The stress determining factors are several and most often not clearly identifiable, often originated by the job’s type and the way it is organized, or by social life and family situations, or by peculiar personality characteristics. Independently from the determining factor, stress (in the negative meaning) translates into one’s inability to manage the required performance, and it is often associated to a set of physical symptoms of various degrees which lead to the need of professional medical intervention. Insomnia, chronic tiredness, headaches, heart throbbing, digestive problems, lack of power of concentration, and up to well known pathologies such as arterial hypertension, coronary disease, gastritis, etc. are typically, subject by subject, characterized by the term “stress”. Such symptoms are associated to modifications of the body controlled processes (mostly immunologic, hormonal, and neurovegetative). The nervous autonomous system, in particular, reacts inadequately to the external solicitations, either due to an excessive demand, or because of a worsened life style (cigarette smoke, alcohol, food, etc.) often caused by the individual’s illusion to be able to improve one’s ability to “manage” stress.

Moreover, stress factors may induce behavioral changes, typically in relationships, alteration of the decisional capabilities, lack of motivation, and inability to define objectives and personal values.

Stress is considered nowadays amongst the main factors of cardiovascular disease risk, and stress management is taking a pivotal role in all cardiovascular disease risk reduction programs.

At the workplace stress is becoming the emerging risk, representing the root cause of between 50% and 60% of yearly sick leave taken. In 2002 the European Union estimated the economic loss related to stress in the workplace at around €20 Billion.

The obligation imposed by the new European regulation concerning the mandatory work-related stress evaluation has generated much discussion over a topic which, as yet, has not been clearly defined. At present, the vast majority of the industry adopted a minimal effort approach just to be compliant with the minimum required level as outlined in the regulation, considering it just a new useless duty. In these cases the evaluation is mainly performed by psychologists, via the use of standardized questionnaires, to produce an assessment of the stress risk level in the company (which could be of 3 possible levels: low, medium, or high). Such a methodology alone to assess the stress levels appears to be seriously flawed from the scientific reliability perspective: a simple filled form cannot be considered as an actual “measurement” of stress.

The AMPSMEDICAL Solution

Working with the University of Milan, and the center for the Therapy of the Autonomic Nervous System (ANS), in Italy, AMPS developed and patented a number of software tools to provide detailed spectral analysis of cardiovascular signals, and in particular on time series derived by the ECG (tachogram), the arterial blood pressure (systogram and diastogram), the respiratory signal (respirogram), and muscle sympathetic nervous activity. 

As of today, stress is a concept which has not yet been scientifically defined and thus cannot be easily measured: there is not a clearly identified biological parameter or clinical test allowing with certainty to provide on a scale, e.g. 1 to 10, the stress level of an individual.

One important aspect that has been scientifically shown is that stress can seriously modify the status of the cardiovascular system (e.g. the interactions between the cardiac activity, arterial blood pressure and respiratory activity) which in turns is largely regulated by the ANS.  An observed alteration of the ANS, based on the modification of measureable parameters (directly or indirectly derived from electrocardiogram, respiration, and blood pressure curves) can then be the consequence of a stress situation.

The quantitative analysis of the cardiovascular signals tied to the ANS is realized thanks to a specific AMPS patented software tool named HeartScope, which allows to measure and to monitor over time the level of alteration of the biological parameters correlated to stress.  Whenever the parameters show abnormalities, and depending on the degree of such abnormalities, it is possible to determine that the subject is not in healthy conditions and that the cause of this condition could be related to stress. On the contrary, i.e. when the parameters fall under normal ranges, it is possible to infer that most likely (100% certainty does not exist in medicine) the individual is not under stress.

This paper (published on Hypertension. 2007 Feb;49(2):291-7. Epub 2007 Jan 8) confirms the effectiveness of the method.

The Stress Measurement in population groups

The stress measurement model offered by AMPS goes beyond the traditional method based on questionnaires and on the analysis of group/organization analysis because it allows the evaluation of the stress level in groups/organizations based on the quantitative assessment of specific physiological parameters related to the autonomic nervous system.  The AMPS stress measurement model is based on the HeartScope software as well as an operational protocol created by a multidisciplinary team comprised of scientists and university professors (MDs, psychologists, and engineers).

The model includes:

• The selection of a sample set of statistically selected individuals (the evaluation can be performed at several different levels:  at the global group/organization level, departmental level, or specific category level)
• The analysis of the sample set via a number of biological parameters, related to life-style and health situation.
• The execution of an autonomic test (similar to an electrocardiogram (ECG)) which, correlating the ECG traces with the respiration and, when possible, the blood-pressure, allows to asses alterations, if present, of the ANS. (test duration 20 min c.a.)
• The production of a global report (as opposed to subject-by-subject) over the statistical sample set which provides the different levels of stress in the group.

The target of the report generated on the subjects of the sample set is not to draw explicit conclusions about the stress level of each individual, but rather to provide an evaluation of the parameters of interest and verify whether the parameters vary with respect to universal reference values or with respect to other specific subsets of subjects.

The global report determines the organizational stress level of the group/organization, based on the normal or abnormally elevated percentages of the subjects with altered parameters, using well-defined statistical models and comparative tests. In fact, in the presence of a statistically significant modification of the parameters correlated to stress, we can infer that the group/organization environment is likely to be the source of the alterations being the sole common factor amongst the subjects of the sample (it thus assumed that external, non group-related factors can characterize all the subject of the statistical sample set).

The parameters analyzed can be monitored over time with the purpose of providing leaders with a tool for verifying the evolution of the stress levels within each sub-group and in general in the whole group.

The Stress measurement in individuals

The same HeartScope tool can be used to monitor over time the health condition of specific individuals performing in a highly stress-inducing environment. By repeating the autonomic test at regular intervals (weekly, monthly) it is possible to detect whenever the parameters show abnormalities, the degree of such abnormalities, and their evolution over time.

The AMPSMEDICAL Service

AMPS can offer its HeartScope technology in several different ways, from licensing the executable software via an annual license fee, for a direct and fully independent usage (after the required training of the operators that will be performing the tests) to providing a fully integrated key-in-hand service (including equipment and personnel) and any of the desired scenarios between the 2 extremes (e.g. independent collection of the data from the subjects and delivery of “anonymized” data to AMPS for processing and reports production).

For further information, or questions please contact: AMPS.Services@amps-llc.com