face Recognition",subtitle:null,reviewType:"peer-reviewed",abstract:"This book aims to bring together selected recent advances, applications and original results in the area of biometric face recognition. They can be useful for researchers, engineers, graduate and postgraduate students, experts in this area and hopefully also for people interested generally in computer science, security, machine learning and artificial intelligence.\r\nVarious methods, approaches and algorithms for recognition of human faces are used by authors of the chapters of this book, e.g. PCA, LDA, artificial neural networks, wavelets, curvelets, kernel methods, Gabor filters, active appearance models, 2D and 3D representations, optical correlation, hidden Markov models and others. Also a broad range of problems is covered: feature extraction and dimensionality reduction (chapters 1-4), 2D face recognition from the point of view of full system proposal (chapters 5-10), illumination and pose problems (chapters 11-13), eye movement (chapter 14), 3D face recognition (chapters 15-19) and hardware issues (chapters 19-20).",isbn:null,printIsbn:"978-953-307-060-5",pdfIsbn:"978-953-51-4550-9",doi:"10.5772/207",price:139,priceEur:155,priceUsd:179,slug:"face-recognition",numberOfPages:412,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:null,bookSignature:"Milos Oravec",publishedDate:"April 1st 2010",coverURL:"https://cdn.intechopen.com/books/images_new/3735.jpg",numberOfDownloads:69070,numberOfWosCitations:107,numberOfCrossrefCitations:64,numberOfCrossrefCitationsByBook:6,numberOfDimensionsCitations:107,numberOfDimensionsCitationsByBook:6,hasAltmetrics:1,numberOfTotalCitations:278,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:null,dateEndSecondStepPublish:null,dateEndThirdStepPublish:null,dateEndFourthStepPublish:null,dateEndFifthStepPublish:null,currentStepOfPublishingProcess:1,indexedIn:"1,2,3,4,5,6,7,8",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"8419",title:"Prof.",name:"Miloš",middleName:null,surname:"Oravec",slug:"milos-oravec",fullName:"Miloš Oravec",profilePictureURL:"https://mts.intechopen.com/storage/users/8419/images/4086_n.jpg",biography:"Milos ORAVEC was born in Bratislava, Slovakia. He received the MSc. degree in telecommunication engineering, PhD. degree in applied informatics, and prof. degree in cybernetics from Faculty of Electrical Engineering and Information Technology, Slovak University of Technology (FEI SUT), Bratislava, Slovakia in 1990, 2002, and 2014, respectively. He is the vice-dean responsible for MSc study. He is with the Institute of Computer Science and Mathematics of Slovak University of Technology, Slovakia. He spent several research stays abroad, e.g. RWTH Aachen, Germany, Politecnico di Torino, Italy, Universitat Politecnica de Catalunya, Barcelona, Spain.\nHe is the author of over 80 scientific papers. His work has been published also in several books, e.g. Selected Methods of data Compression (Faber, Bratislava, 1996), Neural Networks for Digital Signal Processing (Faber, Bratislava, 1998), awarded by Literature Foundation of Ministry of Culture of the Slovak Republic, the chapter in Speech, Audio, Image and Biomedical Signal Processing using Neural Networks (Springer Verlag, Germany, 2008), the chapter in Face Recognition (INTECH, Croatia, 2010). He also edited the book Face Recognition (INTECH, Croatia, 2010).\nHe is a member of IEEE and IET. His research interests include artificial intelligence, machine learning and neural networks, biometrics, data analysis and prediction, signal processing, and communication networks. He is active in Machine Learning Group on FEI SUT Bratislava.\nHe acts as the reviewer for several scientific journals, e.g. IEEE Transactions on Vehicular Technology ISSN 0018-9545, IEE Proceedings on Science, Measurement and Technology ISSN 1751-8822, Sensors ISSN 1424-8220, Radioengineering (Czech Republic, ISSN 1210-2512), Journal of Electrical Engineering (Slovakia, ISSN 1335-3632), Acta Electrotechnica et Informatica (Slovakia, ISSN 1335-8243). He also acts as the editor for Central European Journal of Computer Science (CEJCS) .",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Slovak University of Technology in Bratislava",institutionURL:null,country:{name:"Slovakia"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"571",title:"Security System",slug:"human-computer-interaction-security-system"}],chapters:[{id:"10199",title:"Feature Extraction and Representation for Face Recognition",doi:"10.5772/8936",slug:"feature-extraction-and-representation-for-face-recognition",totalDownloads:7689,totalCrossrefCites:1,totalDimensionsCites:6,hasAltmetrics:0,abstract:null,signatures:"M. Saquib Sarfraz, Olaf Hellwich and Zahid Riaz",downloadPdfUrl:"/chapter/pdf-download/10199",previewPdfUrl:"/chapter/pdf-preview/10199",authors:[null],corrections:null},{id:"10210",title:"An Extension of Principal Component Analysis",doi:"10.5772/8949",slug:"an-extension-of-principal-component-analysis",totalDownloads:2484,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Hongchuan Yu and Jian J. Zhang",downloadPdfUrl:"/chapter/pdf-download/10210",previewPdfUrl:"/chapter/pdf-preview/10210",authors:[null],corrections:null},{id:"10203",title:"Curvelet Based Feature Extraction",doi:"10.5772/8940",slug:"curvelet-based-feature-extraction",totalDownloads:6388,totalCrossrefCites:4,totalDimensionsCites:5,hasAltmetrics:0,abstract:null,signatures:"Tanaya Guha and Q. M. Jonathan Wu",downloadPdfUrl:"/chapter/pdf-download/10203",previewPdfUrl:"/chapter/pdf-preview/10203",authors:[null],corrections:null},{id:"10214",title:"COMPRESSIVE CLASSIFICATION FOR FACE RECOGNITION",doi:"10.5772/8953",slug:"compressive-classification-for-face-recognition",totalDownloads:3213,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:null,signatures:"Angshul Majumdar and Rabab K. Ward",downloadPdfUrl:"/chapter/pdf-download/10214",previewPdfUrl:"/chapter/pdf-preview/10214",authors:[null],corrections:null},{id:"10211",title:"Pixel-Level Decisions based Robust Face Image Recognition",doi:"10.5772/8950",slug:"pixel-level-decisions-based-robust-face-image-recognition",totalDownloads:2312,totalCrossrefCites:0,totalDimensionsCites:4,hasAltmetrics:0,abstract:null,signatures:"Alex Pappachen James",downloadPdfUrl:"/chapter/pdf-download/10211",previewPdfUrl:"/chapter/pdf-preview/10211",authors:[null],corrections:null},{id:"10204",title:"Interest-Point based Face Recognition System",doi:"10.5772/8941",slug:"interest-point-based-face-recognition-system",totalDownloads:2968,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Cesar Fernandez and Maria Asuncion Vicente",downloadPdfUrl:"/chapter/pdf-download/10204",previewPdfUrl:"/chapter/pdf-preview/10204",authors:[null],corrections:null},{id:"10213",title:"Wavelet–Based Face Recognition Schemes",doi:"10.5772/8952",slug:"wavelet-based-face-recognition-schemes",totalDownloads:2754,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Sabah A. Jassim",downloadPdfUrl:"/chapter/pdf-download/10213",previewPdfUrl:"/chapter/pdf-preview/10213",authors:[null],corrections:null},{id:"10206",title:"Face Recognition in Ideal and Noisy Conditions Using Support Vector Machines, PCA and LDA",doi:"10.5772/8943",slug:"face-recognition-in-ideal-and-noisy-conditions-using-support-vector-machines-pca-and-lda",totalDownloads:3153,totalCrossrefCites:11,totalDimensionsCites:14,hasAltmetrics:0,abstract:null,signatures:"Milos Oravec, Jan Mazanec, Jarmila Pavlovicova, Pavel Eiben and Fedor Lehocki",downloadPdfUrl:"/chapter/pdf-download/10206",previewPdfUrl:"/chapter/pdf-preview/10206",authors:[null],corrections:null},{id:"10207",title:"Pseudo 2D Hidden Markov Model and Neural Network Coefficients in Face Recognition",doi:"10.5772/8944",slug:"pseudo-2d-hidden-markov-model-and-neural-network-coefficients-in-face-recognition",totalDownloads:3097,totalCrossrefCites:3,totalDimensionsCites:3,hasAltmetrics:0,abstract:null,signatures:"Domenico Daleno, Lucia Cariello, Marco Giannini and Giuseppe Mastronardi",downloadPdfUrl:"/chapter/pdf-download/10207",previewPdfUrl:"/chapter/pdf-preview/10207",authors:[null],corrections:null},{id:"10196",title:"VG-RAM Weightless Neural Networks for Face Recognition",doi:"10.5772/8933",slug:"vg-ram-weightless-neural-networks-for-face-recognition",totalDownloads:2877,totalCrossrefCites:4,totalDimensionsCites:5,hasAltmetrics:0,abstract:null,signatures:"Alberto F. De Souza, Claudine Badue, Felipe Pedroni, Stiven Schwanz Dias, Hallysson Oliveira and Soterio Ferreira de Souza",downloadPdfUrl:"/chapter/pdf-download/10196",previewPdfUrl:"/chapter/pdf-preview/10196",authors:[null],corrections:null},{id:"10200",title:"Illumination Processing in Face Recognition",doi:"10.5772/8937",slug:"illumination-processing-in-face-recognition",totalDownloads:4979,totalCrossrefCites:7,totalDimensionsCites:9,hasAltmetrics:0,abstract:null,signatures:"Yongping Li, Chao Wang and Xinyu Ao",downloadPdfUrl:"/chapter/pdf-download/10200",previewPdfUrl:"/chapter/pdf-preview/10200",authors:[null],corrections:null},{id:"10201",title:"From Gabor Magnitude to Gabor Phase Features: Tackling the Problem of Face Recognition under Severe Illumination Changes",doi:"10.5772/8938",slug:"from-gabor-magnitude-to-gabor-phase-features-tackling-the-problem-of-face-recognition-under-severe-i",totalDownloads:4404,totalCrossrefCites:7,totalDimensionsCites:8,hasAltmetrics:0,abstract:null,signatures:"Vitomir Struc and Nikola Pavesic",downloadPdfUrl:"/chapter/pdf-download/10201",previewPdfUrl:"/chapter/pdf-preview/10201",authors:[null],corrections:null},{id:"10197",title:"Robust Face Alignment for Illumination and Pose Invariant Face Recognition",doi:"10.5772/8934",slug:"robust-face-alignment-for-illumination-and-pose-invariant-face-recognition",totalDownloads:2806,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Fatih Kahraman, Binnur Kurt and Muhittin Gokmen",downloadPdfUrl:"/chapter/pdf-download/10197",previewPdfUrl:"/chapter/pdf-preview/10197",authors:[null],corrections:null},{id:"10212",title:"Surface representations for 3D face recognition",doi:"10.5772/8951",slug:"surface-representations-for-3d-face-recognition",totalDownloads:3862,totalCrossrefCites:2,totalDimensionsCites:5,hasAltmetrics:1,abstract:null,signatures:"Thomas Fabry, Dirk Smeets and Dirk Vandermeulen",downloadPdfUrl:"/chapter/pdf-download/10212",previewPdfUrl:"/chapter/pdf-preview/10212",authors:[null],corrections:null},{id:"10215",title:"An Integrative Approach to Face and Expression Recognition from 3D Scans",doi:"10.5772/8954",slug:"an-integrative-approach-to-face-and-expression-recognition-from-3d-scans",totalDownloads:1972,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Chao Li",downloadPdfUrl:"/chapter/pdf-download/10215",previewPdfUrl:"/chapter/pdf-preview/10215",authors:[null],corrections:null},{id:"10205",title:"Template Protection For 3D Face Recognition",doi:"10.5772/8942",slug:"template-protection-for-3d-face-recognition",totalDownloads:3076,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The human face is one of the most important biometric modalities for automatic authentication. Three-dimensional face recognition exploits facial surface information. In comparison to illumination based 2D face recognition, it has good robustness and high fake resistance, so that it can be used in high security areas. Nevertheless, as in other common biometric systems, potential risks of identity theft, cross matching and exposure of privacy information threaten the security of the authentication system as well as the user\\\\\\'s privacy. As a crucial supplementary of biometrics, the template protection technique can prevent security leakages and protect privacy. In this chapter, we show security leakages in common biometric systems and give a detailed introduction on template protection techniques. Then the latest results of template protection techniques in 3D face recognition systems are presented. The recognition performances as well as the security gains are analyzed.",signatures:"Xuebing Zhou, Arjan Kuijper and Christoph Busch",downloadPdfUrl:"/chapter/pdf-download/10205",previewPdfUrl:"/chapter/pdf-preview/10205",authors:[null],corrections:null},{id:"10209",title:"Geodesic Distances and Hidden Markov Models for the 3D Face Recognition",doi:"10.5772/8948",slug:"geodesic-distances-and-hidden-markov-models-for-the-3d-face-recognition",totalDownloads:2358,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Giuseppe Mastronardi, Lucia Cariello, Domenico Daleno and Marcello Castellano",downloadPdfUrl:"/chapter/pdf-download/10209",previewPdfUrl:"/chapter/pdf-preview/10209",authors:[null],corrections:null},{id:"10198",title:"Understanding Correlation Techniques for Face Recognition: From Basics to Applications",doi:"10.5772/8935",slug:"understanding-correlation-techniques-for-face-recognition-from-basics-to-applications",totalDownloads:4419,totalCrossrefCites:18,totalDimensionsCites:36,hasAltmetrics:0,abstract:null,signatures:"A. Alfalou and C. 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History, Design, Manufacturing, and Applications",subtitle:null,reviewType:"peer-reviewed",abstract:"
\r\n\tThe development of RNA therapeutics has been an intense journey, with numerous stories of success and failure. The potential, and suitability, of recently discovered RNAs (for therapeutics), stemmed from several Nobel Prize-winning discoveries. Currently, novel RNA drugs are entering clinical trials almost daily. RNA therapeutics are chemically synthesized biomolecules with broad clinical applications, ranging from correcting inherited mutations, to treating cancer, and chronic conditions, improving organ transplant outcomes, and infectious disease prophylaxes.
\r\n\tRNA therapies evolved as profitable and widely applicable individualized treatment solutions. Moreover, RNA-based therapeutic vaccines (e.g., against SARS-CoV-2 infection) have been proven to be safe and effective, and several of them are approved by the United States Food and Drug Administration (FDA).
\r\n\tThis book aims to present distinct classes of RNA therapeutics, ranging from single-stranded antisense oligonucleotides (ASOs), and subclasses of RNA interferences (miRNAs and other RNAi), to in vitro transcribed mRNAs and RNA vaccines. Also, it will present some of the challenges in RNA drug engineering, delivery, and specificity. Additionally, the improvement of pharmacological effectiveness will be discussed. Monumental breakthroughs in molecular biology, computational chemistry, bioinformatics, and individualized genomics, which undoubtedly propelled RNA therapeutics through the commercialization stage, will also be examined in this book.
\r\n\tRNA therapeutics have had a significant impact on medicine, the economy, and overall public health; they are becoming prescription drugs, and this holds great promise for modernizing healthcare.
Stress is a physiological and psychological response to the perception of danger and threat [1]. Stress can occur due to a physical injury, mechanical disturbance, chemical change, or emotional factor known as stress exposure. The body’s response to these factors depends on the magnitude of the stress exposure, the duration of the event, and the patient’s nutritional status [2]. Stress can occur at all ages, including children and adolescents. Various physical and psychological circumstances can cause stress in children, for example, the presence of an illness, injury/trauma, parental divorce, parental death, sexual abuse, natural disasters, war, and so on [3].
Exposure to stress can affect almost all aspects of life, i.e., physiological, psychological, cognitive, and social. Some of the symptoms of stress that appear physically include: increased vital signs, vascular vasodilation, increased sweat production, decreased immune system, complaints of headaches, abdominal pain, and increased neurohormonal responses (cortisol, epinephrine, vasopressin). Psychologically, the symptoms of stress include mood disorders, emotions, anxiety, eating disorders, sleep disorders, low self-esteem, ineffective coping, and irritability. In terms of the cognitive aspect, stress can appear in the form of impaired concentration and memory. Regarding a social aspect, the example of symptoms is impaired interpersonal function such as fear or suspicion, dislike of others, withdrawal, low self-esteem, low self-confidence, affecting relationships and interactions with others [1, 4, 5].
Various exposures to physical and psychological stress harmful to the body can cause it to take defensive actions to overcome the stress. One of the body’s responses as a defense against stress is the constant release of stress hormones, including cortisol [1, 4].
Cortisol hormone is used as a biochemical marker for acute and chronic stress [6]. In addition to the increase in cortisol levels, the secretion of epinephrine and vasopressin will also increase due to exposure to stress, thus causing an increase in blood pressure and pulse [1].
Increased cortisol levels as an indicator of stress can be changed through psychosocial interventions. One of the psychosocial interventions often used to manage stress is music therapy [7]. It is an effective complementary approach to manage stress in children, which can achieve specific therapeutic results with minimal side effects in the clinical management of pediatric patients [8, 9]. For children and adolescents, listening to music in various health care contexts is considered feasible, easy to apply, and cost-effective [10].
The effectiveness of music therapy in reducing stress levels in children has been widely reported. It positively impacts reducing pain, heart rate, respiratory rate, and anxiety in children undergoing medical treatment. It can reduce the risk of increased Post Traumatic Distress Syndrome (PTSD) [11, 12, 13, 14]. This chapter will review the effect of music therapy on salivary cortisol levels as a biomarker of stress in children.
Music therapy is a complementary approach by using music to help someone with various health conditions that can affect their physiology, psychology, and emotion [8, 9, 15, 16]. This therapy can manage stress problems of people of different ages with minimal side effects and a small amount of money. It is easy to apply and does not require the intellectual ability to interpret. There are no limitations for users to use music therapy.
Music therapy can generally be divided into two categories, i.e., active and passive. Active music therapy – in which patients play music, sing, or in some way – is encouraged to create or describe their experiences with music. While passive music therapy is a method in which the patient only listens to live or prerecorded music. In surgical and cancer patients, passive forms of therapy are recommended because this type of music therapy can be easily incorporated into clinical situations that involve minimal equipment and staff attention. The patient listens to relaxing music of their choice. It has a profound effect on stress and anxiety levels [17].
Music therapy can effectively help children adjust to a hospital environment. Children are usually not familiar with the hospital environment. Many new and scary things may happen in a child’s life. Music therapy can be used to intervene for emotional state control, pain management, cognitive processing, and stress management [18, 19].
Music therapy positively affects physiological aspects (such as heart rate, blood pressure, oxygen saturation, and pain). It also positively affects the psychosocial behavior (such as anxiety) of hospitalized children [20]. This therapy reduces postoperative stress and pain in children by improving cardiovascular parameters and improving stress-induced hyperglycemia [21].
Music therapy is often combined with other techniques to improve anesthesia, analgesia, and relaxation. While live music sessions with a music therapist are considered most effective, this may not be possible in an environment or institution that does not have a trained professional therapist. Therefore, recorded music can be a choice.
Characteristics of good music for pediatric patients are that the decibel level of musical stimulation should be 35–85 dB. Music stays in the soft to medium-volume range. The rhythm should also be regular, without sudden fluctuations in tempo. The use of headphones has several advantages, especially in critical care, including improving hearing at an acceptable decibel level, attention to ambient noise, and lower effect on other patients [8]. Several factors affecting the effectiveness of music therapy are as follows:
Environmental disturbances can reduce the effectiveness of music therapy or even have a negative impact. Examples of such environmental disturbances are noise caused by people passing by, talking, crying, or shouting when music therapy is given.
Environmental noise can interfere with the effectiveness of music therapy even though earphones/headphones are being used [8]. This is probably brought about by the activeness of other senses (e.g., sight), which can still receive stimuli from the environment. The effect of uncontrollable noise levels during music therapy resulted in no positive impact of music therapy on neuroendocrine responses (cortisol levels) to stress [22].
Music therapy can provide direct benefits to patients regarding the physiological, psychological, and socio-emotional aspects [23]. An important factor that can increase the effectiveness of music therapy is the type of music that is based on the patient’s choice (preferences), songs that are usually heard (familiarity), cultural context, and past experiences [8, 24]. In addition, letting the patient set the frequency, duration, and timing of the music intervention directly is the best approach in providing music therapy [25]. Giving music therapy more than 20 minutes can negatively impact children’s stress levels, which can be seen from their cortisol levels [26].
The type of diagnosis and level of treatment can influence the level of fatigue and stress in children and adolescents with cancer [27]. In pediatric cancer patients who experience fatigue, non-pharmacological therapy, including music therapy, is not very significant [28].
Stress measurement through hormone examination in determining a person’s emotional status is objective. This method is quite beneficial for pediatric patients who have not been able to express their feelings. It can identify stressful conditions in a person’s body that are not visible to the naked eye. As previously explained, one of the hormonal responses to stress is an increase in cortisol as a self-defense effort. Elevated cortisol levels are a good indicator for someone experiencing acute stress or chronic stress [29]. Cortisol can be detected through a saliva test. Salivary cortisol examination is better, more effective, and more valid than blood examination to assess adrenocortical function [30, 31]. The advantages of using salivary cortisol are easy sampling, non-invasive, fast, and repeatable. It also does not require special equipment and can be performed outside the laboratory [32]. Over the past 20 years, salivary cortisol has become the most popular biomarker used in stress studies.
Cortisol is the main glucocorticoid hormone produced by humans. Glucocorticoids increase blood glucose levels by counteracting insulin secretion and action to inhibit peripheral glucose uptake, promoting hepatic glucose synthesis (gluconeogenesis) and hepatic glycogen levels [33]. The main functions of cortisol are to control carbohydrate, protein, and fat metabolism, suppress inflammatory tissue processes in response to injury, suppress immune responses to foreign antigens, and increase the body’s ability to withstand various harmful stimuli (stress) [34].
Cortisol secretion by the adrenal cortex is controlled by a negative feedback system involving the hypothalamus and anterior pituitary. Adrenocorticotropic Hormone (ACTH) from the anterior pituitary stimulates the adrenal cortex to secrete cortisol. The cells that produce ACTH, in turn, only work following orders from Corticotropin-Releasing Hormone (CRH) from the hypothalamus. The feedback control loop is complemented by the inhibitory effect of cortisol on CRH and ACTH secretion by the hypothalamus and anterior pituitary. The negative feedback system for cortisol maintains a relatively constant level of cortisol secretion. Two additional factors that influence plasma cortisol concentrations in the basic negative feedback control system are diurnal rhythm and stress, both of which react on the hypothalamus to vary the level of CRH secretion [1]. The control of cortisol secretion is shown in Figure 1.
Control of cortisol secretion [
In the absence of stress exposure or under normal conditions, cortisol secretion exhibits a distinct circadian rhythm when concentrations are highest in the morning (circadian peak), progressively decline from late afternoon to early nocturnal periods (circadian trough), and show a sudden increase after the first few hours of sleep [36]. The circadian rhythm of cortisol can be seen in Figure 2.
Circadian rhythm of cortisol [
Normal cortisol in children follows a pattern similar to the circadian pattern in adults, decreasing from 11.00 am to 4.00 pm [37]. The normal range of salivary cortisol levels is between 0.2–11.3 ng/ml. An increase or decrease in salivary cortisol levels is considered significant if there is a difference in 0.05 ng/ml [38].
The interpretation of elevated cortisol can consider several factors (shown in Table 1) that can influence it. Infectious factors such as viral infections are also considered to affect increasing cortisol levels in the body [41]. Elevated cortisol occurs concomitantly with high C-Reactive Protein (CRP) and procalcitonin (PCT) in patients with fever without severe sepsis [42]. A person’s symptoms and stress levels are closely related to physical suffering and psychological characteristics [43]. Thus, high cortisol levels are also associated with disability [26, 44].
Factors affecting | Description |
---|---|
Individual factors including age, gender, and race |
|
Somatic factors |
|
Lifestyle factor |
|
Psychosocial factors | Exposure to acute and chronic psychosocial stress |
Factors affecting cortisol secretion [39].
Acute pain from mechanical, chemical, or thermal stimulation will release chemical mediators in the periphery that initiate the pain. Transient activation of peripheral nociceptive fibers sends pain signals through the dorsal horn of the spinal cord to the brain, where the pain signal is perceived. Stress from perceived pain can cause the release of stress hormones such as cortisol [45]. The slightest medical procedure can cause pain and distress in children [46]. Medical actions against the children’s wishes, such as accidental removal of an IV needle and repeated needle sticking, can result in higher distress [26]. This can directly impact extreme physiological symptoms such as vasovagal responses, heart rate changes, stress hormones (cortisol and corticotrophin), and ECG [47, 48].
A sharp increase in cortisol secretion mediated by the central nervous system through increased activity of the CRH-ACTH-Cortisol system occurs in response to all kinds of stressful situations [1]. The magnitude of the increase in cortisol concentration is generally proportional to the intensity and extent of the stress stimulus. More significant increases in cortisol levels are elicited in response to severe stress. Music therapy is a complementary therapy that can be used to reduce the stress response. Still, for the previously mentioned conditions, music therapy does not positively impact the patient. Giving music therapy to individuals with extreme increases in cortisol levels may have minimal or no effect.
Children with health problems often require painful procedures to diagnose or treat their illness. Treatment of the disease may result in the child having to undergo a series of invasive procedures regularly. The most commonly performed invasive procedure is an intravenous puncture. This puncture can cause pain, resulting in stress, such as behavioral responses including crying, vomiting, verbal complaints, and physiological responses, including increased blood pressure, increased stress hormones, muscle tension, and sweating [49].
Physiological responses are controlled by the HPA axis and the sympathetic and parasympathetic components of the peripheral nervous system. The HPA axis interacts with stress-activating centers in the brainstem and hypothalamus and releases Corticotrophin Releasing Hormone (CRH), which is one of the main effects of the stress reaction. CRH stimulates the anterior pituitary to secrete ACTH, and increased ACTH secretion can stimulate the adrenal cortex to increase cortisol secretion [50]. Most studies support the cortisol response to both acute and chronic stress [51].
Cortisol is an objective biomarker associated with general psychological status. It can be used primarily to evaluate children’s physiological reactions under stress exposure [52]. Stress is associated with increased production of the cortisol hormone, which is known to suppress the immune response [53].
Control of cortisol activity can be altered through psychosocial interventions [7]. Music therapy is a psychosocial intervention that is safe, easy, economical, and feasible to use and has the benefit of reducing cortisol levels as a stress biomarker in pediatric patients. Music is considered as an adjunct therapy in clinical situations causing pain or anxiety [54]. Several studies have shown the effectiveness of music therapy to reduce cortisol as a stress biomarker in pediatric patients. Furthermore, listening to music can reduce subjective stress levels, decrease salivary cortisol secretion, and increase salivary alpha-amylase activity, which is higher [26, 55]. In addition, music therapy has a positive effect in controlling salivary cortisol concentrations, systolic and diastolic pressure, heart rate, body temperature in anxious dental patients [56]. Listening to soft, relaxing music for an hour in the postoperative period has beneficial effects on the stress response, such as a much more significant reduction in cortisol levels [57].
The mechanisms underlying the effects of listening to music on stress levels are still being studied. There are three possible mechanisms. First, the regulation of activity in the mesolimbic dopaminergic system by music (primarily based on increased activity in the ventral tegmental area and nucleus accumbens with corresponding reactions to stress and pain). Second, the downregulation of amygdala central nuclear activity by music with a down-regulatory effect on fear and worry levels and activity of hypothalamic and brainstem nuclei involved in endocrine generation (HPA axis), and vegetative stress responses (such stress-related effects may also include modulation of beta-endorphin levels). The sound of music that has been received and perceived by the brain will stimulate the hypothalamus, which will then prompt the pituitary to produce endorphins. Endorphins are endogenous opiates (morphine) that function as the body’s natural analgesics and protect/relieve the body from stressful conditions [1, 58]. Endorphins are mainly synthesized and stored in the anterior pituitary from the precursor protein proopiomelanocortin (POMC). POMC is a large protein broken down into smaller proteins such as beta-endorphin, alpha-melanocyte-stimulating hormone (MSH), adrenocorticotropin (ACTH), etc. The pituitary synthesizes POMC in response to signals from the hypothalamus (in the form of corticotropin-releasing hormone (CRH)). When POMC cleavage protein products accumulate in excess, a negative feedback loop suppresses CRH production in the hypothalamus, thereby decreasing the secretion of stress hormones, including cortisol [59]. Third, music affects the participants’ cognitive resources (including attention) in the patients given the music intervention (Figure 3) [58, 60].
Mechanism of music therapy in reducing cortisol and stress levels.
Music therapy is not adequate for specific conditions such as fever, the severity of infection, disability, children with cancer with relapse, repeated needle sticking, etc. A person in these conditions usually has extreme levels of cortisol. Music therapy is not effective, even has a negative impact if given when a person has excessive cortisol levels [26].
When a person has a fever, music therapy becomes ineffective in lowering cortisol levels. The cortisol hormone will directly increase when you have a fever. This happens because Cortisol Binding Globulin (CBG) is a thermocouple protein. It is a protein that is sensitive to temperature changes and will release cortisol in response to fever [61]. The cortisol hormone as a biomarker of stress will increase when children with fever are given music therapy [26].
Various physical and psychological events can be a cause of stress in children. This stressful condition can be identified through an increase in cortisol levels. Increased cortisol level is considered the best indicator to determine a person’s stress condition, both acute and chronic. The cortisol examination method can be carried out through saliva and blood. Cortisol examination through saliva is much better, more effective, and more valid than cortisol analysis through blood. Besides, this examination is more beneficial in children because it does not cause pain.
The increase in cortisol as an indicator of stress can be changed through psychosocial interventions, one of which is the provision of music therapy. Music therapy can manage stress problems in various ages with minimal side effects and a small budget. It is easy to use and does not require the intellectual ability to interpret. There are no limitations for users to use music therapy. However, several things must be considered before the therapy is given, for example, environmental conditions when the therapy is provided, adjustment of music type, the duration for pediatric patients (should be less than 20 minutes), and the severity of the disease experienced by the patient.
We thank all those who provided excellent technical support and assistance during the preparation of this manuscript.
The authors declare no conflict of interest.
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The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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