Hypertension linked to allostatic load: from psychosocial stress to inflammation and mitochondrial dysfunction

Methodological influences on circulating cell-free-mitochondrial and nuclear DNA concentrations in response to chronic stress

BACKGROUND

Mitochondria are versatile eukaryotic organelles that play a crucial role in the body's stress response. Prolonged stress exposure can cause structural and functional alterations, leading to mitochondrial DNA (mtDNA) damage and subsequent release of mtDNA into the circulation. Cell-free circulating mtDNA (ccf-mtDNA) is a potential biomarker indicating cellular damage and stress. In this study we investigated the applicability of ccf-mtDNA and cf-nDNA as biomarkers of chronic stress in healthy subjects.

METHODS AND RESULTS

We developed a quantitative polymerase chain reaction (qPCR) assay to directly measure ccf-mtDNA in human blood plasma samples, addressing numerous challenges specifically related to ccf-mtDNA quantification. We validated our 68 bp target assay based on the FDA, International Organization for Standardization (ISO) and Clinical & Laboratory Standards Institute (CLSI) guidelines for assay development, including parameters such as limit of blank (LOB), limit of detection (LOD) and limit of quantification (LOQ). Furthermore, we implemented incurred samples analysis and inter-plate samples to ensure reliability and reproducibility of the assay. In addition, we evaluated the effects of centrifugation forces on ccf-mtDNA and cf-nDNA concentrations in native plasma samples and showed that mainly ccf-mtDNA is strongly affected by centrifugation forces. We found a significant negative correlation between ccf-mtDNA levels and chronic stress. In contrast, cf-nDNA levels were not affected in response to chronic stress.

CONCLUSION

ccf-mtDNA can directly and reliably quantified in unpurified plasma samples. However, the ccf-mtDNA levels in plasma samples of healthy subjects are close the LOQ, showing that the assay is not yet suitable for all conditions.

Allostatic load and cardiometabolic health in a young adult South African population: the African-PREDICT study

Sustained stress, assessed as a high allostatic load score (ALS), is an independent cardiovascular disease (CVD) risk factor in older adults but its associations in young people are undefined. Since neurological maturation impacts stress adaptation and CVD risk, we assessed the relationship of ALS with CVD profile by using a tiered approach stratified by age [emerging adults (EA) aged 20-24 yr vs. young adults (YA) aged 25-30 yr] and ALS (high vs. low). In 1,054 healthy participants of the African Prospective Study on Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT), we determined: 1) ALS in EA versus YA; 2) the relationship between ALS and cardiovascular (CV) health, and 3) the odds of high ALS > 4 to identify masked hypertension (HT) and prediabetes as cardiometabolic outcomes. A nine-component, four-domain ALS was compiled: neuroendocrine [dehydroepiandrosterone (DHEA), cortisol], inflammatory [interleukin-6 (IL-6), C-reactive protein (CRP)], cardiovascular [systolic blood pressure (SBP) and diastolic blood pressure (DBP)], and metabolic [total cholesterol, high density lipoprotein cholesterol (HDL-cholesterol), body mass index (BMI)]. Retinal vessel caliber, pulse wave velocity (PWV), and cardiac structure and function were assessed. Median ALS was 3 (range: 1-9). A high-ALS > 4 was more common in YA versus EA (47 vs. 35%, P = 0.032). Higher ALS associated with narrower retinal arteries (P < 0.01), greater PWV (P ≤ 0.01), lower diastolic function (P < 0.01), and left ventricular (LV) function (P < 0.01). High-ALS increased the odds of having masked hypertension, prediabetes, narrower retinal arteries, higher LV mass, poorer diastolic and ventricular functions (all P ≤ 0.01), in EA and YA independent of traditional CVD risk factors. The composite ALS identified early-stress dysregulation in cardiometabolic health and higher odds for masked hypertension and prediabetes in young adults. Cumulative stress may be a modifiable, independent cardiometabolic risk factor in younger populations that needs further investigation.NEW & NOTEWORTHY This is the first study to assess the effect of stress, as a composite allostatic load score, on micro-, macrovascular, and central cardiac features in healthy emerging and young adults, independent of traditional cardiovascular risk markers. It exemplifies independent stress-induced changes throughout the cardiovascular tree, which may increase the risk of cardiometabolic complications, masked hypertension, and prediabetes. Sustained stress may be a key etiological factor in cardiometabolic disease development in a young population.

Interindividual Variability Response to Resistance and High-Intensity Interval Training on Blood Pressure Reduction in Hypertensive Older Adults

BACKGROUND

This study evaluated the effects of resistance training (RT) and high-intensity interval training (HIIT) on systolic (SBP) and diastolic blood pressure (DBP) in hypertensive older adults undergoing pharmacological therapy over four and eight weeks. We compared the efficacy of RT and HIIT in reducing non-responders (NRs) between weeks 4 and 8 and analyzed time-course adaptations in NRs and responders (Rs).

METHODS

Thirty-nine participants were randomized into RT-G (n = 13), HIIT-G (n = 13), or control (CG, n = 13) groups. RT utilized elastic bands, and HIIT involved cycle ergometers, with three weekly 30 min sessions for 8 weeks. SBP and DBP were measured before intervention and at weeks 4 and 8, respectively. Individual responses were classified as NRs or Rs using the Hopkins method (SDIR = √[SDExp2-SDCon2]). Time-course adaptations were evaluated.

RESULTS

Both the RT-G and HIIT-G reduced SBP at 8 weeks (RT-G: -13 mmHg; [ES: 1.12]; HIIT-G: -12 mmHg [ES: 0.8]; both p < 0.05). The proportion of NRs for SBP decreased from 46% to 38% in RT-G and 69% to 46% in HIIT-G. Rs showed a peak SBP reduction at 4 weeks (-14.7 and -25.5 mmHg), stabilizing by week 8 (-22.8 and -19.6 mmHg) in RT-G and HIIT-G, respectively.

CONCLUSION

Eight weeks of RT and HIIT effectively reduced SBP and NR prevalence, with time-course adaptations favoring Rs.

Allostatic Interoceptive Overload Across Psychiatric and Neurological Conditions

Emerging theories emphasize the crucial role of allostasis (anticipatory and adaptive regulation of the body's biological processes) and interoception (integration, anticipation, and regulation of internal bodily states) in adjusting physiological responses to environmental and bodily demands. In this review, we explore the disruptions in integrated allostatic interoceptive mechanisms in psychiatric and neurological disorders, including anxiety, depression, Alzheimer's disease, and frontotemporal dementia. We assess the biological mechanisms associated with allostatic interoception, including whole-body cascades, brain structure and function of the allostatic interoceptive network, heart-brain interactions, respiratory-brain interactions, the gut-brain-microbiota axis, peripheral biological processes (inflammatory, immune), and epigenetic pathways. These processes span psychiatric and neurological conditions and call for developing dimensional and transnosological frameworks. We synthesize new pathways to understand how allostatic interoceptive processes modulate interactions between environmental demands and biological functions in brain disorders. We discuss current limitations of the framework and future transdisciplinary developments. This review opens a new research agenda for understanding how allostatic interoception involves brain predictive coding in psychiatry and neurology, allowing for better clinical application and the development of new therapeutic interventions.

Involvement of D1 dopamine receptor in the nucleus of the solitary tract of rats in stress-induced hypertension and exercise

OBJECTIVE

Chronic stress can cause hypertension, whereas daily exercise promotes healthy well being through destressing. Although the nucleus of the solitary tract (NTS) is involved in the development of hypertension, the molecular and physiological mechanisms of stress and exercise remain unclear. In this study, we tested whether gene expression in the NTS is altered by stress and daily exercise and whether this is involved in cardiovascular regulation.

METHODS

We have performed RT 2 Profiler PCR arrays targeting a panel of neurotransmitter receptor genes in the NTS of Wistar rats subjected to chronic restraint stress (1 h a day over 3 weeks) with or without voluntary wheel exercise. We also performed immunohistochemistry to determine whether the identified molecules were expressed at the protein level. Additionally, microinjection studies in anesthetized rats were performed to examine whether validated molecules exhibit physiological roles in cardiovascular regulation of the NTS.

RESULTS

We observed that blood pressure was significantly increased by stress and the increase was suppressed by exercise. Using PCR analysis, we determined that the expression levels of four genes in the NTS, including the dopamine receptor D1 gene ( Drd1 ), were significantly affected by stress and suppressed by exercise. We also examined dopamine D1 receptor (D1R) expression in NTS neurons and found significantly greater expression in the stressed than nonstressed animals. Furthermore, the microinjection of a D1R agonist into the NTS in anesthetized rats induced hypotensive effects.

CONCLUSION

These results suggest that NTS D1R plays a role in the counteracting processes of stress-induced hypertension.

Allostatic load increases the incidence and risk of adverse prognosis in inflammatory bowel disease

BACKGROUND

Elevated allostatic load (AL) has been associated with the risk and poor prognosis of many chronic diseases. The association between AL and inflammatory bowel disease (IBD) is unknown.

AIMS

The aim of this study is to investigate the associations between AL and the risk and prognosis of IBD.

METHODS

We included 326,345 adults and 3767 patients with IBD from the UK Biobank. AL served as the exposure, estimated using the AL biomarker panel, with the primary outcomes including the risk and prognosis of IBD. We used Cox regression models to examine the associations.

RESULTS

High AL biomarker panel was associated with a greater risk of IBD (hazard ratio: 1.19, 95% CI: 1.08-1.31), ulcerative colitis (1.17, 95%CI: 1.04-1.32), and Crohn's disease (1.25, 95%CI: 1.05-1.49). Risk of developing IBD increased by 12% in quartile 2, 20% in quartile 3, and 37% in quartile 4 as AL biomarker panel increased. The all-cause mortality risk in IBD compared with quartile 1 rose by 54% for quartile 2, 72% for quartile 3, and 82% for quartile 4, as AL biomarker panel increased. Similar effects were also observed for ulcerative colitis and Crohn's disease. An increase in AL biomarker panel count was associated with an elevated risk of intestinal resection and colorectal cancer in IBD.

CONCLUSIONS

Increased AL is associated with IBD risk, as well as the risks of intestinal resection, colorectal cancer and mortality.

The relevance of the contribution of psychoneuroendocrinoimmunology and psychology of reasoning and decision making to nursing science: A discursive paper

AIM

Patients' death or adverse events appear to be associated with poor healthcare decision-making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem-related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision-making (PRDM) to support a new nursing theoretical frame.

DESIGN

Discursive paper.

METHOD

This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections.

CONCLUSION

Nursing recognizes the patient-nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections.

IMPACT ON NURSING PRACTICE

A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement in the design or writing of this discursive article.

Exploring associations of financial well-being with health behaviours and physical and mental health: a cross-sectional study among US adults

Background

Health disparities exist across socioeconomic status levels, yet empirical evidence between financial well-being (FWB) and health are limited.

Methods

This cross-sectional study combined data from 25 370 adults aged ≥18 years in the 2019 National Health Interview Survey with estimated household FWB scores from the Consumer Financial Protection Bureau's 2016 National Financial Well-being Survey. FWB associations with health service visits, biometric screenings, smoking status, body mass index and physical and mental conditions were tested using age-adjusted, sex-adjusted and health insurance coverage-adjusted linear regression analysis.

Results

In 2019, the mean FWB for US adults was 56.1 (range 14 (worse) to 95 (best)). With increasing time since the last health service visit or screening, FWB was increasingly lower compared with adults with visits or screenings <1 year (≥10 years or 'never', FWB ranged from -1 (blood sugar check) to -6.5 (dental examination/cleaning) points). FWB was lower with declining general health status (excellent (reference), very good (-0.5 points), good (-3.4 points) and fair/poor (-6.6 points)). Adults with physical health conditions had FWB lower than adults without (range -0.4 (high cholesterol) to -4.6 (disability) points). FWB were lower in adults who have ever been diagnosed with anxiety disorder (-1.8 points) or depression (-2 points). Adults managing their anxiety or depression (no/minimal symptoms currently) had greater FWB (anxiety: 3 points and depression: 4.1 points) than those with symptoms.

Conclusion

Given the observed associations between FWB and health-related measures, it is crucial to consider FWB in primary and secondary health prevention efforts, recognising the relationship between economics, health and wellness.

Racial differences in hypertensive disorders in pregnancy during the COVID-19 pandemic

OBJECTIVE

To compare rates of pregnancy induced hypertensive disorders during the period of the COVID-19 pandemic to prior, baseline years.

METHODS

We conducted a retrospective study of 17,742 patients on rates for pregnancy induced hypertensive disorders delivering at 2 local hospitals before (Cohort 1; January 2018 to December 2019; n = 8245) and after (Cohort 2; February 2020 to February 2022; n = 9497) the onset of the COVID-19 pandemic. The primary outcomes were rates of gestational hypertension, pre-eclampsia, and chronic hypertension in patients.Wecompared by year (2018-2022), by patient COVID infection status, and by racial demographics.

RESULTS

During the pandemic (Cohort 2), there were lower rates of chronic hypertension (7.4 % vs 6.5 %, p =.02), higher rates of gestational hypertension (26.3 % vs 27.8 %, p =.03), and higher rates of preeclampsia (11.3 % vs 13.1 %, p <.001) compared to years prior to the pandemic (Cohort 1). When evaluating by year, rates of chronic hypertension did not statistically change while rates for preeclampsia increased in the first year of the pandemic and remained high, and rates for gestational hypertension did not increase until the second year of the pandemic. When evaluating by COVID infection status, rates for gestational hypertension were significantly higher for individuals with a positive COVID infection status (COVID negative = 27.4 % vs. COVID positive = 32.8 %; p <.004). Rates of preeclampsia did not differ according to COVID infection status (p = 0.15).

CONCLUSION

In this study, rates of pregnancy induced hypertensive disorders increased during the COVID pandemic regardless of COVID infection status.

Income Inequality, Gender Disparities, and Ethnic Differences: Investigating Allostatic Load in American Adults

AIM

To estimate the association between income inequality and allostatic load score (AL) in adults ages 20 years and older, with a particular focus on the differential impacts across racial and gender groups. By examining this association, the study seeks to inform targeted policy interventions to mitigate health disparities exacerbated by economic inequality.

METHODS

Utilizing data from the 1999-2016 National Health and Nutrition Examination Survey (NHANES), we assessed AL through eight biomarkers: systolic blood pressure (mm Hg), diastolic blood pressure (mm Hg), pulse rate (beats/min), body mass index (kg/m2), glycohemoglobin (%), direct HDL cholesterol (mg/dL), total cholesterol (mg/dL), and serum albumin (g/dL). Employing negative binomial regression (NBRG), we estimated incidence rate ratios (IRR) for a sample comprising 7367 men and 7814 women, adjusting for age, race/ethnicity, marital status, education, health insurance, comorbidity, and mental health professional utilization. Gini coefficients (GC) were calculated to assess income inequality among men and women.

RESULTS

Findings revealed that men exhibited a higher poverty-to-income ratio (PIR) compared to women (3.12 vs. 2.86, p < 0.01). Yet, women experienced higher rates of elevated AL (AL > 4) (31.8% vs. 29.0%) and were more adversely affected by income inequality (GC: 0.280 vs. 0.333). NBRG results indicated that high PIR individuals had a lower IRR (0.96; CI:0.92-0.95) compared to their low PIR counterparts, a trend observed in women but not men. High PIR was notably protective among White non-Hispanic (WNH) men and women. Additionally, vigorous and moderate physical activity engagement was associated with lower AL (IRR: 0.89, CI: 0.85-0.93).

CONCLUSION

The study emphasizes the importance of implementing policies that target AL in low-income populations across all racial groups, with a specific focus on Black non-Hispanic (BNH) and Hispanic communities. By prioritizing these groups, policies can more effectively target the nexus of income inequality, health disparities, and allostatic load, contributing to the reduction of health inequities.

Emerging Theories of Allostatic-Interoceptive Overload in Neurodegeneration

Recent integrative multilevel models offer novel insights into the etiology and course of neurodegenerative conditions. The predictive coding of allostatic-interoception theory posits that the brain adapts to environmental demands by modulating internal bodily signals through the allostatic-interoceptive system. Specifically, a domain-general allostatic-interoceptive network exerts adaptive physiological control by fine-tuning initial top-down predictions and bottom-up peripheral signaling. In this context, adequate adaptation implies the minimization of prediction errors thereby optimizing energy expenditure. Abnormalities in top-down interoceptive predictions or peripheral signaling can trigger allostatic overload states, ultimately leading to dysregulated interoceptive and bodily systems (endocrine, immunological, circulatory, etc.). In this context, environmental stress, social determinants of health, and harmful exposomes (i.e., the cumulative life-course exposition to different environmental stressors) may interact with physiological and genetic factors, dysregulating allostatic interoception and precipitating neurodegenerative processes. We review the allostatic-interoceptive overload framework across different neurodegenerative diseases, particularly in the behavioral variant frontotemporal dementia (bvFTD). We describe how concepts of allostasis and interoception could be integrated with principles of predictive coding to explain how the brain optimizes adaptive responses, while maintaining physiological stability through feedback loops with multiple organismic systems. Then, we introduce the model of allostatic-interoceptive overload of bvFTD and discuss its implications for the understanding of pathophysiological and neurocognitive abnormalities in multiple neurodegenerative conditions.

Linkage, Empowerment, and Access to Prevent Hypertension: A Novel Program to Prevent Hypertension and Reduce Cardiovascular Health Disparities in Detroit, Michigan

BACKGROUND

Serious cardiovascular health disparities persist across the United States, disproportionately affecting Black communities. Mounting evidence supports negative social determinants of health (SDoH) as contributing factors to a higher prevalence of hypertension along with lower control rates. Here, we describe a first-of-a-kind approach to reducing health disparities by focusing on preventing hypertension in Black adults with elevated blood pressure (BP) living in socially vulnerable communities.

METHODS AND RESULTS

Linkage, Empowerment, and Access to Prevent Hypertension (LEAP-HTN) is part of the RESTORE (Addressing Social Determinants to Prevent Hypertension) health equity research network. The trial will test if a novel intervention reduces systolic BP (primary outcome) and prevents the onset of hypertension over 1 year versus usual care in 500 Black adults with elevated BP (systolic BP 120-129 mm Hg; diastolic BP <80 mm Hg) in Detroit, Michigan. LEAP-HTN leverages our groundbreaking platform using geospatial health and social vulnerability data to direct the deployment of mobile health units (MHUs) to communities of greatest need. All patients are referred to primary care providers. Trial participants in the active limb will receive additional collaborative care delivered remotely by community health workers using an innovative strategy termed pragmatic, personalized, adaptable approaches to lifestyle, and life circumstances (PAL2) which mitigates the impact of negative SDoH.

CONCLUSIONS

LEAP-HTN aims to prevent hypertension by improving access and linkage to care while mitigating negative SDoH. This novel approach could represent a sustainable and scalable strategy to overcoming health disparities in socially vulnerable communities across the United States.

Sex and Gender and Allostatic Mechanisms of Cardiovascular Risk and Disease

Cardiovascular diseases are leading causes of mortality and morbidity in adults worldwide. Multiple studies suggest that there are clinically relevant sex differences in cardiovascular disease. Women and men differ substantially in terms of prevalence, presentation, management, and outcomes of cardiovascular disease. To date, however, little is known about why cardiovascular disease affects women and men differently. Because many studies do not differentiate the concept of sex and gender, it is sometimes difficult to discriminate sociocultural vs biological contributors that drive observed clinical differences. Female sex has some biological advantages in relation to cardiovascular disease, but many of these advantages seem to disappear as soon as women develop cardiovascular risk factors (eg, type 2 diabetes, hypertension, dyslipidemia). Furthermore, stress and allostatic load could play an important role in the relationship between sex/gender and cardiovascular diseases. In this narrative review, we argue that chronic stress and psychosocial factors might better encompass the patterns of allostatic load increases seen in women, while biological risk factors and unhealthy behaviours might be more important mechanisms that drive increased allostatic load in men. Indeed, men show allostatic load patterns that are more associated with impaired anthropometric, metabolic, and cardiovascular functioning and women have greater dysregulation in neuroendocrine and immune functioning. Thus gender-related factors might contribute to the pathogenesis of cardiovascular disease especially through stress mechanisms. It is important to continue to study the mechanisms by which gender influences chronic stress, because chronic stress could influence modifiable gendered factors to promote cardiovascular disease prevention.

A molecular framework for autistic experiences: Mitochondrial allostatic load as a mediator between autism and psychopathology

Molecular autism research is evolving toward a biopsychosocial framework that is more informed by autistic experiences. In this context, research aims are moving away from correcting external autistic behaviors and toward alleviating internal distress. Autism Spectrum Conditions (ASCs) are associated with high rates of depression, suicidality and other comorbid psychopathologies, but this relationship is poorly understood. Here, we integrate emerging characterizations of internal autistic experiences within a molecular framework to yield insight into the prevalence of psychopathology in ASC. We demonstrate that descriptions of social camouflaging and autistic burnout resonate closely with the accepted definitions for early life stress (ELS) and chronic adolescent stress (CAS). We propose that social camouflaging could be considered a distinct form of CAS that contributes to allostatic overload, culminating in a pathophysiological state that is experienced as autistic burnout. Autistic burnout is thought to contribute to psychopathology via psychological and physiological mechanisms, but these remain largely unexplored by molecular researchers. Building on converging fields in molecular neuroscience, we discuss the substantial evidence implicating mitochondrial dysfunction in ASC to propose a novel role for mitochondrial allostatic load in the relationship between autism and psychopathology. An interplay between mitochondrial, neuroimmune and neuroendocrine signaling is increasingly implicated in stress-related psychopathologies, and these molecular players are also associated with neurodevelopmental, neurophysiological and neurochemical aspects of ASC. Together, this suggests an increased exposure and underlying molecular susceptibility to ELS that increases the risk of psychopathology in ASC. This article describes an integrative framework shaped by autistic experiences that highlights novel avenues for molecular research into mechanisms that directly affect the quality of life and wellbeing of autistic individuals. Moreover, this framework emphasizes the need for increased access to diagnoses, accommodations, and resources to improve mental health outcomes in autism.

Epigenetic Mechanisms Involved in Inflammaging-Associated Hypertension

PURPOSE OF REVIEW

This review summarizes the involvement of inflammaging in vascular damage with focus on the epigenetic mechanisms by which inflammaging-induced hypertension is triggered.

RECENT FINDINGS

Inflammaging in hypertension is a complex condition associated with the production of inflammatory mediators by the immune cells, enhancement of oxidative stress, and tissue remodeling in vascular smooth muscle cells and endothelial cells. Cellular processes are numerous, including inflammasome assembly and cell senescence which may involve mitochondrial dysfunction, autophagy, DNA damage response, dysbiosis, and many others. More recently, a series of noncoding RNAs, mainly microRNAs, have been described as possessing epigenetic actions on the regulation of inflammasome-related hypertension, emerging as a promising therapeutic strategy. Although there are a variety of pharmacological agents that effectively regulate inflammaging-related hypertension, a deeper understanding of the epigenetic events behind the control of vessel deterioration is needed for the treatment or even to prevent the disease onset.

Development of the College Student Acute Stress Scale (CSASS)

PURPOSE

The purpose of this study is to develop and validate the College Student Acute Stress Scale, a measure of acute stress specific to college students.

DESIGN AND METHODS

A total sample of 440 young adults from a university in the northeast United States were surveyed across three separate research studies. Exploratory principal component analysis, internal consistency reliability, convergent and divergent validity, and test-retest reliability analyses were performed.

FINDINGS

Evidence of convergent and divergent validity were obtained, and adequate internal consistency and test-retest reliability were identified.

PRACTICE IMPLICATIONS

This study provides evidence for the validity and reliability of a self-report measure of college students' acute stress experiences.

The associations of job strain and leisure-time physical activity with the risk of hypertension: the population-based Midlife in the United States cohort study

OBJECTIVES

Job strain is positively associated with incident hypertension, while increasing leisure-time physical activity (LTPA) can reduce incident hypertension. However, the joint associations of job strain and LTPA with incident hypertension among United States workers have yet to be investigated. This study examined the independent and joint associations of job strain and LTPA with incident hypertension.

METHODS

This prospective cohort study (n=1,160) utilized data from the population-based Midlife in the United States study. The associations of job strain and LTPA at baseline with incident hypertension during follow-up were examined using Cox proportional hazards models. High job strain was derived from a combination of high job demands and low job control, and high LTPA was defined as engagement in moderate or vigorous LTPA at least once per week.

RESULTS

During 9,218 person-years of follow-up, the hypertension incidence rate was 30.6 (95% confidence interval [CI], 27.3 to 34.3) per 1,000 person-years. High job strain was associated with a higher risk for hypertension than low job strain (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.00 to 1.67). High LTPA was associated with lower hypertension risk than low LTPA (aHR, 0.77; 95% CI, 0.60 to 0.98). Hypertension risk was higher among workers with high job strain and low LTPA than among those with low job strain and high LTPA (aHR, 1.70; 95% CI, 1.18 to 2.43).

CONCLUSIONS

Job strain and LTPA showed positive and inverse associations, respectively, with incident hypertension. The combination of high job strain and low LTPA was associated with the highest risk for hypertension.

Parameters of Hemodynamic Allostasis in Patients of Various Age Groups with Essential Arterial Hypertension

We determined the criteria for the diagnosis of hemodynamic allostasis and compared it with the index of allostatic load in patients of different age group with essential arterial hypertension without metabolic syndrome. The study included 87 subjects divided into 3 groups: patients with essential arterial hypertension at the age ⩽60 years (n=31; group 1), patients with essential arterial hypertension above 60 years (n=41; group 2), and healthy volunteers (n=15; age 25-69 years, group 3). The data of 24-h BP monitoring were processed by methods of linear and nonlinear rhythm analysis. Based on the analysis, parameters were identified that allow determining the state of allostatic regulation of the 24-h dynamics of BP, as well as parameters that determine the allostatic hemodynamic load on the cardiovascular system. The data obtained were compared with the index of allostatic load in patients of both groups. Regulation of the hemodynamics in patients with essential hypertension without metabolic syndrome in both age groups remained within the limits of hemodynamic allostasis forming the allostatic load on the body, which does not depend on patient's age.

Chronic stress increases transcriptomic indicators of biological aging in mouse bone marrow leukocytes

Research with animals and humans has demonstrated that chronic stress exposure can impact key biological aging pathways such as inflammation and DNA damage, suggesting a mechanism through which stress may increase risk for age-related disease. However, it is less clear whether these effects extend to other hallmarks of the aging process, such as cellular senescence. Male SCID mice were exposed to 14 days of restraint stress, with (n ​= ​6) or without (n ​= ​10) propranolol administration, or a non-stress control condition (n ​= ​10). Normal femoral bone marrow leukocytes were isolated from engrafted leukemia cells that had been injected prior to the stressor, as the mice were also under a cancer challenge. We performed whole genome transcriptional profiling to assess indicators of biological aging: cell stress, DNA damage repair, cellular senescence markers p16^INK4a and p21, and the pro-inflammatory senescence-associated secretory phenotype (SASP). ANCOVAs that adjusted for tumor load and Fisher's pairwise comparisons revealed that stressed mice had enhanced p16^INK4a (p ​= ​.02) and p21 (p ​= ​.004), lower DNA damage repair (p ​< ​.001), and higher SASP (p ​= ​.03) gene expression than control mice. Stressed mice also showed up-regulated beta-adrenergic (CREB) and inflammatory (NF-кB, AP-1) and down-regulated cell stress (Nrf2) transcription factor activity relative to control mice (ps ​< ​.01). Propranolol reversed CREB and Nrf2 activity (ps ​< ​.03). Findings suggest that chronic stress exposure can impact several key biological aging pathways within bone marrow leukocytes and these effects may be partially mediated by sympathetic beta-adrenergic receptor activation.

Chronic Stress and Depression in Periodontitis and Peri-Implantitis: A Narrative Review on Neurobiological, Neurobehavioral and Immune-Microbiome Interplays and Clinical Management Implications

Besides the well-known systemic factors for periodontal and peri-implant diseases, additional co-factors, such as chronic stress and depression, may also affect disease onset and progression as well as treatment responsiveness. Neurobiological and neurobehavioral pathogenic links between chronic stress and depression, on the one side, and periodontitis and peri-implantitis, on the other side, which have been little investigated and principally related to necrotizing periodontal disease, have been reviewed, along with their putative interconnections with periodontal immune-microbiome balance. Rising evidence suggest that dysregulated neurobiological and neurobehavioral factors, as well as periodontal immune-microbiome unbalance, all related to chronic stress and depression, may crucially interact and thus represent contributing factors in the genesis and worsening not only of necrotizing periodontal lesions, but also of chronic periodontitis and peri-implantitis. Such potential interconnections may be even more relevant in recurrent and aggressive cases of periodontal and peri-implant disease, which are frequently refractory to therapy, and may, if corroborated, coherently pave the way for personalized prevention and treatment strategies, possibly targeting immune-microbiome unbalance and neurobehavioral factors and focusing on neurobiological ones, especially in chronically stressed and depressed subjects with periodontitis and peri-implantitis.

Recent Progress of Chronic Stress in the Development of Atherosclerosis

With the development of the times, cardiovascular diseases have become the biggest cause of death in the global aging society, causing a serious social burden. Atherosclerosis is a chronic inflammatory disease, which can occur in large and medium-sized blood vessels in the whole body. It takes atherosclerotic plaque as the typical pathological change and endothelial injury as the core pathophysiological mechanism. It is the pathological basis of coronary heart disease, peripheral artery disease, cerebrovascular disease, and other diseases. Recent studies have shown that chronic stress plays an important role in the occurrence and development of atherosclerosis, endothelial injury, lipid metabolism, and chronic inflammation. This process involves a large number of molecular targets. It is usually the cause of atherosclerotic cardiovascular and cerebrovascular diseases. If chronic stress factors exist for a long time, patients have genetic susceptibility, and the combination of environmental factors triggers the pathogenesis, which may eventually lead to complete blockage of the blood vessels, unstable rupture of plaques, and serious adverse cardiovascular events. This paper reviews the role of chronic stress in the occurrence and development of atherosclerosis, focusing on the pathophysiological mechanism.

The Danaid Theory of Aging

The classical evolutionary theories of aging suggest that aging evolves due to insufficient selective pressure against it. In these theories, declining selection pressure with age leads to aging through genes or resource allocations, implying that aging could potentially be stalled were genes, resource allocation, or selection pressure somewhat different. While these classical evolutionary theories are undeniably part of a description of the evolution of aging, they do not explain the diversity of aging patterns, and they do not constitute the only possible evolutionary explanation. Without denying selection pressure a role in the evolution of aging, we argue that the origin and diversity of aging should also be sought in the nature and evolution of organisms that are, from their very physiological make up, unmaintainable. Drawing on advances in developmental biology, genetics, biochemistry, and complex systems theory since the classical theories emerged, we propose a fresh evolutionary-mechanistic theory of aging, the Danaid theory. We argue that, in complex forms of life like humans, various restrictions on maintenance and repair may be inherent, and we show how such restrictions are laid out during development. We further argue that there is systematic variation in these constraints across taxa, and that this is a crucial factor determining variation in aging and lifespan across the tree of life. Accordingly, the core challenge for the field going forward is to map and understand the mosaic of constraints, trade-offs, chance events, and selective pressures that shape aging in diverse ways across diverse taxa.

Examination of the Allostatic Load Construct and Its Longitudinal Association With Health Outcomes in the Boston Puerto Rican Health Study

OBJECTIVE

Despite evidence on allostatic load (AL) as a model explaining associations between stress and disease, there is no consensus on its operationalization. This study aimed to contrast various AL constructs and their longitudinal associations with disease and disability.

METHODS

Baseline and 5-year follow-up data from 738 adults participating in the Boston Puerto Rican Health Study were used. Five AL scores were created by summing the presence of 21 dysregulated multisystem physiological parameters using the following: a) z scores, b) population-based quartile cutoffs, c) clinical-based cutoffs, d) 10 preselected clinical-based cutoffs (AL-reduced), and e) 12 clinical-based cutoffs selected a posteriori based on association with disease (AL-select). Adjusted logistic regression models examined associations between each AL score at baseline and 5-year incident type 2 diabetes (T2D), cardiovascular disease (CVD), activities (or instrumental activities) of daily living (ADL; IADL) for physical impairment, and cognitive impairment.

RESULTS

AL-quartile was associated with greater odds of T2D (odds ratio [OR] = 1.20; 95% confidence interval [CI] = 1.07-1.35) and CVD (OR = 1.14; 95% CI = 1.06-1.22). AL-reduced was associated with higher odds of IADL (OR = 1.21; 95% CI = 1.07-1.37) and AL-clinical with CVD (OR = 1.14; 95% CI = 1.07-1.21), IADL (OR = 1.11; 95% CI = 1.04-1.19), and ADL (OR = 1.15; 95% CI = 1.04-1.26). AL-select showed associations with T2D (OR = 1.35; 95% CI = 1.14-1.61), CVD (OR = 1.21; 95% CI = 1.11-1.32), IADL (OR = 1.15; 95% CI = 1.04-1.26), and ADL (OR = 1.24; 95% CI = 1.08-1.41). No associations were found with AL z-score.

CONCLUSIONS

AL scores computed with clinical-based cutoffs performed robustly in our sample of mainland Puerto Ricans, whereas z scores did not predict disease and disability. AL-select was the most consistent predictor, supporting its use as a disease-predicting model. Future assessment of AL-select in other populations may help operationalize AL.

24-Hour Physical Behavior Balance for Better Health for All: "The Sweet-Spot Hypothesis"

"Sit less-move more" has been the univocal advice to adults for better health. Predominantly, this advice is based on research of physical behaviors during leisure-time. A recent study among > 100,000 adults indicates a u-shaped association between leisure-time physical activity and risk for cardiovascular disease and mortality among adults in physically active occupations. This may be explained by the considerable difference in 24-h physical behaviors between adults in sedentary and physically active occupations. Thus, the advice "sit less-move more" might not be the best for health among adults in physically active occupations. To provide a scientific approach and encourage research on 24-h physical behaviors and health for those in physically active occupations, we propose the "Sweet-Spot Hypothesis." The hypothesis postulates that the "Sweet-Spot" of 24-h physical behaviors for better health differs between adults, depending on their occupation. Specifically, the hypothesis claims that the advice "sit less-move more" does not bring adults in physically active occupations toward their "Sweet-Spot" of 24-h physical behaviors for better health. The purpose of our paper is to encourage researchers to test this proposed hypothesis by describing its origin, its theoretical underpinning, approaches to test it, and practical implications. To promote health for all, and decrease social health inequalities, we see a great need for empirically testing the "Sweet-Spot Hypothesis." We propose the "Sweet-Spot Hypothesis" to encourage discussion, debates, and empirical research to expand our collective knowledge about the healthy "24-h physical behavior balance" for all.

Blood pressure time load formation in patients with arterial hypertension without metabolic syndrome

Relevance . The study of the daily dynamics of blood pressure in arterial hypertension both on the basis of the daily index and on the basis of the time load is a relevant task, since, these indicators are associated in the literature with stable changes in the neurohumoral regulation of the cardiovascular system in arterial hypertension . The aim of the study was to compare data of the time load in patients with arterial hypertension , depending on the nocturnal blood pressure profile, with integrative indicators of the activity of the cardiovascular system in the form of a Circadian index, a structural point of blood pressure, double product. Materials and Methods. The study included 72 patients who were treated at the City Clinical Hospital No 13 in Moscow and signed a voluntary consent to participate in the research and the processing of personal data. Inclusion criteria: arterial hypertension. Exclusion criteria: metabolic syndrome, secondary forms of arterial hypertension and concomitant pathology. Depending on the daily index (DI10% and DI10%) patients were divided into 2 groups: 1 group (N= 32): patients with arterial hypertension without nocturnal decrease in blood pressure (non-dippers and night-pickers100%); Group 2 (N = 40): patients with arterial hypertension who had a nocturnal decrease in blood pressure (dippers and over dippers 100%). All patients and members of the control group (N=15) underwent daily monitoring of blood pressure (24-hour Arterial Blood Pressure Monitoring). The data were statistically processed to determine the 5% level of significance of differences (p0.05) (Students test). In the comparative analysis of integrative indicators at day and at night, a variance analysis was applied. Results and Discussion . As a result of the study, it was found that the values of Circadian Index for blood pressure vary depending on the type of night decrease in blood pressure and the blood pressure time load, while daily index and structural point of blood pressure remain on the same level as a reflection of the hemodynamic allostasis existing in both groups. Conclusion. Reflection of the allostatic load on hemodynamics is change of values of double product and of the structural point of blood pressure compared with the control group. These changes are not associated with the peculiarities of the nocturnal blood pressure profile in patients with hypertension without metabolic syndrome.

Allostatic Load and Its Impact on Health: A Systematic Review

INTRODUCTION

Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria.

OBJECTIVE

To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature.

METHODS

PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations.

RESULTS

A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings.

CONCLUSIONS

The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.

The psychobiological links between chronic stress-related diseases, periodontal/peri-implant diseases, and wound healing

Chronic stress is a relevant disease to periodontal practice, encompassing 25%-28% of the US population (American Psychological Association 2015). While it is well established that chronic psychologic stress can have significant deleterious systemic effects, only in recent decades have we begun to explore the biochemical, microbial, and physiologic impacts of chronic stress diseases on oral tissues. Currently, chronic stress is classified as a "risk indicator" for periodontal disease. However, as the evidence in this field matures with additional clinically controlled trials, more homogeneous data collection methods, and a better grasp of the biologic underpinnings of stress-mediated dysbiosis, emerging evidence suggests that chronic stress and related diseases (depression, anxiety) may be significant contributing factors in periodontal/peri-implant disease progression and inconsistent wound healing following periodontal-related therapeutics. Ideal solutions for these patients include classification of the disease process and de-escalation of chronic stress conditions through coping strategies. This paper also summarizes periodontal/implant-related therapeutic approaches to ensure predictable results for this specific patient subpopulation.

Cardiac medication use in patients with suspected ischaemia without obstructive coronary arteries: sex differences and psychological distress

BACKGROUND

Ischaemia without obstructive coronary arteries (INOCA) is more prevalent in women and associated with psychological distress. Pharmacological treatment goals are angina relief and cardiovascular risk management. The present study aims to examine sex differences in cardiac and non-cardiac medication use, as well as medication and sex differences related to consistent psychological distress in patients with suspected INOCA.

DESIGN

A TweeSteden mild stenosis observational cohort study in patients with suspected INOCA as detected by ischaemic reason for referral and non-obstructive arteries based on coronary angiography or computed tomography.

METHODS

Medication documented in the hospital records of 488 patients (53% women) was coded as angina relief medication, blood-pressure-lowering medication, antithrombotics, statins, and non-cardiac medication, using the Anatomical Therapeutic Chemical code. Depressive symptoms and anxiety were recoded as 'consistent distress' (above the cut-off score for depression and anxiety on validated questionnaires), 'inconsistent distress' (above the cut-off for depression or anxiety) or 'no distress' (below the cut-off).

RESULTS

No sex differences were observed in cardiac medication use. Women used anxiolytic benzodiazepines more often (12% vs 4%, p = 0.002) compared to men. Consistent distress was more prevalent in women (22% vs 15%, p = 0.004) and was related to the use of more angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and diuretics in women and to calcium antagonist use as well as lower adherence levels in men. Women who reported chest pain more often received angina relief medication and blood-pressure-lowering medication than men.

CONCLUSION

No sex differences were observed in cardiac medication use in patients with suspected INOCA. Psychological distress may reflect hypertension and subsequent medication use in women, and experiencing chest pain and subsequent medication use in men.

Work-life conflict and cardiovascular health: 5-year follow-up of the Gutenberg Health Study

INTRODUCTION

Work-life conflicts (WLC) may impact health, but few studies prospectively consider the impact of WLC on objective outcomes such as cardiovascular disease. Using data from the Gutenberg Health Study (GHS), we examined if WLC at baseline was associated with an increased five-year incidence of cardiovascular events (myocardial infarct, stroke, atrial fibrillation, peripheral artery disease, coronary artery disease, chronic heart failure, sudden cardiac death). We also considered if WLC was associated with incident hypertension and arterial stiffness and if the effects of WLC on cardiovascular health differ for men and women.

METHODS

A working subsample of the 15,010 GHS cohort participants completed the Copenhagen Psychosocial Questionnaire, which included five "work-privacy conflict" questions at baseline and at the five-year follow-up. Relative risks for incident hypertension due to increased WLC at baseline (WLC scores exceeding 60 out of 100) were estimated with Poisson regression in the subgroup of participants without hypertension at baseline (n = 2426). Categories of WLC at baseline and follow-up were also used to examine the risk of hypertension due to chronic/recurrent WLC. In this subgroup, we also examined the association between WLC as a continuous score ranging from 0 to 100 with change to arterial stiffness after five years using linear regression. Hazard ratios were estimated for incident cardiovascular events in a larger subsample of participants without prevalent cardiovascular disease at baseline (n = 3698) using Cox regression. We used various multivariable regression models to adjust for sex, age, socioeconomic status, occupational, household, and cardiovascular risk factors.

RESULTS

We found no association between WLC and incident hypertension or increased arterial stiffness. The fully-adjusted relative risk for WLC >60 at baseline and hypertension was 0.93 (95% 0.74-1.17). The risk of hypertension due to chronic/recurrent WLC >60 was increased but not statistically significant (RR = 1.13, 95% CI 0.83-1.54). Overall, hazard ratios for incident cardiovascular events were also not increased. However, stratifying the results by sex resulted in a hazard ratio of 1.47 (95% CI 0.54-3.98) for incident cardiovascular disease among women in the fully adjusted model.

CONCLUSIONS

Although our results were not statistically significant, they indicate that WLC is negatively impacting the cardiovascular health of women. While these results need to be confirmed with additional research and a longer follow-up, interventions to prevent WLC will promote health and could be especially beneficial for women.

Aging and Allostasis: Using Bayesian Network Analytics to Explore and Evaluate Allostatic Markers in the Context of Aging

Allostatic load reflects the cumulative strain on organic functions that may gradually evolve into overt disease. Our aim was to evaluate the allostatic parameters in the context of aging, and identify the parameters that may be suitable for an allostatic load index for elderly people (>60 years). From previously published studies, 11 allostatic (bio)markers could be identified that sustain sufficient variability with aging to capture meaningful changes in health status. Based on reported statistics (prevalence of a biomarker and its associated outcome, and/or an odds/risk ratio relating these two), seven of these could be adopted in a Bayesian Belief Network (BBN), providing the probability of “disturbed” allostasis in any given elder. Additional statistical analyses showed that changes in IL-6 and BMI contributed the most to a “disturbed” allostasis, indicating their prognostic potential in relation to deteriorating health in otherwise generally healthy elderly. In this way, and despite the natural decline in variance that irrevocably alters the prognostic relevance of most allostatic (bio)markers with aging, it appeared possible to outline an allostatic load index specifically for the elderly. The allostatic parameters here identified might consequently be considered a useful basis for future quantitative modelling in the context of (healthy) aging.

Allostatic Load and Glaucoma: Are We Missing the Big Picture?

How to cite this article: Dada T, Mahalingam K, Gupta V. Allostatic Load and Glaucoma: Are We Missing the Big Picture? J Curr Glaucoma Pract 2020;14(2):47–49.

Hyper-reactivity of HPA axis in Fischer 344 rats is associated with impaired cardiovascular and behavioral adaptation to repeated restraint stress

Fischer 344 (F344) rats are characterized by the hyper-reactive hypothalamic-pituitary-adrenal axis to stressful stimuli, while Lewis (LEW) rats are considered to be hypo-reactive. We studied stress-induced cardiovascular, neuroendocrine, and behavioral responses of adult male F344 and LEW rats subjected to the single (120 min) or the repeated restraint stress (daily 120 min for 1 week). Mean arterial pressure (MAP) and heart rate (HR) were measured in the restrained rats (n = 7-8 for each group) via a catheter inserted into the femoral artery. Baroreceptor sensitivity was evaluated using NO donor sodium nitroprusside and α₁-adrenoceptor agonist phenylephrine. The plasma levels of adrenocorticotropic hormone (ACTH), corticosterone, aldosterone, and adrenaline were determined before and during the restraint. Exploratory behavior was tested in open field test. F344 rats exerted the augmented stress-induced increase in plasma ACTH, corticosterone, and adrenaline as well as the impaired endocrine adaptation to the repeated stress compared to LEW rats. F344 rats exhibited higher MAP than LEW rats during single and repeated restraint. Moreover, repeatedly restrained F344 showed elevated HR and diminished baroreflex sensitivity. F344 and LEW rats exhibited similar total locomotor activity and the time spent in the center of open field arena, both parameters being decreased by the repeated restraint. The detailed analysis revealed altered pattern of locomotor behavior in F344 rats subjected to repeated restraint. In conclusion, F344 rats showed the impaired endocrine adaptation that resulted in allostatic overload, which might contribute to the impaired cardiovascular and behavioral adaptation to chronic stress observed in this strain. Lay summary F344 rats, characterized by HPA axis hyper-reactivity, exhibited higher blood pressure during restraint than LEW rats. Moreover, repeatedly restrained F344 rats showed elevated heart rate and impaired baroreflex sensitivity. It can be concluded that a poor adaptation to the repeated stress in F344 rats is not only limited to the neuroendocrine response but also has important cardiovascular consequences.

Heart-brain interactions during social and cognitive stress in hypertensive disease: A multidimensional approach

Hypertensive disease (HTD), a prominent risk factor for cardiovascular and cerebrovascular diseases, is characterized by elevated stress-proneness. Since stress levels are underpinned by both cardiac and neural factors, multidimensional insights are required to robustly understand their disruption in HTD. Yet, despite their crucial relevance, heart rate variability (HRV) and multimodal neurocognitive markers of stress in HTD remain controversial and unexplored respectively. To bridge this gap, we studied cardiodynamic as well as electrophysiological and neuroanatomical measures of stress in HTD patients and healthy controls. Both groups performed the Trier Social Stress Test (TSST), a validated stress-inducing task comprising a baseline and a mental stress period. During both stages, we assessed a sensitive HRV parameter (the low frequency/high frequency [LF/HF ratio]) and an online neurophysiological measure (the heartbeat-evoked potential [HEP]). Also, we obtained neuroanatomical data via voxel-based morphometry (VBM) for correlation with online markers. Relative to controls, HTD patients exhibited increased LF/HF ratio and greater HEP modulations during baseline, reduced changes between baseline and stress periods, and lack of significant stress-related HRV modulations associated with the grey matter volume of putative frontrostriatal regions. Briefly, HTD patients presented signs of stress-related autonomic imbalance, reflected in a potential basal stress overload and a lack of responsiveness to acute psychosocial stress, accompanied by neurophysiological and neuroanatomical alterations. These multimodal insights underscore the relevance of neurocognitive data for developing innovations in the characterization, prognosis and treatment of HTD and other conditions with autonomic imbalance. More generally, these findings may offer new insights into heart-brain interactions.

Syndemic frameworks to understand the effects of COVID-19 on commercial driver stress, health, and safety

INTRODUCTION

U.S. commercial drivers are entrenched in a stressogenic profession, and exposures to endemic chronic stressors shape drivers' behavioral and psychosocial responses and induce profound health and safety disparities. To gain a complete understanding of how the COVID-19 pandemic will affect commercial driver stress, health, and safety over time, and to mitigate these impacts, research and prevention efforts must be grounded in theoretical perspectives that contextualize these impacts within the chronic stressors already endemic to profession, the historical and ongoing forces that have induced them, and the potentially reinforcing nature of the resulting afflictions.

METHODS

Extant literature reveals how an array of macro-level changes has shaped downstream trucking industry policies, resulting in stressogenic work organization and workplace characteristics. Emerging evidence suggests that the COVID-19 pandemic exacerbates existing stressors and introduces novel stressors, with potentially exacerbatory impacts on health and safety disparities.

RESULTS

As COVID-19 exerts an array of multi-level stressors on commercial drivers, syndemic frameworks can provide the appropriate theoretical lens to guide research and prevention. Syndemic frameworks can provide the grounding to allow foregoing commercial driver COVID-19 research to transcend the limitations of prevailing research frameworks by contextualizing COVID-19 stressors holistically within the complex system of endemic chronic stressors and interrelated health and safety afflictions. Syndemic-informed prevention efforts can then be implemented that simultaneously tackle multiple afflictions and the macro-level forces that result in the emergence of commercial drivers' health and safety disparities over time.

CONCLUSIONS

The impacts of the COVID-19 pandemic on commercial drivers cannot be adequately understood or acted upon in isolation from the endemic chronic stressors and interrelated health and safety disparities that characterize the profession. Instead, commercial driver COVID-19 research and prevention needs syndemic frameworks to holistically understand the impacts of COVID-19 on commercial driver stress, health, and safety, and to identify high-leverage preventive actions.

Understanding the effects of COVID-19 on the health and safety of immigrant hospitality workers in the United States

The U.S. tourism and hospitality workforce is disproportionately represented by immigrants and minorities, particularly in low-wage jobs with adverse work conditions. Immigrant hotel and foodservice workers face excess chronic stress and related syndemic risks, exacerbated by social, political, and economic inequities. COVID-19 has suddenly intensified the stressful and already difficult circumstances of immigrant service sector workers. The travel and tourism sector is one of the hardest hit due to widespread travel restrictions and shelter-in-place orders designed to curb infection spread. Restrictions and lockdowns have devastated tourism-dependent destinations and displaced millions of vulnerable workers, causing them to lose their livelihoods. Compared to the general workforce, a sizeable increase in occupational stress has already been observed in the hospitality/tourism sector over the past 15-20 years. COVID-19 and related fears add further strains on immigrant hotel and foodservice workers, potentially exerting a significant toll on mental and physical health and safety.

Walking the Tightrope: A Proposed Model of Chronic Pain and Stress

Pain and stress are both phenomena that challenge an individual’s homeostasis and have significant overlap in conceptual and physiological processes. Allostasis is the ability to adapt to pain and stress and maintain homeostasis; however, if either process becomes chronic, it may result in negative long-term outcomes. The negative effects of stress on health outcomes on physiology and behavior, including pain, have been well documented; however, the specific mechanisms of how stress and what quantity of stress contributes to the maintenance and exacerbation of pain have not been identified, and thus pharmacological interventions are lacking. The objective of this brief review is to: 1. identify the gaps in the literature on the impact of acute and chronic stress on chronic pain, 2. highlight future directions for stress and chronic pain research; and 3. introduce the Pain-Stress Model in the context of the current literature on stress and chronic pain. A better understanding of the connection between stress and chronic pain could provide greater insight into the neurobiology of these processes and contribute to individualized treatment for pain rehabilitation and drug development for these often comorbid conditions.

Allicin pharmacology: Common molecular mechanisms against neuroinflammation and cardiovascular diseases

According to investigations in phytomedicine and ethnopharmacology, the therapeutic properties of garlic (Allium sativum) have been described by ancestral cultures. Notwithstanding, it is of particular concern to elucidate the molecular mechanisms underlying this millenary empirical knowledge. Allicin (S-allyl prop-2-ene-1-sulfinothioate), a thioester of sulfenic acid, is one of the main bioactive compounds present in garlic, and it is responsible for the particular aroma of the spice. The pharmacological attributes of allicin integrate a broad spectrum of properties (e.g., anti-inflammatory, immunomodulatory, antibiotic, antifungal, antiparasitic, antioxidant, nephroprotective, neuroprotective, cardioprotective, and anti-tumoral activities, among others). The primary goal of the present article is to review and clarify the common molecular mechanisms by which allicin and its derivates molecules may perform its therapeutic effects on cardiovascular diseases and neuroinflammatory processes. The intricate interface connecting the cardiovascular and nervous systems suggests that the impairment of one organ could contribute to the dysfunction of the other. Allicin might target the cornerstone of the pathological processes underlying cardiovascular and neuroinflammatory disorders, like inflammation, renin-angiotensin-aldosterone system (RAAS) hyperactivation, oxidative stress, and mitochondrial dysfunction. Indeed, the current evidence suggests that allicin improves mitochondrial function by enhancing the expression of HSP70 and NRF2, decreasing RAAS activation, and promoting mitochondrial fusion processes. Finally, allicin represents an attractive therapeutic alternative targeting the complex interaction between cardiovascular and neuroinflammatory disorders.

Allostatic overload in patients with essential hypertension

The role of psychosocial stress in the development of essential hypertension has attracted increasing attention in the last decades, even though research findings have been often inconclusive. We specifically investigated allostatic overload (AO) in hypertensive patients using a clinimetric approach. Allostatic overload was assessed by a semi-structured research interview based on clinimetric criteria in 80 consecutive outpatients with essential hypertension (46.3 % females; mean age 62.18 ± 8.59 years; age range 47-74 years) and 80 normotensive matched controls. Three clinical interviews and two self-rating questionnaires for assessing psychological distress and well-being were also administered. Cardiac variables were collected. AO was present in 26 (32.5 %) of the hypertensive patients based on clinical interviewing, and in only 6 normotensive controls (p < .001). Hypertensive patients with AO had significantly higher levels of psychological distress than those without. Further, patients with AO displayed significantly lower levels of well-being and quality of life (p < .001). A significantly greater prevalence of psychosomatic syndromes was found to be associated with the presence of AO (p < .05), whereas no significant association was detected as to psychiatric diagnoses. Significantly greater cardiovascular risk was found among hypertensive patients reporting AO compared to those without (p < .05). The results of this study support the clinical relevance of a psychological assessment of hypertensive patients, with important implications for the non-pharmacological management of hypertension.

Clinical characterization of allostatic overload

Allostatic load reflects the cumulative effects of stressful experiences in daily life and may lead to disease over time. When the cost of chronic exposure to fluctuating or heightened neural and systemic physiologic responses exceeds the coping resources of an individual, this is referred to as "toxic stress" and allostatic overload ensues. Its determination has initially relied on measurements of an interacting network of biomarkers. More recently, clinical criteria for the determination of allostatic overload, that provide information on the underlying individual experiential causes, have been developed and used in a number of investigations. These clinimetric tools can increase the number of people screened, while putting the use of biomarkers in a psychosocial context. The criteria allow the personalization of interventions to prevent or decrease the negative impact of toxic stress on health, with particular reference to lifestyle modifications and cognitive behavioral therapy.

The relationship between chronic stress, hair cortisol and hypertension

Inconsistencies in studies of chronic psychosocial stress and hypertension may be explained by the use of stress markers greatly influenced by circadian rhythm and transient stressors. We assessed whether hair cortisol, a marker that captures systemic cortisol over months, was independently associated with hypertension. We measured hair cortisol and blood pressure in 75 consecutive participants in the Survey of the Health of Wisconsin, using an ELISA test. Individuals with values ​≥ ​median (78.1 ​pg/mg) were considered exposed. We used approximate Bayesian logistic regression, with a prior odds ratio of 1.0–4.0, to quantify the multivariate-adjusted hair cortisol-hypertension association. Participants' average age was 46.9 years; 37.3% were male; and 25.3% were hypertensive. Hypertension prevalence was 2.23 times higher in exposed (95% CI: 1.69–3.03). This finding was unlikely explained by differential measurement errors, since we conducted blinded measurements of exposure and outcome. Sensitivity analyses showed the association was unlikely explained by an unmeasured confounder, survival bias, or reverse causality bias. Findings suggest elevated hair cortisol is a risk factor for hypertension. Although feasible, the clinical value of hair cortisol as a tool for hypertension risk stratification or for monitoring the effect of chronic psychosocial stress management interventions is still uncertain.

The Risk of Hypertension Doubles Every 10 Years in China: Age, Period, and Birth Cohort Effects on the Prevalence of Hypertension From 2004 to 2013

BACKGROUND

Hypertension is a growing problem worldwide and can often result in a variety of negative health outcomes. The aim of this study was to assess the effects of age at diagnosis, calendar period, and birth cohort on the change in the prevalence rate of hypertension in Guangzhou from 2004 to 2013.

METHODS

We used data from the Guangzhou Community Health Survey, a population-based study designed by the National Health and Family Planning Commission of the PRC every 5 years. A total of 27,299, 23,467, and 18,362 participants aged 15-79 years completed the survey in 2004, 2009, and 2013, respectively.

RESULTS

Age effects increased slowly before the age of 42 years but increased rapidly after the age of 42 years, peaking at 79 years. Cohort effects grew slowly before the end of the 1960s but grew quickly after the end of the 1960s. The risk of suffering from hypertension among people born in 1962, 1972, 1982, and 1992 was 1.39, 2.68, 5.55, and 11.53 times, respectively, than that of people born in 1952. The period effects increased 25% from 2004 to 2009 and later declined 27% from 2009 to 2013 in the entire population. There was no gender difference in age effects and period effects, but strong cohort effects on hypertension were observed among males compared with females.

CONCLUSIONS

For Chinese individuals, the later one is born, the higher the risk is of suffering from hypertension. Strong cohort effects for hypertension were observed among males compared with females, indicating that males are more easily affected by hypertension based on the change in birth cohort.