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Verhoeven JE, Wolkowitz OM, Barr Satz I, Conklin Q, Lamers F, Lavebratt C, Lin J, Lindqvist D, Mayer SE, Melas PA, Milaneschi Y, Picard M, Rampersaud R, Rasgon N, Ridout K, Söderberg Veibäck G, Trumpff C, Tyrka AR, Watson K, Wu GWY, Yang R, Zannas AS, Han LKM, Månsson KNT. The researcher's guide to selecting biomarkers in mental health studies. Bioessays 2024:e2300246. [PMID: 39258367 DOI: 10.1002/bies.202300246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 09/12/2024]
Abstract
Clinical mental health researchers may understandably struggle with how to incorporate biological assessments in clinical research. The options are numerous and are described in a vast and complex body of literature. Here we provide guidelines to assist mental health researchers seeking to include biological measures in their studies. Apart from a focus on behavioral outcomes as measured via interviews or questionnaires, we advocate for a focus on biological pathways in clinical trials and epidemiological studies that may help clarify pathophysiology and mechanisms of action, delineate biological subgroups of participants, mediate treatment effects, and inform personalized treatment strategies. With this paper we aim to bridge the gap between clinical and biological mental health research by (1) discussing the clinical relevance, measurement reliability, and feasibility of relevant peripheral biomarkers; (2) addressing five types of biological tissues, namely blood, saliva, urine, stool and hair; and (3) providing information on how to control sources of measurement variability.
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Affiliation(s)
- Josine E Verhoeven
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
| | - Owen M Wolkowitz
- Department of Psychiatry and Behavioral Sciences, and Weill Institute for Neurosciences, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Isaac Barr Satz
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Quinn Conklin
- Center for Mind and Brain, University of California, Davis, California, USA
- Center for Health and Community, University of California, San Francisco, California, USA
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, L8:00, Karolinska University Hospital, Stockholm, Sweden
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Daniel Lindqvist
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Lund, Sweden
| | - Stefanie E Mayer
- Department of Psychiatry and Behavioral Sciences, and Weill Institute for Neurosciences, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Philippe A Melas
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Complex Trait Genetics, Amsterdam, The Netherlands
| | - Martin Picard
- Department of Psychiatry, Division of Behavioral Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA
- Department of Neurology, H. Houston Merritt Center, Columbia Translational Neuroscience Initiative, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA
- New York State Psychiatric Institute, New York, USA
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ryan Rampersaud
- Department of Psychiatry and Behavioral Sciences, and Weill Institute for Neurosciences, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Natalie Rasgon
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Kathryn Ridout
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry, Kaiser Permanente, Santa Rosa Medical Center, Santa Rosa, California, USA
| | - Gustav Söderberg Veibäck
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Lund, Sweden
| | - Caroline Trumpff
- Department of Psychiatry, Division of Behavioral Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA
| | - Audrey R Tyrka
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kathleen Watson
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Gwyneth Winnie Y Wu
- Department of Psychiatry and Behavioral Sciences, and Weill Institute for Neurosciences, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Ruoting Yang
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Anthony S Zannas
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Laura K M Han
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Kristoffer N T Månsson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
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Rallidis LS, Papathanasiou KA, Kosmas N, Iordanidis D, Rallidis SL, Simitsis P. Is premorbid stress assessed by hair cortisol concentration linked to Takotsubo syndrome? Results from a pilot study. Int J Cardiol 2024; 410:132241. [PMID: 38844095 DOI: 10.1016/j.ijcard.2024.132241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/26/2024] [Accepted: 06/03/2024] [Indexed: 06/17/2024]
Abstract
INTRODUCTION The pathophysiology of Takotsubo syndrome (TTS) is not completely understood and the role of chronic stress is among the main mechanistic links. The aim of this study was to explore whether accumulating hair cortisol concentration (HCC), a novel biomarker of chronic stress, is associated with the occurrence of TTS. METHODS A consecutive series of 18 TTS patients and 36 age and sex matched healthy controls were included in our analysis. Hair samples were collected from participants'' vertex. The proximal 2.5 cm of hair was cut in equal parts of 0.5 cm, reflecting mean cortisol levels in time intervals of 0-15, 15-30, 30-45, 45-60 and 60-75 days prior to hair collection. RESULTS HCC was higher in TTS group compared to controls at any time point and increased over time starting from 75 days prior to the event. The rate of HCC increase was significantly higher in TTS patients versus controls (beta of interaction = 0.48; 95%CI: 0.36-0.60; p < 0.001). CONCLUSIONS The steadily increasing trend of HCC in TTS patients suggests that the additive effect of multiple stressful events over several weeks prior TTS onset may disrupt cortisol homeostasis and play a role in TTS pathophysiology.
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Affiliation(s)
- Loukianos S Rallidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece.
| | - Konstantinos A Papathanasiou
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Nikolaos Kosmas
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Dimitrios Iordanidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | | | - Panagiotis Simitsis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
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Dong T, Yu C, Mao Q, Han F, Yang Z, Yang Z, Pires N, Wei X, Jing W, Lin Q, Hu F, Hu X, Zhao L, Jiang Z. Advances in biosensors for major depressive disorder diagnostic biomarkers. Biosens Bioelectron 2024; 258:116291. [PMID: 38735080 DOI: 10.1016/j.bios.2024.116291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024]
Abstract
Depression is one of the most common mental disorders and is mainly characterized by low mood or lack of interest and pleasure. It can be accompanied by varying degrees of cognitive and behavioral changes and may lead to suicide risk in severe cases. Due to the subjectivity of diagnostic methods and the complexity of patients' conditions, the diagnosis of major depressive disorder (MDD) has always been a difficult problem in psychiatry. With the discovery of more diagnostic biomarkers associated with MDD in recent years, especially emerging non-coding RNAs (ncRNAs), it is possible to quantify the condition of patients with mental illness based on biomarker levels. Point-of-care biosensors have emerged due to their advantages of convenient sampling, rapid detection, miniaturization, and portability. After summarizing the pathogenesis of MDD, representative biomarkers, including proteins, hormones, and RNAs, are discussed. Furthermore, we analyzed recent advances in biosensors for detecting various types of biomarkers of MDD, highlighting representative electrochemical sensors. Future trends in terms of new biomarkers, new sample processing methods, and new detection modalities are expected to provide a complete reference for psychiatrists and biomedical engineers.
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Affiliation(s)
- Tao Dong
- X Multidisciplinary Research Institute, School of Instrument Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China; State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, 710049, China; Chongqing Key Laboratory of Micro-Nano Transduction and Intelligent Systems, Collaborative Innovation Center on Micro-Nano Transduction and Intelligent Eco-Internet of Things, Chongqing Key Laboratory of Colleges and Universities on Micro-Nano Systems Technology and Smart Transducing, National Research Base of Intelligent Manufacturing Service, Chongqing Technology and Business University, Nan'an District, Chongqing, 400067, China.
| | - Chenghui Yu
- Chongqing Key Laboratory of Micro-Nano Transduction and Intelligent Systems, Collaborative Innovation Center on Micro-Nano Transduction and Intelligent Eco-Internet of Things, Chongqing Key Laboratory of Colleges and Universities on Micro-Nano Systems Technology and Smart Transducing, National Research Base of Intelligent Manufacturing Service, Chongqing Technology and Business University, Nan'an District, Chongqing, 400067, China.
| | - Qi Mao
- X Multidisciplinary Research Institute, School of Instrument Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China; State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Feng Han
- X Multidisciplinary Research Institute, School of Instrument Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China; State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Zhenwei Yang
- X Multidisciplinary Research Institute, School of Instrument Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China; State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Zhaochu Yang
- Chongqing Key Laboratory of Micro-Nano Transduction and Intelligent Systems, Collaborative Innovation Center on Micro-Nano Transduction and Intelligent Eco-Internet of Things, Chongqing Key Laboratory of Colleges and Universities on Micro-Nano Systems Technology and Smart Transducing, National Research Base of Intelligent Manufacturing Service, Chongqing Technology and Business University, Nan'an District, Chongqing, 400067, China
| | - Nuno Pires
- Chongqing Key Laboratory of Micro-Nano Transduction and Intelligent Systems, Collaborative Innovation Center on Micro-Nano Transduction and Intelligent Eco-Internet of Things, Chongqing Key Laboratory of Colleges and Universities on Micro-Nano Systems Technology and Smart Transducing, National Research Base of Intelligent Manufacturing Service, Chongqing Technology and Business University, Nan'an District, Chongqing, 400067, China
| | - Xueyong Wei
- X Multidisciplinary Research Institute, School of Instrument Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China; State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Weixuan Jing
- X Multidisciplinary Research Institute, School of Instrument Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China; State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Qijing Lin
- X Multidisciplinary Research Institute, School of Instrument Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China; State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Fei Hu
- X Multidisciplinary Research Institute, School of Instrument Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China; State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiao Hu
- Engineering Research Center of Ministry of Education for Smart Justice, School of Criminal Investigation, Southwest University of Political Science and Law, Chongqing, 401120, China.
| | - Libo Zhao
- X Multidisciplinary Research Institute, School of Instrument Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China; State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Zhuangde Jiang
- X Multidisciplinary Research Institute, School of Instrument Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China; State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
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Arregi A, Vegas O, Lertxundi A, García-Baquero G, Ibarluzea J, Andiarena A, Babarro I, Subiza-Pérez M, Lertxundi N. Hair cortisol determinants in 11-year-old children: Environmental, social and individual factors. Horm Behav 2024; 164:105575. [PMID: 38851169 DOI: 10.1016/j.yhbeh.2024.105575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Children's exposure to chronic stress is associated with several health problems. Measuring hair cortisol concentration is particularly useful for studying chronic stress but much is unknown about hair cortisol determinants in children and adolescents, and previous research has often not considered the simultaneous exposure of multiple variables. This research is focused on investigating the relationship between environmental, social and individual factors with hair cortisol concentration in children. METHODS The data used in this study are from the INMA prospective epidemiological cohort study. The assessment of chronic stress was made on the basis of hair samples taken at the age of 11 years in the INMA-Gipuzkoa cohort (n = 346). A metamodel summarizing the hypothesized relationships among environmental, social and individual factors and hair cortisol concentration was constructed based on previous literature. Structural Equation Modelling was performed to examine the relationships among the variables. RESULTS In the general model higher behavioural problems were associated with higher cortisol levels and an inverse relationship between environmental noise and cortisol levels was observed, explaining 5 % of the variance in HCC. Once stratified by sex these associations were only hold in boys, while no significant effect of any of the study variables was related with cortisol levels in girls. Importantly, maternal stress was positively related to behavioural difficulties in children. Finally, higher traffic-related air pollution and lower exposure to neighborhood greenness were related to higher environmental noise. DISCUSSION This study highlights that simultaneous exposure to different environmental, social and individual characteristics may determine the concentration of hair cortisol. More research is needed and future studies should include this complex view to better understanding of hair cortisol determinants in children.
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Affiliation(s)
- Ane Arregi
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain.
| | - Oscar Vegas
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
| | - Aitana Lertxundi
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Gonzalo García-Baquero
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Faculty of Biology, University of Salamanca, Campus Miguel de Unamuno, Avda Licenciado Méndez Nieto s/n, 37007 Salamanca, Spain
| | - Jesus Ibarluzea
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain; Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013 San Sebastian, Spain
| | - Ainara Andiarena
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
| | - Izaro Babarro
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Faculty of Medicine and Nursing of the University of the Basque Country (UPV/EHU), 20014 Donostia/San Sebastian, Spain
| | - Mikel Subiza-Pérez
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain; Bradford Institute for Health Research, Bradford BD9 6RJ, UK
| | - Nerea Lertxundi
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain
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Arregi A, Vegas O, Lertxundi A, Silva A, Ferreira I, Bereziartua A, Cruz MT, Lertxundi N. Road traffic noise exposure and its impact on health: evidence from animal and human studies-chronic stress, inflammation, and oxidative stress as key components of the complex downstream pathway underlying noise-induced non-auditory health effects. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:46820-46839. [PMID: 38977550 PMCID: PMC11297122 DOI: 10.1007/s11356-024-33973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 06/08/2024] [Indexed: 07/10/2024]
Abstract
In heavily urbanized world saturated with environmental pollutants, road traffic noise stands out as a significant factor contributing to widespread public health issues. It contributes in the development of a diverse range of non-communicable diseases, such as cardiovascular diseases, metabolic dysregulation, cognitive impairment, and neurodegenerative disorders. Although the exact mechanisms behind these non-auditory health effects remain unclear, the noise reaction model centres on the stress response to noise. When exposed to noise, the body activates the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, leading to the secretion of stress hormones like catecholamines and cortisol. Prolonged exposure to noise-induced stress results in chronic inflammation and oxidative stress. This review underscores the role of inflammation and oxidative stress in the progression of noise-induced vascular dysfunction, disruption of the circadian rhythm, accelerated aging, neuroinflammation, and changes in microbiome. Additionally, our focus is on understanding the interconnected nature of these health outcomes: These interconnected factors create a cascade effect, contributing to the accumulation of multiple risk factors that ultimately lead to severe adverse health effects.
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Affiliation(s)
- Ane Arregi
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008, San Sebastian, Spain
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain S/N, 20014, San Sebastian, Spain
| | - Oscar Vegas
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008, San Sebastian, Spain
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain S/N, 20014, San Sebastian, Spain
| | - Aitana Lertxundi
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain S/N, 20014, San Sebastian, Spain
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029, Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain
| | - Ana Silva
- Center for Neuroscience and Cell Biology and Institute for Biomedical Imaging and Life Sciences, University of Coimbra, 3000-548, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Isabel Ferreira
- Center for Neuroscience and Cell Biology and Institute for Biomedical Imaging and Life Sciences, University of Coimbra, 3000-548, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Ainhoa Bereziartua
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain S/N, 20014, San Sebastian, Spain
| | - Maria Teresa Cruz
- Center for Neuroscience and Cell Biology and Institute for Biomedical Imaging and Life Sciences, University of Coimbra, 3000-548, Coimbra, Portugal.
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.
- Faculty of Pharmacy, University of Coimbra, 3000-548, Coimbra, Portugal.
| | - Nerea Lertxundi
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008, San Sebastian, Spain
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain S/N, 20014, San Sebastian, Spain
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029, Madrid, Spain
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Shah K, Kumari R, Jain M. Unveiling stress markers: A systematic review investigating psychological stress biomarkers. Dev Psychobiol 2024; 66:e22490. [PMID: 38680082 DOI: 10.1002/dev.22490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/31/2024] [Indexed: 05/01/2024]
Abstract
Psychological stress is a ubiquitous facet of modern life, impacting individuals across diverse contexts and demographics. Understanding its physiological manifestations through biomarkers has gained substantial attention within the scientific community. A comprehensive search was conducted across multiple databases for peer-reviewed articles published within the past decade. Preliminary findings reveal many biomarkers associated with psychological stress across different biological systems, including the hypothalamic-pituitary-adrenal axis, immune system, cardiovascular system, and central nervous system. This systematic review explores psychological, physiological, and biochemical biomarkers associated with stress. Analyzing recent literature, it synthesizes findings across these three categories, elucidating their respective roles in stress response mechanisms. Psychological markers involve subjective assessments like self-reported stress levels, perceived stress scales, or psychometric evaluations measuring anxiety, depression, or coping mechanisms. Physiological markers include heart rate variability, blood pressure, and immune system responses such as cytokine levels or inflammatory markers. Biochemical markers involve hormones or chemicals linked to stress. It includes cortisol, catecholamines, copeptin, salivary amylase, IL-6, and C-reactive protein.
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Affiliation(s)
- Khushi Shah
- Cell and Developmental Biology Lab, Research and Development Cell, Parul University, Vadodara, Gujarat, India
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, Gujarat, India
| | - Ruchi Kumari
- Cell and Developmental Biology Lab, Research and Development Cell, Parul University, Vadodara, Gujarat, India
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, Gujarat, India
| | - Mukul Jain
- Cell and Developmental Biology Lab, Research and Development Cell, Parul University, Vadodara, Gujarat, India
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, Gujarat, India
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Mazgelytė E, Karčiauskaitė D. Cortisol in metabolic syndrome. Adv Clin Chem 2024; 123:129-156. [PMID: 39181620 DOI: 10.1016/bs.acc.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Cortisol, a stress hormone, plays a crucial role in regulating metabolic, hemodynamic, inflammatory, and behavioral processes. Its secretion is governed by the hypothalamic-pituitary-adrenal axis. However, prolonged activation of this axis and increased cortisol bioavailability in tissues can result in detrimental metabolic effects. Chronic exposure to excessive cortisol is associated with insulin resistance and visceral obesity, both significant contributors to metabolic syndrome. This review delves into the regulation of the hypothalamic-pituitary-adrenal axis, the molecular mechanisms underlying cortisol synthesis and its actions, as well as the key factors influencing cortisol bioavailability. Furthermore, it provides a summary of available clinical research data on the involvement of cortisol in metabolic syndrome, alongside a discussion on the various biomatrices used for cortisol measurement in clinical settings.
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Affiliation(s)
- Eglė Mazgelytė
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Dovilė Karčiauskaitė
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Madigan JA, Waters SF, Gartstein MA, Mattera JA, Connolly CP, Crespi EJ. Perinatal hair cortisol concentrations linked to psychological distress and unpredicted birth complications. Psychoneuroendocrinology 2024; 161:106921. [PMID: 38141367 DOI: 10.1016/j.psyneuen.2023.106921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 11/25/2023] [Accepted: 12/05/2023] [Indexed: 12/25/2023]
Abstract
Maternal well-being and stress during the perinatal period have been hypothesized to influence birth outcomes and the postnatal development of offspring. In the present study, we explored whether hair cortisol concentration (HCC) was related to symptoms of psychological distress during the perinatal period and with unpredicted birth complications (UBCs). Surveys measuring symptoms of perceived stress, state/trait anxiety, and depression were collected from 53 participants (mean age = 31.1, SD = 4.04; 83% Caucasian, 17% other races) during the third trimester and again at two and six months after birth, 24.5% of which reported UBCs. In a subset of participants, we measured HCC in hair samples collected during the third trimester (27-39 weeks) and six months after birth. Compared to participants reporting normal births, those reporting UBCs had significantly elevated composite stress, anxiety, and depression (SAD) scores two months after birth, but scores decreased by six months postpartum. During the third trimester, HCC was positively associated with reported SAD scores, and HCC was elevated in participants reporting birth complications. Logistic regression showed HCC, but not SAD scores, predicted UBCs (p = 0.023, pseudo R2= 19.7%). Repeated measures MANOVA showed HCC varied over the perinatal period depending on both SAD scores reported at two months postpartum and the experience of UBCs; but when SAD scores reported at six months postpartum were included in the model, the association between HCC and SAD scores and the influence of UBCs was diminished. Although generalizability is limited by our relatively small, homogeneous sample, findings support a positive association between reported psychological distress and HCC during pregnancy and at two months postpartum. We also report a novel finding that chronically elevated cortisol concentrations during pregnancy were related to the risk of UBCs and remain elevated through the early postpartum period, suggesting the importance of monitoring both psychological distress and HCC during the perinatal period.
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Affiliation(s)
- J A Madigan
- School of Biological Sciences, Washington State University, Pullman, WA 99164, USA; Center for Reproductive Biology, Washington State University, Pullman, WA 99164, USA
| | - Sara F Waters
- Department of Human Development, Washington State University, Vancouver, WA 99164, USA
| | - Maria A Gartstein
- Center for Reproductive Biology, Washington State University, Pullman, WA 99164, USA; Department of Psychology, Washington State University, Pullman, WA 99164, USA
| | - Jennifer A Mattera
- Center for Reproductive Biology, Washington State University, Pullman, WA 99164, USA; Department of Psychology, Washington State University, Pullman, WA 99164, USA
| | - Christopher P Connolly
- Department of Kinesiology and Educational Psychology, Washington State University, Pullman, WA 99164, USA
| | - Erica J Crespi
- School of Biological Sciences, Washington State University, Pullman, WA 99164, USA; Center for Reproductive Biology, Washington State University, Pullman, WA 99164, USA.
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9
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Samad S, Baloch B, Qadeer MA. Revolutionizing depression diagnosis: earwax analysis for cortisol and beyond. Bioanalysis 2024; 16:429-430. [PMID: 38415689 PMCID: PMC11216613 DOI: 10.4155/bio-2023-0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/14/2024] [Indexed: 02/29/2024] Open
Affiliation(s)
- Shahzaib Samad
- Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
| | - Bilqees Baloch
- Ziauddin Medical College, 4/B, Shahrah-e-Ghalib, Block 6, Clifton Karachi, Sindh, 75600, Pakistan
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10
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Verscheure E, Stierum R, Schlünssen V, Lund Würtz AM, Vanneste D, Kogevinas M, Harding BN, Broberg K, Zienolddiny-Narui S, Erdem JS, Das MK, Makris KC, Konstantinou C, Andrianou X, Dekkers S, Morris L, Pronk A, Godderis L, Ghosh M. Characterization of the internal working-life exposome using minimally and non-invasive sampling methods - a narrative review. ENVIRONMENTAL RESEARCH 2023; 238:117001. [PMID: 37683788 DOI: 10.1016/j.envres.2023.117001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Abstract
During recent years, we are moving away from the 'one exposure, one disease'-approach in occupational settings and towards a more comprehensive approach, taking into account the totality of exposures during a life course by using an exposome approach. Taking an exposome approach however is accompanied by many challenges, one of which, for example, relates to the collection of biological samples. Methods used for sample collection in occupational exposome studies should ideally be minimally invasive, while at the same time sensitive, and enable meaningful repeated sampling in a large population and over a longer time period. This might be hampered in specific situations e.g., people working in remote areas, during pandemics or with flexible work hours. In these situations, using self-sampling techniques might offer a solution. Therefore, our aim was to identify existing self-sampling techniques and to evaluate the applicability of these techniques in an occupational exposome context by conducting a literature review. We here present an overview of current self-sampling methodologies used to characterize the internal exposome. In addition, the use of different biological matrices was evaluated and subdivided based on their level of invasiveness and applicability in an occupational exposome context. In conclusion, this review and the overview of self-sampling techniques presented herein can serve as a guide in the design of future (occupational) exposome studies while circumventing sample collection challenges associated with exposome studies.
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Affiliation(s)
- Eline Verscheure
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Rob Stierum
- Netherlands Organisation for Applied Scientific Research TNO, Risk Analysis for Products in Development, Utrecht, the Netherlands
| | - Vivi Schlünssen
- Department of Public Health, Research unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Anne Mette Lund Würtz
- Department of Public Health, Research unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Dorian Vanneste
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Manolis Kogevinas
- Environment and Health over the Lifecourse Program, ISGlobal, Barcelona, Spain
| | - Barbara N Harding
- Environment and Health over the Lifecourse Program, ISGlobal, Barcelona, Spain
| | - Karin Broberg
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Mrinal K Das
- National Institute of Occupational Health, Oslo, Norway
| | - Konstantinos C Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Corina Konstantinou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Xanthi Andrianou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Susan Dekkers
- Netherlands Organisation for Applied Scientific Research TNO, Risk Analysis for Products in Development, Utrecht, the Netherlands
| | | | - Anjoeka Pronk
- Netherlands Organisation for Applied Scientific Research TNO, Risk Analysis for Products in Development, Utrecht, the Netherlands
| | - Lode Godderis
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium; Idewe, External Service for Prevention and Protection at work, Heverlee, Belgium.
| | - Manosij Ghosh
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium.
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11
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Adav SS, Ng KW. Recent omics advances in hair aging biology and hair biomarkers analysis. Ageing Res Rev 2023; 91:102041. [PMID: 37634889 DOI: 10.1016/j.arr.2023.102041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/27/2023] [Accepted: 08/23/2023] [Indexed: 08/29/2023]
Abstract
Aging is a complex natural process that leads to a decline in physiological functions, which is visible in signs such as hair graying, thinning, and loss. Although hair graying is characterized by a loss of pigment in the hair shaft, the underlying mechanism of age-associated hair graying is not fully understood. Hair graying and loss can have a significant impact on an individual's self-esteem and self-confidence, potentially leading to mental health problems such as depression and anxiety. Omics technologies, which have applications beyond clinical medicine, have led to the discovery of candidate hair biomarkers and may provide insight into the complex biology of hair aging and identify targets for effective therapies. This review provides an up-to-date overview of recent omics discoveries, including age-associated alterations of proteins and metabolites in the hair shaft and follicle, and highlights the significance of hair aging and graying biomarker discoveries. The decline in hair follicle stem cell activity with aging decreased the regeneration capacity of hair follicles. Cellular senescence, oxidative damage and altered extracellular matrix of hair follicle constituents characterized hair follicle and hair shaft aging and graying. The review attempts to correlate the impact of endogenous and exogenous factors on hair aging. We close by discussing the main challenges and limitations of the field, defining major open questions and offering an outlook for future research.
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Affiliation(s)
- Sunil S Adav
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Kee Woei Ng
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore; Nanyang Environment and Water Research Institute, Nanyang Technological University, 1 Cleantech Loop, CleanTech One, 637141, Singapore.
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12
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Otridge J, Meyer JS, Dettmer AM. Amniotic fluid cortisol predicts neonatal and infant development in non-stressed rhesus monkeys: Implications for prenatal stress. Neurotoxicol Teratol 2023; 100:107308. [PMID: 37890675 PMCID: PMC10872548 DOI: 10.1016/j.ntt.2023.107308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
Prenatal stress adversely affects offspring development, with fetal cortisol (CORT) exposure being a primary hypothesized mechanism for stress-induced developmental deficits. Fetal CORT exposure can be assessed via measurements in amniotic fluid. However, in humans, amniocentesis is typically only performed for clinical reasons such as karyotyping; thus, amniotic fluid CORT cannot be obtained from a random sample. To test the hypothesis that fetal CORT exposure predicts neonatal and infant development in healthy primates, we measured amniotic fluid CORT in N = 18 healthy rhesus macaque (Macaca mulatta) dams (50:50 female:male infants) between 80 and 124 days gestation (mean ± SEM = 98.3 ± 2.9 days out of 165 days gestational length; i.e., second trimester). Maternal hair cortisol concentrations (HCCs) were assessed throughout pregnancy and lactation. Offspring were assessed for physical growth, neurological development, cognitive development, and HCCs across postnatal days 30-180. Controlling for gestational age at amniocentesis, higher amniotic fluid CORT significantly predicted slower infant growth rate (g/day) in the first 30 days (β = -0.19; R2 = 0.71, p = .008), poorer sensorimotor scores on the day 30 neonatal assessment (β = -0.28; R2 = 0.76, p = .015), and longer time to complete training (β = 0.48; R2 = 0.54, p = .026), but better performance (β = 0.91; R2 = 0.60, p = .011) on a discrimination cognitive task at 120-180 days. Amniotic fluid CORT was not associated with maternal or infant HCCs. Although these results are correlative, they raise the intriguing possibility that fetal CORT exposure in non-stress-exposed primates, as measured by amniotic fluid CORT, programs multiple aspects of neonatal and infant development. On the other hand, amniotic fluid CORT may not relate to chronic CORT levels in either mothers or infants when assessed by hair sampling.
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Affiliation(s)
| | - Jerrold S Meyer
- Department of Psychological & Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Amanda M Dettmer
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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13
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Lawton R, Frankenberg E, Seeman T, Crimmins E, Sumantri C, Thomas D. Exposure to the Indian Ocean Tsunami shapes the HPA-axis resulting in HPA "burnout" 14 years later. Proc Natl Acad Sci U S A 2023; 120:e2306497120. [PMID: 37844215 PMCID: PMC10622908 DOI: 10.1073/pnas.2306497120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/29/2023] [Indexed: 10/18/2023] Open
Abstract
Despite significant research on the effects of stress on the hypothalamic-pituitary-adrenal (HPA) axis, questions remain regarding long-term impacts of large-scale stressors. Leveraging data on exposure to an unanticipated major natural disaster, the 2004 Indian Ocean tsunami, we provide causal evidence of its imprint on hair cortisol levels fourteen years later. Data are drawn from the Study of the Tsunami Aftermath and Recovery, a population-representative longitudinal study of tsunami survivors who were living along the coast of Aceh, Indonesia, when the tsunami hit. Annual rounds of data, collected before, the year after and 2 y after the disaster provide detailed information about tsunami exposures and self-reported symptoms of post-traumatic stress. Hair samples collected 14 y after the tsunami from a sample of adult participants provide measures of cortisol levels, integrated over several months. Hair cortisol concentrations are substantially and significantly lower among females who were living, at the time of the tsunami, in communities directly damaged by the tsunami, in comparison with similar females living in other, nearby communities. Differences among males are small and not significant. Cortisol concentrations are lowest among those females living in damaged communities who reported elevated post-traumatic stress symptoms persistently for two years after the tsunami, indicating that the negative effects of exposure were largest for them. Low cortisol is also associated with contemporaneous reports of poor self-rated general and psychosocial health. Taken together, the evidence points to dysregulation in the HPA axis and "burnout" among these females fourteen years after exposure to the disaster.
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Affiliation(s)
- Ralph Lawton
- Graduate School of Arts and Sciences, Harvard University, Cambridge, MA02115
| | | | - Teresa Seeman
- Department of Medicine, Division of Geriatrics, University of California, Los Angeles, CA90095
| | - Eileen Crimmins
- Andrus Gerontology Center, Davis School of Gerontology, University of Southern California, Los Angeles, CA90089
| | | | - Duncan Thomas
- Department of Economics, Duke University, Durham, NC27708
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Singh Solorzano C, Serwinski B, Grano C, Steptoe A. Longitudinal association between saliva and hair cortisol concentration: A systematic comparison. Psychoneuroendocrinology 2023; 156:106340. [PMID: 37524026 DOI: 10.1016/j.psyneuen.2023.106340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/15/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
Cortisol assays from hair have become increasingly common in psychoneuroendocrinological research as indicators of long-term output relevant to stress and health outcomes. Comparisons of hair cortisol concentration (HCC) with salivary samples have produced mixed findings, and it remains unclear which aspects of the diurnal salivary profile correspond most closely to HCC, and what time intervals between saliva and hair sampling are most relevant, taking the rate of hair growth into account. This longitudinal study aimed to evaluate the correspondence between HCC and parameters of total salivary cortisol output in the morning (CARauc and CARi) and during the rest of the day excluding the early morning period (DAYauc), by systematically studying three time periods - two weeks, four weeks, and six weeks - before hair sampling. At each time period, 54 female university students (mean age: 20.85 ± 1.16 years) provided three saliva cortisol samples on day 1 at 11 am, 3 pm, at bedtime, then two samples the following day on waking and 30 min after awakening. Hair strand collection (1 cm nearest the scalp) took place two weeks after the last saliva sample. Results of multivariable regressions indicate that HCC was consistently associated with DAYauc for all three time periods and with the aggregate DAYauc across days after adjusting for age, body mass index, smoking, oral contraceptive use, hair washing frequency and hair treatments. The strongest associations were found for DAYauc two weeks before hair sampling (β = 0.578, p < 0.001) and the aggregated DAYauc across all three time periods (β = 0.596, p < 0.001), although the confidence intervals overlapped those for four and six week analyses. There was no significant association between HCC and either CARauc or CARi. Our study confirms that hair cortisol could be a reliable retrospective biomarker of basal and long-term cortisol output secretion at least up to six weeks earlier. The results contribute to a better understanding of the different associations between HCC and salivary cortisol in the morning and the rest of the day, while also having implications for the use of HCC as an outcome measure in intervention and treatment research.
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Affiliation(s)
- Claudio Singh Solorzano
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK; Department of Psychology, Sapienza University, Via dei Marsi 78, Rome 00185, Italy.
| | - Bianca Serwinski
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK; Northeastern University London, Devon House, 58 St Katharine's Way, London E1W 1LP, UK
| | - Caterina Grano
- Department of Psychology, Sapienza University, Via dei Marsi 78, Rome 00185, Italy
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
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Davis SL, Latimer M, Rice M. Biomarkers of Stress and Inflammation in Children. Biol Res Nurs 2023; 25:559-570. [PMID: 37010976 PMCID: PMC10626617 DOI: 10.1177/10998004231168805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Background: Children are increasingly exposed to stressors that can affect their immune function. Given the possible negative effects of stress and inflammation on health, researchers need to use appropriate biomarkers to measure both the effects of stress and subsequent inflammatory responses. Purpose: The purpose of this paper is to briefly review stress and inflammatory pathways, identify biomarkers used to measure chronic stress and chronic inflammation particularly in children in clinical and community settings, and to discuss methodological considerations when measuring stress and inflammation in children. Discussion: Biomarkers of chronic stress can be classified as central, meaning they are made in the brain, or peripheral, meaning they are made in the peripheral tissues in response to central signals. The peripheral biomarker, cortisol, is most frequently used in the community setting. In addition, indirect measures, such as oxytocin, may complement the assessment of stress. Common biomarkers of chronic inflammation in children are C-reactive protein (CRP), TNF-α, and IL-6. Similarly, indirect biomarkers of chronic inflammation, such as IL-2 and IL-1β, may also be considered. Conclusions: Various types of specimens can be used to measure these biomarkers of stress and inflammation including blood, saliva, urine, sweat, hair, nails, and tears. Each type of specimen has different requirements for collection, storage, and assay. Future research would benefit from standardized biomarker levels across age and development in children and incorporation of other biomarkers.
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Affiliation(s)
- Sara L. Davis
- College of Nursing, University of South Alabama, Mobile, AL, USA
| | - Mary Latimer
- School of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marti Rice
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Yoo JY, McSkimming D, Rajan K, Sarkar A, Labbé N, Groer M, Menon U. A Preliminary Study Exploring the Relationship between Occupational Health Hazards and Gut Microbiota among Firefighters. Life (Basel) 2023; 13:1928. [PMID: 37763331 PMCID: PMC10533145 DOI: 10.3390/life13091928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Firefighters are exposed to occupational hazards and have a higher prevalence of health issues. The gut microbiota plays a crucial role in the immune, endocrine, and neural systems, and disruptions in its composition can impact health outcomes. This pilot study aimed to investigate the potential association between occupational factors, changes in gut microbiota, and the development of adverse health outcomes in firefighters. To test this hypothesis, we recruited 15 firefighters and age/sex-matched controls to investigate the relationship between occupational environment and gut microbiota. Firefighters exhibit lower intestinal bacterial alpha diversity and a higher presence of pathogenic bacteria than the control. Moreover, unique gut bacterial taxa were observed in firefighters with high post-traumatic stress disorder (PTSD) scores, which could contribute to immune dysregulation and higher susceptibility to pathogen colonization. These preliminary findings suggest that occupational factors, including exposure to traumatic stressors and chemicals, may influence firefighters' health by modulating their gut microbiota. The observed changes in gut microbiota composition and the potential link to occupational hazards highlight the need for further research in larger sample-size studies. Understanding the role of gut microbiota in firefighter health may have implications for preventive measures and interventions to mitigate occupational health risks and improve overall well-being.
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Affiliation(s)
- Ji Youn Yoo
- College of Nursing, University of Tennessee Knoxville, Knoxville, TN 37996, USA; (A.S.); (M.G.)
| | - Daniel McSkimming
- Interdisciplinary Unit in Data Science & Analytics, Buffalo State University, Buffalo, NY 14222, USA;
| | - Kalavathy Rajan
- Department of Plant and Soil Science, Fiber and Biopolymer Research Institute, Texas Tech University, Lubbock, TX 79403, USA;
| | - Anujit Sarkar
- College of Nursing, University of Tennessee Knoxville, Knoxville, TN 37996, USA; (A.S.); (M.G.)
| | - Nicole Labbé
- Center for Renewable Carbon, The University of Tennessee Institute of Agriculture, Knoxville, TN 37996, USA;
| | - Maureen Groer
- College of Nursing, University of Tennessee Knoxville, Knoxville, TN 37996, USA; (A.S.); (M.G.)
| | - Usha Menon
- College of Nursing, University of South Florida, Tampa, FL 33612, USA;
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Stromájer GP, Csima M, Iváncsik R, Varga B, Takács K, Stromájer-Rácz T. Stress and Anxiety among High School Adolescents: Correlations between Physiological and Psychological Indicators in a Longitudinal Follow-Up Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1548. [PMID: 37761509 PMCID: PMC10529881 DOI: 10.3390/children10091548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
Mental and psychological disorders are serious health problems worldwide. Anxiety among high school students can affect school performance, relationships, and family life. OBJECTIVE Our aim is to understand the anxiety levels and associated factors among high school students and compare the results of psychological tests measuring anxiety with the cortisol levels obtained from biological sampling. METHOD In our longitudinal follow-up study, we involved 125 individuals in May 2019. Validated measurement tools were used during questionnaire data collection, including the State-Trait Anxiety Inventory, Clear Communication Scale, Multiple Social Perceived Support Scale, and related HBSC questions. As objective data, we collected hair samples for cortisol level measurement. RESULTS At the end of the school year, the anxiety levels measured by psychological tests were significantly higher (p = 0.001) compared to the anxiety levels at the beginning of the next school year. Anxiety levels were higher among girls and were influenced by the type of school and parental expectations. Both state anxiety and trait anxiety showed a strong correlation with psychosomatic symptoms (p < 0.001) and anxiety arising from school expectations (p < 0.05). The changes in cortisol levels did not follow the changes in psychological tests. Cortisol level increased (p = 0.01) in the second sample.
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Affiliation(s)
- Gábor Pál Stromájer
- Institute of Basics of Health Sciences, Midwifery and Health Visiting, Faculty of Health Sciences, University of Pécs, H-7621 Pécs, Hungary; (G.P.S.); (B.V.); (K.T.)
| | - Melinda Csima
- Institute of Education, Hungarian University of Agriculture and Life Sciences, H-7400 Kaposvár, Hungary; (M.C.); (R.I.)
| | - Réka Iváncsik
- Institute of Education, Hungarian University of Agriculture and Life Sciences, H-7400 Kaposvár, Hungary; (M.C.); (R.I.)
| | - Bernadett Varga
- Institute of Basics of Health Sciences, Midwifery and Health Visiting, Faculty of Health Sciences, University of Pécs, H-7621 Pécs, Hungary; (G.P.S.); (B.V.); (K.T.)
| | - Krisztina Takács
- Institute of Basics of Health Sciences, Midwifery and Health Visiting, Faculty of Health Sciences, University of Pécs, H-7621 Pécs, Hungary; (G.P.S.); (B.V.); (K.T.)
| | - Tímea Stromájer-Rácz
- Institute of Diagnostic, Faculty of Health Sciences, University of Pécs, H-7621 Pécs, Hungary
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18
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Anderson AR, Mahajan I, Ford JL, Wright KD, Mackos AR, Rose KM, Monroe TB, Moss KO. Dyadic Hair Cortisol Self-Collection Procedure. Nurs Res 2023; 72:404-408. [PMID: 37625184 PMCID: PMC10463209 DOI: 10.1097/nnr.0000000000000672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND At-home self-collection of specimens has become more commonplace because of measures taken in response to the coronavirus pandemic. Self-collection of hair cortisol is important because chronic stress is present in many populations, such as older adults living with Alzheimer's disease and their family caregivers. For the evaluation of chronic stress, scalp hair can be used as a predictive biomarker because it examines the cumulative, retrospective stress from previous months. OBJECTIVES The aim of the paper is to provide a study procedure for at-home, scalp hair self-collection for cortisol concentration analysis from dyads consisting of a person living with Alzheimer's disease and their family caregiver. METHODS After informed electronic consent is obtained, a package containing the necessary tools for self-collection of hair samples from the dyad is mailed to the participant's home. Participants are provided detailed print and video multimedia guides outlining how to obtain the hair samples. Ideally, the hair samples are obtained during the virtual data collection meeting with research personnel. Participants mail back the hair sample in a prepaid package to the biomedical laboratory for analysis. DISCUSSION At-home, self-collection of hair provides potential advantages such as reduced participant burden, especially for vulnerable populations where transportation and different environments are challenging. At-home sample collection options may increase research participation and can be applied to multiple research foci. Research considerations for dyads, such as people living with Alzheimer's disease and their caregivers, are discussed.
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White S, Mauer R, Lange C, Klimecki O, Huijbers W, Wirth M. The effect of plasma cortisol on hippocampal atrophy and clinical progression in mild cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12463. [PMID: 37583892 PMCID: PMC10423926 DOI: 10.1002/dad2.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/19/2023] [Accepted: 07/01/2023] [Indexed: 08/17/2023]
Abstract
Introduction Both elevated cortisol and hippocampal volume have been linked to an increased risk for the development of Alzheimer's disease (AD). This longitudinal study assessed the effects of plasma cortisol on hippocampal atrophy and clinical progression rates in patients with mild cognitive impairment (MCI). Methods Patients with amnestic MCI (n = 304) were selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) based on availability of baseline plasma cortisol and hippocampal volume measures, assessed at baseline and during follow-ups. We investigated associations between plasma cortisol, hippocampal volume, and risk of clinical progression to AD over a study period of up to 100 months (mean follow-up time 36.8 months) using linear mixed models, Cox proportional hazards models, and Kaplan-Meier estimators. Results Plasma cortisol predicted greater hippocampal atrophy, such that participants with higher cortisol showed faster decline in hippocampal volume over time (interaction: β = -0.15, p = 0.004). Small hippocampal volume predicted a higher risk of clinical progression to AD (haard ratio [HR] = 2.15; confidence in terval [CI], 1.64-2.80; p < 0.001). A similar effect was not found for cortisol (HR = 1.206; CI, 0.82-1.37; p = 0.670) and there was no statistical evidence for an interaction between hippocampal volume and cortisol on clinical progression (HR = 0.81; CI, 0.57-0.17; p = 0.260). Discussion Our findings suggest that higher cortisol predicts higher hippocampal atrophy, which in turn is a risk factor for progression to AD. Regulation of the hypothalamic-pituitary-adrenal axis through stress-reducing lifestyle interventions might be a protective factor against hippocampal degeneration at the prodromal stage of AD.
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Affiliation(s)
- Silke White
- German Center for Neurodegenerative Diseases (DZNE)DresdenSaxonyGermany
| | - René Mauer
- Institute for Medical Informatics and BiometryFaculty of MedicineDresden University of TechnologyDresdenSaxonyGermany
| | - Catharina Lange
- Department of Nuclear MedicineCharité—Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Olga Klimecki
- German Center for Neurodegenerative Diseases (DZNE)DresdenSaxonyGermany
| | | | - Miranka Wirth
- German Center for Neurodegenerative Diseases (DZNE)DresdenSaxonyGermany
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Falco A, Girardi D, Elfering A, Peric T, Pividori I, Dal Corso L. Is Smart Working Beneficial for Workers' Wellbeing? A Longitudinal Investigation of Smart Working, Workload, and Hair Cortisol/Dehydroepiandrosterone Sulfate during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6220. [PMID: 37444069 PMCID: PMC10341102 DOI: 10.3390/ijerph20136220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/23/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Building on the job demands-resources (JD-R) and allostatic load (AL) models, in the present study we examined the role of smart working (SW) in the longitudinal association between workload/job autonomy (JA) and a possible biomarker of work-related stress (WRS) in the hair-namely, the cortisol-dehydroepiandrosterone sulfate (DHEA(S)) ratio-during the COVID-19 pandemic. Overall, 124 workers completed a self-report questionnaire (i.e., psychological data) at Time 1 (T1) and provided a strand of hair (i.e., biological data) three months later (Time 2, T2). Results from moderated multiple regression analysis showed that SW at T1 was negatively associated with the hair cortisol/DHEA(S) ratio at T2. Additionally, the interaction between workload and SW was significant, with workload at T1 being positively associated with the hair cortisol/DHEA(S) ratio at T2 among smart workers. Overall, this study indicates that SW is a double-edged sword, with both positive and negative consequences on employee wellbeing. Furthermore, our findings suggest that the hair cortisol/DHEA(S) ratio is a promising biomarker of WRS. Practical implications that organizations and practitioners can adopt to prevent WRS and promote organizational wellbeing are discussed.
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Affiliation(s)
- Alessandra Falco
- FISPPA Section of Applied Psychology, University of Padua, 35131 Padua, Italy
| | - Damiano Girardi
- FISPPA Section of Applied Psychology, University of Padua, 35131 Padua, Italy
| | - Achim Elfering
- Institute of Psychology, University of Bern, 3012 Bern, Switzerland
| | - Tanja Peric
- Department of Agricultural, Environmental and Animal Sciences, University of Udine, 33100 Udine, Italy
| | - Isabella Pividori
- Department of Agricultural, Environmental and Animal Sciences, University of Udine, 33100 Udine, Italy
| | - Laura Dal Corso
- FISPPA Section of Applied Psychology, University of Padua, 35131 Padua, Italy
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Portella MJ, González-González I, Jubero M, Trujols J, Pérez V. Depressive-Like Effects of Foreclosing: A Cross-Sectional Study of Hair Cortisol Concentration. Psychopathology 2023; 57:10-17. [PMID: 37331349 DOI: 10.1159/000530706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/12/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Foreclosing and home eviction have been associated with various negative health outcomes, probably due to exposure to such stressful circumstance, but there is no evidence about foreclosure and home eviction to elicit cortisol responses. METHODS Participants who recently had received a court eviction notice were compared to subjects suffering a depressive disorder and to healthy controls in terms of hair cortisol concentrations. RESULTS Subjects under the stressful circumstance of foreclosure and patients with depression showed comparable concentrations in most of the hair segments while healthy subjects displayed the lowest levels of cortisol. CONCLUSION The findings show that foreclosure and home eviction are associated with increased cumulative hair cortisol and with depressive-like symptoms. Foreclosing procedures yielded to maintain high levels of cortisol which may increase the risk to develop major depression.
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Affiliation(s)
- Maria J Portella
- Mental Health, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | - Miriam Jubero
- Mental Health, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Joan Trujols
- Mental Health, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Víctor Pérez
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- INAD Parc de Salut Mar, Barcelona, Spain
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Juvinao-Quintero DL, Larrabure-Torrealva GT, Sanchez SE, Kirschbaum C, Williams MA, Gelaye B. Maternal hair cortisol concentrations and its association with increased insulin resistance in midpregnancy. Ann Epidemiol 2023; 81:14-23.e8. [PMID: 36841381 PMCID: PMC10204096 DOI: 10.1016/j.annepidem.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/01/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
PURPOSE Stress and elevated maternal glycemia have negative effects on pregnancy. We evaluated the association of hair cortisol concentrations (HCC), a marker of chronic stress, with insulin resistance and gestational diabetes (GDM). METHODS In total, 527 women from Lima, Peru, provided a hair sample in the second trimester of their pregnancy to measure HCC using liquid chromatography-tandem mass spectrometry. Each 6 cm of hair captured HCC in early (T1=1-12 weeks) and midpregnancy (T2 = 13-24 weeks). GDM diagnosis was conducted in midpregnancy. Multivariable regression models adjusted for putative risk factorsincluding maternal sociodemographic factors, diabetes history, and hair characteristics, were used to estimate the association of HCC with GDM and various glycemic traits. RESULTS GDM was diagnosed in 122 (23%) women. Mean HCC across pregnancy was T1 = 3.7 (±3.4) pg/mg and T2 = 4.8 (±3.4) pg/mg. HCC was associated with increased log-transformed units of fasting insulin (T1 = 0.15 [0.03, 0.27], T2 = 0.17 [0.04, 0.30]), homeostasis model assessment for insulin resistance (T1 = 0.14 [0.01, 0.26], T2 = 0.17 [0.03, 0.30]), and homeostasis model assessment for β-cell function (T1 = 0.20 [0.05, 0.34], T2 = 0.20 [0.04, 0.36]), but not with GDM (T1 = 0.95 [0.63, 1.40], T2 = 1.11 [0.74, 1.67]). CONCLUSIONS Elevated maternal HCC was associated with abnormal insulin homeostasis in pregnancy. Dysregulation of the hypothalamic-pituitary-adrenal axis, as reflected by high HCC, may also contribute to insulin resistance syndrome in pregnancy.
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Affiliation(s)
| | - Gloria T Larrabure-Torrealva
- Departamento Académico de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Perú; Instituto Nacional Materno Perinatal, Lima, Perú
| | - Sixto E Sanchez
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Instituto de Investigación, Lima, Perú; Asociación Civil PROESA, Lima, Perú
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; The Chester M. Pierce, M.D. Division of Global Psychiatry, Massachusetts General Hospital, Boston; Center for Bioethics, Harvard Medical School, Boston, MA
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Kaur S, Gupta N, Malhotra BD. Recent developments in wearable & non-wearable point-of-care biosensors for cortisol detection. Expert Rev Mol Diagn 2023; 23:217-230. [PMID: 36880128 DOI: 10.1080/14737159.2023.2184260] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Cortisol is one of the most prominent biomarkers used for the detection of psychological stress and related disorders. It plays an important role in many physiological processes including immunomodulation and fat metabolism. Thus, monitoring of cortisol levels can be used to indicate different pathological conditions including stress disorders. There has been a gradual rise in the development of point of care (PoC) biosensors for continuous cortisol monitoring. AREAS COVERED This review discusses recent breakthroughs toward the development of PoC sensors (wearable and non wearable) for cortisol monitoring. Challenges associated with them have also been summarized. EXPERT OPINION Electrochemical PoC devices have recently emerged as a powerful tools for continuous monitoring of cortisol that can be utilized for stress management and treatment of related disorders. However, there are many challenges that should be addressed before such devices can be deployed at mass level, such as inter-individual variability, changing the device calibration with the circadian rhythm, interference from other endocrine moieties, etc. [Figure: see text].
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Affiliation(s)
- Simran Kaur
- Nanobioelectronics Lab, Department of Biotechnology, Delhi Technological University, Delhi, INDIA
| | - Niharika Gupta
- Nanobioelectronics Lab, Department of Biotechnology, Delhi Technological University, Delhi, INDIA
| | - Bansi D Malhotra
- Nanobioelectronics Lab, Department of Biotechnology, Delhi Technological University, Delhi, INDIA.,Biomedical Instrumentation Section, CSIR-National Physical Laboratory, New Delhi, India
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Integrative and Mechanistic Approach to the Hair Growth Cycle and Hair Loss. J Clin Med 2023; 12:jcm12030893. [PMID: 36769541 PMCID: PMC9917549 DOI: 10.3390/jcm12030893] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
The hair cycle is composed of four primary phases: anagen, catagen, telogen, and exogen. Anagen is a highly mitotic phase characterized by the production of a hair shaft from the hair follicle, whereas catagen and telogen describe regression and the resting phase of the follicle, respectively, ultimately resulting in hair shedding. While 9% of hair follicles reside in telogen at any time, a variety of factors promote anagen to telogen transition, including inflammation, hormones, stress, nutritional deficiency, poor sleep quality, and cellular division inhibiting medication. Conversely, increased blood flow, direct stimulation of the hair follicle, and growth factors promote telogen to anagen transition and subsequent hair growth. This review seeks to comprehensively describe the hair cycle, anagen and telogen balance, factors that promote anagen to telogen transition and vice versa, and the clinical utility of a variety of lab testing and evaluations. Ultimately, a variety of factors impact the hair cycle, necessitating a holistic approach to hair loss.
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Finnerty R, McWeeny S, Trainor L. Online group music therapy: proactive management of undergraduate students' stress and anxiety. Front Psychiatry 2023; 14:1183311. [PMID: 37151974 PMCID: PMC10160410 DOI: 10.3389/fpsyt.2023.1183311] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/30/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction In alignment with the World Health Organization's (WHO) goal to provide comprehensive and integrated mental health services in community-based settings, this randomized control trial explored the efficacy of online group music therapy as a proactive intervention for reducing stress and anxiety in university students who do not necessarily have a diagnosis. Methods The study took place during COVID-19 restrictions. Students who volunteered were randomly assigned to 6 weeks of weekly (1) online active group music therapy, (2) online receptive group music therapy, (3) online group verbal therapy (standard of care), or (4) no-intervention (control group). Students rated their stress (Likert scale) and anxiety [State-Trait Anxiety Inventory, State version (STAI-S)], and provided heart rate variability (HRV) using a phone app, pre and post each therapy session. Results STAI-S and Likert stress scores significantly reduced from pre to post 45-min online music therapy sessions, with moderate evidence that these changes did not differ from the standard of care (verbal therapy). HRV results were not analyzed statistically as HRV collection was likely compromised due to challenges of remote collection. Students completed the Perceived Stress Scale (PSS) and provided a hair sample for cortisol analysis before and after the 6-week intervention. Changes in stress from week 1 to week 6 were not observed in the PSS measure; however, cortisol increased significantly in the control group as the term progressed, while it remained relatively stable in the therapy groups, suggesting therapy may lead to greater control of stress. Of participants' demographic characteristics, music sophistication, personality, and changes in quality of life, only the personality trait of conscientiousness correlated significantly with PSS, suggesting online group therapy may be beneficial for a wide range of university students. Discussion The results suggest group music therapy can be as effective as group verbal therapy. Further, the study indicates that online delivery can be achieved effectively, supporting the idea that remote therapy may be a viable option for other populations. While the study should be replicated with a larger multi-site sample, it provides one example toward achieving a health-promoting culture on university campuses, consistent with the mental health goals of the Okanagan Charter.
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Affiliation(s)
- Rachael Finnerty
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
- *Correspondence: Rachael Finnerty,
| | - Sean McWeeny
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Laurel Trainor
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Music and the Mind, Faculty of Science, McMaster University, Hamilton, ON, Canada
- Rotman Research Institute, Baycrest Hospital, Toronto, ON, Canada
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Toly VB, Fiala M, Shi S. Self-collection of hair samples during the COVID-19 pandemic. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 12:100156. [PMID: 35990595 PMCID: PMC9375250 DOI: 10.1016/j.cpnec.2022.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose Due to the COVID-19 Pandemic, public health restrictions were implemented that required study protocol revisions for our collection of hair cortisol samples from in-person to self-collection. The purpose is to provide descriptions of the protocol transition process from in-person hair cortisol sample collection to participant self-collection using written and video instructions as well as the acceptability and feasibility of this transition. Main results The protocol transition required revisions to the written instructions with a link to a newly developed video for hair sample self-collection. There was little difference in the initial participant agreement to provide a hair sample between in-person (79/114; 69.3%) versus self-collection (254/417; 60.9%) protocol methods. Some participants were initially hesitant to provide a self-collected hair sample but commented that self-collection was easier than they anticipated which supports the acceptability of this protocol change. However, regarding feasibility, 16.8% of participant self-collected hair samples were not received by study staff despite reminders (14.3%) or there was an issue with mail delivery or return (2.5%). Major conclusions The transition of our hair sample collection protocol from in-person to self-collection was acceptable and feasible. Providing instructions for hair sample self-collection in a variety of formats (oral, written, video) helped to decrease uncertainty and hesitancy regarding the process and promote agreement among participants. In addition, consistent follow-up communication was key to timely receipt of the hair samples from participants.
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Affiliation(s)
- Valerie Boebel Toly
- Arline H. and Curtis F. Garvin Professorship in Nursing Excellence, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave. Cleveland, Ohio, 44106, USA
| | - Marisa Fiala
- Arline H. and Curtis F. Garvin Professorship in Nursing Excellence, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave. Cleveland, Ohio, 44106, USA
| | - Sophie Shi
- Arline H. and Curtis F. Garvin Professorship in Nursing Excellence, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave. Cleveland, Ohio, 44106, USA
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Wuttke-Linnemann A, Palm S, Geschke K, Skoluda N, Bischoff T, Nater UM, Endres K, Fellgiebel A. Psychobiological Evaluation of Day Clinic Treatment for People Living With Dementia – Feasibility and Pilot Analyses. Front Aging Neurosci 2022; 14:866437. [PMID: 35847670 PMCID: PMC9279127 DOI: 10.3389/fnagi.2022.866437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background Hospitalization is often stressful and burdensome for people living with dementia (PwD) and their informal caregivers (ICs). Day clinic treatment may provide a suitable alternative, but is often precluded by a diagnosis of dementia. Furthermore, it is often caregiver-based ratings that measure treatment success as the validity of self-reports in PwD is critically discussed. We therefore set out to examine the feasibility of psychobiological stress measures in PwD and ICs and to evaluate treatment trajectories considering both the day clinic context and the daily life of the dyads. Method A total of 40 dyads of PwD (mean age: 78.15 ± 6.80) and their ICs (mean age: 63.85 ± 13.09) completed paper-and-pencil questionnaires (covering stress, depressive symptoms, and caregiver burden among others) in addition to the measurement of hair cortisol concentrations (HCC) at admission, discharge, and follow-up 6 months after day clinic treatment. As part of an ambulatory assessment, for 2 days at the beginning and 2 days at the end of the day clinic treatment, PwD and ICs collected six saliva samples per day for the analysis of salivary cortisol (sCort) and alpha-amylase (sAA). Results Paper-and-pencil questionnaires and HCC assessments were more feasible than the ambulatory assessment. We found discrepancies between subjective and physiological markers of stress in PwD. Whereas HCC decreased over time, self-reported stress increased. Child–parent dyads reported decreases in neuropsychiatric symptoms, associated burden, and self-reported stress from admission to follow-up. In daily life, both PwD and ICs showed characteristic diurnal profiles of sAA and sCort, however, we found no differences in summary indicators of salivary stress markers over time. Discussion The psychobiological evaluation was feasible and added informative value, underlining the potential of physiological stress markers to complement self-reports on stress in PwD and to objectively evaluate treatment trajectories. In this sample, HCC was more feasible and acceptable as biological marker of stress compared to saliva samples. Concerning treatment trajectories, differential effects on the dyads were found, with child–parent dyads benefiting more from day clinic treatment compared to spousal dyads.
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Affiliation(s)
- Alexandra Wuttke-Linnemann
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
- *Correspondence: Alexandra Wuttke-Linnemann,
| | - Svenja Palm
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Katharina Geschke
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- Katharina Geschke,
| | - Nadine Skoluda
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
- University Research Platform “The Stress of Life (SOLE) – Processes and Mechanisms Underlying Everyday Life Stress”, University of Vienna, Vienna, Austria
| | - Theresa Bischoff
- Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Urs M. Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
- University Research Platform “The Stress of Life (SOLE) – Processes and Mechanisms Underlying Everyday Life Stress”, University of Vienna, Vienna, Austria
| | - Kristina Endres
- Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Fellgiebel
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- Hospital for Psychiatry, Psychosomatic and Psychotherapy, Agaplesion Elisabethenstift, Darmstadt, Germany
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Richards EL, Wright KD, Richards Adams IK, Klatt MD, Monroe TB, Nguyen CM, Rose KM. Hair Cortisol Concentration, Perceived Stress, Mental Well-Being, and Cardiovascular Health in African American Older Adults: A Pilot Study. Geriatrics (Basel) 2022; 7:geriatrics7030053. [PMID: 35645276 PMCID: PMC9149889 DOI: 10.3390/geriatrics7030053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/12/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: African Americans experience high rates of psychological stress and hypertension, which increases their risk of cardiovascular disease with age. Easy-to-collect psychological and biological stress data are valuable to investigations of this association. Hair cortisol concentration (HCC), as a proxy biomarker of chronic stress exposure, provides such advantages in contrast to collection of multiple daily samples of saliva. Objective: To examine the relationships among HCC, perceived stress, mental well-being, and cardiovascular health (systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)). (2) Methods: Cross-sectional secondary data (N = 25) were used from a mind–body intervention study in hypertensive African Americans ages 65 and older. Data included HCC, a four-item perceived stress scale, SF-36 mental components summary, and SBP/DBP. SBP + 2 (DBP)/3 was used to calculate MAP. (3) Results: The relationship between mental well-being and perceived stress (r = −0.497, p ≤ 0.01) and mental well-being and DBP (r = −0.458, p = 0.02) were significant. HCC change was not significant. In a regression model, every unit increase in well-being predicted a 0.42 decrease in DBP (β = −0.42, 95% CI (−0.69–0.15)) and a 1.10 unit decrease in MAP (β = −1.10, 95% CI (−1.99–0.20)). (4) Conclusions: This study contributes to the knowledge of physiologic data regarding the relationship between MAP and well-being. Findings from this study may aid in the development of interventions that address mental well-being and cardiovascular health in African American older adults with hypertension.
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Affiliation(s)
- Ericka L. Richards
- Center for Healthy Aging, Self-Management, and Complex Care, College of Nursing, The Ohio State University, Columbus, OH 43210, USA; (E.L.R.); (T.B.M.); (K.M.R.)
| | - Kathy D. Wright
- Center for Healthy Aging, Self-Management, and Complex Care, College of Nursing, The Ohio State University, Columbus, OH 43210, USA; (E.L.R.); (T.B.M.); (K.M.R.)
- Correspondence: ; Tel.: +1-614-292-0309
| | - Ingrid K. Richards Adams
- School of Health & Rehabilitation Sciences, Medical Dietetics, The Ohio State University College of Medicine, Columbus, OH 43210, USA;
- Department of Extension, College of Food, Agricultural, and Environmental Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Maryanna D. Klatt
- Center for Integrative Health, Department of Family and Community Medicine, The Ohio State University College of Medicine, Columbus, OH 43201, USA;
| | - Todd B. Monroe
- Center for Healthy Aging, Self-Management, and Complex Care, College of Nursing, The Ohio State University, Columbus, OH 43210, USA; (E.L.R.); (T.B.M.); (K.M.R.)
| | - Christopher M. Nguyen
- Department of Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43214, USA;
| | - Karen M. Rose
- Center for Healthy Aging, Self-Management, and Complex Care, College of Nursing, The Ohio State University, Columbus, OH 43210, USA; (E.L.R.); (T.B.M.); (K.M.R.)
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Kim E, Bolkan C, Crespi E, Madigan J. Feasibility of Hair Cortisol as a Biomarker of Chronic Stress in People With Dementia. Biol Res Nurs 2022; 24:388-399. [DOI: 10.1177/10998004221090468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hair cortisol concentrations (HCC) are an innovative way to measure chronic stress relying on a small sample of hair. To date, there are no studies that have studied HCC as a biomarker of chronic stress in individuals with dementia. Given the vulnerability to chronic stress in people with dementia, using HCC as an objective measure of physiological stress in those with dementia has potential to enhance our understanding of this population. The goal of this exploratory, multidisciplinary, pilot study was to establish feasibility of HCC testing in people with dementia as a biomarker of chronic stress. HCC was examined over a 6-month period to assess physiological stress response during a transition to memory care. Newly admitted memory care residents ( n = 13, mean age = 82) were followed over 6 months. Residents’ hair samples and health information were collected at 3-month intervals. HCC levels significantly changed during the transition to memory care, which may reflect chronic physiological stress. Participants with frequent behavioral and psychological symptoms of dementia (BPSD) had significantly lower HCC at baseline and exhibited a blunted cortisol reactivity at follow-up. Based on detected changes in HCC, participants likely experienced stress reactions during the transition to memory care, providing preliminary evidence that HCC may be a useful, non-invasive measure of physiological stress in this population. This approach may also be applied to understanding the significance of person-centered care environments on minimizing chronic stress for people with dementia.
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Affiliation(s)
- Eunsaem Kim
- Mo-Im Kim Nursing Research Institute, Yonsei University Colleage of Nursing, Seoul, Korea
| | - Cory Bolkan
- Department of Human Development, Washington State University, Vancouver. WA, USA
| | - Erica Crespi
- School of Biological Sciences, Washington State University, Pullman, WA, USA
| | - Jennifer Madigan
- School of Biological Sciences, Washington State University, Pullman, WA, USA
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Rasing NL, Janus SIM, Kreutz G, Sveinsdottir V, Gold C, Nater UM, Zuidema SU. The Impact of Music on Stress Biomarkers: Protocol of a Substudy of the Cluster-Randomized Controlled Trial Music Interventions for Dementia and Depression in ELderly Care (MIDDEL). Brain Sci 2022; 12:brainsci12040485. [PMID: 35448016 PMCID: PMC9026401 DOI: 10.3390/brainsci12040485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Recently, a large cluster-randomized controlled trial was designed-Music Interventions for Dementia and Depression in ELderly care (MIDDEL)-to assess the effectiveness of music interventions on depression in care home residents with dementia (ClinicalTrials.gov NCT03496675). To understand the pathophysiological mechanisms, we observed the effect of repeated music interventions on stress in this population since chronic stress was associated with depression and an increased risk for dementia. An exploratory study was designed to assess: (1) changes in hair cortisol concentrations as an indicator of longer-term stress; (2) whether baseline stress is a predictor of therapy outcome; (3) pre- and post-treatment effects on salivary α-amylase and cortisol response as an indicator of immediate stress in 180-200 care home residents with dementia and depressive symptoms who partake in the MIDDEL trial. Insights into mediatory effects of stress to explain the effect of music interventions will be gained. Hair cortisol concentrations were assessed at baseline and at 3, 6, and 12 months along with the Perceived Stress Scale. Salivary α-amylase and cortisol concentrations were assessed at 1, 3, and 6 months. Saliva was collected just before a session and 15 and 60 min after a session, along with a stress Visual Analogue Scale.
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Affiliation(s)
- Naomi L. Rasing
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9700 AD Groningen, The Netherlands; (S.I.M.J.); (S.U.Z.)
- Correspondence:
| | - Sarah I. M. Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9700 AD Groningen, The Netherlands; (S.I.M.J.); (S.U.Z.)
| | - Gunter Kreutz
- Department of Music, Speech and Music Lab, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany;
| | - Vigdis Sveinsdottir
- NORCE Norwegian Research Centre AS, Nygårdsgaten 112, 5008 Bergen, Norway; (V.S.); (C.G.)
| | - Christian Gold
- NORCE Norwegian Research Centre AS, Nygårdsgaten 112, 5008 Bergen, Norway; (V.S.); (C.G.)
- Department of Clinical and Health Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria;
| | - Urs M. Nater
- Department of Clinical and Health Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria;
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9700 AD Groningen, The Netherlands; (S.I.M.J.); (S.U.Z.)
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Aarts E, Akkerman A, Altgassen M, Bartels R, Beckers D, Bevelander K, Bijleveld E, Blaney Davidson E, Boleij A, Bralten J, Cillessen T, Claassen J, Cools R, Cornelissen I, Dresler M, Eijsvogels T, Faber M, Fernández G, Figner B, Fritsche M, Füllbrunn S, Gayet S, van Gelder MMHJ, van Gerven M, Geurts S, Greven CU, Groefsema M, Haak K, Hagoort P, Hartman Y, van der Heijden B, Hermans E, Heuvelmans V, Hintz F, den Hollander J, Hulsman AM, Idesis S, Jaeger M, Janse E, Janzing J, Kessels RPC, Karremans JC, de Kleijn W, Klein M, Klumpers F, Kohn N, Korzilius H, Krahmer B, de Lange F, van Leeuwen J, Liu H, Luijten M, Manders P, Manevska K, Marques JP, Matthews J, McQueen JM, Medendorp P, Melis R, Meyer A, Oosterman J, Overbeek L, Peelen M, Popma J, Postma G, Roelofs K, van Rossenberg YGT, Schaap G, Scheepers P, Selen L, Starren M, Swinkels DW, Tendolkar I, Thijssen D, Timmerman H, Tutunji R, Tuladhar A, Veling H, Verhagen M, Verkroost J, Vink J, Vriezekolk V, Vrijsen J, Vyrastekova J, van der Wal S, Willems R, Willemsen A. Protocol of the Healthy Brain Study: An accessible resource for understanding the human brain and how it dynamically and individually operates in its bio-social context. PLoS One 2021; 16:e0260952. [PMID: 34965252 PMCID: PMC8716054 DOI: 10.1371/journal.pone.0260952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/20/2021] [Indexed: 12/29/2022] Open
Abstract
The endeavor to understand the human brain has seen more progress in the last few decades than in the previous two millennia. Still, our understanding of how the human brain relates to behavior in the real world and how this link is modulated by biological, social, and environmental factors is limited. To address this, we designed the Healthy Brain Study (HBS), an interdisciplinary, longitudinal, cohort study based on multidimensional, dynamic assessments in both the laboratory and the real world. Here, we describe the rationale and design of the currently ongoing HBS. The HBS is examining a population-based sample of 1,000 healthy participants (age 30–39) who are thoroughly studied across an entire year. Data are collected through cognitive, affective, behavioral, and physiological testing, neuroimaging, bio-sampling, questionnaires, ecological momentary assessment, and real-world assessments using wearable devices. These data will become an accessible resource for the scientific community enabling the next step in understanding the human brain and how it dynamically and individually operates in its bio-social context. An access procedure to the collected data and bio-samples is in place and published on https://www.healthybrainstudy.nl/en/data-and-methods/access. Trail registration:https://www.trialregister.nl/trial/7955.
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Affiliation(s)
- Healthy Brain Study consortium
- Radboud University, Nijmegen, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
- Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
| | - Esther Aarts
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Agnes Akkerman
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | | | - Ronald Bartels
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Debby Beckers
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - Erik Bijleveld
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | | | - Janita Bralten
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Toon Cillessen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Jurgen Claassen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roshan Cools
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Martin Dresler
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Myrthe Faber
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guillén Fernández
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Bernd Figner
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Matthias Fritsche
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Sascha Füllbrunn
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Surya Gayet
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | | | - Marcel van Gerven
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Sabine Geurts
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Corina U. Greven
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martine Groefsema
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Koen Haak
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Hagoort
- Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Yvonne Hartman
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Erno Hermans
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Florian Hintz
- Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
| | | | - Anneloes M. Hulsman
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Sebastian Idesis
- Center for Brain and Cognition, University Pompeu Fabra, Barcelona, Spain
| | - Martin Jaeger
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther Janse
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
| | - Joost Janzing
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roy P. C. Kessels
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johan C. Karremans
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Willemien de Kleijn
- School of Psychology and Artificial Intelligence, Radboud University, Nijmegen, The Netherlands
| | - Marieke Klein
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris Klumpers
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Nils Kohn
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hubert Korzilius
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Bas Krahmer
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris de Lange
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Judith van Leeuwen
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Huaiyu Liu
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Maartje Luijten
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Peggy Manders
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katerina Manevska
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - José P. Marques
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Jon Matthews
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - James M. McQueen
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Pieter Medendorp
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - René Melis
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antje Meyer
- Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
| | - Joukje Oosterman
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Lucy Overbeek
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marius Peelen
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Jean Popma
- Interdisciplinary Hub for Security, Privacy and Data Governance, Radboud University, Nijmegen, The Netherlands
| | - Geert Postma
- Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - Karin Roelofs
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - Gabi Schaap
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Paul Scheepers
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luc Selen
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Marianne Starren
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
| | | | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dick Thijssen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Timmerman
- University Medical Center Groningen, Groningen, The Netherlands
| | - Rayyan Tutunji
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anil Tuladhar
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harm Veling
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Maaike Verhagen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - Jacqueline Vink
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - Janna Vrijsen
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jana Vyrastekova
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | | | - Roel Willems
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
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Scalp hair sweating as a predictor of hair cortisol level in human compared to obesity and other confounders. Sci Rep 2021; 11:24160. [PMID: 34921159 PMCID: PMC8683402 DOI: 10.1038/s41598-021-02223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
Inconsistent results were found throughout the literature regarding factors affecting hair cortisol levels. Hair cortisol level in humans was not studied for its associations to scalp hair sweating or hair wash frequency in a patient-based way. Factors affecting hair cortisol levels must be precisely known in order to interpret the results correctly. The aims of the study are to assess if BMI, Perceived Stress Scale (PSS), hair wash frequency, and sweating with scalp hair affect hair cortisol levels. It will assess which of these factors are more significant predictors of hair cortisol levels. In a study on healthy adults, information about history, socio-demographics, PSS, hair wash frequency, hair treatment, and scalp hair sweating were collected, and hair samples were taken and analyzed for their hair cortisol level. Associations of hair cortisol levels with each of the variables were investigated and significant predictors of hair cortisol levels among the variables were found. Mean hair cortisol level in the study participants was 16.84 pg/mg hair. Hair cortisol has a significant positive association with weight, BMI, PSS, and scalp hair sweating, p < 0.05. Scalp hair sweating significantly predicts hair cortisol levels by 12.3%, while other variables did not significantly predict hair cortisol levels, p < 0.05. Scalp hair sweating significantly predicts hair cortisol levels. Age, hair wash frequency, hair treatment, and stressful events have no associations with hair cortisol levels. Although BMI and PSS are associated with hair cortisol levels, they do not significantly predict it. Obesity is significantly associated with profuse sweating, thus the increase in hair cortisol levels in obese individuals could partly be the result of a higher incidence of sweating in these individuals. Thus, scalp hair sweating should be taken into consideration during the study and interpretation of hair cortisol levels.
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Mathew A, Doorenbos AZ, Li H, Jang MK, Park CG, Bronas UG. Allostatic Load in Cancer: A Systematic Review and Mini Meta-Analysis. Biol Res Nurs 2021; 23:341-361. [PMID: 33138637 PMCID: PMC8755951 DOI: 10.1177/1099800420969898] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Individuals with cancer experience stress throughout the cancer trajectory. Allostatic load (AL), a cumulative multi-system measure, may have a greater value in stress assessment and the associated biological burden than individual biomarkers. A better understanding of the use of AL and its operationalization in cancer could aid in early detection and prevention or alleviation of AL in this population. PURPOSE To consolidate findings on the operationalization, antecedents, and outcomes of AL in cancer. METHODS Seven databases (CINAHL, Ovid MEDLINE, Web of Science, APA PsycInfo, Scopus, Embase, and Cochrane CENTRAL) were searched for articles published through April 2020. The NIH tools were used to assess study quality. RESULTS Twelve studies met inclusion criteria for this review. Although variability existed in the estimation of AL, biomarkers of cardiovascular, metabolic, and immune systems were mostly used. Associations of AL with cancer-specific variables were examined mostly utilizing population-databases. Significant associations of AL with variables such as cancer-related stress, positive cancer history, post traumatic growth, resilience, tumor pathology, and cancer-specific mortality were found. Mini meta-analysis found that a one-unit increase in AL was associated with a 9% increased risk of cancer-specific mortality. CONCLUSION This review reveals heterogeneity in operationalization of AL in cancer research and lack of clarity regarding causal direction between AL and cancer. Nevertheless, AL holds a significant promise in cancer research and practice. AL could be included as a screening tool for high-risk individuals or a health outcome in cancer. Optimal standardized approaches to measure AL would improve its clinical utility.
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Affiliation(s)
- Asha Mathew
- College of Nursing, University of Illinois, Chicago, IL, USA
- College of Nursing, Christian Medical College, Vellore, India
| | - Ardith Z. Doorenbos
- College of Nursing, University of Illinois, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Hongjin Li
- College of Nursing, University of Illinois, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Min Kyeong Jang
- College of Nursing, University of Illinois, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Chang Gi Park
- College of Nursing, University of Illinois, Chicago, IL, USA
- Department of Population Health Nursing Science, Office of Research Facilitation, Chicago, IL, USA
| | - Ulf G. Bronas
- College of Nursing, University of Illinois, Chicago, IL, USA
- Laboratory of Vascular and Cognitive Health, Chicago, IL, USA
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Ren SY, Zhang YN, Wang MJC, Wen BR, Xia CY, Li X, Wang HQ, Zhang RP, Zhang Y, Wang ZZ, Chen NH. Hair growth predicts a depression-like phenotype in rats as a mirror of stress traceability. Neurochem Int 2021; 148:105110. [PMID: 34166749 DOI: 10.1016/j.neuint.2021.105110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/09/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
As a subjective mood-related disorder with an unclear mechanism, depression has many problems in its diagnosis, which offers great space and value for research. At present, the methods commonly used to judge whether an animal model of depression has been established are mainly by biochemical index detection and behavioral tests, both of which inevitably cause stress in animals. Stress-induced hair growth inhibition has been widely reported in humans and animals. The simplicity of collecting hair samples and the observable state of hair growth has significant advantages; we tried to explore whether the parameters related to hair growth could be used as auxiliary indicators to evaluate a depression model in animals. The length and weight of the hair were calculated. Correlation analysis was conducted between the depressive behavioral results and the glucocorticoid levels in hair and serum. Learned helplessness combined with chronic restraint stress, and chronic unpredictable stress in the animal were detectable by superficial observation, weight ratio, and length of hair, and follicular development scores were significantly reduced compared to the control. The hair growth parameters of rats with depression, the rise in corticosterone, and the corresponding changes in behavioral parameters were significantly correlated. The neurotrophic factors, glucocorticoid-receptor (GR), brain-derived neurotrophic factor (BDNF), fibroblast growth factor 2 (FGF2), and fibroblast growth factor 5 (FGF5), are associated with depression and hair growth. Significant differences were detected between the stress and control groups, suggesting that the mechanism underlying the stress-phenomenon inhibition of hair growth may be related to growth factor mediation.
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Affiliation(s)
- Si-Yu Ren
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces, Hunan University of Chinese Medicine, Changsha Hunan, 410208, China.
| | - Ya-Ni Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
| | - Man-Jiang-Cuo Wang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
| | - Bi-Rui Wen
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces, Hunan University of Chinese Medicine, Changsha Hunan, 410208, China.
| | - Cong-Yuan Xia
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
| | - Xun Li
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces, Hunan University of Chinese Medicine, Changsha Hunan, 410208, China.
| | - Hui-Qin Wang
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces, Hunan University of Chinese Medicine, Changsha Hunan, 410208, China.
| | - Rui-Ping Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
| | - Yi Zhang
- Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China.
| | - Zhen-Zhen Wang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
| | - Nai-Hong Chen
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces, Hunan University of Chinese Medicine, Changsha Hunan, 410208, China; State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
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Lee SH, Baldina E, Lee E, Youm Y. Social connectedness and hair cortisol in community-dwelling older adults. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 6:100053. [PMID: 35757361 PMCID: PMC9216631 DOI: 10.1016/j.cpnec.2021.100053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sung-Ha Lee
- Center for Interdisciplinary Approaches on Aging, Yonsei University, Seoul, Republic of Korea
| | - Ekaterina Baldina
- Department of Sociology, Yonsei University, Seoul, Republic of Korea
| | - Eun Lee
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoosik Youm
- Center for Interdisciplinary Approaches on Aging, Yonsei University, Seoul, Republic of Korea
- Department of Sociology, Yonsei University, Seoul, Republic of Korea
- Corresponding author. Department of Sociology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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BFF: Bayesian, Fiducial, and Frequentist Analysis of Cognitive Engagement among Cognitively Impaired Older Adults. ENTROPY 2021; 23:e23040428. [PMID: 33917284 PMCID: PMC8067417 DOI: 10.3390/e23040428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 01/04/2023]
Abstract
Engagement in cognitively demanding activities is beneficial to preserving cognitive health. Our goal was to demonstrate the utility of frequentist, Bayesian, and fiducial statistical methods for evaluating the robustness of effects in identifying factors that contribute to cognitive engagement for older adults experiencing cognitive decline. We collected a total of 504 observations across two longitudinal waves of data from 28 cognitively impaired older adults. Participants’ systolic blood pressure responsivity, an index of cognitive engagement, was continuously sampled during cognitive testing. Participants reported on physical and mental health challenges and provided hair samples to assess chronic stress at each wave. Using the three statistical paradigms, we compared results from six model testing levels and longitudinal changes in health and stress predicting changes in cognitive engagement. Findings were mostly consistent across the three paradigms, providing additional confidence in determining effects. We extend selective engagement theory to cognitive impairment, noting that health challenges and stress appear to be important moderators. Further, we emphasize the utility of the Bayesian and fiducial paradigms for use with relatively small sample sizes because they are not based on asymptotic distributions. In particular, the fiducial paradigm is a useful tool because it provides more information than p values without the need to specify prior distributions, which may unduly influence the results based on a small sample. We provide the R code used to develop and implement all models.
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Chronic unpredictable mild stress produces depressive-like behavior, hypercortisolemia, and metabolic dysfunction in adolescent cynomolgus monkeys. Transl Psychiatry 2021; 11:9. [PMID: 33414370 PMCID: PMC7791128 DOI: 10.1038/s41398-020-01132-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/05/2020] [Accepted: 12/02/2020] [Indexed: 01/29/2023] Open
Abstract
Adolescent depression is a common and serious mental disorder with unique characteristics that are distinct from adult depression. The adult non-human primate stress-induced model of depressive-like behavior is an excellent model for the study of mechanisms; however, an adolescent nonhuman primate model is still lacking. Ten male adolescent cynomolgus monkeys were divided into a chronic unpredictable mild stress (CUMS, n = 5) group and a control (CON, n = 5) group by age and weight-matched pairs. The CUMS group was exposed to multiple unpredictable mild stressors for five cycles over 55 days. At baseline, there were no differences between CUMS and CON groups. At endpoint, the CUMS group demonstrated significantly higher depressive-like behavior (huddle posture), and significantly lower locomotion compared with the CON group. Furthermore, depressive-like behavior increased from baseline to endpoint in the CUMS group, but not changed in the CON group. In the attempt for apple test, the CUMS group made significantly fewer attempts for the apple than the CON group. In the human intruder test, the CUMS group showed significantly higher anxiety-like behaviors in the stare phase than the CON group. Hair cortisol level was significantly higher in the CUMS group than the CON group at endpoint, and was also elevated from baseline to endpoint. Metabolic profiling of plasma at endpoint identified alterations in metabolite pathways which overlapped with those of adolescent depression patients. CUMS can induce depressive-like and anxiety-like behaviors, hypercortisolemia, and metabolic perturbations in adolescent cynomolgus monkeys. This is a promising model to study the mechanisms underlying adolescent depression.
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Application of Salivary Biomarkers in the Diagnosis of Fibromyalgia. Diagnostics (Basel) 2021; 11:diagnostics11010063. [PMID: 33401557 PMCID: PMC7824401 DOI: 10.3390/diagnostics11010063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022] Open
Abstract
Fibromyalgia (FM) is a highly prevalent syndrome that impairs the quality of life of the patients; however, its diagnosis is complex and mainly centered on pain symptoms. The study of salivary biomarkers has proven highly useful for the diagnosis and prognosis of numerous diseases. The objective of this review was to gather published data on the utilization of salivary biomarkers to facilitate and complement the diagnosis of FM. Salivary biomarkers used in FM diagnosis include cortisol; calgranulin; and the enzymes α-amylase, transaldolase, and phosphoglycerate mutase. Increased serum levels of C-reactive protein, cytokines interleukin 1-β, interleukin 6, interleukin 8, interleukin 10, interleukin 17, tumor necrosis factor α, and various chemokines may serve as salivary biomarkers, given observations of their increased serum levels in patients with FM. Further research is warranted to study in depth the role and performance of biomarkers currently used in FM diagnosis/prognosis and to identify novel salivary biomarkers for this disease.
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Feeney JC, O'Halloran AM, Kenny RA. The Association Between Hair Cortisol, Hair Cortisone, and Cognitive Function in a Population-Based Cohort of Older Adults: Results From The Irish Longitudinal Study on Ageing. J Gerontol A Biol Sci Med Sci 2020; 75:257-265. [PMID: 30412218 DOI: 10.1093/gerona/gly258] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 01/03/2023] Open
Abstract
Experimental evidence to date largely supports an association between the stress hormone cortisol and cognitive performance. Older adults, in particular, may be vulnerable to the neurotoxic effects of prolonged increases in cortisol; however, the assessment of chronic hormone levels has previously been challenging. Hair cortisol analysis has advantages over other cortisol metrics for this purpose as it facilitates the assessment of total hormone secretion over several months. Cortisol and cortisone were measured in the scalp hair of 1,876 older adults from The Irish Longitudinal Study on Ageing. Participants underwent a battery of cognitive tests assessing global function, memory, executive function, and processing speed. After adjustment for hair characteristics, demographics, metabolic risk factors, cardiovascular conditions, and depression, regression analysis revealed an inverse relationship of hair glucocorticoids to immediate (cortisol: β = -.12, p = .032; cortisone: β = -.021, p = .036) and delayed (cortisol: β = -.13, p = .003; cortisone: β = -.23, p = .006) word recall performance. They were also associated with more errors on the Mini-Mental State Examination (cortisol: incidence rate ratio (IRR) = 1.06, p = .008; cortisone: IRR = 1.14, p = .002) and Montreal Cognitive Assessment (cortisone: IRR = 1.06, p = .015). Higher hair glucocorticoids are inversely associated with memory and global cognition in a population-based sample of older adults. Future work should explore the prognostic significance of these findings.
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Affiliation(s)
- Joanne C Feeney
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, The University of Dublin, Trinity College, Dublin, Ireland
| | - Aisling M O'Halloran
- Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Queen's University, Belfast, UK
| | - Rose Anne Kenny
- Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Queen's University, Belfast, UK
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Abstract
The cumulative science linking stress to negative health outcomes is vast. Stress can affect health directly, through autonomic and neuroendocrine responses, but also indirectly, through changes in health behaviors. In this review, we present a brief overview of (a) why we should be interested in stress in the context of health; (b) the stress response and allostatic load; (c) some of the key biological mechanisms through which stress impacts health, such as by influencing hypothalamic-pituitary-adrenal axis regulation and cortisol dynamics, the autonomic nervous system, and gene expression; and (d) evidence of the clinical relevance of stress, exemplified through the risk of infectious diseases. The studies reviewed in this article confirm that stress has an impact on multiple biological systems. Future work ought to consider further the importance of early-life adversity and continue to explore how different biological systems interact in the context of stress and health processes.
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Affiliation(s)
- Daryl B O'Connor
- School of Psychology, University of Leeds, Leeds LS2 9JT, United Kingdom;
| | - Julian F Thayer
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, California 92697, USA;
| | - Kavita Vedhara
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom;
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Ladwig KH, Schriever SC, Atasoy S, Bidlingmaier M, Kruse J, Johar H. Association of generalized and central obesity with serum and salivary cortisol secretion patterns in the elderly: findings from the cross sectional KORA-Age study. Sci Rep 2020; 10:14321. [PMID: 32868802 PMCID: PMC7458904 DOI: 10.1038/s41598-020-71204-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/20/2020] [Indexed: 12/12/2022] Open
Abstract
The study aimed to examine the sex specific association of obesity with cortisol metabolism in a sample of older community dwelling people. The cross-sectional analysis included 394 men and 375 women (aged 65–90 years) of the population-based KORA-Age study. Multivariable regression analyses were employed to examine the association between cortisol samples (serum and salivary samples of morning after awakening (M1), 30 min later (M2) and at late night (LNSC)). Obesity was calculated as waist-to-hip ratio (WHR) and body mass index (BMI). Cortisol levels were not significantly different between obesity measures except for elevated serum cortisol (P = 0.02) levels in individuals with a low WHR. Higher M1 levels were especially apparent in women with normal BMI. Serum cortisol levels were inversely related to WHR (P = 0.004) and CARAUC was inversely associated with BMI (P = 0.007). Sex-stratified analytic models revealed that both obesity measures showed a non-linear association with cortisol diurnal pattern (M1/LNSC) in men. Impaired cortisol patterns emerged at both very ends of the body weight distribution. These findings do not support a cortisol driven obesity etiology in an older population and even point to an inverse association of body weight with cortisol levels. Differences of cortisol secretion patterns in generalized and abdominal fat distribution were marginal.
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Affiliation(s)
- Karl-Heinz Ladwig
- Mental Health Research Unit, Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany. .,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany. .,Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany.
| | - Sonja Charlotte Schriever
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.,Research Unit Neurobiology of Diabetes, Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Seryan Atasoy
- Mental Health Research Unit, Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Gießen, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik Und Poliklinik IV, Klinikum Der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Johannes Kruse
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Gießen, Germany
| | - Hamimatunnisa Johar
- Mental Health Research Unit, Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Gießen, Germany
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Adeola HA, Khumalo NP, Arowolo AT, Mehlala N. No difference in the proteome of racially and geometrically classified scalp hair sample from a South African cohort: Preliminary findings. J Proteomics 2020; 226:103892. [DOI: 10.1016/j.jprot.2020.103892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
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Martins RC, Blumenberg C, Tovo-Rodrigues L, Gonzalez A, Murray J. Effects of parenting interventions on child and caregiver cortisol levels: systematic review and meta-analysis. BMC Psychiatry 2020; 20:370. [PMID: 32669084 PMCID: PMC7362449 DOI: 10.1186/s12888-020-02777-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/05/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Nurturing care, in which children are raised in engaging and safe environments, may reduce child stress and shape hypothalamic-pituitary-adrenal axis functioning. Hence, parent-training programs may impact child cortisol levels, as well as behavioral, social and health outcomes. We conducted a systematic review of the impact of parent-training interventions on children's and caregivers' cortisol levels, and meta-analyzed the results. METHODS In January 2020, searches in PubMed, LILACS, ERIC, Web of Science, Scielo, Scopus, PsycNET and POPLINE databases were conducted, and two independent researchers screened the results for eligible studies - randomized trials that assessed the impact of parent-training interventions on child or caregiver cortisol levels. Random effects were used to pool the estimates, separately for children and caregivers, and for children's morning and evening cortisol levels, as well as change across the day. RESULTS A total of 27 eligible studies were found. Data from 19 studies were extracted and included in the meta-analyses, with 18 estimates of child cortisol levels and 5 estimates for caregiver cortisol levels. The pooled effect size (standardized mean difference) for the effects of parent training programs on morning child cortisol was 0.01 (95%CI: - 0.14 to 0.16; I2: 47.5%), and for caregivers it was 0.04 (95%CI: - 0.22 to 0.30; I2: 0.0%). Similar null results were observed for child evening cortisol and for the slope between morning and evening child cortisol. No evidence of publication bias was found. CONCLUSION Existing evidence shows no effect of parent-training interventions on child or caregiver post-intervention cortisol. Researchers are encouraged to adopt standardized protocols to improve evaluation standards, to test for intervention effects on psychosocial outcomes that are theorized to mediate the effects on biomarkers, and to use additional biomarkers for chronic stress.
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Affiliation(s)
- Rafaela Costa Martins
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS, 96020-220, Brazil.
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Cauane Blumenberg
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Luciana Tovo-Rodrigues
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS, 96020-220, Brazil
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Joseph Murray
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS, 96020-220, Brazil
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Koncz A, Demetrovics Z, Takacs ZK. Meditation interventions efficiently reduce cortisol levels of at-risk samples: a meta-analysis. Health Psychol Rev 2020; 15:56-84. [PMID: 32635830 DOI: 10.1080/17437199.2020.1760727] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels. In the present meta-analysis we tested whether effects are larger for those who might be in need of such stress reduction programs due to a risk for elevated cortisol levels as compared to no-risk samples. We included RCTs that measured change in cortisol levels. Based on 10 studies using blood samples meditation interventions had a significant, medium effect from pre-to post-test compared to the control group. Upon closer inspection, this effect was only present for at-risk samples, that is, patients with a somatic illness. In the 21 studies using saliva samples the effect was small and not significant, but there was a marginally significant effect for groups living in stressful life situations. This pattern may suggest that that meditation interventions are most beneficial for at-risk populations. These interventions might provide people with strategies of stress management that can contribute to well-being. Preliminary results suggest that benefits of meditation interventions might not fade with time.
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Affiliation(s)
- Adam Koncz
- Doctoral School of Psychology, ELTE Eötvös Loránd University, MTA-ELTE Lendület Adaptation Research Group, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zsofia K Takacs
- Institute of Education, ELTE Eötvös Loránd University; MTA-ELTE Lendület Adaptation Research Group, Budapest, Hungary
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Physiological and economic benefits of abandoning invasive surgical procedures and enhancing animal welfare in swine production. Sci Rep 2019; 9:16093. [PMID: 31695123 PMCID: PMC6834556 DOI: 10.1038/s41598-019-52677-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/12/2019] [Indexed: 01/02/2023] Open
Abstract
Food-animal welfare is a major ethical and social concern. Pork is the most consumed meat worldwide, with over a billion pigs slaughtered annually. Most of these pigs routinely undergo painful surgical procedures (surgical castration, tail docking, teeth clipping), which farmers often reluctant to avoid, claiming it would increase cost and reduce production efficiency. Herein, this study indicates that these procedures compromise pigs' health and condition. Replacing surgical castration with immunocastration, avoiding tail docking and teeth clipping, and providing environmental enrichment, resulted in significant increase in weight gain, lowered risks for injuries and death, and reduced saliva and hair cortisol, both biomarkers for stress. Testosterone and DHEA analyses confirmed that immunocastration was an effective alternative to surgical castration. Economic models for the entire US swine market revealed that following across-the-board acceptance of this management, pork meat price is expected to drop, while the total annual social welfare (combined consumer and producer surplus) is expected to increase by $US 1.48 to 1.92 billion. In conclusion, sustainable swine farming management can be beneficial for both animals and farmers. Applying such welfare-friendly management is expected to reduce stress, enhance piglet/pig welfare and production, and improve the economics of swine operations in the global agro-food system.
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46
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Hair cortisol levels, psychological stress and psychopathological symptoms prior to instrumental deliveries. Midwifery 2019; 77:45-52. [DOI: 10.1016/j.midw.2019.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/05/2023]
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Abstract
PURPOSE OF REVIEW This review focuses on the concentration of cortisol in human hair as a biomarker of chronic stress in cardiovascular disease (CVD). We outline the cardiovascular consequences of cortisol excess and provide a comprehensive overview of recent studies investigating the relationship of hair cortisol with CVD. In addition, clinical implications and limitations of the evidence are discussed, together with directions for future research. RECENT FINDINGS Hair cortisol may be a reliable biomarker of chronic stress since it provides quantification of total cortisol secreted into hair over several weeks. A growing body of evidence suggests that elevated hair cortisol levels are associated with both the incidence of CVD and poorer recovery and treatment outcomes. Moreover, increased hair cortisol concentration has been linked with established cardiometabolic risk factors for CVD including high blood pressure, diabetes, and adiposity. Hair cortisol is a promising biomarker of chronic cortisol excess which may contribute to both the pathogenesis and prognosis of CVD. However, the current evidence relies on small-scale cross-sectional studies. Further research adopting longitudinal designs across larger samples of CVD patients and healthy participants is required to inform the development of novel evidence-based interventions.
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Affiliation(s)
- Eleonora Iob
- Department of Behavioural Science and Health, University College London, UCL, Gower Street, London, WC1E 6BT UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, UCL, Gower Street, London, WC1E 6BT UK
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Haas AV, Hopkins PN, Brown NJ, Pojoga LH, Williams JS, Adler GK, Williams GH. Higher urinary cortisol levels associate with increased cardiovascular risk. Endocr Connect 2019; 8:634-640. [PMID: 31018177 PMCID: PMC6528405 DOI: 10.1530/ec-19-0182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022]
Abstract
There are conflicting data on whether variations of physiologic cortisol levels associated with cardiovascular risk. We hypothesize that prior discordant findings are related to problems associated with varying sample size, techniques for assessing cardiovascular risk and failure to adequately account for environmental factors. To address these issues, we utilized a large sample size, selected the Framingham risk score to compute cardiovascular risk and performed the study in a highly controlled setting. We had two main objectives: determine whether higher, yet physiologic, cortisol levels associated with increased cardiovascular risk and determine whether caveolin-1 (rs926198) risk allele carriers associated with increased cardiovascular risk. This was a cross-sectional study of 574 non-diabetic individuals who completed a common protocol. Data collection included fasting blood samples, blood pressure measurements and a 24-h urine-free cortisol collection. Five hundred seventeen of these participants also completed caveolin-1 genotyping. Subjects were classified as belonging to either the low-mode or high-mode urine-free cortisol groups, based on the bimodal distribution of urine-free cortisol. In multivariate analysis, Framingham risk score was statistically higher in the high-mode cortisol group (10.22 (mean) ± 0.43 (s.e.m.)) compared to the low-mode cortisol group (7.73 ± 0.34), P < 0.001. Framingham risk score was also statistically higher in the caveolin-1 risk allele carriers (8.91 ± 0.37) compared to caveolin-1 non-risk allele carriers (7.59 ± 0.48), P = 0.034. Overall, the estimated effect on Framingham risk score of carrying the caveolin-1 risk allele was 1.33 ± 0.61, P = 0.029. Both urinary cortisol and caveolin-1 risk allele status are independent predictors of Framingham risk score.
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Affiliation(s)
- Andrea V Haas
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Correspondence should be addressed to A V Haas:
| | - Paul N Hopkins
- Cardiovascular Genetics, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Nancy J Brown
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Luminita H Pojoga
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gail K Adler
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gordon H Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ryde GC, Dreczkowski G, Gallagher I, Chesham R, Gorely T. Device-Measured Desk-Based Occupational Sitting Patterns and Stress (Hair Cortisol and Perceived Stress). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111906. [PMID: 31151142 PMCID: PMC6603713 DOI: 10.3390/ijerph16111906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/15/2019] [Accepted: 05/27/2019] [Indexed: 12/19/2022]
Abstract
Background: Stress and poor mental health are significant issues in the workplace and are a major cause of absenteeism and reduced productivity. Understanding what might contribute towards employee stress is important for managing mental health in this setting. Physical activity has been shown to be beneficial to stress but less research has addressed the potential negative impact of sedentary behaviour such as sitting. Therefore, the aim of this study was to assess the relationship between device-measured occupational desk-based sitting patterns and stress (hair cortisol levels (HCL), as a marker of chronic stress and self-reported perceived stress (PS)). Methods: Employees were recruited from four workplaces located in Central Scotland with large numbers of desk-based occupations. Seventy-seven participants provided desk-based sitting pattern data (desk-based sitting time/day and desk-based sit-to-stand transitions/day), a hair sample and self-reported perceived stress. HCL were measured using enzyme-linked immunosorbent assay and PS using the Cohen Self-Perceived Stress Scale. Linear regression models were used to test associations between desk-based sitting time/day, desk-based sit-to-stand transitions/day, HCL and PS. Results: There were no associations between any of the desk-based sitting measures and either HCL or PS. Conclusions: Desk-based sitting patterns in the workplace may not be related to stress when using HCL as a biomarker of chronic stress or PS. The relationship between sitting patterns and stress therefore requires further investigation.
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Affiliation(s)
- Gemma C Ryde
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK.
| | - Gillian Dreczkowski
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK.
| | - Iain Gallagher
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK.
| | - Ross Chesham
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK.
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness IV3 5SQ, UK.
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Larsen SC, Rohde JF, Olsen NJ, Händel MN, Stougaard M, Fahrenkrug J, Heitmann BL. Association between hair cortisol concentration and dietary intake among normal weight preschool children predisposed to overweight and obesity. PLoS One 2019; 14:e0213573. [PMID: 30849107 PMCID: PMC6407774 DOI: 10.1371/journal.pone.0213573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background The association between chronically elevated cortisol, as measured by hair cortisol concentration (HCC), and dietary intake among children has generally not been explored. Moreover, it is unknown whether there is an association between parental HCC and dietary intake among their children. Objective To examine associations between HCC and dietary intake among children, and to explore the association between parental HCC and dietary intake among their children. Methods We conducted a cross-sectional study based on 296 children predisposed to overweight and obesity who participated in the Healthy Start study. Multiple Linear regression analyses were conducted to assess the association between HCC and total energy intake, macronutrients, fruit and vegetables, added sugar, sugar-sweetened beverages (SSB), and a diet quality index (DQI). Results Among the children, we found that higher HCC was associated with a lower consumption of dietary fat (β: -0.7 g/day [95% CI: -1.3, -0.0] per 100 pg/mg HCC). We found no statistically significant association between HCC and intake of total energy, protein, carbohydrate, fruit and vegetables, added sugar, SSB or DQI. We found no association between parental HCC and intake of total energy, added sugar, selected food groups or DQI among their children. However, stratified analyses showed that paternal HCC was associated with a borderline significant lower total energy intake and significantly lower protein intake, but only among daughters (adjusted β: -42 kcal/day [95% CI: -85, 0] and -2.6 g/day [95% CI: -4.4, -0.8] per 100 pg/mg HCC, respectively). Conclusion Among children, chronic stress as measured by HCC may be associated with a lower fat consumption, and paternal HCC may be associated with a lower intake of energy and protein among their daughters. However, the associations observed were weak, and any clinical relevance of these findings remains questionable.
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Affiliation(s)
- Sofus C. Larsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
- * E-mail:
| | - Jeanett F. Rohde
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
- Department of Research and Development, Health Science, University College UCC, Hillerød, Denmark
| | - Nanna J. Olsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
| | - Mina N. Händel
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
| | - Maria Stougaard
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
| | - Jan Fahrenkrug
- Department of Clinical Biochemistry, Faculty of Health Sciences, Bispebjerg Hospital, Copenhagen NV, Denmark
| | - Berit L. Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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