Stress and cardiovascular disease. Nat Rev Cardiol. 2012;9:360-370. [PMID: 22473079 DOI: 10.1038/nrcardio.2012.45]

Intimate partner violence and cognitive functioning - toward quantifying dementia risk

INTRODUCTION

Intimate partner violence (IPV) victimization is highly common among women and associated with adverse health consequences that may be linked to dementia risk.

METHODS

Nurses' Health Study II participants (N = 14,771) reported adult (age ≥ 18) emotional, physical, and sexual IPV in 2001/2008 and completed the Cogstate Brief Battery 2014-2019 (4/6 maximum assessments). Any versus no IPV and IPV subtypes were used to predict cognition in confounder-adjusted generalized estimating equation models weighted to account for attrition.

RESULTS

Mean age at baseline was 61.0 years (standard deviation = 4.6); 46.5% reported any IPV (42.3% emotional, 22.6% physical, and 11.3% sexual). IPV victimization was associated with 0.029 SD unit (95% confidence interval [CI]: -0.068, 0.009) lower global cognitive score but not rate of cognitive change. Among IPV types, emotional IPV had the strongest association (β = -0.048; 95% CI: -0.075, -0.020) with cognitive scores.

DISCUSSION

Gendered social experiences such as IPV may influence dementia risk. Further assessment of IPV in aging cohorts is needed.

HIGHLIGHTS

IPV predicted lower average cognitive score over follow-up. Emotional abuse had the largest associations with cognitive score among subtypes. We found no differences in rate of cognitive score change by violence exposure. Even modest impacts of violence would translate to large population effects. Gendered experiences warrant additional research in understanding dementia risk.

The Effectiveness of a Race-Based Stress Reduction Intervention on Improving Stress-Related Symptoms and Inflammation in African American Women at Risk for Cardiometabolic Disease: Protocol for Recruitment and Intervention for a Randomized Controlled Trial

BACKGROUND

In recent years, the prevalence of cardiometabolic disease (CMD) in African American women has risen; the risk also increases with age, in comparison to men. Evidence demonstrates that stressful life events, including experiences of racism and perceived discrimination, contribute substantially to inflammatory diseases, such as CMD. Despite this evidence, few evidence-based interventions are available to assist individuals from minoritized communities in coping with the chronic stress related to their racial or ethnic identity.

OBJECTIVE

Our proposed randomized controlled trial will test a novel, race-based intervention tailored to African American women, called Resilience, Stress, and Ethnicity (RiSE).

METHODS

In this randomized controlled trial, we will randomize participants 1:1 to the 8-week, group-based RiSE program (intervention) or a health education program (active control group). Both programs will consist of synchronous classes on Zoom and will be led by experts. The primary end point will be stress at 6 months after the intervention, and the efficacy of RiSE will be evaluated for improving stress-related symptoms (current perceived stress, depressive symptoms, fatigue, and sleep disturbance), improving coping strategies, and reducing inflammatory burden in African American women at risk for CMD. Validated survey measures and inflammatory biomarkers will be assessed at baseline, midintervention, intervention completion, and 6 months after the intervention, and differences over time by intervention will be evaluated using mixed effects models.

RESULTS

This study was funded by the National Institute on Aging on March 30, 2023, with recruitment and enrollment beginning in October 2023. The study is underway, with 120 participants enrolled as of March 2025.

CONCLUSIONS

This study will be one of the first to examine a race-based stress reduction intervention in African American women and has the potential to improve the health of minoritized groups faced with chronic stress associated with experiencing racism and discrimination. We anticipate that RiSE will reduce stress-related symptoms, enhance adaptive coping, and reduce inflammation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05902741; https://www.clinicaltrials.gov/study/NCT05902741.

Comparing a cardiac sympathetic activity index with pre-ejection period in time series

Over the last decade, cardiology research has yielded a Sympathetic Activity Index (SAI) that captures the non-linear response patterns of the sympathetic nervous system. We investigated this chronotropic index alongside pre-ejection period (PEP), an inotropic index. While SAI has been validated in physiology, cardiology, and biomedical engineering research, this study introduces SAI to biopsychology. SAI is calculated exclusively from ECG, while PEP requires both ECG and impedance cardiography (ICG) as inputs. An average of 1468 time series observations were analysed per participant per sympathetic index (SAI, PEP) across 17 participants (13 female). The mean SAI-PEP correlation increased significantly from baseline to stimulus (rB->S(16) = .22, p = 0.042), and then dropped from stimulus to recovery, back to near baseline levels (rS->R(16) = -.21, p = 0.047). Ideographic patterns emerged, although overall average PEP-SAI correlations were lower than expected, as the procedure did not include a physical stressor. Participants with the strongest positive SAI-PEP correlations (mean r(1565) = .579, p < 0.001) had a matching pattern of psychological distress, as measured by Subjective Units of Distress Scale time series. When psychological distress patterns diverged from both SNS indices, SAI and PEP also diverged from each other. Results suggest that cardiac rate (SAI) and contractility (PEP) may reflect similar temporal dynamics when psychological and physiological stress patterns are aligned. PEP's lability in time series was over 10 times higher than that for SAI. While theoretical and methodological advantages are associated with SAI, further research is needed to comprehensively assess it as a cardiac sympathetic index.

Global evidence on the prevalence of and risk factors associated with stress

BACKGROUND

Stress is a major public health issue linked to physical and mental health disorders, economic burdens, and social challenges. Understanding its prevalence and determinants across demographic and economic groups is essential for effective intervention.

METHODS

This study uses data from the Gallup World Poll, with over 300,000 participants across 131 countries. We apply linear probability regression models to examine the relationships between stress and factors such as demographics, socioeconomic status, and health.

RESULTS

Overall, 35.1 % of respondents report experiencing stress, with higher prevalence among females (36.1 %) compared to males (33.6 %) (p < .001). Stress is more common in high-income countries (36 %) than in low- and middle-income countries, but differences are small (2.3 percentage points). Key stress correlates include income instability (p < .01), health issues (p < .01), and food insecurity (p < .01). Gender differences are pronounced in high-income countries, where women report more stress.

CONCLUSIONS

Addressing stress requires gender-sensitive interventions and economic policies that target income stability and job creation. Tailored programs can mitigate the health impacts of stress, reduce health disparities, and support progress toward UN SDG 3 on health and well-being.

Activation of glutamine synthetase (GS) as a new strategy for the treatment of major depressive disorder and other GS-related diseases

Glutamine synthetase (GS) plays a crucial role in the homeostasis of the glutamate-glutamine cycle in the brain. Hypoactive GS causes depressive behaviors. Under chronic stress, GS has no change in expression, but its activity is decreased due to nitration of tyrosine (Tyr). Thus, we speculate that agents that prevent nitration or facilitate denitration of GS would be candidates for new antidepressants. Using human recombinant GS and mouse lysate from the medial prefrontal cortex, we demonstrated that Tyr (0.0313-0.5 µM) dose-dependently protected GS activity against peroxynitrite-induced Tyr-nitration of GS. Diet supplementation with Tyr exerted significant antidepressant effects in a chronic immobilization stress depression mouse model. We further found that dipeptides, such as tyrosyl-glutamine (YQ), that had appropriate chemical properties for medication also increased GS activity both in vitro and in vivo and exerted antidepressant effects. Because reduced GS activity also occurs in epilepsy and hyperammonemia, we evaluated whether Tyr and YQ had therapeutic effects. Interestingly, Tyr or YQ administration significantly attenuated kainic acid-induced seizures in mice and reduced blood ammonia levels in azoxymethane- or bile duct ligation-induced hyperammonemia mouse models, which was accompanied by an increment in GS activity. The activation of GS was accomplished by a decrement in Tyr-nitration, so-called Tyr-denitration. Therefore, this study demonstrates that the activation of GS could be a new strategy to treat depression and other GS-related diseases.

Residential exposure to green and blue spaces over childhood and cardiometabolic health outcomes: The generation XXI birth cohort

Evidence on the effects of green and blue spaces on childhood cardiometabolic health is inconsistent and mostly cross-sectional. We assessed the associations of green and blue spaces exposure at birth 4, 7, and 10 years (to identify vulnerable periods of exposure) and as longitudinal trajectories (to identify the longitudinal effect over time) with cardiometabolic outcomes at 10 years. Among 4669 participants from a population-based birth cohort, we assessed the residential normalized difference vegetation index (NDVI) and distance to urban green and blue spaces at each time point using geographic information systems and standardized by dividing the observed value by the standard deviation. Longitudinal exposure trajectories were derived using latent class mixed models. At 10 years, we measured body mass index, fat mass index, android-to-gynoid fat ratio, blood pressure, and metabolic outcomes. We defined overweight/obesity (World Health Organization), high blood pressure (American Academy of Pediatrics), and metabolic syndrome (IDEFICS). No significant associations were observed between natural spaces exposure and adiposity outcomes. We found an inverse association between distance to nearest blue space at birth and systolic blood pressure z-scores, and a positive association between distance to nearest green space at 7 and 10 years and metabolic syndrome score (p < 0.05). Children in the descending NDVI500m trajectory, compared to those in the high stable trajectory, showed lower diastolic blood pressure z-scores and metabolic syndrome scores (p < 0.05). However, after multiple testing corrections, all associations lost statistical significance. This study did not find robust associations between natural spaces during key developmental periods and cardiometabolic health.

Stressor-Evoked Brain Activity, Cardiovascular Reactivity, and Subclinical Atherosclerosis in Midlife Adults

BACKGROUND

Cardiovascular responses to psychological stressors have been separately associated with preclinical atherosclerosis and hemodynamic brain activity patterns across different studies and cohorts; however, what has not been established is whether cardiovascular stress responses reliably link indicators of stressor-evoked brain activity and preclinical atherosclerosis that have been measured in the same individuals. Accordingly, the present study used cross-validation and predictive modeling to test for the first time whether stressor-evoked systolic blood pressure responses statistically mediated the association between concurrently measured brain activity and a vascular marker of preclinical atherosclerosis in the carotid arteries.

METHODS AND RESULTS

Six hundred twenty-four midlife adults (aged 28-56 years, 54.97% women) from 2 different cohorts underwent 2 information-conflict functional magnetic resonance imaging tasks, with concurrent systolic blood pressure measures collected. Carotid artery intima-media thickness was measured by ultrasonography. A mediation framework that included harmonization, cross-validation, and penalized principal component regression was then used. Brain areas where functional magnetic resonance imaging activity exhibited reliable direct and indirect effects were identified through bootstrapping. Sensitivity analysis further tested the robustness of findings after accounting for prevailing levels of cardiovascular disease risk and brain imaging data quality. Task-averaged patterns of functional magnetic resonance imaging activity across distributed brain areas exhibited a generalizable association with carotid artery intima-media thickness, which was reliably mediated by an area under the curve measure of aggregate systolic blood pressure reactivity. Importantly, this effect held in sensitivity analyses. Implicated brain areas in this mediation included the ventromedial prefrontal cortex, anterior cingulate cortex, insula, and amygdala.

CONCLUSIONS

These novel findings support a link between stressor-evoked brain activity and preclinical atherosclerosis, which is accounted for by individual differences in corresponding levels of stressor-evoked cardiovascular reactivity.

Perceived association of mood and symptom severity in adults with mitochondrial diseases

Individuals with genetic mitochondrial diseases suffer from multisystem symptoms that vary in severity and over time, but the factors influencing disease manifestations are poorly understood. Based upon i) patient and family reports that stressful life events trigger or exacerbate symptoms, ii) biologically plausible pathways whereby psychological states and stress hormones influence mitochondrial energy transformation capacity, and iii) epidemiological literature linking traumatic/stressful life events and multiple neurologic disorders, we hypothesized that mitochondrial disease symptom severity may in part vary with daily mood. To examine patients' perception around potential psycho-biological mechanisms known to operate in other chronic illnesses, we administered the Stress, Health and Emotion Survey (SHES) to 70 adults with self-reported mitochondrial diseases. Participants rated how severe each of their symptom(s) was over the past year, separately for either 'good' (happy, calm) or 'bad' (stress, sad) emotional days. On average, patients reported that most symptoms were better on "good" emotional days (p < 0.0001) and worse on "bad" emotional days (p < 0.0001). Of the 29 symptoms assessed, 27 were associated with daily mood (p < 0.01). Some but not all symptoms were reported to be less or more severe on good and bad days, respectively, including fatigue, exercise intolerance, brain fog, and fine motor coordination (ps < 0.0001). These associative results suggest that on average individuals living with mitochondrial diseases perceive a connection between their mood and symptoms severity. These preliminary findings constitute an initial step towards developing more comprehensive models to understand the psychobiological factors that influence the course of mitochondrial diseases.

Psychological Distress and Cardiovascular Health in Pregnancy: Findings From the U.S. National Health Interview Survey

BACKGROUND

The relationship between psychological health and cardiovascular health (CVH) during pregnancy is not well characterized.

OBJECTIVES

The purpose of this study was to perform a cross-sectional analysis in order to assess the relationships between psychological distress and CVH among pregnant individuals in the United States.

METHODS

U.S. National Health Interview Survey (2013-2018) data were used for the analyses. The sample included all pregnant participants aged ≥18 years, but excluded those with missing data for the exposure, outcome, or covariates. Psychological health was measured with the 6-item Kessler scale, and severe psychological distress was defined as 6-item Kessler scale ≥13. CVH was quantified using the American Heart Association's Life's Essential 8; as detailed dietary data were unavailable, a 7-item score was used (higher scores indicated worse CVH). Multivariable Poisson regression tested associations between severe psychological distress and CVH, adjusting for potential confounders including age, race/ethnicity, sexual orientation, education level, family income, any known cardiovascular conditions, and insurance.

RESULTS

Among 1,110 pregnant individuals (representing >1.5 million pregnant individuals each year of the survey), 3.5% reported severe psychological distress (95% CI: 2.2%-5.5%), 21.7% reported moderate psychological distress (95% CI: 18.8%-24.9%), and 74.9% reported either mild or no psychological distress (95% CI: 71.4%-78.0%). Individuals reporting moderate psychological distress (adjusted rate ratio: 1.25 [95% CI: 1.13-1.38], P < 0.001) or severe psychological distress (adjusted rate ratio: 1.42 [95% CI: 1.20-1.68], P < 0.001) had lower CVH scores compared to those with mild or no psychological distress. A stepwise relation was observed between the severity of psychological distress and CVH.

CONCLUSIONS

We observed a strong association between psychological distress and suboptimal CVH during pregnancy, highlighting the need to manage psychological health along with CVH in pregnant individuals.

Floods and cause-specific mortality in the United States applying a triply robust approach

The health impact of floods has not been well characterized. This study evaluated long-term associations between cause-specific mortality rates and county-level monthly flood days (excluding coastal floods caused by tropical storms) in the post-flood year in the contiguous U.S., using a triply robust approach incorporating propensity score, counterfactual estimation, and confounder adjustment. Death records came from the CDC National Center for Health Statistics (2001-2020) and floods came from the NOAA Storm Events Database (2000-2020). We found that one flood day was associated with 8.3 (95% CI: 2.5 to 14.1) excess all-cause deaths per 10 million individuals, 3.1 due to myocardial infarction, 2.4 due to respiratory diseases, and 5.9 due to external causes. From 2001 to 2020, 22,376 (95% CI: 6,758 to 37,993) all-cause deaths were attributable to floods. Our findings highlight the long-term health risks after floods, and a need for measures to reduce these risks.

Mediation role of health behaviours in the relation between mental resilience and cardiovascular risk in young adults with a diagnosed congenital heart defect

INTRODUCTION

With age, patients with a congenital heart defect are under higher risk of cardiovascular diseases and more complex selfcare requirements.

AIM OF THE STUDY

The analysis of the mediation role of health-oriented behaviours in the relation between mental resilience and the cardiovascular risk in young adults with congenital heart defects.

MATERIALS AND METHODS

This is an observational study with a cross-sectional design. The research was based on the examination of 201 patients with congenital heart defects using the medical record analysis, the method of estimating and the diagnostic survey method. The other examination tools included the Cardiovascular Disease Risk Factors Scale, the Resilience Assessment Scale (SPP-25) and the Health Behaviour Inventory (HBI).

RESULTS

The examination confirmed that 50% of patients were susceptible to a cardiovascular disease due to the prevalence of three risk factors. The general indicator of the intensity of health-related behaviours amounted to 83.16 ± 12.94. The lowest intensity of all health behaviours was observed for eating habits (3.14 ± 0.83). The highest score of mental resilience was reported in terms of openness to new experience and sense of humour (15.31 ± 3.05), whereas the lowest was related to optimism and mobilization capability in difficult situations (12.97 ± 3.46). The higher the perseverance and determination (β = -0.16; p < 0.001), openness and sense of humour (β = -0.09; p < 0.01), tolerance to failure and perceiving life as a challenge (β = -0.09; p < 0.01), optimism and the mobilization capability in difficult situations (β = -0.08; p < 0.01) and overall mental resilience scale measurement (β = -0.11; p < 0.001), the lower the cardiovascular risk. In short, higher psychological resilience was associated with higher intensity of health-related behaviours. Greater intensity of health behaviours and higher indices of eating habits, prophylactic behaviours and health practices fostered lower risk of CVDs.

CONCLUSIONS

Health-related behaviours play a mediation role between mental resilience and the cardiovascular risk in the group of young adults with congenital heart defects. Psychological resilience as a preventive and promotional factor of mental health appears to be of a very essential value while developing health promoting programmes aimed at decreasing the cardiovascular risk in patients with a congenital heart defect. The evaluation of mental resilience may provide better understanding of the patient and ensure proper health care.

Mediating pathways between neighborhood disadvantage and cardiovascular risk: quasi-experimental evidence from a Danish refugee dispersal policy

Research has documented that neighborhood disadvantage is associated with increased cardiovascular disease risk, but it is unclear which mechanistic pathways mediate this association across the life course. Leveraging a natural experiment in which refugees to Denmark were quasi-randomly assigned to neighborhoods across the country during 1986-1998, and using 30 years of follow-up data from population and health registers, we assessed whether and how individual-level poverty, unstable employment, and poor mental health mediate the relation between neighborhood disadvantage and the risk of hypertension, hyperlipidemia, and type 2 diabetes among Danish refugees (n = 40 811). Linear probability models using the discrete time-survival framework showed that neighborhood disadvantage was associated with increased risk of hypertension (0.05 percentage points [pp] per year [95% CI, -0.00 to 0.10]); hyperlipidemia (0.03 pp per year [95% CI, -0.01 to 0.07]), and diabetes (0.01 pp per year [95% CI, -0.02 to 0.03]). The Baron-Kenny product-of-coefficients method for counterfactual mediation analysis indicated that cumulative income mediated 6%-28% of the disadvantage effect on these outcomes. We find limited evidence of mediation by unstable employment and poor mental health. This study informs our theoretical understanding of the pathways linking neighborhood disadvantage with cardiovascular disease risk and identifies income security as a promising point of intervention to be studied in future research.

A bibliometric analysis of coronary heart disease impacted by work stress elements and lifestyle disease

PURPOSE

One psychosocial risk factor that has drawn attention is work-related stress, although it is still unclear how exactly this risk factor relates to poor health. Prospective observational studies have found a 40%-50% raise in the incidence of coronary heart disease in those who experience chronic stress at work and in their personal lives.

THEORETICAL FRAMEWORK

In the recent decade, there has been a rise in the requirement for firms to gather information on job stress on employees that leads to coronary heart disease. As a result, this study on trends in Coronary Heart Disease induced by Work Stress becomes necessary to examine all of these efforts.

DESIGN/METHODOLOGY

This research employs bibliometric analysis and charting to describe the growth and structure of the research field of work-related stress causing coronary heart disease. The field's conceptual framework and research boundaries, the connections between publications and the contributors, key phrases, the latest networks of collaboration, the most prevalent concepts, and the most cited authors are all revealed by our findings.

FINDINGS

Research found that this field has seen a significant increase in research on coronary heart disease in recent years. Because it has been demonstrated that there is a rise in deaths from cardiovascular disease, researchers, academics, and professionals should be made aware of how stress can lead to coronary heart disease.

ORIGINALITY/VALUE

The study suggests that workplace health should be a priority for both developed and developing nations, and it must be disseminated in several languages.

The effect of social exclusion on the cognitive health of middle-aged and older adults: A systematic review

This systematic review aimed to evaluate the independent and joint effects of social exclusion in three specific domains-economic, social relations, and civic participation-on the cognitive health of middle-aged and older adults. Longitudinal studies from January 2000 to October 2023 were identified via Web of Science, Scopus, and PubMed, with sixty-five studies meeting inclusion criteria. The quality of the studies was assessed with Newcastle-Otawa Scale. Analysis revealed a strong association between economic exclusion and cognitive decline, with most studies indicating a significant negative impact. Ten studies found a positive link between volunteering and cognitive health for civic participation, while eight did not, showing mixed evidence. In social relations, most studies connected loneliness, social isolation, smaller social networks, reduced contact with family and friends, lower engagement in activities, and negative social interactions with cognitive decline. Notably, one study found that older adults experiencing social exclusion in multiple domains simultaneously face even greater cognitive decline. In summary, this review shows that social exclusion in economic, social relations, and civic participation and all together domains is associated with greater cognitive decline in older adults.

A Plague(d) Tale: Are violent video games effective in reducing stress levels?

Stress relief is often cited as the main motive for playing video games. However, the effectiveness of video games in coping with stress, especially when comparing violent and non-violent genres, remains uncertain. In the present lab experiment with N = 82 participants, we assessed acute stress reduction after playing a violent vs. non-violent video game that followed stress induction using the Socially Evaluated Cold Pressor Test. We hypothesized that playing video games causes physiological (i.e., an increase in heart rate variability and a decrease in cortisol) and self-reported effects of stress relief, and a reduction in aggression levels, leading to restoration. Aggressive behavior was measured as self-reports and seconds in the Cold Pressor Test allocated to the next participant. In line with previous studies, participants playing a violent passage of a game reported feeling more stressed and aggressive, while those playing a non-violent passage of the same game felt less stressed and more relaxed. In contrast, however, we found an increase in heart rate variability as well as a decrease in heart rate and cortisol regardless of playing group, which indicates relaxation. This dissociation between self-reported and physiological stress results indicates that the own state of arousal is incorrectly assessed. This may be due to a different cognitive assessment of the characteristics of the respective game groups, as the violent game sequence was judged to be more difficult and challenging. However, the observed physiological relaxation effect might also suggest the potential of video game engagement for stress interventions.

Molecular mechanism underlying stress response and adaptation

Stress, a common life experience, impacts both mental and physical health, contributing to conditions such as anxiety and cardiovascular disease. It triggers physiological and psychological responses, primarily through the Hypothalamic-Pituitary-Adrenal (HPA) and Sympathetic-Adrenal-Medullary (SAM) axes, which are coordinated by the autonomic nervous system. Dysregulation of the glucocorticoid system, mediated by mineralocorticoid and glucocorticoid receptors, plays a critical role in neurodegenerative disorders like Alzheimer's disease. Cellular pathways like PI3K/Akt, NF-κB, and AP-1 transcription factors maintain homeostasis during stress and are targets for therapeutic research. Epigenetic influences and genomic modifications highlight the long-lasting effects of stress on gene expression. Adaptive responses, such as allostasis, allow the body to maintain stability amid stress. However, excessive stress leads to allostatic load, negatively impacting the immune, endocrine, and nervous systems. Current treatments include pharmacological and lifestyle interventions, with emerging approaches such as psychobiotics and precision medicine offering future potential.

Home Environment as a Therapeutic Target for Prevention and Treatment of Chronic Diseases: Delivering Restorative Living Spaces, Patient Education and Self-Care by Bridging Biophilic Design, E-Commerce and Digital Health Technologies

A high prevalence of chronic diseases exposes diverse healthcare pain points due to the limited effectiveness of pharmaceutical drugs and biologics, sedentary lifestyles, insufficient health literacy, chronic stress, unsatisfactory patient experience, environmental pollution and competition with commercial determinants of health. To improve patient care and long-term outcomes, the impact of the home environment is overlooked and underutilized by healthcare. This cross-disciplinary work describes perspectives on (1) the home environment as a therapeutic target for the prevention and treatment of chronic diseases and (2) transforming health-centric household goods e-commerce platforms into digital health interventions. We provide a rationale for creating therapeutic home environments grounded in biophilic design (multisensory, environmental enrichment) and supporting physical activities, quality sleep, nutrition, music, stress reduction, self-efficacy, social support and health education, hence providing clinical benefits through the modulation of the autonomic nervous system, neuroplasticity and behavior change. These pleiotropic "active non-pharmacological ingredients" can be personalized for people living with depression, anxiety, migraine, chronic pain, cancer, cardiovascular and other conditions. We discuss prospects for integrating e-commerce with digital health platforms to create "therapeutic home environment" interventions delivered through digital therapeutics and their combinations with prescription drugs. This multimodal approach can enhance patient engagement while bridging consumer spending with healthcare outcomes.

Lost opportunities: How gendered arrangements harm men

Traditional gendered arrangements-norms, roles, prejudices, and hierarchies-shape every human life. Associated harms are primarily framed as women's issues due to more severe consequences women face. Yet, gendered arrangements also shape men's relationships, career paths, and health. Current work on gender equity overlooks men's perspectives. Despite benefits they gain from out-ranking women, men's position paradoxically entraps them in restrictive roles, compelling them to prioritize dominance. An inclusive framework challenges prevailing narratives by considering personal costs borne by men. Identifying with a man's traditional role is a mixed privilege, as five gendered arrangements show for men who subscribe to them: 1. Masculine norms can restrict men's choices and are associated with adverse health trajectories; 2. Some men's disengagement from communal roles denies them positive outcomes associated with caring for others; 3. Hostile sexism fosters antipathy, fueling tension in some men's interactions with women; 4. Benevolent sexism forces some men into scripted interactions, preventing genuine connections and burdening them with unrealistic breadwinner and protector roles; 5. Societal shifts in gender hierarchies can elicit threat responses in men, depending on intersections with social class and racial identities. Understanding costs to men calls for more empirical research. Gender equity for men, whose circumstances differ from those of women, would enable men to make informed choices and achieve better outcomes for themselves-paralleling the progress women have made in many areas of life. Striving for equity for all genders can ultimately enhance overall human well-being.

Habituation of the biological response to repeated psychosocial stress: a systematic review and meta-analysis

Recurrent psychosocial stress poses a significant health challenge, prompting research into mechanisms of successful adaptation. Physiological habituation, defined as decreased reactivity to repeated stressors, is pivotal in protecting the organism from allostatic load. Here, we systematically review and meta-analyze data from studies investigating the capacity of central stress systems to habituate when repeatedly exposed to a standardized psychosocial stressor, the Trier Social Stress Test (k = 47). For a comprehensive overview of biological stress systems, we examine multiple markers of the hypothalamic-pituitary-adrenal (HPA) axis, the autonomic nervous system (ANS), and the immune system. Our findings indicate that habituation patterns vary substantially between different stress systems. While most studies provide robust evidence for rapid and substantial HPA-axis habituation, ANS and immune marker responses to repeated stress are less uniform. We further integrate existing knowledge on personal and environmental influences contributing to individual differences in habituation capacity. Additionally, we discuss the implications of stress habituation patterns for health outcomes and the design of longitudinal stress studies and highlight potential avenues for future research.

Potential of Klotho as a Biomarker for Overwork: A Study of Frontline Medical Workers

OBJECTIVE

This study evaluates the utility of serum s-αKlotho levels as a quantifiable biomarker for overwork.

METHODS

Frontline medical workers aged 20-55 years from Yiling People's Hospital of Yichang were recruited. Criteria included nonsmokers, non-heavy drinkers, no chronic medication use, and no acute illnesses recently. Participants worked over 10 hours per day, 60 hours weekly, and had at least 3 years of experience. A control group was matched except for work conditions. Data were collected through surveys, and serum levels were measured.

RESULTS

Significant differences in serum Klotho were found between overwork and control groups. The overwork group had higher median s-αKlotho levels (49.99 pg/mL) compared to controls (27.88 pg/mL).

CONCLUSION

Overworked medical workers exhibited elevated serum s-αKlotho, suggesting s-αKlotho as a potential biomarker for overwork. Future research should use multicenter designs with larger samples to validate findings.

Dexmedetomidine Alleviates Acute Stress-Induced Acute Kidney Injury by Attenuating Inflammation and Oxidative Stress via Inhibiting the P2X7R/NF-κB/NLRP3 Pathway in Rats

This study aimed to investigate the potential protective effects of Dexmedetomidine (DEX) against acute kidney injury (AKI) induced by acute stress (AS). Wistar rats were divided into five groups: Control, DEX, AS, AS + DEX, and AS + A438079. The results showed that AS led to AKI by increasing inflammatory biomarkers and oxidative stress-related indicators. The acute stress model in rats was successfully established. Renal function, histopathology, oxidative stress, and inflammation were assessed. Localization of P2X7 receptor (P2X7R) was determined by immunofluorescence. Additionally, the key inflammatory proteins of the P2X7R/NF-κB/NLRP3 signaling pathway were measured by Western blotting. DEX significantly improved kidney function, alleviated kidney injury, and reduced oxidative stress and inflammation. DEX inhibited the activation of the P2X7R, decreased the expression of NF-κB, NLRP3 inflammasome, and Caspase-1, and inhibited the expression of interleukin-1β (IL-1β) and tumor necrosis factor α (TNFα). Furthermore, DEX also alleviated AS-induced AKI by inhibiting the excessive production of reactive oxygen species (ROS) and reducing oxidative stress. In conclusion, DEX attenuates AS-induced AKI by mitigating inflammation and oxidative stress through the inhibition of the P2X7R/NF-κB/NLRP3 pathway in rats.

Stress regulatory hormones and cancer: the contribution of epinephrine and cancer therapeutic value of beta blockers

The word "cancer" evokes myriad emotions, ranging from fear and despair to hope and determination. Cancer is aptly defined as a complex and multifaceted group of diseases that has unapologetically led to the loss of countless lives and affected innumerable families across the globe. The battle with cancer is not only a physical battle, but also an emotional, as well as a psychological skirmish for patients and for their loved ones. Cancer has been a part of our history, stories, and lives for centuries and has challenged the ingenuity of health and medical science, and the resilience of the human spirit. From the early days of surgery and radiation therapy to cutting-edge developments in chemotherapeutic agents, immunotherapy, and targeted treatments, the medical field continues to make significant headway in the fight against cancer. However, even after all these advancements, cancer is still among the leading cause of death globally. This urges us to understand the central hallmarks of neoplastic cells to identify novel molecular targets for the development of promising therapeutic approaches. Growing research suggests that stress mediators, including epinephrine, play a critical role in the development and progression of cancer by inducing neoplastic features through activating adrenergic receptors, particularly β-adrenoreceptors. Further, our experimental data has also shown that epinephrine mediates the growth of T-cell lymphoma by inducing proliferation, glycolysis, and apoptosis evasion via altering the expression levels of key regulators of these vital cellular processes. The beauty of receptor-based therapy lies in its precision and higher therapeutic value. Interestingly, the enhanced expression of β-adrenergic receptors (ADRBs), namely ADRB2 (β2-adrenoreceptor) and ADRB3 (β3-adrenoreceptor) has been noted in many cancers, such as breast, colon, gastric, pancreatic, and prostate and has been reported to play a pivotal role in facilitating cancer growth mainly by promoting proliferation, evasion of apoptosis, angiogenesis, invasion and metastasis, and chemoresistance. The present review article is an attempt to summarize the available findings which indicate a distinct relationship between stress hormones and cancer, with a special emphasis on epinephrine, considered as a key stress regulatory molecule. This article also discusses the possibility of using beta-blockers for cancer therapy.

Psychosocial well-being index and sick leave in the workplace: a structural equation modeling of Wittyfit data

Background

Psychosocial well-being, which assesses emotional, psychological, social, and collective well-being, could help measure risk and duration of sick leave in workers.

Objective

This study aims to build a structural equation model of a psychosocial well-being index based on 10 psychosocial factors and investigate its association with sick leave.

Methods

Data of workers using Wittyfit was collected in 2018. Psychosocial factors (job satisfaction, atmosphere, recognition, work-life balance, meaning, work organization, values, workload, autonomy, and stress) were self-assessed using health-related surveys, while sick leave records were provided by volunteer companies.

Results

A total of 1,399 workers were included in the study (mean age: 39.4 ± 9.4, mean seniority: 9.2 ± 7.7, 49.8% of women, 12.0% managers). The prevalence of absenteeism was 34.5%, with an average of 8.48 ± 28.7 days of sick leave per worker. Structural equation modeling facilitated computation of workers' psychosocial well-being index (AIC: 123,016.2, BIC: 123,231.2, RMSEA: 0.03). All factors, except workload (p = 0.9), were influential, with meaning (β = 0.72, 95% CI 0.69-0.74), values (0.69, 0.67-0.70) and job satisfaction (0.64, 0.61-0.66) being the main drivers (p < 0.001). Overall, psychosocial well-being was found to be a protective factor for sick leave, with a 2% decreased risk (OR = 0.98, 95% CI 0.98-0.99, p < 0.001) and duration (IRR = 0.98, 95% CI 0.97-0.99, p < 0.001) per psychosocial well-being index point.

Conclusion

The psychosocial well-being index provides a measure of psychosocial well-being and helps predict sick leave in the workplace. This new indicator could be used to analyze the association between psychosocial well-being and other health outcomes.

Clinical trial registration

Clinicaltrials.gov, identifier NCT02596737.

Increasing stress resilience in older adults through a 6-week prevention program: effects on coping strategies, anxiety symptoms, and cortisol levels

Introduction

As people age, chronic stress, resulting in prolonged or repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis, has been associated with long-term adverse health outcomes. Coping strategies and social support have been recognized as contributing to resilience to stress in older adults. Few studies have evaluated stress management training (SMT) interventions based on psychoneuroendocrinology that were designed to be delivered to healthy older adults in community settings.

Methods

In this study, a total of 170 older adults (mean age = 76.07, SD = 7.67) participated in a cluster-randomized trial designed to compare the delivery of an SMT intervention with a waitlist condition.

Results

The effect of SMT on coping strategies, stress, anxiety, and depression was measured 3 weeks and 3 months after the intervention. In addition, we tested the effect on basal cortisol secretion over 2 days from saliva samples upon awakening and the total diurnal cortisol output [area under the curve with respect to ground (AUCg)]. Results from repeated measures analyses of variance showed that participants who received the intervention demonstrated a significant increase in problem-solving coping strategies and a decrease in anxiety scores 3 weeks after the intervention compared to the waitlist group. STM participants also demonstrated lower cortisol levels on the AUCg index. At the 3-month follow-up, gains were maintained only on the AUCg index.

Discussion

This type of brief preventive program could reduce basal cortisol levels in older adults, which may be an important protective factor against health outcomes associated with chronic HPA activation. Our results provide sufficient evidence to warrant further research to improve the effectiveness of O'stress in different settings.

Ambulatory autonomic nervous system activity in relation to hearing impairment

Previous research has demonstrated that hearing impairment is associated with heightened subjective experiences of listening effort, fatigue, and stress, impacting daily functioning. This study aimed to evaluate whether hearing impairment alters physiological stress systems and whether different aspects of hearing impairment could vary in predicting dysregulation in these systems. Hallmark measures of parasympathetic and sympathetic nervous system activity were derived from electrocardiography, impedance cardiography, and electrodermal activity recordings taken from 133 individuals, aged 37 to 73, over two 24-hr periods, including sleep. Using ecological momentary assessment (EMA), participants reported mood, listening effort, and fatigue seven times daily. Hearing impairment was quantified through pure tone thresholds, speech perception in noise testing, and the Amsterdam Inventory for Auditory Disability questionnaire (Amsterdam Inventory). Using mixed models, we compared average daytime and sleep values of physiological measures across the 2 days, and their daytime-to-sleep contrast, based on each hearing impairment assessment. Results indicated that all three hearing impairment assessments were strong predictors of EMA outcomes of listening effort and fatigue. Contrary to expectations, hearing impairment did not have a significant impact on parasympathetic activity in daily life or on skin sympathetic activity. However, individuals with higher impairment exhibited a larger change in a cardiac sympathetic measure, the pre-ejection period, during wakefulness compared to sleep. Overall, hearing impairment had a small impact on autonomic nervous system functioning in daily life, but the effects were potentially attenuated by reduced exposure to listening demand in those with hearing impairment.

Causal Effects of Air Pollution, Noise, and Shift Work on Unstable Angina and Myocardial Infarction: A Mendelian Randomization Study

Cardiovascular disease continues to be a major contributor to global morbidity and mortality, with environmental and occupational factors such as air pollution, noise, and shift work increasingly recognized as potential contributors. Using a two-sample Mendelian randomization (MR) approach, this study investigates the causal relationships of these risk factors with the risks of unstable angina (UA) and myocardial infarction (MI). Leveraging single nucleotide polymorphisms (SNPs) as genetic instruments, a comprehensive MR study was used to assess the causal influence of four major air pollutants (PM2.5, PM10, NO2, and NOx), noise, and shift work on unstable angina and myocardial infarction. Summary statistics were derived from large genome-wide association studies (GWASs) from the UK Biobank and the FinnGen consortium (Helsinki, Finland), with replication using an independent GWAS data source for myocardial infarction. The inverse-variance weighted (IVW) approach demonstrated a significant positive correlation between shift work and the increased risk of both unstable angina (OR with 95% CI: 1.62 [1.12-2.33], p = 0.010) and myocardial infarction (OR with 95% CI: 1.46 [1.00-2.14], p = 0.052). MR-PRESSO analysis identified outliers, and after correction, the association between shift work and myocardial infarction strengthened (OR with 95% CI: 1.58 [1.11-2.27], p = 0.017). No notable causal associations were identified for air pollution or noise with either outcome. The replication of myocardial infarction findings using independent data supported a possible causal link between shift work and myocardial infarction (OR with 95% CI: 1.41 [1.08-1.84], p = 0.012). These results provide novel evidence supporting shift work as a likely causal risk factor for unstable angina and myocardial infarction, underscoring the need for targeted public health strategies to mitigate its cardiovascular impact. However, further investigation is necessary to elucidate the role of air pollution and noise in cardiovascular outcomes.

Validation of the Turkish version of the Chronic Stress Scale: assessing social role-related stressors and their impact on psychopathology

Introduction

Chronic social-role-related stress plays a crucial role in the development and progression of mental and medical disorders, making it an important factor to consider. This study aimed to translate and validate The Chronic Stress Scale (CSS) adapted by Turner for a Turkish population and explore its role in depression, anxiety, and perceived stress.

Methods

A total of 524 participants (mean age 31.59 years, 68% women) were recruited from Koç University and Basaksehir Cam Sakura City Hospitals, including 260 from the general population and 264 with depressive or anxiety disorders. The 51-item CSS was translated into Turkish and validated through reliability and validity analyses, including Cronbach's alpha, exploratory factor analysis, and correlations with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Perceived Stress Scale (PSS-14).

Results

The Turkish CSS showed good internal consistency (Cronbach's alpha = 0.90) and identified 13 dimensions of chronic stress (partner, children, work, loneliness, finances, workload, debt, relationship inoccupancy, family health, residence, family, ex-partner, and others). Dimensions were named based on the content of the items included. Significant correlations were found between CSS and BDI (r = 0.611, p < 0.001), BAI (r = 0.558, p < 0.001), and PSS-14 (r = 0.222, p < 0.001). Discriminant validity revealed significant score differences between clinical and general populations.

Conclusion

The Turkish CSS is a reliable and valid tool for assessing chronic social role-related stressors, supporting its use for both research and practice.

Teacher stress in social interactions in the light of polyvagal theory. An ambulatory assessment approach to teachers' heart rate and heart rate variability

Background

Teaching is a genuinely social and highly demanding task. Drawing on Porges' phylogenetic polyvagal theory with three evolved systems and three associated behavioral responses (social engagement, mobilization, and immobilization), we investigated teachers' heart rate and heart rate variability in social interactions using ambulatory assessments.

Methods

We continuously measured heart rate and heart rate variability of 42 apparently healthy teachers on a work and leisure day with ambulatory electrocardiogram. We videotaped four consecutive, same-day lectures of each teacher. We trained observers to code student aggression and frontal teaching behaviors in an event sampling procedure with the behavior observation system for analyzing aggressive behavior in school settings. Additionally, perceived teacher-student relationship, social support from other teachers / school management, occupational complaints, and vital exhaustion were assessed by teacher self-reports.

Results

Teachers showed an increased heart rate and a decreased heart rate variability on a workday compared to a leisure day, anticipatory stress before classes, as well as insufficient recovery during lunchtime. Observed student aggression and high proportion of frontal teaching were associated with lower heart rate variability, while better perceived teacher-student relationship was correlated with higher heart rate variability. Differently, teachers' psychological strain and heart rate variability were unrelated to each other.

Conclusion

Corresponding to polyvagal theory, results suggest that successful social interactions are fundamental for teachers' favorable cardiological reactions.

Mindfulness therapy for patients with coronary heart disease: A systematic review and meta-analysis

AIM

Coronary heart disease (CHD) is a prevalent cardiovascular disease with high mortality rates worldwide. Patients with CHD often experience adverse psychological stress related to the disease's diagnosis, treatment and recovery phases. This stress can hurt sleep quality and overall quality of life. Mindfulness-based interventions (MBIs) have been studied as a psychotherapeutic approach to alleviating the psychological stress associated with CHD. This study aimed to determine the effectives of MBIs for health outcomes in patients with CHD.

METHODS

A total of eight English-language databases were searched, and eight relevant studies were included in the analysis. The included studies were assessed for literature quality, and data were extracted and analysed using Review Manager 5.3.

RESULTS

A total of eight studies involving 802 participants were included in the analysis. Compared to control groups, MBIs significantly reduced anxiety, depression, perceived stress, and systolic blood pressure. However, there was no significant effect on diastolic blood pressure, quality of life or body mass index. One study reported that MBIs significantly improved sleep quality in patients with acute myocardial infarction after percutaneous coronary intervention but had no significant effect on body mass index.

CONCLUSION

MBIs had significant effects on anxiety and depression in patients with CHD, reduced perceived stress and were associated with reductions in systolic blood pressure and improvements in sleep quality. However, they did not significantly affect diastolic blood pressure, quality of life or body mass index.

The brain under pressure: Exploring neurophysiological responses to cognitive stress

Stress is an increasingly dominating part of our daily lives and higher performance requirements at work or to ourselves influence the physiological reaction of our body. Elevated stress levels can be reliably identified through electroencephalogram (EEG) and heart rate (HR) measurements. In this study, we examined how an arithmetic stress-inducing task impacted EEG and HR, establishing meaningful correlations between behavioral data and physiological recordings. Thirty-one healthy participants (15 females, 16 males, aged 20 to 37) willingly participated. Under time pressure, participants completed arithmetic calculations and filled out stress questionnaires before and after the task. Linear mixed effects (LME) allowed us to generate topographical association maps showing significant relations between EEG features (delta, theta, alpha, beta, and gamma power) and factors such as task difficulty, error rate, response time, stress scores, and HR. With task difficulty, we observed left centroparietal and parieto-occipital theta power decreases, and alpha power increases. Furthermore, frontal alpha, delta and theta activity increased with error rate and relative response time, while parieto-temporo-occipital alpha power decreased. Practice effects on EEG power included increases in temporal, parietal, and parieto-occipital theta and alpha activity. HR was positively associated with frontal delta, theta and alpha power whereas frontal gamma power decreases. Significant alpha laterality scores were observed for all factors except task difficulty and relative response time, showing overall increases in left parietal regions. Significant frontal alpha asymmetries emerged with increases in error rate, sex, run number, and HR and occipital alpha asymmetries were also found with run number and HR. Additionally we explored practice effects and noted sex-related differences in EEG features, HR, and questionnaire scores. Overall, our study enhances the understanding of EEG/ECG-based mental stress detection, crucial for early interventions, personalized treatment and objective stress assessment towards the development of a neuroadaptive system.

Prevalence and Mitigation of Cardiovascular Disease Risk Factors Among the Corporate Workforce in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Cardiovascular disease (CVDs) is the leading cause of mortality worldwide. Corporate workplaces have been identified as important environmental factors that can increase the risk and severity of CVDs. Evidence indicates that the risk and severity of CVDs can be effectively reduced by mitigating modifiable behavioural and intermediate risk factors. Although the prevalence of CVDs and their associated risk factors is increasing in sub-Saharan Africa (SSA), most published data from the region are hospital-based and may not be true estimates. This study investigated the prevalence and distribution of CVD risk factors among the corporate workforce in SSA and the effects of workplace wellness programmes (WWP) on these risk factors. Accordingly, a systematic search was performed using Google Scholar, Cochrane Library, PubMed, MEDLINE, Scopus and Science Direct for articles published between January 2010 and March 2024. A total of 105 studies (n = 76,027) across nine countries met the eligibility criteria and were analysed. The pooled prevalence of the risk factors was unhealthy diet (80%), high salt intake (32%), stress (58%), poor sleep (59%), physical inactivity (PI, 59%), alcohol consumption (29%), harmful alcohol consumption (26%), tobacco smoking (7%), khat chewing (6%), overweight (36%), obesity (23%), central obesity (44%), high blood pressure (29%), high total cholesterol (33%), high low-density lipoprotein cholesterol (LDL-c) (41%), low high-density lipoprotein cholesterol (HDL-c) (45%), hypertriglyceridaemia (17%), dysglycaemia (9%), and metabolic syndrome (MS; 45%). The highest prevalence of unhealthy diet and PI was recorded in East Africa and Central Africa, respectively, whereas West Africa had the highest prevalence of high body mass index (BMI). Ethiopia had the highest prevalence of unhealthy diets, whereas Nigeria had the highest prevalence of stress and poor sleep. The healthcare sector had the highest cluster of risk factors and the highest prevalence of unhealthy diets. Only 5.7% of the studies implemented WWP, which had significant mitigating effects on most risk factors. This study concluded that the prevalence of most modifiable CVD risk factors is high among the corporate workforce in SSA, which is higher than that in the general population in most cases, and a well-designed WWP can significantly mitigate these risk factors.

Sex-specific behavioral, cardiac, and neuroendocrine responses to repeated witness social stress in adult rats

In humans, sex disparities exist in the prevalence of social stress-related disorders, yet our understanding of the predisposing factors and underlying mechanisms is still elusive. Also at the preclinical level, the investigation of sex differences in social stress responses is limited. In this study, adult male and female wild-type Groningen rats were repeatedly exposed to witness social defeat stress (WS) to assess sex-specific behavioral, neuroendocrine, and cardiac responses to the same social stress paradigm. Male and female rats bore witness to an aggressive social defeat episode between two males for nine consecutive days or were exposed to a control (CTR) procedure. Stress-related parameters were assessed in correspondence to the first and last WS/CTR exposure and also during subsequent exposure to the stress context alone in the absence of social defeat. During WS, rats of both sexes displayed larger amounts of burying behavior and smaller amounts of rearing and grooming behaviors, but with a greater extent in female witnesses. Cardiac autonomic responses to WS were similar between the sexes, yet only females displayed higher plasma corticosterone levels after the first WS exposure compared to CTRs, and had a larger corticosterone increase than male witnesses upon repeated WS. Exposure to the stress context alone (i.e., without the presence of the aggressive resident rat) elicited greater amount of burying behavior and more pronounced and persistent tachycardic responses in females than males with a history of WS. Our findings suggest sex-disparities in the response of adult rats to WS at multiple behavioral, cardiac, and neuroendocrine levels, highlighting the utility of this social stress paradigm for investigating predisposing factors and pathophysiological mechanisms underlying sex-specific vulnerabilities to stress-related pathologies.

A Review of the Links Between Work and Heart Disease in the 21st Century

This review explores the multifaceted exposures in the workplace that contribute to cardiovascular diseases (CVD), including physical, ergonomics, chemical, biological, psychosocial, and emerging occupational hazards. These well-documented occupational hazards have long been linked to heart disease. Exposures arising from these hazards present significant concerns for worker health and safety. Moreover, heat stress is an emerging and increasingly pervasive threat, exacerbated by climate change, particularly in outdoor, high-exposure industries like agriculture and construction. While the epidemiological links between heat and CVD are well established, there is a critical gap in research on the physiological impacts of heat on workers' cardiovascular health. In particular, migrant workers are especially vulnerable to these occupational hazards, particularly in the absence of targeted, equitable interventions. As global temperatures rise, addressing these occupational exposures is important for protecting the cardiovascular health of the workforce and the expanding field of occupational cardiology.

Acceptability and Feasibility of Using Hair Samples for Chronic Stress Measurement Among Transgender Women in Brazil

INTRODUCTION

The ability to objectively measure chronic stress has important implications for research, prevention, and treatment. Cortisol is currently the most used biological marker in the investigation of stress and can be measured via blood, saliva, and urine; however, these methods have disadvantages. The measurement of cortisol in hair is a more recently developed method that quantifies the cumulative production of cortisol over longer periods of time. Given the potential benefits of hair as a chronic stress biometric, research with this novel method is burgeoning, yet rarely involves transgender ("trans") populations, despite high levels of reported stress among trans people due to experiences of stigma and discrimination. Since hair is a key part of gender presentation, trans people might be less likely than cisgender people to donate hair for research. To explore the feasibility and acceptability of hair collection for use as a stress biometric with trans women, we nested a study into an ongoing clinical trial in São Paulo, Brazil, "Manas por Manas" (Sisters for Sisters). Here, we describe the hair biometric substudy protocol, as well as the feasibility and acceptability of collecting hair in the study cohort.

METHODS

We randomly selected a subsample (n = 180) from the Manas por Manas cohort (n = 392), all of whom are trans women, age 18 or older. We messaged participants via phone, WhatsApp, or social media for at least three attempted contacts. Study visits included four components: (1) video introduction, including a demonstration of hair sampling; (2) informed consent; (3) a brief survey with the validated Short Stress Overload Scale (translated to Portuguese) and questions on hair care that could moderate stress hormone results; and (4) hair sample collection. Hair samples were collected and stored using validated protocols. Participants were reimbursed for travel costs.

RESULTS

Between April and December 2022, we messaged with 143 individuals out of the 180 sampled (79%) and invited them to participate in the study. Of those invited to participate, we scheduled study visits with 102 people (71.3% of those invited to participate), of whom 100 attended their study visits and completed all activities. Two people did not attend their study visits and stopped communication. Of those who were invited to participate and declined a study visit, four individuals declined due to the hair sample collection procedures (2.8% of those invited to participate). Other reasons for declining to participate included having moved (n = 7), lack of time (n = 11), not interested in research participation (n = 8), or unknown/stopped responding to messages (n = 11). Most participants reported that they chemically treated their hair to bleach, color, or straighten it, which could impact laboratory assays.

CONCLUSION

We found hair sampling for stress measurement to be feasible and acceptable to our participants. We successfully completed all study activities for our desired sample size, and most recruited individuals volunteered to participate. Reasons provided for declining study participation reflected general barriers to research participation, with only four people declining due to hair sample collection procedures.

Sociodemographic, Occupational, and Health Profile of Brazilian Housekeepers and House Cleaners-A Hypothesis-Generating Study

For many women, house cleaning is an important way to participate in the labor market. In Brazil, there are 2 types of domestic workers: housekeepers have relatively secure employment and house cleaners are day laborers. The aim of this hypothesis-generating study was to describe the sociodemographic, occupational and health profile of a sample of domestic workers in Brazil. House cleaners received lower wages, had longer daily working hours and worked in a larger number of homes each week in comparison to housekeepers. About 51% of the domestic workers in this sample reported the use of pain medication and 34% reported spinal problems. Musculoskeletal symptoms were frequent in the lower back and upper limbs. Forty-seven percent reported high blood pressure. This study highlights the vulnerability of domestic workers, especially house cleaners, regarding workload, salary, and health conditions. Level of education is a contributing factor to this vulnerability.

Health Coaching Impacts Stage-Specific Transitions in Multiple Health Behaviors for Patients at High Risk for Coronary Heart Disease and Type 2 Diabetes: A Multigroup Latent Transition Analysis

BACKGROUND

Multiple behavior change interventions have gained traction in the behavioral health space. Yet, previous studies on health coaching (HC) focused on testing its effect on stages of change for individual health behaviors.

OBJECTIVE

The purpose of this study was to examine the effects of HC on stages of change across multiple health behavior domains among patients at high risk of coronary heart disease and type 2 diabetes.

METHODS

This secondary analysis of a randomized clinical trial included 200 primary care patients (mean age of 47.7 years, 49.0% women, 60.5% Whites) who completed transtheoretical model-based questionnaires related to weight reduction, exercise, healthier eating, and stress management. Multigroup latent transition analysis was used to compare the stage of change distributions and transitions over time between HC and controls at baseline, midpoint of the intervention (3 months), and postintervention (6 months).

RESULTS

Three distinct categories of behavior change were identified ("Contemplation," "Preparation to Action," and "Action"), and membership in these categories changed over time as a function of intervention exposure. Both groups exhibited positive transitions through stages of change from baseline to 3 months. Pronounced intervention effects emerged from 3 to 6 months, revealing larger differences in transition probabilities between the groups. In particular, HC increased patients' likelihood of transitioning from "Contemplation" to both "Preparation for Action" and "Action," as well as from "Preparation for Action" to "Action." The control group remained stagnant during the same period.

CONCLUSIONS

Although HC produces changes across multiple behavioral domains, it was most effective for patients who were reluctant or ambivalent about changing their behaviors.

Facilitators of and Barriers to Teachers' Engagement With Consumer Technologies for Stress Management: Qualitative Study

BACKGROUND

Consumer technology is increasingly being adopted to support personal stress management, including by teachers. Multidisciplinary research has contributed some knowledge of design and features that can help detect and manage workplace stress. However, there is less understanding of what facilitates engagement with ubiquitous "off the shelf" technologies, particularly in a specific occupational setting. An understanding of features that facilitate or inhibit technology use, and the influences of contexts on the manner of interaction, could improve teachers' stress-management opportunities.

OBJECTIVE

The aim of the study was to investigate the interaction features that facilitated or inhibited engagement with 4 consumer technologies chosen by teachers for stress management, as well as the influence of the educational contexts on their engagement. We also examined how use of well-being technology could be better supported in the school.

METHODS

The choice of consumer technologies was categorized in a taxonomy for English secondary school teachers according to stress-management strategies and digital features. Due to the COVID-19 pandemic, we adapted the study so that working from home in the summer could be contrasted with being back in school. Thus, a longitudinal study intended for 6 weeks in the summer term (in 2020) was extended into the autumn term, lasting up to 27 weeks. Teachers chose to use either a Withings smartwatch or Wysa, Daylio, or Teacher Tapp apps. Two semistructured interviews and web-based surveys were conducted with 8 teachers in England in the summer term, and 6 (75%) of them took part in a third interview in the autumn term. Interviews were analyzed using reflexive thematic analysis informed by interpretive phenomenological analysis.

RESULTS

Technology elements and characteristics such as passive data collation, brevity of interaction, discreet appearance, reminders, and data visualization were described by teachers as facilitators. Lack of instructions and information on features, connectivity, extended interaction requirements, and nondifferentiation of activity and exercise data were described as barriers. Mesocontextual barriers to engagement were also reported, particularly when teachers were back on school premises, including temporal constraints, social stigma, and lack of private space to de-stress. Teachers had ideas for feature improvements and how educational leadership normalizing teachers' stress management with consumer technologies could benefit the school culture.

CONCLUSIONS

Having preselected their stress-management strategies, teachers were able to harness design features to support themselves over an extended period. There could be an important role for digital interventions as part of teachers' stress management, which the school leadership would need to leverage to maximize their potential. The findings add to the holistic understanding of situated self-care and should inform developers' considerations for occupational digital stress support.

Glucocorticoid alleviates hypothalamic nerve injury via remodeling HPA axis homeostasis in stressed rats

Excessive stress can exceed the adjustment ability of body and cause injury and dysfunction, while elucidation of the mechanism and prevention measures of stress-related injury are still insufficient. The present study was to observe the effect of glucocorticoid (GC) on stress-induced hypothalamic nerve injury and elucidate the potential mechanism. The present study intended to establish a chronic restraint stress rat model for follow-up study. Open field test and elevated plus maze test were used to observe behavioral changes of stress rats; Enzyme-linked immunosorbent assay (ELISA) was used to detect changes in the levels of hypothalamus-pituitary-adrenal (HPA) axis-related hormones and inflammatory factors in hypothalamus; toluidine blue staining was used to observe pathological changes of hypothalamus. The results showed that stress rats showed obvious anxiety-like behaviors, the levels of HPA axis-related hormones and inflammatory factors showed abnormal fluctuations, and morphological results showed significant nerve injury in hypothalamus. Low-dose GC treatment significantly improved behavioral changes, alleviated hypothalamic nerve injury, and restored hypothalamic levels of inflammatory factors, serum levels of GC, corticotropin-releasing hormone (CRH), and adrenocorticotropic hormone (ACTH) and GC level in adrenal cortex of stressed rats, while GC receptor (GR) inhibitor, CRH receptor inhibitor, and adrenalectomy reversed the ameliorative effects of low-dose GC. Our study clarified that low-dose GC can restore stress coping ability by reshaping the homeostasis of the HPA axis, thus alleviating behavioral abnormalities and hypothalamic nerve injury in stressed rats.

A novel GWAS locus influences microvascular response to mental stress and predicts adverse cardiovascular events

Excessive peripheral microvascular constriction during acute psychological stress reflects similar changes in coronary blood flow and is a predictor of adverse cardiovascular outcomes. Among individuals with coronary artery disease (CAD), we sought to determine if genetic factors contribute to the degree of microvascular constriction during mental stress. A total of 580 stable CAD individuals from two prospective cohort studies underwent mental stress testing. Digital pulse wave amplitude was continuously measured and the stress/rest (sPAT) ratio of pulse wave amplitude was calculated. Race stratified genome-wide association studies (GWAS) of sPAT-ratio were conducted using linear regression of additive genetic models. A trans-ethnic meta-analysis integrated the four sets of GWAS results. Participants were followed for the outcome of recurrent cardiovascular events (myocardial infarction, heart failure, revascularization, and CV death) for a median of 5 years. We used Wei-Lin-Weissfeld (WLW) model to assess the association between sPAT-ratio with recurrent events. Mean age was 63 ± 9. We identified three SNPs in linkage disequilibrium, closely related to chr7:111,666,943 T > C (rs6466396) that were associated with sPAT-ratio (p = 6.68E-09). Participants homozygous for the T allele had 80% higher risk of incident adverse events (HR 1.8, 95% CI, 1.4-2.2). Also, participants with a lower sPAT-ratio (< median) had a higher adverse event rate, hazard ratio (HR) = 1.3, [95%confidence interval (CI), 1.1-1.6]. However, adjustment for the genotypes did not substantially alter the impact of sPAT ratio on adverse outcome rate. In conclusion, we have identified a genetic basis for stress-induced vasomotion. The 3 linked variants modulate vasoconstriction during mental stress may have a prognostic importance.

Self-blame, posttraumatic stress, and cardiovascular reactivity among sexual trauma survivors

Although trauma is closely linked with hyperarousal and cardiovascular health, little research has examined the effects of posttraumatic stress symptoms (PTSS) on cardiovascular reactivity to trauma reminders among sexual trauma survivors. One type of negative appraisal after trauma, self-blame, is common after sexual trauma, but its relation to cardiovascular reactivity is unknown. The present study aimed to examine the influence of both PTSS and self-blame on blood pressure and heart rate (HR) reactivity to a trauma reminder. Cardiovascular reactivity was measured before, during, and after a laboratory-based sexual trauma reminder among 72 young adult women who have experienced sexual trauma. Higher PTSS predicted lower diastolic blood pressure (DBP) reactivity during the trauma reminder. Higher levels of self-blame predicted higher HR and systolic blood pressure (SBP) reactivity during and after the trauma reminder. Overall, these findings suggest that survivors of sexual trauma with higher levels of PTSS experience a blunting reaction of DBP when exposed to trauma reminders, as opposed to a more typical cardiovascular stress reaction that may elevate and then extinguish to baseline levels. Meanwhile, individuals with higher levels of self-blame have heightened cardiovascular SBP and HR responses during trauma reminders that do not return to baseline levels, perhaps due to self-blame leading individuals to be more 'on guard' to prevent future threats. Longitudinal studies are needed to explore the potential long-term cardiovascular impacts of heightened self-blame and PTSS and their associated cardiovascular reactivity patterns.

How Do Occupational Physicians Address Employees' Financial Problems? An Exploratory Interview Study Into Current Practice and Potential Improvements

OBJECTIVE

Problematic debt poses a considerable challenge in the Netherlands, impacting health and work-related outcomes. Occupational physicians play a vital role in guiding absent employees and identifying work-related risk factors for illness. This study investigates how occupational physicians address financial issues among employees and proposes improvements.

METHODS

Semistructured interviews were conducted with a diverse group of 12 occupational physicians and residents.

RESULTS

Thematic content analysis revealed that while physicians do not routinely inquire about financial problems, they approach socioeconomic concerns cautiously and consider multiple (structural and individual) risk factors. Current interventions include budget coaching and lifestyle enhancements.

CONCLUSIONS

Despite awareness, current interventions focus on immediate advice targeting downstream factors (ie, social determinants at the individual level), thereby overlooking structural, upstream factors (ie, social determinants on a societal and systemic level) of employees' financial problems. Exploring systems approaches, targeting both individual and structural factors, and more attention for this subject in occupational physicians education, are considered crucial for future effective approaches.

Eight weeks of high-intensity interval training versus stretching do not change the psychoneuroendocrine response to a social stress test in emotionally impulsive humans

PURPOSE

Research supports physical activity as a method to heighten stress resistance and resilience through positive metabolic alterations mostly affecting the neuroendocrine system. High-intensity interval training (HIIT) has been proposed as a highly effective time-saving method to induce those changes. However, existing literature relies heavily on cross-sectional analyses, with few randomised controlled trials highlighting the necessity for more exercise interventions. Thus, this study aims to investigate the effects of HIIT versus an active control group on the stress response to an acute psychosocial stressor in emotionally impulsive humans (suggested as being strong stress responders).

METHODS

The study protocol was registered online (DRKS00016589) before data collection. Sedentary, emotionally impulsive adults (30.69 ± 8.20 y) were recruited for a supervised intervention of 8 weeks and randomly allocated to either a HIIT (n = 25) or a stretching group (n = 19, acting as active controls). Participants were submitted to a test battery, including saliva samples, questionnaires (self-efficacy- and perceived stress-related), visual analogue scales (physical exercise- and stress-related), and resting electroencephalography and electrocardiography assessing their reaction to an acute psychological stressor (Trier Social Stress Test) before and after the exercise intervention.

RESULTS

HIIT increased aerobic fitness in all participants, whereas stretching did not. Participants from the HIIT group reported perceiving exercising more intensively than those from the active control group (ƞp2 = 0.108, p = 0.038). No further group differences were detected. Both interventions largely increased levels of joy post-TSST (ƞp2 = 0.209, p = 0.003) whilst decreasing tension (ƞp2 = 0.262, p < 0.001) and worries (ƞp2 = 0.113, p = 0.037). Finally, both interventions largely increased perceived levels of general self-efficacy (ƞp2 = 0.120, p = 0.029).

CONCLUSION

This study suggests that 8 weeks of HIIT does not change the psychoneuroendocrine response to an acute psychological stress test compared to an active control group in emotionally impulsive humans. Further replications of supervised exercise studies highly powered with active and passive controls are warranted.

Association of Cardiovascular Health with the Incidence of Venous Thromboembolism: A Prospective Study of 275,149 Participants from the UK Biobank

BACKGROUND

 The Life's Essential 8 (LE8) score, recently proposed by the American Heart Association, represents a new paradigm for evaluating cardiovascular health (CVH). We aimed to explore the association between CVH, estimated using LE8, and venous thromboembolism (VTE) incidence.

METHODS

 A total of 275,149 participants were recruited from the UK Biobank and divided into high (LE8 score ≥ 80), moderate (LE8 score < 80 but ≥ 50), and low (LE8 score < 50) CVH groups. Restricted cubic spline analysis, the Kaplan-Meier method, and the Cox proportional hazards model were used to explore the association between CVH and VTE. The genetic predisposition to VTE was assessed with a polygenic risk score. Sensitivity analyses were performed to validate the results.

RESULTS

 During a median follow-up of 12.56 years, VTE developed in 506 (4.09%), 6,069 (2.78%), and 720 (1.66%) participants with low, moderate, and high CVH levels, respectively. Compared with the low CVH group, participants in the moderate and high CVH groups had a 23% (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.71-0.85) and 41% (HR: 0.59; 95% CI: 0.52-0.66) lower risk of VTE, respectively, after adjusting for demographic characteristics, medical history, socioeconomic status, and genetic predisposition. This association remained robust in multiple sensitivity analyses. Higher CVH levels led to a more pronounced reduction in the risk of VTE in females and could appreciably offset the genetic risk of VTE.

CONCLUSION

 Higher CVH levels were significantly associated with a lower incidence of VTE, encouraging efforts to increase LE8 scores in individuals.

A platform to map the mind-mitochondria connection and the hallmarks of psychobiology: the MiSBIE study

Health emerges from coordinated psychobiological processes powered by mitochondrial energy transformation. But how do mitochondria regulate the multisystem responses that shape resilience and disease risk across the lifespan? The Mitochondrial Stress, Brain Imaging, and Epigenetics (MiSBIE) study was established to address this question and determine how mitochondria influence the interconnected neuroendocrine, immune, metabolic, cardiovascular, cognitive, and emotional systems among individuals spanning the spectrum of mitochondrial energy transformation capacity, including participants with rare mitochondrial DNA (mtDNA) lesions causing mitochondrial diseases (MitoDs). This interdisciplinary effort is expected to generate new insights into the pathophysiology of MitoDs, provide a foundation to develop novel biomarkers of human health, and integrate our fragmented knowledge of bioenergetic, brain-body, and mind-mitochondria processes relevant to medicine and public health.

Neurocardiac Axis Physiology and Clinical Applications

The neurocardiac axis constitutes the neuronal circuits between the arteries, heart, brain, and immune organs (including thymus, spleen, lymph nodes, and mucosal associated lymphoid tissue) that together form the cardiovascular brain circuit. This network allows the individual to maintain homeostasis in a variety of environmental situations. However, in dysfunctional states, such as exposure to environments with chronic stressors and sympathetic activation, this axis can also contribute to the development of atherosclerotic vascular disease as well as other cardiovascular pathologies and it is increasingly being recognized as an integral part of the pathogenesis of cardiovascular disease. This review article focuses on 1) the normal functioning of the neurocardiac axis; 2) pathophysiology of the neurocardiac axis; 3) clinical implications of this axis in hypertension, atherosclerotic disease, and heart failure with an update on treatments under investigation; and 4) quantification methods in research and clinical practice to measure components of the axis and future research areas.

Stress increases sperm respiration and motility in mice and men

Semen quality and fertility has declined over the last 50 years, corresponding to ever-increasing environmental stressors. However, the cellular mechanisms involved and their impact on sperm functions remain unknown. In a repeated sampling human cohort study, we identify a significant effect of prior perceived stress to increase sperm motility 2-3 months following stress, timing that expands upon our previous studies revealing significant stress-associated changes in sperm RNA important for fertility. We mechanistically examine this post-stress timing in mice using an in vitro stress model in the epididymal epithelial cells responsible for sperm maturation and find 7282 differentially H3K27me3 bound DNA regions involving genes critical for mitochondrial and metabolic pathways. Further, prior stress exposure significantly changes the composition and size of epithelial cell-secreted extracellular vesicles that when incubated with mouse sperm, increase mitochondrial respiration and sperm motility, adding to our prior work showing impacts on embryo development. Together, these studies identify a time-dependent, translational signaling pathway that communicates stress experience to sperm, ultimately affecting reproductive functions.

Depleted Housing Elicits Cardiopulmonary Dysfunction After a Single Flaming Eucalyptus Wildfire Smoke Exposure in a Sex-Specific Manner in ApoE Knockout Mice

Although it is well established that wildfire smoke exposure can increase cardiovascular morbidity and mortality, the combined effects of non-chemical stressors and wildfire smoke remains understudied. Housing is a non-chemical stressor that is a major determinant of cardiovascular health, however, disparities in neighborhood and social status have exacerbated the cardiovascular health gaps within the United States. Further, pre-existing cardiovascular morbidities, such as atherosclerosis, can worsen the response to wildfire smoke exposures. This represents a potentially hazardous interaction between inadequate housing and stress, cardiovascular morbidities, and worsened responses to wildfire smoke exposures. The purpose of this study was to examine the effects of enriched (EH) versus depleted (DH) housing on pulmonary and cardiovascular responses to a single flaming eucalyptus wildfire smoke (WS) exposure in male and female apolipoprotein E (ApoE) knockout mice, which develop an atherosclerosis-like phenotype. The results of this study show that cardiopulmonary responses to WS exposure occur in a sex-specific manner. EH blunts adverse WS-induced ventilatory responses, specifically an increase in tidal volume (TV), expiratory time (Te), and relaxation time (RT) after a WS exposure, but only in females. EH also blunted an increase in isovolumic relaxation time (IVRT) and the myocardial performance index (MPI) 1-week after exposures, also only in females. Our results suggest that housing alters the cardiovascular response to a single WS exposure, and that DH might cause increased susceptibility to environmental exposures that manifest in altered ventilation patterns and diastolic dysfunction in a sex-specific manner.

Stress in the collective: Psychophysiological reactivity to an orchestra concert as a collective naturalistic, real-life stressor of psychosocial nature

BACKGROUND & OBJECTIVES

The investigation of collective stress experiences, including collective stressors and the psychophysiological reactivity of a collective to these stressors, has been widely neglected so far. Here, we examined public non-professional orchestra concerts as collective naturalistic, real-life stressors of psychosocial nature and the resulting psychophysiological reactivity in a collective of non-professional orchestra musicians.

METHODS

The members of two non-professional music orchestras (N = 54) were accompanied during a public concert (stress condition) and a rehearsal (control condition). We repeatedly assessed heart rate, salivary cortisol, and excitement levels before, during, and after the concert/rehearsal in addition to the anticipatory cognitive stress appraisal.

RESULTS

We observed greater physiological reactivity to the concert compared to the rehearsal (p's ≤.017), with higher increases in heart rate levels in anticipation of and in reaction to the concert and in cortisol levels in reaction to the concert compared to the rehearsal. Moreover, orchestra members reported greater psychological reactivity to the concert than to the rehearsal (p's ≤.024) in terms of higher cognitive stress appraisal in anticipation and increased excitement levels before and during the concert compared to the rehearsal.

DISCUSSION

Our findings indicate that orchestra concerts by non-professional musicians constitute collective naturalistic, real-life stressors of psychosocial nature, resulting in significant psychophysiological stress responses with reactivity kinetics differing between the sympathetic-adrenal-medullary axis, the hypothalamic-pituitary-adrenal axis, and the psychological response. Potential implications and modulating factors need to be elucidated in future studies.

Perseverative cognition and health behaviours: exploring the role of intentions and perceived behavioural control

OBJECTIVE

Worry and rumination (Perseverative Cognition, PC) have been associated with health behaviours, but the underlying mechanisms are unknown. Given the role of physiological experiences on perceived behavioural control (PBC) and emotion regulation on intention-health behaviour relationships, we tested whether: PC prospectively predicts poorer health behaviours; PC moderates the relationship(s) between intentions/PBC and health behaviour, as well as whether the relationship between PC and health behaviour is mediated by intentions and PBC.

METHODS AND MEASURES

In a prospective design, 650 participants (mean age = 38.21 years; 49% female) completed baseline measures of intentions, PBC and PC (worry and rumination) and 590 (mean age = 38.68 years; 50% female) completed follow-up (Time 2) measures of health behaviours (physical activity, sleep, sedentary activity, unhealthy snacking) 1-week later.

RESULTS

Worry and rumination (at T1) predicted poorer sleep quality. Worry, but not rumination, moderated PBC-physical activity frequency relations. Consistent with mediation, the indirect paths from both worry and rumination, through PBC, to sleep quality and total sleep time were significant.

CONCLUSION

PC is associated with poorer sleep quality and PBC can play a mediating role in such relationships. Future research should further consider the role that PBC plays in PC-health behaviour relations.